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Ksienski D, Truong PT, Wai ES, Croteau NS, Chan A, Patterson T, Clarkson M, Hackett S, Irons S, Lesperance M. Survival Outcomes Following Discontinuation of Ipilimumab and Nivolumab for Advanced Melanoma in a Population-based Cohort. Clin Oncol (R Coll Radiol) 2021; 33:e561-e569. [PMID: 34226113 DOI: 10.1016/j.clon.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
AIMS Induction ipilimumab and nivolumab followed by maintenance nivolumab improve overall survival compared with ipilimumab alone in patients with advanced melanoma, but immune-related adverse events (irAE) occur commonly. The need for induction discontinuation because of irAE and the relationship between irAE and survival in non-trials patients are unclear. MATERIALS AND METHODS Patients with unresectable stage III-IV melanoma receiving first-line combination immunotherapy at one of six centres between December 2017 and February 2020 outside of trials were identified retrospectively. Landmark 12-week Kaplan-Meier analyses and log-rank tests were used to evaluate associations between discontinuation of induction therapy on overall survival and time to treatment failure (TTF). Multivariable analysis of factors influencing overall survival and TTF was undertaken. RESULTS Among 95 patients, the median age was 62 years, 38.9% had Eastern Cooperative Oncology Group performance status ≥1 and 22.1% had brain metastases. The median follow-up for the whole cohort was 19.8 months by the reverse Kaplan-Meier method. Any grade and grade 3-4 irAE were noted in 78.9% and 44.2% of the cohort, respectively. 44.2% of patients completed induction immunotherapy, whereas 41.1% did not due to irAE. Twelve-week landmark overall survival and TTF were similar in patients who completed induction versus those who did not due to irAE. On multivariable analysis, any grade irAE (versus none) was associated with longer overall survival (hazard ratio = 0.35, 95% confidence interval 0.15-0.82, P = 0.02) and TTF (hazard ratio = 0.38, 95% confidence interval = 0.17-0.81, P = 0.01). Grade 3-4 irAE correlated with longer TTF (hazard ratio = 0.45, 95% confidence interval = 0.20-1.01, P = 0.05). CONCLUSION In this population-based cohort, discontinuation of induction immunotherapy as a result of irAE did not adversely affect overall survival or TTF. irAE observed during ipilimumab and nivolumab induction were associated with improved survival outcomes.
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D'Atri D, Zerrillo L, Garcia J, Oieni J, Lupu-Haber Y, Schomann T, Chan A, Cruz LJ, Creemers LB, Machluf M. Nanoghosts: Mesenchymal Stem cells derived nanoparticles as a unique approach for cartilage regeneration. J Control Release 2021; 337:472-481. [PMID: 34015401 DOI: 10.1016/j.jconrel.2021.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) is a chronic degenerative disease, which affects the joints and is characterized by inflammation, cartilage loss and bone changes. Nowadays, there are no treatments for OA, and current therapies are focused on relieving the symptoms. As a new therapy approach, micro and nanoparticles have been extensively explored and among all the studied particles, the use of cell-membrane-based particles is expanding. Another promising approach studied to treat OA, is the use of mesenchymal stem cells (MSCs) which play an important role modulating inflammation. We developed a novel kind of MSCs' cytoplasmic-membrane-based nanoparticles, termed nano-ghosts (NGs). Retaining MSCs' surface properties and lacking cells' internal machinery allow the NGs to have immunomodulatory capacity and to be immune-evasive while not susceptible to host-induced changes. In this study, we demonstrate NGs' ability to target cartilage tissues, in vitro and in vivo, while modulating the inflammatory process. In vivo studies demonstrated NGs ability to act as an immunomodulatory drug slowing down cartilage degeneration process. Our proof-of-concept experiments show that NGs system is a versatile nano-carrier system, capable of therapeutics loading, with targeting capabilities towards healthy and inflamed cartilage cells. Our results, along with previously published data, clearly reveal the NGs system as a promising nano-carrier platform and as a potential immunomodulatory drug for several inflammation-related diseases.
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Georgevsky D, Li Y, Pather S, Tejada-Berges T, Robinson D, Laurence J, Campbell N, Wyburn K, Liyanagama K, Narayan R, Lutz T, Chan A, Heaney SA, Kitzing YX, Anderson L, Testa G, Johannesson L, Marren A. Uterus transplantation and pregnancy induction: Approved protocol at the Royal Prince Alfred Hospital. Aust N Z J Obstet Gynaecol 2021; 61:621-624. [PMID: 33956989 DOI: 10.1111/ajo.13364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 12/21/2022]
Abstract
Absolute uterine factor infertility (AUFI) is defined as the absence of a uterus or the presence of a non-functional uterus. Before the first live birth from a uterus transplant in 2014, the only fertility options for women with AUFI were surrogacy and adoption. In November 2019, our team was granted approval for the first uterus transplant trial in Australia using known living donors. Our program is based on that of our overseas collaborators in Dallas, Texas; this team will also be proctoring us for our first two cases.
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Fasching P, Bardia A, Nusch A, Jerusalem G, Chan A, El Saghir N, Alba Conejo E, Im SA, Janni W, Chandiwana D, Lanoue B, Thuerigen A, Gu E, Harbeck N. 91O Pooled analysis of patient (pt)-reported outcomes (PROs) in the MONALEESA (ML)-2, -3, and -7 trials: Additional results and key subgroup findings. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.105] [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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Martin M, Holmes F, Moy B, Mansi J, Gnant M, Buyse M, Barrios C, Bryce R, Wong A, Chan A. Continued efficacy of neratinib in patients with HER2-positive (HER2+) early-stage breast cancer: final overall survival (OS) analysis from the randomized phase 3 ExteNET trial. Breast 2021. [PMID: 33183970 DOI: 10.1016/s0960-9776(21)00093-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Ruiz-Borrego M, Chan A, Marx G, Brufsky A, Trudeau M, Egle D, McCulloch L, Tripathy D, Barcenas C. Bringing diarrhea under CONTROL: dose escalation reduces neratinib-associated diarrhea and improves tolerability in HER2-positive early-stage breast cancer. Breast 2021. [DOI: 10.1016/s0960-9776(21)00092-8] [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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Diem L, Hoepner R, Bagnoud M, Salmen A, Chan A, Friedli C. Natalizumab induced blood eosinophilia: A retrospective pharmacovigilance cohort study and review of the literature. J Neuroimmunol 2021; 353:577505. [PMID: 33548621 DOI: 10.1016/j.jneuroim.2021.577505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe frequency of natalizumab related eosinophilia and clinical symptoms of eosinophilic disease in our monocentric cohort. METHODS Comparison of clinical characteristics of 115 natalizumab treated and 116 untreated RRMS patients and review of literature. RESULTS 38% of natalizumab treated patients had eosinophilia, which occurred significantly more frequently compared to untreated MS patients (3%, p-value<0.001). In symptomatic patients, mean eosinophil counts were significantly higher than in asymptomatic patients and symptoms developed within one year. DISCUSSION Eosinophilia is a side effect of natalizumab and mostly asymptomatic. However, few patients develop within one year after start of natalizumab an eosinophilic disease as severe side effect.
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Chan A, Dinsfriend W, Kim J, Steingart R, Weinsaft J. Prognostic utility of differential contrast-enhancement patterns on late gadolinium enhancement cardiac MRI (LGE-CMR) in patients with cancer-associated cardiac masses. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
LGE-CMR tissue characterization is widely used to identify cardiac masses (CMASS) in cancer patients – including neoplasm (NEO) and thrombus (THR). Prognostic utility of their differential LGE patterns is unknown.
Purpose
To determine incremental prognostic utility of LGE patterns in CMASS
Methods
The population comprised of cancer patients with CMASS on LGE-CMR, for which etiology was classified based on presence (NEO) or absence (THR) of enhancement, and controls matched for cancer type/stage. LGE-CMR tissue properties of NEO was classified based on extent of contrast enhancement – diffusely enhancing (DE), mixed (ME), and predominantly avascular (PA). Clinical follow up was performed for embolic events within 6 months of CMR and all-cause mortality.
Results
330 cancer patients (55% M; 55±16yo) with an array of cancer diagnoses (19% sarcoma, 17% GI, 13% GU) were studied. Among CMASS+ pts (n=190), 66% had NEO and 34% had THR on LGE. All THR were non-enhancing. Among NEO, LGE pattern was variable (46% DE, 41% ME, 13% PA); ME lesions were larger than other groups (Fig. 1A). Quantitative tissue properties were consistent with qualitative groups, as evidenced by stepwise variation in signal intensity and CNR. Cumulative embolic events were 3-fold higher in CMASS+ than controls (All: 20% vs. 7%, p=0.001; PE: 13% vs. 5%, p=0.02; CVA/systemic embolism: 10% vs. 3%, p=0.01). Median time to event was 1.3 months [IQR 0.1–2.3] from CMR. Aggregate events were similar between NEO and THR, reflecting similar rates of PE and CVA (p=NS). Among CMASS pts with embolic events, 56% were on anticoagulation at time of event (59% NEO, 50% THR, p=0.61). Regarding CMASS morphology, emboli were 3-fold higher among intracavitary (IC) or highly mobile (HM) CMASS (IC: 25% vs 7%, p<0.001; HM: 38% vs 12%, p=0.001). Regarding location, right sided CMASS were associated with a 3–5 fold increase in PE (IC: 19% vs 6%; HM: 35% vs 7%, both p<0.001) and similar CVA events among left sided CMASS (IC: 17% vs. 6%, p=0.02; HM: 33% vs 6%, p=0.05). Embolic events were similar when partitioned based on quantitative LGE patterns between patients with and without embolic events. As for all-cause mortality, NEO on CMR conferred increased mortality than THR (HR 3.06 [CI=1.84–5.1], p<0.001) and matched controls (HR 2.08 [CI=1.42–3.04], p<0.001) during a median follow-up of 9.4 months [IQR 3.6–23.2]. Among NEO subgroups (Fig. 1B), survival was lower in patients with heterogeneous LGE patterns vs matched controls: the lowest survival in ME (p=0.002) suggests increased vascularity and tumor hypoxia/necrosis associated with aggressive tumors and hence larger lesions.
Conclusions
Among cancer patients, CMR-evidenced CMASS confers high short-term embolic risk, which are equivalently common between NEO and THR. Intra-cavitary location and increased mobility augment embolic risk irrespective of CMASS tissue properties whereas differential LGE patterns on CMR strongly impact prognosis.
Funding Acknowledgement
Type of funding source: None
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Hearn N, Cahill K, Atwell D, Bugg W, Chan A, Vignarajah D, Lagopoulos J, Min M. Quantitative Approaches to Locally Advanced Rectal Cancer GTV and Subvolume Contouring with Diffusion-Weighted MRI: Implications for MRI-Guided Boost Strategies. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1794] [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]
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Deshpande D, Chan A, Scalchunes C, Milner J. P257 CHARACTERIZING ASTHMA AMONG ADULTS WITH PRIMARY ANTIBODY DEFICIENCIES: RESULTS FROM A NATIONWIDE PATIENT SURVEY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.135] [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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de Claro RA, Spillman D, Hotaki LT, Shum M, Mouawad LS, Santos GML, Robinson K, Hunt M, Healy C, Chan A, Looi YH, Rodrigues C, Rohr UP, Walther C, Pazdur R. Project Orbis: Global Collaborative Review Program. Clin Cancer Res 2020; 26:6412-6416. [PMID: 33037016 DOI: 10.1158/1078-0432.ccr-20-3292] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/16/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022]
Abstract
In 2019, the FDA Oncology Center of Excellence launched Project Orbis, a global collaborative review program to facilitate faster patient access to innovative cancer therapies across multiple countries. Project Orbis aims for concurrent submission, review, and regulatory action for high-impact clinically significant marketing applications among the participating partner countries. Current Project Orbis partners (POP) include the regulatory health authorities (RHA) of Australia, Brazil, Canada, Singapore, and Switzerland. Project Orbis leverages the existing scientific and regulatory partnerships between the various RHA under mutual confidentiality agreements. While FDA serves as the primary coordinator for application selection and review, each country remains fully independent on their final regulatory decision. In the first year of Project Orbis (June 2019 to June 2020), a total of 60 oncology marketing applications were received, representing 16 unique projects, and resulting in 38 approvals. New molecular entities, also known as new active substances, comprised 28% of the received marketing applications. The median time gap between FDA and Orbis submission dates was 0.6 months with a range of -0.8 to 9.0 months. Across the program, the median time-to-approval was similar between FDA (4.2 months, range 0.9-6.9, N = 18) and the POP (4.4 months, range 1.7-6.8, N = 20). Participating countries have signified a strong commitment for continuation and growth of the program. Project Orbis expansion considerations include the addition of more countries and management of more complex applications.
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Smit T, Chan A, Chasen M, Bhargava R, Bošnjak S, Zilic A, Chia J, Jabbar A, Yaxiong Z, de Necker M, Mhazo T, Heyman L, Rapoport B. 1816MO ICES (International Carboplatin Emesis Survey) for the evaluation of the emetogenicity of carboplatin-based chemotherapy – with a focus on nausea. MASCC Antiemetic Study Group survey. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1463] [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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Barcenas CH, Hurvitz SA, Di Palma JA, Bose R, Chien AJ, Iannotti N, Marx G, Brufsky A, Litvak A, Ibrahim E, Alvarez RH, Ruiz-Borrego M, Chan N, Manalo Y, Kellum A, Trudeau M, Thirlwell M, Garcia Saenz J, Hunt D, Bryce R, McCulloch L, Rugo HS, Tripathy D, Chan A. Improved tolerability of neratinib in patients with HER2-positive early-stage breast cancer: the CONTROL trial. Ann Oncol 2020; 31:1223-1230. [PMID: 32464281 DOI: 10.1016/j.annonc.2020.05.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for extended adjuvant treatment in early-stage HER2-positive breast cancer based on the phase III ExteNET study. In that trial, in which no antidiarrheal prophylaxis was mandated, grade 3 diarrhea was observed in 40% of patients and 17% discontinued due to diarrhea. The international, open-label, sequential-cohort, phase II CONTROL study is investigating several strategies to improve tolerability. PATIENTS AND METHODS Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year plus loperamide prophylaxis (days 1-28 or 1-56). Sequential cohorts evaluated additional budesonide or colestipol prophylaxis (days 1-28) and neratinib dose escalation (DE; ongoing). The primary end point was the incidence of grade ≥3 diarrhea. RESULTS Final data for loperamide (L; n = 137), budesonide + loperamide (BL; n = 64), colestipol + loperamide (CL; n = 136), and colestipol + as-needed loperamide (CL-PRN; n = 104) cohorts, and interim data for DE (n = 60; completed ≥six cycles or discontinued; median duration 11 months) are available. No grade 4 diarrhea was observed. Grade 3 diarrhea rates were lower than ExteNET in all cohorts and lowest in DE (L 31%, BL 28%, CL 21%, CL-PRN 32%, DE 15%). Median number of grade 3 diarrhea episodes was one; median duration per grade 3 episode was 1.0-2.0 days across cohorts. Most grade 3 diarrhea and diarrhea-related discontinuations occurred in month 1. Diarrhea-related discontinuations were lowest in DE (L 20%, BL 8%, CL 4%, CL-PRN 8%, DE 3%). Decreases in health-related quality of life did not cross the clinically important threshold. CONCLUSIONS Neratinib tolerability was improved with preemptive prophylaxis or DE, which reduced the rate, severity, and duration of neratinib-associated grade ≥3 diarrhea compared with ExteNET. Lower diarrhea-related treatment discontinuations in multiple cohorts indicate that proactive management can allow patients to stay on neratinib for the recommended time period. CLINICALTRIALS.GOV: NCT02400476.
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Chan A, Flores C, Fan SS. Elevated HbA1c in Peritoneal Dialysis Patients without Diabetes Mellitus. Perit Dial Int 2020. [DOI: 10.1177/089686080602600621] [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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Langford BJ, Beriault D, Schwartz KL, Seah J, Pasic MD, Cirone R, Chan A, Downing M. A real-world assessment of procalcitonin combined with antimicrobial stewardship in a community ICU. J Crit Care 2020; 57:130-133. [PMID: 32145655 DOI: 10.1016/j.jcrc.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE We evaluated the feasibility and impact of PCT-guided antibiotic duration combined with an established antibiotic stewardship program (ASP) in a community hospital intensive care unit (ICU). METHODS We implemented daily PCT levels for ICU patients receiving antibiotics. Our protocol recommended stopping antibiotic therapy if PCT met an absolute or relative stopping threshold. We evaluated the adherence to stopping criteria within 48 h, antibiotic use [days of therapy (DOT) per 1000 patient-days (PD)], length of stay and ICU-mortality. We performed interrupted time series analysis to compare 24 months before and 12 months after implementation. RESULTS A total of 297 antibiotic courses were monitored with PCT in 217 patients. Protocol adherence was 34% (absolute threshold: 39%, relative threshold: 12%). Antibiotic use pre-PCT was 935 DOTs/1000 PDs and post-PCT was 817 DOTs/1000 PDs (RRadj 0.73, 95% CI: 0.62 to 0.86). No statistically significant changes in clinical outcomes were noted. CONCLUSION In the context of an established ASP in a community hospital ICU, PCT monitoring was feasible and associated with an adjusted overall decrease of 27% in antibiotic use with no adverse impact on clinical outcomes. Incorporating PCT testing to guide antibiotic duration can be successful if integrated into workflow and paired with ASP guidance.
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Yap N, Ho H, Zheng H, Tan C, Toh Y, Ng C, Chan A. An in vitro evaluation of CYP2D6 enzymatic inhibition activities of a Chinese herbal medicine formulation (Xiang Bei Yangrong Tang) for the management of cancer-related fatigue. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz434.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chan A, Feuille E, Bassetti J, Pereira E, Demirdag Y. M232 VARIABLE PHENOTYPES ASSOCIATED WITH P.H648TFSX20 PATHOGENIC VARIANT IN CARMIL2 GENE: A REPORT OF TWO CASES. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tan C, Tan L, Loh K, Neo P, Finkelstein E, Chan A. Work-related outcomes among cancer survivors in Singapore. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz432.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Guo Y, Ahn MJ, Chan A, Wang CH, Kang JH, Kim SB, Bello M, Arora RS, Zhang Q, He X, Li P, Dechaphunkul A, Kumar V, Kamble K, Li W, Kandil A, Cohen EEW, Geng Y, Zografos E, Tang PZ. Afatinib versus methotrexate as second-line treatment in Asian patients with recurrent or metastatic squamous cell carcinoma of the head and neck progressing on or after platinum-based therapy (LUX-Head & Neck 3): an open-label, randomised phase III trial. Ann Oncol 2019; 30:1831-1839. [PMID: 31501887 PMCID: PMC6927323 DOI: 10.1093/annonc/mdz388] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treatment options are limited for patients with recurrent or metastatic squamous cell carcinoma of the head and neck (HNSCC) following progression after first-line platinum-based therapy, particularly in Asian countries. PATIENTS AND METHODS In this randomised, open-label, phase III trial, we enrolled Asian patients aged ≥18 years, with histologically or cytologically confirmed recurrent/metastatic HNSCC following first-line platinum-based therapy who were not amenable for salvage surgery or radiotherapy, and had an Eastern Cooperative Oncology Group (ECOG) performance status of 0/1. Patients were randomised (2 : 1) to receive oral afatinib (40 mg/day) or intravenous methotrexate (40 mg/m2/week), stratified by ECOG performance status and prior EGFR-targeted antibody therapy. The primary end point was progression-free survival (PFS) assessed by an independent central review committee blinded to treatment allocation. RESULTS A total of 340 patients were randomised (228 afatinib; 112 methotrexate). After a median follow-up of 6.4 months, afatinib significantly decreased the risk of progression/death by 37% versus methotrexate (hazard ratio 0.63; 95% confidence interval 0.48-0.82; P = 0.0005; median 2.9 versus 2.6 months; landmark analysis at 12 and 24 weeks, 58% versus 41%, 21% versus 9%). Improved PFS was complemented by quality of life benefits. Objective response rate was 28% with afatinib and 13% with methotrexate. There was no significant difference in overall survival. The most common grade ≥3 drug-related adverse events were rash/acne (4% with afatinib versus 0% with methotrexate), diarrhoea (4% versus 0%), fatigue (1% versus 5%), anaemia (<1% versus 5%) and leukopenia (0% versus 5%). CONCLUSIONS Consistent with the phase III LUX-Head & Neck 1 trial, afatinib significantly improved PFS versus methotrexate, with a manageable safety profile. These results demonstrate the efficacy and feasibility of afatinib as a second-line treatment option for certain patients with recurrent or metastatic HNSCC. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01856478.
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Toh Y, Maung S, Chan A. Evaluating mitochondrial biomarkers between fatigue subclasses identified using latent class analysis in early-stage breast cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz434.019] [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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Manzie T, Vujcich N, Chan A. Osteonecrosis of the jaw in an anti‐resorptive naïve patient taking trastuzumab and pertuzumab: case report. Aust Dent J 2019; 65:305-307. [DOI: 10.1111/adj.12723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2019] [Indexed: 11/28/2022]
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Ocaña A, Chacón JILM, Calvo L, Antón A, Mansutti M, Alba E, Lluch A, Lahuerta A, Bisagni G, Bermejo B, Semiglazov V, Thill M, Chan A, Morales S, Albanell J, Herranz J, Trias Bes IT, Valagussa P, Chiesa M, Gianni L. Association of derived neutrophil-to-lymphocyte ratio (dNLR) with pathological complete response (pCR) after neoadjuvant chemotherapy (CT). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ksienski D, Wai E, Croteau N, Freeman A, Fiorino L, Chan A, Fenton D, Geller G, Brooks E, Poonja Z, Irons S, Lesperance M. MA07.11 Survival Outcomes Based on Gender of Advanced Nonsmall Cell Lung Cancer Patients Treated with Pembrolizumab or Nivolumab in Everyday Clinical Practice. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tolaney S, Wardley A, Zambelli S, Hilton J, Troso-Sandoval T, Ricci F, Im SA, Kim SB, Johnston S, Chan A, Goel S, Catron K, Yang Z, Gainford C, André F. MonarcHER: A randomized phase II study of abemaciclib plus trastuzumab with or without fulvestrant versus trastuzumab plus standard-of-care chemotherapy in women with HR+, HER2+ advanced breast cancer (ABC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Petersen L, Mcneil R, Dean M, Chan A, Orton S, Kovalchuk O, Bebb G. P2.04-30 Seq-ing a Better Way to Detect PD-L1 in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1535] [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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