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Heilig CE, Horak P, Kreutzfeldt S, Teleanu V, Mock A, Renner M, Bhatti IA, Hutter B, Hüllein J, Fröhlich M, Uhrig S, Süße H, Heiligenthal L, Ochsenreither S, Illert AL, Vogel A, Desuki A, Heinemann V, Heidegger S, Bitzer M, Scheytt M, Brors B, Hübschmann D, Baretton G, Stenzinger A, Steindorf K, Benner A, Jäger D, Heining C, Glimm H, Fröhling S, Schlenk RF. Rationale and design of the CRAFT (Continuous ReAssessment with Flexible ExTension in Rare Malignancies) multicenter phase II trial. ESMO Open 2021; 6:100310. [PMID: 34808524 PMCID: PMC8609144 DOI: 10.1016/j.esmoop.2021.100310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Approvals of cancer therapeutics are primarily disease entity specific. Current molecular diagnostic approaches frequently identify actionable alterations in rare cancers or rare subtypes of common cancers for which the corresponding treatments are not approved and unavailable within clinical trials due to entity-related eligibility criteria. Access may be negotiated with health insurances. However, approval rates vary, and critical information required for a scientific evaluation of treatment-associated risks and benefits is not systematically collected. Thus clinical trials with optimized patient selection and comprehensive molecular characterization are essential for translating experimental treatments into standard care. PATIENTS AND METHODS Continuous ReAssessment with Flexible ExTension in Rare Malignancies (CRAFT) is an open-label phase II trial for adults with pretreated, locally advanced, or metastatic solid tumors. Based on the evaluation by a molecular tumor board, patients are assigned to combinations of six molecularly targeted agents and a programmed death-ligand 1 (PD-L1) antagonist within seven study arms focusing on (i) BRAF V600 mutations; (ii) ERBB2 amplification and/or overexpression, activating ERBB2 mutations; (iii) ALK rearrangements, activating ALK mutations; (iv and v) activating PIK3CA and AKT mutations, other aberrations predicting increased PI3K-AKT pathway activity; (vi) aberrations predicting increased RAF-MEK-ERK pathway activity; (vii) high tumor mutational burden and other alterations predicting sensitivity to PD-L1 inhibition. The primary endpoint is the disease control rate (DCR) at week 16; secondary and exploratory endpoints include the progression-free survival ratio, overall survival, and patient-reported outcomes. Using Simon's optimal two-stage design, 14 patients are accrued for each study arm. If three or fewer patients achieve disease control, the study arm is stopped. Otherwise, 11 additional patients are accrued. If the DCR exceeds 7 of 25 patients, the null hypothesis is rejected for the respective study arm. CONCLUSIONS CRAFT was activated in October 2021 and will recruit at 10 centers in Germany. TRIAL REGISTRATION NUMBERS EudraCT: 2019-003192-18; ClinicalTrials.gov: NCT04551521.
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Vogel A, Saborowski A, Hinrichs J, Ettrich T, Ehmer U, Martens U, Mekolli A, De Toni E, Berg T, Geißler M, Maenz M, Kirstein M, Waldschmidt D. LBA37 IMMUTACE: A biomarker-orientated, multi center phase II AIO study of transarterial chemoembolization (TACE) in combination with nivolumab performed for intermediate stage hepatocellular carcinoma (HCC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Vogel A, Behringer D, Bröckling S, Chater J, Derigs HG, Fietz T, Götze T, Hartmann F, Lutz M, Müller L, Moosmann N, Moulin JC, Potenberg J, Saborowski A, Späth-Schwalbe E, Schuler M, Pauligk C, Westphalen C, Zäpf B, Al-Batran SE. 1871TiP PLATON – “Platform for Analyzing Targetable Tumor Mutations”: A pilot study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Laethem JLV, Borbath I, Karwal M, Verslype C, Van Vlierberghe H, Kardosh A, Zagonel V, Stal P, Sarker D, Palmer D, Vogel A, Edeline J, Cattan S, Kudo M, Cheng AL, Ogasawara S, Siegel A, Chisamore M, Wang A, Zhu A. 933P Updated results for pembrolizumab (pembro) monotherapy as first-line therapy for advanced hepatocellular carcinoma (HCC) in the phase II KEYNOTE-224 study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bekaii-Saab T, Valle J, Van Cutsem E, Rimassa L, Furuse J, Ioka T, Macarulla T, Bridgewater J, Wasan H, Borad M, Vogel A, Lihou C, Zhen H, Jiang P, Langmuir P, Melisi D. P-113 FIGHT-302: Phase 3 study of first-line pemigatinib vs gemcitabine + cisplatin for cholangiocarcinoma with FGFR2 fusions or rearrangement. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.168] [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] Open
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Huynh J, Cho M, Kim E, Ren M, Amaya-Chanaga C, Vogel A. P-78 Post hoc analysis in patients with unresectable hepatocellular carcinoma who progressed to Child-Pugh B liver function in the phase 3 REFLECT study of lenvatinib vs sorafenib. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abou-Alfa G, Sahai V, Hollebecque A, Vaccaro G, Melisi D, Al-Rajabi R, Paulson A, Borad M, Gallinson D, Murphy A, Oh D, Dotan E, Catenacci D, Van Cutsem E, Lihou C, Ren H, Bibeau K, Feliz L, Vogel A. SO-4 Progression-free survival in patients with cholangiocarcinoma with FGFR2 fusions or rearrangements: A FIGHT-202 post-hoc analysis of prior systemic therapy response. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Stintzing S, Hübner G, Schröder J, Kisro J, Welslau M, Bürkle D, Göhler T, Schmidt B, Müller-Huesmann H, Krammer-Steiner B, von der Heyde E, Reichenbach F, Arnold D, Gerger A, Hegewisch-Becker S, Vogel A, Winder T, Prager G. P-58 Encorafenib and cetuximab in patients with metastatic, BRAF V600E-mutated, colorectal carcinoma: A multi-centric, multi-national, prospective, longitudinal, non-interventional study in Germany and Austria – BERING CRC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Raghav K, Yoshino T, Taniguchi H, Tejpar S, Vogel A, Wainberg Z, Yamaguchi K, Fakih M, Pedersen K, Bando K, Kawakami H, Beck J, Kanai M, Liu Y, Mekan S, Pudussery G, Qiu Y, Kopetz S. P-45 An open-label, phase 2 study of patritumab deruxtecan in patients with previously treated advanced/metastatic colorectal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.100] [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] Open
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Vogel A, Zhu A, Cheng A, Yau T, Zhou J, Kim E, Malhotra U, Siegel A, Kudo M. Abstract No. 210 KEYNOTE-937 trial in progress: adjuvant pembrolizumab for hepatocellular carcinoma and complete radiologic response after surgical resection or local ablation. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Levy J, David E, Hopkins T, Morris J, Tran N, Farid H, Massari F, O’Connell W, Vogel A, Gangi A, Sunenshine P, Dixon R, Bagla S. Abstract No. 78 Improvement in quality of life in patients treated for painful osseous metastases with radiofrequency ablation: the OPuS One study. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vogel A, Martinelli E. Updated treatment recommendations for hepatocellular carcinoma (HCC) from the ESMO Clinical Practice Guidelines. Ann Oncol 2021; 32:801-805. [PMID: 33716105 DOI: 10.1016/j.annonc.2021.02.014] [Citation(s) in RCA: 204] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
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Vogel A, Brouqui P, Boudjema S. Disinfection of gloved hands during routine care. New Microbes New Infect 2021; 41:100855. [PMID: 33854786 PMCID: PMC8025050 DOI: 10.1016/j.nmni.2021.100855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
Healthcare-associated infections are a major issue in public health. After several decades of hand hygiene programmes, it is time to admit that we have failed to achieve our goal. One of the reasons is the overuse of gloves, which is in part justified by the nature of the nursing care. Several experimental studies supported the effectiveness of disinfecting gloves, but evidence for routine feasibility and effectiveness is lacking. The aim of this study was to evaluate the effectiveness of alcohol-based disinfection of gloves during nursing care. Swabs were taken from the most contaminated part of both hands at different times: T0 (before wearing gloves), T10 (after 10 minutes of nursing care) from both gloves, T10A (just after the gloves were disinfected for 30 seconds with bedside disposable hydroalcoholic solution) and when possible at T20 and T20A. After 10 minutes of nursing care, gloves were contaminated in 72.5% of cases. After alcohol-based disinfection, gloves became free of microorganism in 79.3% of cases. Alcohol-based disinfection of gloves during routine care is effective and appears to be a reasonable alternative to current recommendations.
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Dewald CLA, Becker LS, Maschke SK, Meine TC, Alten TA, Kirstein MM, Vogel A, Wacker FK, Meyer BC, Hinrichs JB. Percutaneous isolated hepatic perfusion (chemosaturation) with melphalan following right hemihepatectomy in patients with cholangiocarcinoma and metastatic uveal melanoma: peri- and post-interventional adverse events and therapy response compared to a matched group without prior liver surgery. Clin Exp Metastasis 2020; 37:683-692. [PMID: 33034815 PMCID: PMC7666275 DOI: 10.1007/s10585-020-10057-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/25/2020] [Indexed: 01/15/2023]
Abstract
To evaluate feasibility, frequency and severity of peri-procedural complications and post-procedural adverse events (AEs) in patients with advanced cholangiocarcinoma or liver metastasis of uveal melanoma and prior hemihepatectomy undergoing chemosaturation percutaneous hepatic perfusion (CS-PHP) and to analyze therapy response and overall survival compared to a matched group without prior surgery. CS-PHP performed between 10/2014 and 02/2018 were retrospectively assessed. To determine peri-procedural safety and post-procedural adverse events, hospital records and hematological, hepatic and biliary function were categorized using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 (1–5; mild-death). Significance was tested using Wilcoxon signed-rank and Mann–Whitney U test. Kaplan–Meier estimation and log-rank test assessed survival. Overall 21 CS-PHP in seven patients (4/7 males; 52 ± 10 years) with hemihepatectomy (grouphemihep) and 22 CS-PHP in seven patients (3/7 males; 63 ± 12 years) without prior surgery (groupnoresection) were included. No complications occurred during the CS-PHP procedures. Transient changes (CTCAE grade 1–2) of liver enzymes and blood cells followed all procedures. In comparison, grouphemihep presented slightly more AEs grade 3–4 (e.g. thrombocytopenia in 57% (12/21) vs. 41% (9/22; p = 0.37)) 5–7 days after CS-PHP. These AEs were self-limiting or responsive to treatment (insignificant difference of pre-interventional to 21–45 days post-interventional values (p > 0.05)). One patient in grouphemihep with high tumor burden died eight days following CS-PHP. No deaths occurred in groupnoresection. In comparison, overall survival after first diagnosis was insignificantly shorter in groupnoresection (44.7(32–56.1) months) than in grouphemihep (48.3(34.6–72.8) months; p = 0.48). The severity of adverse events following CS-PHP in patients after hemihepatectomy was comparable to a matched group without prior liver surgery. Thus, the performance of CS-PHP is not substantially compromised by a prior hemihepatectomy.
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Droz Dit Busset M, Shaib W, Harris W, Damjanov N, Borad M, Vogel A, Bridgewater J, Sellmann L, Dadduzio V, Borner M, Snider J, Cantero F, Saulay M, Braun S, Mazzaferro V, Javle M. 45P Efficacy of derazantinib in intrahepatic cholangiocarcinoma patients with FGFR2 mutations or amplifications: Pooled analysis of clinical trials and early access programs. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Götze T, Hofheinz R, Reichart A, Pauligk C, Schlag R, Siegler G, Hoeffkes HG, Blau W, Homann N, Trojan J, Waidmann O, Pink D, Messmann H, Kunzmann V, Vogel A, Ettrich T, Schönherr C, Schaaf M, zur Hausen G, Al-Batran SE. 1525O The QOLIXANE trial - Real life QoL and efficacy data in 1st line pancreatic cancer from the prospective platform for outcome, quality of life, and translational research on pancreatic cancer (PARAGON) registry. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Llovet J, El-Khoueiry A, Vogel A, Madoff D, Finn R, Ogasawara S, Ren Z, Mody K, Li JJ, Siegel A, Dubrovsky L, Kudo M. 1016TiP LEAP-012 trial in progress: Pembrolizumab plus lenvatinib and transarterial chemoembolization (TACE) in patients with intermediate-stage hepatocellular carcinoma (HCC) not amenable to curative treatment. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vogel A, Merle P, Verslype C, Finn R, Zhu A, Cheng AL, Chan S, Yau T, Ryoo BY, Wei Z, Malhotra U, Siegel A, Kudo M. 1003P Baseline (BL) liver function and outcomes in patients (pts) with unresectable hepatocellular carcinoma (HCC) in KEYNOTE-240. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vogel A, Müller D, De Toni E, Siegler G, Siebler J, Lindig U, Müller T, Schultheiss M, Geißler M, Krammer-Steiner B, Reichart A, Lammert F, Prause C, Walker M, Al-Batran SE, Kosic N. 988P Safety analysis of the run-in phase (1st and 2nd cohort) of the IMMUNIB trial (AIO-HEP-0218/ass) - An open-label, single-arm phase II study evaluating safety and efficacy of immunotherapy with nivolumab in combination with lenvatinib in advanced stage HCC. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vogel A, Finn R, Kelley R, Furuse J, Edeline J, Ren Z, Su S, Malhotra U, Siegel A, Valle J. P-99 Pembrolizumab in combination with gemcitabine and cisplatin for the treatment of advanced biliary tract cancer: phase 3 KEYNOTE-966 trial in progress. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Schuler M, Berardi R, Lim WT, de Jonge M, Bauer TM, Azaro A, Gottfried M, Han JY, Lee DH, Wollner M, Hong DS, Vogel A, Delmonte A, Akimov M, Ghebremariam S, Cui X, Nwana N, Giovannini M, Kim TM. Molecular correlates of response to capmatinib in advanced non-small-cell lung cancer: clinical and biomarker results from a phase I trial. Ann Oncol 2020; 31:789-797. [PMID: 32240796 DOI: 10.1016/j.annonc.2020.03.293] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dysregulation of receptor tyrosine kinase MET by various mechanisms occurs in 3%-4% of non-small-cell lung cancer (NSCLC) and is associated with unfavorable prognosis. While MET is a validated drug target in lung cancer, the best biomarker strategy for the enrichment of a susceptible patient population still remains to be defined. Towards this end we analyze here primary data from a phase I dose expansion study of the MET inhibitor capmatinib in patients with advanced MET-dysregulated NSCLC. PATIENTS AND METHODS Eligible patients [≥18 years; Eastern Cooperative Oncology Group (ECOG) performance status ≤2] with MET-dysregulated advanced NSCLC, defined as either (i) MET status by immunohistochemistry (MET IHC) 2+ or 3+ or H-score ≥150, or MET/centromere ratio ≥2.0 or gene copy number (GCN) ≥5, or (ii) epidermal growth factor receptor wild-type (EGFRwt) and centrally assessed MET IHC 3+, received capmatinib at the recommended dose of 400 mg (tablets) or 600 mg (capsules) b.i.d. The primary objective was to determine safety and tolerability; the key secondary objective was to explore antitumor activity. The exploratory end point was the correlation of clinical activity with different biomarker formats. RESULTS Of 55 patients with advanced MET-dysregulated NSCLC, 40/55 (73%) had received two or more prior systemic therapies. All patients discontinued treatment, primarily due to disease progression (69.1%). The median treatment duration was 10.4 weeks. The overall response rate per RECIST was 20% (95% confidence interval, 10.4-33.0). In patients with MET GCN ≥6 (n = 15), the overall response rate by both the investigator and central assessments was 47%. The median progression-free survival per investigator for patients with MET GCN ≥6 was 9.3 months (95% confidence interval, 3.8-11.9). Tumor responses were observed in all four patients with METex14. The most common toxicities were nausea (42%), peripheral edema (33%), and vomiting (31%). CONCLUSIONS MET GCN ≥6 and/or METex14 are suited to predict clinical activity of capmatinib in patients with NSCLC (NCT01324479).
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Chen LT, Martinelli E, Cheng AL, Pentheroudakis G, Qin S, Bhattacharyya GS, Ikeda M, Lim HY, Ho GF, Choo SP, Ren Z, Malhotra H, Ueno M, Ryoo BY, Kiang TC, Tai D, Vogel A, Cervantes A, Lu SN, Yen CJ, Huang YH, Chen SC, Hsu C, Shen YC, Tabernero J, Yen Y, Hsu CH, Yoshino T, Douillard JY. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with intermediate and advanced/relapsed hepatocellular carcinoma: a TOS-ESMO initiative endorsed by CSCO, ISMPO, JSMO, KSMO, MOS and SSO. Ann Oncol 2020; 31:334-351. [PMID: 32067677 DOI: 10.1016/j.annonc.2019.12.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/18/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of hepatocellular carcinoma (HCC) was published in 2018, and covered the diagnosis, management, treatment and follow-up of early, intermediate and advanced disease. At the ESMO Asia Meeting in November 2018 it was decided by both the ESMO and the Taiwan Oncology Society (TOS) to convene a special guidelines meeting immediately after the Taiwan Joint Cancer Conference (TJCC) in May 2019 in Taipei. The aim was to adapt the ESMO 2018 guidelines to take into account both the ethnic and the geographic differences in practice associated with the treatment of HCC in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with intermediate and advanced/relapsed HCC representing the oncology societies of Taiwan (TOS), China (CSCO), India (ISMPO) Japan (JSMO), Korea (KSMO), Malaysia (MOS) and Singapore (SSO). The voting was based on scientific evidence, and was independent of the current treatment practices, the drug availability and reimbursement situations in the individual participating Asian countries.
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Asmus A, Vogel K, Vogel A, Eichenauer F, Kim S, Eisenschenk A. [Pedicled vascularized iliac bone graft for treatment of osteonecrosis of the femoral head]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:127-138. [PMID: 32052100 DOI: 10.1007/s00064-020-00650-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/29/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Illustration of a nowadays only rarely performed operative procedure for the treatment of osteonecrosis of the femoral head to prevent or at least delay advanced arthrosis and the need for a total hip replacement. The pedicled vascularized iliac bone graft is raised without the need for special microsurgical techniques and has less vascular complications often seen in free vascularized grafts. INDICATIONS Early stages of osteonecrosis of the femoral head stages II and III according to the Association Research Circulation Osseous (ARCO) up to the detection of fracture lines (crescent sign) but without mechanical insufficiency. CONTRAINDICATIONS Osteonecrosis of the femoral head with collapse of the femoral head (ARCO stage ≥IIIB) and mechanical insufficiency. Patients who are noncompliant or a not able to take the weight off the operated leg. Patients who had radiotherapy or an operation on ipsilateral inguinal lymph nodes and patients who have vascular anomalies or severe arteriosclerosis. SURGICAL TECHNIQUE Debridement of the femoral head osteonecrosis and implantation of a pedicled vascularized iliac bone graft. POSTOPERATIVE MANAGEMENT Free movement of the hip joint 4 weeks after surgery. Outward rotation of the hip joint allowed after 3 months and restriction of weight load on the operated leg for at least 3-6 months postoperatively depending on the bony consolidation. RESULTS Vascularized bone grafts for the treatment of femoral head necrosis show better clinical and radiological results than avascular bone grafts. Nevertheless, after 5 years follow-up approximately 25% of the operated hips formerly in stage II show further progression of radiological necrosis. In stage III all hips eventually show progress of femoral head collapse and the need of a total hip replacement. Concerning the outcome of a free vascularized bone graft (fibula flap) compared to the pedicled vascularized graft from the iliac crest for treatment, the anatomically demanding area and a higher complication rate should be considered even though the cancellous bone of the iliac crest is biologically ideal. Nowadays a free vascularized fibular graft is the most frequently used bone graft for treatment of femoral head necrosis.
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Moehler M, Maderer A, Thuss-Patience PC, Brenner B, Meiler J, Ettrich TJ, Hofheinz RD, Al-Batran SE, Vogel A, Mueller L, Lutz MP, Lordick F, Alsina M, Borchert K, Greil R, Eisterer W, Schad A, Slotta-Huspenina J, Van Cutsem E, Lorenzen S. Cisplatin and 5-fluorouracil with or without epidermal growth factor receptor inhibition panitumumab for patients with non-resectable, advanced or metastatic oesophageal squamous cell cancer: a prospective, open-label, randomised phase III AIO/EORTC trial (POWER). Ann Oncol 2019; 31:228-235. [PMID: 31959339 DOI: 10.1016/j.annonc.2019.10.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Palliative chemotherapy of advanced oesophageal squamous cell cancer (ESCC) consists of cisplatin/5-fluorouracil (CF) to target epidermal growth factor receptor (EGFR) with panitumumab (P); chemotherapy enhanced overall survival (OS) in advanced colorectal or squamous cell head and neck cancers. With prospective serum and tumour biomarkers, we tested if P added to CF (CFP) improved OS in advanced ESCC. PATIENTS AND METHODS Eligible patients with confirmed ESCC that was not curatively resectable or did not qualify for definitive radiochemotherapy, were randomised 1 : 1 to receive CF [cisplatin (C) 100 mg/m2 i.v., day 1; 5-fluorouracil (F) 1000 mg/m2 i.v., days 1-4] or CF plus P (9 mg/kg, i.v., day 1, each q3-week cycle) until progressive disease or unacceptable toxicity. Safety was reviewed by the Data Safety Monitoring Board after 40, 70 and 100 patients who completed at least one cycle. After 53 enrolled patients, cisplatin was reduced from 100 mg/m2 to 80 mg/m2. RESULTS The trial was stopped early based on interim efficacy results triggered by the third safety analysis: median OS (mOS) favoured CF over CFP, regardless of cisplatin dose [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.06-2.98; P = 0.028]. In the final analysis, mOS was 10.2 versus 9.4 months for CF versus CFP, respectively (HR 1.17, 95% CI 0.79-1.75; P = 0.43). One hundred (70.4%) of 142 patients in the safety population died, 51 (51.0%) with CFP. Most deaths were related to disease progression [44/49 (90%) deaths in CF versus 34/51 (67%) deaths in CFP]; objective responses [27/73 (37.0%)] were identical. The most common serious adverse events were kidney injury [3 (4.3%) versus 7 (9.7%)], general health deterioration [5 (7.1%) versus 5 (6.9%)] and dysphagia [4 (5.7%) versus 4 (5.6%)] in CF versus CFP, respectively. There were three (4.3%) and 17 (23.6%) common terminology criteria for adverse events (CTCAE) grade 5 events in CF versus CFP, respectively. Low soluble (s)EGFR levels were associated with better progression-free survival; sEGFR was induced under CFP. CONCLUSION EGFR inhibition added to CF did not improve survival in unselected advanced ESCC patients. The results support further liquid biopsy studies. TRIAL REGISTRATION ClinicalTrials.gov (NCT01627379) and EudraCT (2010-020606-15).
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Thell K, Urban M, Harrauer J, Haslinger I, Kuttke M, Brunner J, Vogel A, Schabbauer G, Penninger J, Gaweco A. Master checkpoint Cbl-b inhibition: Anti-tumour efficacy in a murine colorectal cancer model following siRNA-based cell therapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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