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Gillessen S, Lauritsen J, Sauvé N, Tryakin A, Jiang D, Huddart R, Heng D, Terbuch A, Winquist E, Chovanec M, Hentrich M, Fankhauser C, Shamash J, Garcia Del Muro X, Vaughn D, Heidenreich A, Jandari A, Collette L, Beyer J, Daugaard K. 512MO Outcomes of relapsed clinical stage I versus de novo metastatic testicular cancer patients: An analysis of the IGCCCG Update database. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ah-Chuen J, Ball S, Shamash J, Tarver K. Real world outcomes in large cell neuroendocrine carcinoma of the lung according to chemotherapy type. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Newton C, Murali K, Ahmad A, Hockings H, Graham R, Liberale V, Sarker SJ, Ledermann J, Berney DM, Shamash J, Banerjee S, Stoneham S, Lockley M. A multicentre retrospective cohort study of ovarian germ cell tumours: Evidence for chemotherapy de-escalation and alignment of paediatric and adult practice. Eur J Cancer 2019; 113:19-27. [PMID: 30954883 PMCID: PMC6522056 DOI: 10.1016/j.ejca.2019.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 03/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult guidelines recommend BEP (bleomycin, etoposide, cisplatin) for all ovarian germ cell tumours, causing debilitating toxicities in young patients who will survive long term. Paediatricians successfully reduce toxicities by using lower bleomycin doses and substituting carboplatin for cisplatin, while testicular and paediatric immature teratomas (ITs) are safely managed with surgery alone. AIM The aim was to determine whether reduced-toxicity treatment could rationally be extended to patients older than 18 years. METHODS Multicentre cohort study was carried out in four large UK cancer centres over 12 years. RESULTS One hundred thirty-eight patients were enrolled. Overall survival was 93%, and event-free survival (EFS) was 72%. Neoadjuvant/adjuvant chemotherapy (82% BEP) caused 27 potentially chronic toxicities, and one patient subsequently died from acute lymphoblastic leukaemia. There was no difference in histology, stage or grade in patients ≤/>18 years, and EFS was not different in these age groups (≤18:28% and >18:28%; log-rank P = 0.96). Histological subtype powerfully predicted EFS (log-rank P = 4.9 × 10-7). Neoadjuvant/adjuvant chemotherapy reduced future relapse/progression in dysgerminoma (n = 37, chemo:0% vs. no chemo:20%), yolk sac tumour (n = 23, 26.3% vs.75%) and mixed germ cell tumour (n = 32, 40%vs.70%) but not in IT (n = 42, 33% vs.15%). Additionally, we observed no radiological responses to chemotherapy in ITs, pathological IT grade did not predict EFS (univariate hazard ratio 0.82, 95% confidence interval: 0.57-1.19, P = 0.94) and there were no deaths in this subtype. CONCLUSION Survival was excellent but chemotherapy toxicities were severe, implying significant overtreatment. Our data support the extension of reduced-toxicity, paediatric regimens to adults. Our practice-changing findings that IT was chemotherapy resistant and pathological grade uninformative strongly endorse exclusive surgical management of ovarian ITs at all ages.
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Gjafa E, Grunewald T, Skyllberg E, Alifrangis C, Shamash J. Does the Reduction in Dexamethasone Used as an Anti-emetic Lead to a Reduced Incidence of Infection during BEP Chemotherapy? Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abdul-Latif M, Macdonald A, Ng K, Alifrangis C, Shamash J. Upfront Docetaxel in the Post-STAMPEDE Era – An Analysis of Treatment Population, Toxicities and Outcomes. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ng K, Sarker SJ, Greenwood M, Gjafa E, Alifrangis C, Shamash J. A Phase II Trial of Triamcinolone with Hormone Therapy for Prostate Cancer (TRICREST) in Chemotherapy Naive Metastatic Castration Resistant Prostate Cancer. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Huddart R, Cafferty F, White J, Shamash J, Hennig I, Cullen M, Stenning S. Long term follow-up of the MRC TE23 randomized phase II trial of intensive induction chemotherapy (CBOP/BEP) in poor prognosis germ cell tumours (GCT) (CRUK/05/014; ISRCTN53643604). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shamash J, Sarker SJ, Huddart R, Harland S, Joffe J, Mazhar D, Birtle A, White J, Chowdhury K, Wilson P, Marshall M, Vinnicombe S. A randomized phase III study of 72 h infusional versus bolus bleomycin in BEP (bleomycin, etoposide and cisplatin) chemotherapy to treat IGCCCG good prognosis metastatic germ cell tumours (TE-3). Ann Oncol 2017; 28:1333-1338. [DOI: 10.1093/annonc/mdx071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mee M, Hall P, Wilson P, Shamash J. GAMEC Chemotherapy for Untreated and Relapsed Germ Cell Tumours: 15 Years of Experience with a Dose Intense Regimen at St Bartholomew's Hospital. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2016.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Di Martino M, Dhanji A, Shamash J, Wood A, Lau K. 178 Postchemotherapy resection of malignant mediastinal germ cell tumours – does persistent malignancy matter? Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fischer S, Tandstad T, Weather M, Fléchon A, Aparicio J, Klingbiel D, Skrbinc B, Shamash J, Lorch A, Basso U, Dieckmann K, Huddart R, Cohn-Cedermark G, Ståhl O, Chau C, Arriola E, Laguerre B, Maroto P, Beyer J, Gillessen S. 2601 Outcome of relapses after adjuvant carboplatin in clinical stage I seminoma. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31419-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Soosaipillai G, Hawkesford K, Benafif S, Syed F, Shamash J. An Audit of the Use of Olanzapine as an Anti-emetic, in Combination with Ondansetron, Domperidone and Single Dose Dexamethasone, in Patients Undergoing BEP Chemotherapy (Cisplatin, Etoposide and Bleomycin) in Germ Cell Tumours. Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2014.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shamash J, Sarker SJ. Comment on 'Anti-tumour activity of abiraterone and diethylstilboestrol when administered sequentially to men with castration-resistant prostate cancer'. Br J Cancer 2014; 110:266-7. [PMID: 24300970 PMCID: PMC3887310 DOI: 10.1038/bjc.2013.736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Powles T, Kayani I, Sharpe K, Lim L, Peters J, Stewart G, Berney D, Sahdev A, Chowdhury S, Boleti E, Shamash J, Reynolds A, Jones R, Blank C, Haanen J, Bex A. A prospective evaluation of VEGF-targeted treatment cessation in metastatic clear cell renal cancer. Ann Oncol 2013; 24:2098-103. [DOI: 10.1093/annonc/mdt130] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Payne SJL, Krell J, Wilson P, Ansell W, Frampton AE, Stebbing J, Shamash J. The efficacy of tacrolimus and sirolimus in heavily pre-treated unresectable thymic malignancies. Lung Cancer 2013; 80:228-9. [PMID: 23380223 DOI: 10.1016/j.lungcan.2012.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/27/2012] [Accepted: 12/28/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND Thymomas and thymic carcinomas, although uncommon, constitute a significant proportion of anterior mediastinal tumours. Systemic chemotherapy is the mainstay of treatment for inoperable or recurrent disease, but immunosuppressive therapy may provide an alternative treatment strategy. PATIENTS AND METHODS We present a series of 18 patients diagnosed with unresectable thymic tumours, of which eight received immunosuppressive therapy following relapse after chemotherapy. RESULTS Eight individuals were treated with primary immunotherapy after a median of 3.5 lines of chemotherapy (range 2-6 lines), of which 3 had confirmed myasthenia gravis (MG). After 3 months, 2 patients achieved a radiological partial response and 4 had stable disease. The median time to progression measured 6.8 months (CI 1.4-19.3 months). Two of the 4 patients who progressed on tacrolimus and prednisolone received sirolimus. One of these patients has stable disease (SD) at 21 months, and the other has SD at 3 months. CONCLUSIONS Although previous case reports have related tacrolimus therapy with tumour shrinkage in patients with MG-associated invasive thymomas, these data are the first to demonstrate the efficacy of such immunosuppressive agents in a larger cohort of heavily pre-treated patients with thymic tumours. Our experience adds to the limited anecdotal evidence in the literature, and suggests that immunosuppressive agents represent a valuable additional treatment for thymic tumours.
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Hardt A, Wilson P, Powles T, Shamash J. The Outcome of Brain Metastases in Patients with Metastatic Germ Cell Tumours — Is Cranial Irradiation Necessary? Clin Oncol (R Coll Radiol) 2013. [DOI: 10.1016/j.clon.2012.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith K, Gibbs S, O'Brien N, McFaul S, Wilson P, Shamash J. Transdermal Oestradiol in the Management of Castration-resistant and Corticosteroid-resistant Prostate Cancer — a Dose Escalation Study. Clin Oncol (R Coll Radiol) 2013. [DOI: 10.1016/j.clon.2012.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dekel-Naftali M, Aviram-Goldring A, Litmanovitch T, Shamash J, Hourvitz A, Yung Y, Brengauz M, Schiff E, Rienstein S. P41 Chromosomal instability at different developmental stages of human preimplantation embryos. Reprod Biomed Online 2012. [DOI: 10.1016/s1472-6483(12)60258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Oliver T, Shamash J, Nargund V. UP-03.115 Update on Phase 1/2 Evaluation of Chemotherapy Plus Residual Tumour Excision for Testis Conservation. Urology 2011. [DOI: 10.1016/j.urology.2011.07.1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rimmer Y, Chester J, Joffe J, Stark D, Shamash J, Powles T, White J, Wason J, Parashar D, Armstrong G, Mazhar D, Williams MV. Accelerated BEP: a phase I trial of dose-dense BEP for intermediate and poor prognosis metastatic germ cell tumour. Br J Cancer 2011; 105:766-72. [PMID: 21847130 PMCID: PMC3171015 DOI: 10.1038/bjc.2011.309] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: We used bleomycin, etoposide, cisplatin (BEP), the most effective regimen in the treatment of germ cell tumours (GCTs) and increased dose-density by using pegfilgrastim to shorten cycle length. Our aim was to assess safety and tolerability. Methods: Sixteen male patients with intermediate or poor prognosis metastatic GCT were treated with four cycles of 3-day BEP with G-CSF on a 14-day cycle for a planned relative dose-density of 1.5 compared with standard BEP. Results: Eleven intermediate and five poor prognosis patients were treated. In all, 14 of 16 patients completed the study treatment. Toxicities were comparable to previous studies using standard BEP, except for mucositis and haematological toxicity that were more severe. The overall relative dose-density for all 16 patients was mean 1.38 (range 0.72–1.5; median 1.46). Complete response was achieved after chemotherapy alone in two patients (13%) and following chemotherapy plus surgery in nine additional patients (56%). Four patients (25%) had a partial response and normalised their marker levels. At a median follow-up of 4.4 years (range 2.1–6.8) the estimated 5-year progression-free survival probability is 81% (95% CI 64–100%). Conclusion: Accelerated BEP is tolerable without major additional toxicity. A randomised controlled trial will be required to obtain comparative efficacy data.
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Shamash J, Jacob J, Powles T, Agrawal S, Mutsvangwa K, Saunders N, Wilson P, Stebbing J. Melphalan and whole-blood stem cell reinfusion in castration-resistant prostate cancer (CRPC): A phase I/II study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Huddart RA, Gabe R, Cafferty F, Pollock P, White JD, Shamash J, Stenning SP. A randomized phase II trial of intensive induction chemotherapy (CBOP/BEP) and standard BEP in poor prognosis germ cell tumors (MRC TE23, CRUK 05/014, ISRCTN53643604). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Powles T, Chowdhury S, Avril N, Bomanji J, Shamash J, Sarwar N, Rockall A, Sahdev A, Nathan PD, Kayani I. Sequential FDG-PET/CT as a surrogate marker of response to sunitinib in metastatic clear cell renal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
301 Background: The purpose of this study was to investigate sequential FDG PET-CT as a correlative marker in metastatic clear cell renal cancer (mRCC) patients treated with first line sunitinib. Three sequential scans were performed to determine the importance of the timing of scans. Methods: Forty-four untreated mRCC patients with MSKCC intermediate risk and poor risk disease were enrolled into a prospective study. FDG PET-CT scans were performed before (n=44), after 4 weeks (n=43) and 16 weeks (n=40) of sunitinib given at standard doses as the translational aspect of this trial ( NCT01024205 ). The primary endpoint was to determine whether 18F-FDG PET-CT response (defined as a 20% reduction in SUVmax) correlated with survival. Results: Forty-three (98%) patients had FDG PET-CT avid lesions at diagnosis (median SUVmax 6.8 range: <2.5–18.4). In multivariate analysis a high SUVmax and increased number of PET positive lesions correlated with worse overall survival (OS) (HR: 3.30 (95%CI: 1.36–8.45) and 3.67 (95%CI: 1.43–9.39) respectively[p<0.05]). After 4 weeks of sunitinib, metabolic responses occurred in 24 (57%) patients at 4 weeks, but this did not correlate with progression-free survival [PFS] (HR for responders= 0.87 [95%CI: 0.40–1.99]) or OS (HR for responders= 0.80 [95%CI: 0.34–1.85]) (p>0.05 for both). After 16 weeks of treatment, FDG PET-CT demonstrated disease progression in 28% (n=12) patients. At this time point, the FDG PET-CT correlated with both OS and PFS (HR 5.96 [95%CI: 2.43–19.02] and HR 12.13 [95%CI: 3.72–46.45] respectively). Conclusions: Baseline FDG PET prior to sunitinib yields prognostically significant data. FDG PET response at 16 weeks predicts outcome, which is not the case at 4 weeks. This subsets of patients with a poor prognosis at 16 weeks could be investigated within the context of a randomized clinical trial. [Table: see text]
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Powles T, Kayani I, Blank C, Chowdhury S, Horenblas S, Peters J, Shamash J, Sarwar N, Boletti K, Sadev A, O'Brien T, Berney D, Beltran L, Haanen J, Bex A. The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Ann Oncol 2011; 22:1041-1047. [PMID: 21242586 PMCID: PMC3082157 DOI: 10.1093/annonc/mdq564] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The safety and efficacy of upfront sunitinib, before nephrectomy in metastatic clear cell renal cancer (mCRC), has not been prospectively evaluated. Methods: Two prospective single-arm phase II studies investigated either two cycles (study A: n = 19) or three cycles (study B: n = 33) of sunitinib before nephrectomy in mCRC. Results: Overall, 38 of 52 (73%) of patients obtained clinical benefit (by RECIST) before surgery. The partial response rate of the primary tumour was 6% [median reduction in longest diameter of 12% (range 8%−35%)]. No patients became ineligible due to local progression of disease. A nephrectomy was carried out in 37 (71%) of patients. Necrosis (>50%) was a prominent feature at nephrectomy in 49%. Surgical complications (Clavien–Dindo classification) occurred in 10 (27%) patients, including one death (3%). The median blood loss and surgical time were 725 (90–4200) ml and 189 (70–420) min, respectively. The median progression-free survival was 8 months (95% confidence interval 6–15 months). A comparison of two versus three pre-surgery cycles showed no significant difference in terms of surgical complications or efficacy. Conclusions: Nephrectomy after upfront sunitinib can be carried out safely. It obtains control of disease. Randomised studies are required to address if this approach is beneficial.
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Powles T, Chowdhury S, Shamash J, Bazeos A, Gillessen S, Saunders N, Lim L, Sarwar N, Sadev A, Wilson P, Nathan P, Boleti K, Peters J, Agrawal S. Increased haematopoietic progenitor cells are associated with poor outcome in patients with metastatic renal cancer treated with sunitinib. Ann Oncol 2010; 22:815-820. [PMID: 20943595 DOI: 10.1093/annonc/mdq469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Haematopoietic progenitor cells (HPCs) are present in blood in metastatic renal cell cancer (mRCC). We investigate their expression in mRCC patients treated with sunitinib and correlate their expression with plasma growth factor levels [insulin-like growth factor (IGF)-1]. METHODS Circulating HPCs (CD34(+)/CD45(+)) and plasma IGF-1 levels were measured at specific sequential time points (0, 6, 18 and 28 weeks) in 43 untreated mRCC patients receiving sunitinib (50 mg for 28 days followed by 14-day off treatment). Univariate and multivariate analysis assessed the prognostic significance of HPCs and IGF-1. RESULTS HPCs levels were raised in 40 of 43 (93%) of patients. IGF-1 levels were raised in 9 of 43 patients (21%). Univariate and multivariate analysis revealed that high HPCs before treatment were associated with a significantly shorter overall survival (hazard ratio 3.3, 95% confidence interval 1.23-8.8, P=0.01), which was not the case for IGF-1 levels. Both HPC and IGF-1 levels fell with sunitinib (61% and 14% fall, respectively, P <0.05 for both). A positive correlation between the falls in HPC and IGF-1 occurred (P<0.001). CONCLUSIONS HPCs are over expressed in the peripheral blood in the majority of patients with mRCC. Higher levels are associated with poor prognosis. A concurrent fall in HPCs and growth factor expression (IGF-1) with sunitinib occurs.
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