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Burmeister T, Schwartz S, Horst HA, Rieder H, Gökbuget N, Hoelzer D, Thiel E. Molecular heterogeneity of sporadic adult Burkitt-type leukemia/lymphoma as revealed by PCR and cytogenetics: correlation with morphology, immunology and clinical features. Leukemia 2005; 19:1391-8. [PMID: 15973450 DOI: 10.1038/sj.leu.2403847] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chromosomal translocations involving the MYC oncogene are a hallmark of Burkitt lymphoma but they are only found in a varying frequency in mature Burkitt-type acute lymphoblastic leukemia (B-ALL). We have investigated samples of 56 sporadic Burkitt leukemia/lymphoma patients for the translocations t(8;14)(q24;q32), t(2;8)(p11;q24) and t(8;22)(q24;q11). Long PCR was used for detecting the immunoglobulin heavy chain (IgH) translocation and cytogenetics and/or fluorescence in situ hybridization for detecting the 'variant' MYC translocations. A total of 29 samples (51.8%) were t(8;14)-positive by long PCR. Approximately one-third had a chromosomal breakpoint in the IgH joining region while the others had breakpoints in the IgH switch regions. Among them were two cases with a previously unreported MYC translocation into the IgE switch region. Long PCR was more reliable compared to conventional cytogenetics for detecting the t(8;14). Epstein-Barr virus was detected in high copy number in two (3.6%) t(8;14)-positive cases by real-time quantitative PCR. Human herpesvirus 8 was not detected in any case by nested PCR. A typical L3 or L3-compatible cytomorphology was highly predictive (>80%) but not specific of a MYC translocation. A total of 34 patients were treated according to the GMALL B-ALL therapy protocols and there was no significant difference in overall survival between patients with or without t(8;14).
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102
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Korfel A, Jahnke K, Martus P, Schwartz S, Fischer L, Stein H, Thiel E. Central nervous system involvement in non-Hodgkin’s lymphoma: A single-center analysis of prognostic factors for survival. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6718] [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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103
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Schmittel A, Fischer von Weikersthal L, Sebastian M, Link H, Schulze K, Thiel E, Keilholz U. Irinotecan plus carboplatin versus etoposide plus carboplatin in extensive disease small cell lung cancer: A randomized phase II trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7046] [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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104
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Schmid P, Kiewe P, Kuehnhardt D, Korfel A, Lindemann S, Giurescu M, Reif S, Thiel E, Possinger K. A phase I study of the novel, third generation epothilone ZK-EPO in patients with advanced solid tumors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2051] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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105
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Thiel E, Jahnke K, Schilling A, Fischer L, Heidenreich J, Stein H, Korfel A. Radiological morphology of low-grade primary central nervous system lymphoma in immunocompetent patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.1536] [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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106
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Fischer L, Thiel E, Klasen HA, Hans K, Jahnke K, Pees H, Birkmann J, Agnieszka K. Long-term remissions in relapsed/refractory primary central nervous system lymphoma (PCNSL) after topotecan chemotherapy. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.1528] [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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107
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Kiewe P, Hasmüller S, Kahlert S, Heinrigs M, Rack B, Marmé A, Korfel A, Thiel E, Sommer H, Untch M. Phase I trial of the trifunctional anti-HER2 x anti-CD3 antibody ertumaxomab in metastatic breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2530] [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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108
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Schwartz S, Müller K, Fischer L, Korfel A, Jahnke K, Auton T, Thiel E. Favorable outcome in excessive methotrexate (MTX) intoxication after high-dose (HD) MTX therapy by early use of carboxypeptidase G2 (CPG2). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8255] [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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109
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Jahnke K, Korfel A, Wagner T, Bechrakis NE, Coupland SE, Fischer L, Foerster MH, Thiel E. Ifosfamide and trofosfamide for intraocular lymphoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.1529] [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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110
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Penack O, Gentilini C, Fischer L, Asemissen AM, Scheibenbogen C, Thiel E, Uharek L. CD56dimCD16neg cells are responsible for natural cytotoxicity against tumor targets. Leukemia 2005; 19:835-40. [PMID: 15744340 DOI: 10.1038/sj.leu.2403704] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 12/07/2004] [Indexed: 11/09/2022]
Abstract
The activation of natural killer (NK) cells leads to degranulation and secretion of cytotoxic granula. During this process, the lytic granule membrane protein CD107a becomes detectable at the cell surface. Based on this phenomenon, we have analyzed by a novel flow cytometry-based assay, the number and phenotype of NK cells responding to tumor targets. Using human leukemia and lymphoma cell lines, we observed a close correlation between CD107a surface expression and target cell lysis, indicating that NK cell cytotoxicity can be assessed by this method. The number of degranulating NK cells was closely related to the ratio of effector and target cells and showed a maximum at a ratio of 1:1. Moreover, we were able to show that the population of CD56(dim)/CD16(neg) NK cells is primarily responsible for the cytotoxic activity against tumor targets whereas neither CD56(dim)/CD16(pos) nor CD56(bright) NK cells degranulated in response to the cell lines. Our results indicate that the CD107a assay represents a promising new method for the quantification and characterization of cells exhibiting natural cytotoxicity.
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Jahnke K, Korfel A, Martus P, Weller M, Herrlinger U, Schmittel A, Fischer L, Thiel E. High-dose methotrexate toxicity in elderly patients with primary central nervous system lymphoma. Ann Oncol 2005; 16:445-9. [PMID: 15653703 DOI: 10.1093/annonc/mdi075] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The dose of high-dose methotrexate (HDMTX) in elderly patients often has to be reduced, resulting in a loss of treatment efficacy. We evaluated HDMTX-related toxicity with special regard to age distribution in patients with primary central nervous system lymphoma (PCNSL) in a phase IV multicenter trial. PATIENTS AND METHODS One hundred and fifty-four patients (median age 61 years; 89 patients >60 years old, 21 patients >70 years old) received 619 HDMTX cycles. Toxicity was evaluated prospectively using the WHO classification. Unless a reduced dose was required after calculating a decreased glomerular filtration rate (GFR), the patients received 4 g/m(2) HDMTX followed by leucovorin rescue. RESULTS Toxicity was generally mild with toxicities of WHO grade > or =3 usually <10%. The differences in the incidence and severity of toxicity were not statistically significant between patients >60 years and < or =60 years old. The same was true for therapy termination owing to MTX toxicity and for delayed serum MTX clearance. Dose reduction significantly differed between patients < or =60 years and those >60 years old (18% versus 44%; P = 0.001). CONCLUSIONS HDMTX is a safe treatment for PCNSL patients regardless of age, with adherence to dose reduction determined by calculating the GFR before each treatment cycle.
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112
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Schmittel A, Jahnke K, Thiel E, Keilholz U. Neomycin as secondary prophylaxis for irinotecan-induced diarrhea. Ann Oncol 2004; 15:1296. [PMID: 15277273 DOI: 10.1093/annonc/mdh310] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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113
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Dimeo F, Schmittel A, Fietz T, Schwartz S, Köhler P, Böning D, Thiel E. Physical performance, depression, immune status and fatigue in patients with hematological malignancies after treatment. Ann Oncol 2004; 15:1237-42. [PMID: 15277264 DOI: 10.1093/annonc/mdh314] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fatigue is a frequent and severe problem after treatment of patients with hematological malignancies. This symptom has been associated with anemia, reduced physical performance, mood, endocrine disorders and impaired nutritional status. Recently, it has been suggested that fatigue can be related to a persistent activation of the immune system with increased production of proinflammatory cytokines. However, there is no conclusive evidence regarding the role of the immune system in the origin of fatigue in cancer patients. PATIENTS AND METHODS We evaluated the correlation of fatigue with thyroid function, markers of immune activity [interleukin (IL)-1alpha, IL-1 soluble receptor, IL-6, C-reactive protein and neopterin], liver and kidney function, mood and physical ability in 71 patients with hematological malignancies. All patients had been free of relapse and not received treatment (chemotherapy, radiotherapy or immune modulators) for at least 3 months. RESULTS Fatigue was related to depression (r=0.84; P<0.0001) and reduced performance status (r=-0.61; P<0.0001). However, there was no correlation between fatigue and thyroid, liver and kidney function, anemia, albumin concentration or markers of immune activity (all r-values <0.20; P>0.05). CONCLUSIONS We conclude that fatigue in relapse-free patients with hematological malignancies is associated with depressive mood and reduced physical performance, but not with impairment of thyroid function, anemia or persistent activation of the immune system.
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Gleissner B, Schilling A, Anagnostopolous I, Siehl I, Thiel E. Improved outcome of zygomycosis in patients with hematological diseases? Leuk Lymphoma 2004; 45:1351-60. [PMID: 15359632 DOI: 10.1080/10428190310001653691] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Zygomycosis is an opportunistic fungal infection that is increasingly reported in hematological patients. We describe 2 cases of successfully treated rhino-cerebral zygomycosis and give an overview of 120 patients from the literature with underlying hematological or oncological disorders. These data document the improved survival in sinus (15/17 patients surviving) and cutaneous (6/9 patients surviving) disease. Hematological patients with pulmonary (9/30 patients surviving) or disseminated (4/38 patients surviving) zygomycosis still have a poor prognosis. The clinical course of sinus-orbital involvement (4/11 patients surviving) follows sinus-cerebral (2/3 patients surviving) or cerebral (3/6 patients surviving) disease. Besides deoxycholate amphotericin B (AmB) (24/62 patients surviving), patients seem to benefit from liposomal amphotericin B (L-AmB) (10/16 patients surviving) or sequential AmB/L-AmB treatment (6/8 patients surviving). Alternative treatment options lead only in a few patients to success.
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Fischer L, Thiel E, Klasen HA, Kirchen H, Jahnke K, Korfel A. Response of relapsed or refractory primary central nervous system lymphoma (PCNSL) to topotecan. Neurology 2004; 62:1885-7. [PMID: 15159503 DOI: 10.1212/01.wnl.0000125334.16420.d4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors treated 16 immunocompetent patients with refractory or relapsed primary CNS lymphoma with topotecan. Fifteen patients had been pretreated with up to three chemotherapy regimens, three of them additionally with whole brain irradiation (WBI), and one with WBI alone. Four complete remissions and two partial remissions were achieved. Progression-free survival was 20% at 6 months and 13% at 12 months.
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Schwartz S, Borner K, Müller K, Fischer L, Korfel A, Atkinson T, Melton R, Thiel E. Rescue with recombinant Carboxypeptidase G2 (CPG2) in high-dose methotrexate (HD-MTX) induced renal failure: Results in 42 patients from a German emergency protocol. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8067] [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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117
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Keilholz U, Busse A, Schmittel A, Hütter G, Siehl J, Thiel E. A phase I/IIa clinical trial of CLAOP21 and CLAOP14 in patients with high-grade non-Hodgkin's lymphoma and cardiac risk factors. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6708] [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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118
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Korfel A, Martus P, Nowrousian M, Hossfeld D, Weber W, Bruecher J, Berdel W, Birkmann J, Peschel C, Thiel E. Impact of response to chemotherapy and treating institution on survival in primary CNS lymphoma (PCNSL): Long-term results of the multicenter BMPD study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1522] [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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119
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Thiel E, Jahnke K, Wagner T, Bechrakis NE, Coupland SE, Schmittel A, Fischer L, Foerster MH, Korfel A. Ifosfamide for intraocular lymphoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1520] [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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120
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Jahnke K, Korfel A, Martus P, Weller M, Herrlinger U, Fischer L, Thiel E. Comparison of high-dose methotrexate (HDMTX) toxicity in elderly and younger patients (pts) with primary central nervous system lymphoma (PCNSL). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8041] [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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121
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Deckert PM, Siehl JM, Thiel E, Schmittel A, Hütter G, Szelényi H, Keilholz U. Phase II study of liposomal daunorubicin and ifosfamide (IDx) as first line chemotherapy in soft tissue sarcoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9011] [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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122
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Schmittel AH, Schuster R, Bechrakis N, Siehl J, Foerster MH, Thiel E, Keilholz U. Phase I/II trial of gemcitabine plus treosulfan (GeT) in stage IV uveal melanoma and carcinomas. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7525] [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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123
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Schmittel A, Schulze K, Hütter G, Krebs P, Thiel E, Keilholz U. Phase I Dose Escalation Study of Carboplatin to a Fixed Dose of Irinotecan as First-Line Treatment of Small Cell Lung Cancer. Oncol Res Treat 2004; 27:280-4. [PMID: 15249718 DOI: 10.1159/000077979] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Superiority of irinotecan (CPT-11) plus cisplatin over etoposide plus cisplatin in small cell lung cancer (SCLC) has recently been demonstrated. This study determines dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of escalating doses of carboplatin to a fixed dose of irinotecan in Caucasians with small cell lung cancer. PATIENTS AND METHODS Patients with extensive small cell lung cancer received 50 mg/m(2) irinotecan on day 1, 8, and 15. Dose escalation of carboplatin on day 1 started in dose level 1 at an AUC of 5 mg x min/ml and was escalated to AUC 6 in level 2. Cycles were repeated on day 29. Dose escalation was evaluated after 3 consecutive patients. If no grade IV neutropenia lasting for > or =7 days or thrombopenia or non-hematologic toxicity > or = grade III occurred, treatment was continued in the next dose level. RESULTS 16 patients were treated. DLT was reached in dose level 2 with 2 grade IV neutropenias and 1 grade IV thrombopenia and diarrhea. Toxicity was further investigated at dose level 1 in a total of 10 patients, which revealed 2 grade III neutropenias and 1 grade III diarrhea. Of 15 evaluable patients, 10 had a partial response, 3 had disease stabilization and 2 progressed. CONCLUSION Dose level 1 was found to be MTD, this dose is currently compared to the combination of etoposide plus carboplatin within a randomised phase II/III trial.
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Hütter G, Szélenyi H, Deckert PM, Keilholz U, Thiel E. Phase I/II trial of topotecan given as continuous infusion in combination with oxaliplatin in 5-FU-pretreated patients with colorectal cancer. Cancer Chemother Pharmacol 2004; 54:178-84. [PMID: 15114411 DOI: 10.1007/s00280-004-0796-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 02/16/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Oxaliplatin and topotecan are novel options for a variety of neoplasms. Topotecan has shown fewer side effects and higher efficacy when given as a continuous i.v. infusion compared to single doses, but this regimen has not yet been combined with oxaliplatin. PATIENTS AND METHODS This phase I/II trial was designed to establish the dose-limiting toxicity of a combination of oxaliplatin (85-130 mg/m2 on day 1) and a continuous infusion of topotecan (initial 0.9 mg/m2 over 72-120 h). Eligible patients with metastatic colorectal cancer had progressive disease during, or within 12 weeks after, palliative fluoropyrimidine-based chemotherapy or in whom intolerable 5-FU toxicity had developed. RESULTS The study included 21 patients. Subjectively the treatment was well tolerated but haematological toxicity was observed with the initial treatment schedule of oxaliplatin 85 mg/m2 on day 1 and topotecan 0.9 mg/m2 on days 1-5. Reducing topotecan to 0.9 mg/m2 on days 1-3 resulted also in acceptable haematological toxicity. In patients completing three or more therapy cycles, median progression-free survival was 5 months, and 50% had stable disease or showed a partial response. CONCLUSION The recommended dose of this combination for further testing is oxaliplatin 85 mg/m2 on day 1 and topotecan 0.9 mg/m2 per day as a continuous infusion on days 1-3.
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Zander AR, Kröger N, Schmoor C, Krüger W, Möbus V, Frickhofen N, Metzner B, Schultze W, Berdel WE, Koenigsmann M, Thiel E, Wandt H, Possinger K, Trümper L, Kreienberg R, Carstensen M, Schmidt EH, Jänicke F, Schumacher M, Jonat W. High-dose chemotherapy with autologous hematopoietic stem-cell support compared with standard-dose chemotherapy in breast cancer patients with 10 or more positive lymph nodes: first results of a randomized trial. J Clin Oncol 2004; 22:2273-83. [PMID: 15111618 DOI: 10.1200/jco.2004.07.026] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Investigation of high-dose chemotherapy (HD-CT) followed by autologous hematopoietic stem-cell support compared with standard-dose chemotherapy (SD-CT) as adjuvant treatment in patients with primary breast cancer and 10 or more positive axillary lymph nodes. PATIENTS AND METHODS Between November 1993 and September 2000, 307 patients were randomized to receive (following four cycles of epirubicin 90 mg/m(2) and cyclophosphamide 600 mg/m(2), intravenously every 21 days) either HD-CT of cyclophosphamide 1500 mg/m(2), thiotepa 150 mg/m(2), and mitoxantrone 10 mg/m(2), intravenously for 4 consecutive days followed by stem-cell support; or SD-CT in three cycles of cyclophosphamide 500 mg/m(2), methotrexate 40 mg/m(2), and fluorouracil 600 mg/m(2) intravenously on days 1 and 8, every 28 days. The primary end point was event-free survival. RESULTS After a median follow-up of 3.8 years, 144 events with respect to event-free survival have been observed (HD-CT: 63 events; SD-CT: 81 events). The first event of failure (HD-CT v SD-CT) was an isolated locoregional recurrence (nine v 11), a distant failure (52 v 68), and death without recurrence (two v two). The estimated relative risk of HD-CT versus SD-CT was 0.75 (95% CI, 0.54 to 1.06; P =.095). Overall survival showed no difference (HD-CT: 40 deaths; SD-CT: 49 deaths). CONCLUSION There was a trend in favor of HD-CT with respect to event-free survival, but without statistical significance. Further follow-up and a meta-analysis of all randomized studies will reveal the effect of HD-CT as compared with SD-CT as adjuvant treatment in high-risk primary breast cancer.
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