51
|
Wong SE, North SA, Sweeney CJ, Stockler MR, Sridhar SS. Screen Failure Rates in Contemporary Randomized Clinical Phase II/III Therapeutic Trials in Genitourinary Malignancies. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30274-4. [PMID: 28993132 DOI: 10.1016/j.clgc.2017.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Screen failures, defined as individuals who undergo screening but are not enrolled in a clinical trial, incur significant costs without contributing valuable data to the study. Despite these costs, there are few published data about the rate or reasons for screen failures in advanced genitourinary cancer clinical trials. MATERIALS AND METHODS We reviewed 50 phase II and III trials in advanced genitourinary cancers conducted between 1999 and 2016. RESULTS Of the 50 trials, only 48% (24 of 50) published screen failure rates: 68% (13 of 19) of those in prostate cancer, 33% (6 of 18) in kidney cancer, and 58% (5 of 13) in bladder cancer. Among the phase III trials in prostate cancer, the mean screen failure rate was 26% (range, 12%-45%). The main reason for screen failure was reported as ineligibility. Among the phase III trials in kidney cancer, the mean screen failure rate was 25% (range, 21%-29%), with the most frequent reasons being ineligibility and patient refusal. Among the phase II/III trials in bladder cancer, the mean screen failure rate was 19% (range, 4%-28%), with the main reasons being ineligibility and patient refusal. CONCLUSION Contemporary trials in genitourinary cancer reported screen failure rates of approximately 20% to 30%. Many trials did not report on the numbers of, and reasons for, screen failures. Greater standardization of definitions, methods, and reporting are needed to better understand and decrease screen failure rates in genitourinary cancer clinical trials.
Collapse
Affiliation(s)
- Sarah E Wong
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Martin R Stockler
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | |
Collapse
|
52
|
Risk of gastrointestinal events with newly approved (after 2011) vascular endothelial growth factor receptor tyrosine kinase inhibitors in cancer patients: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2017; 73:1209-1217. [PMID: 28710508 DOI: 10.1007/s00228-017-2299-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/03/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE We performed a meta-analysis to systematically review the gastrointestinal (GI) events (diarrhea, nausea, vomiting, anorexia) of five newly approved (after 2011) VEGFR-TKIs in cancer patients. METHODS The relevant studies of the randomized controlled trials (RCTs) in cancer patients treated with cabozantinib, vandetanib, lenvatinib, regorafenib, and axitinib were retrieved and the systematic evaluation was conducted. RESULTS Forty-one randomized controlled trials and 10,860 patients were included. Current analysis suggested that the use of these agents increased the risk of all-grade and high-grade GI events, and the diarrhea was the most common GI events. The risk of all-grade and high-grade GI events varies significantly within drug types, tumor types, and VEGFR-TKIs-based regimens. CONCLUSION The available data suggested that the use of the five newly approved VEGFR-TKIs may increase risk of GI events in cancer patients. Physicians and patients should be aware of these risks and frequent monitoring and careful management should be emphasized when managing these VEGFR-TKIs.
Collapse
|
53
|
Bellmunt J, Kerst J, Vázquez F, Morales-Barrera R, Grande E, Medina A, González Graguera M, Rubio G, Anido U, Fernández Calvo O, González-Billalabeitia E, Van den Eertwegh A, Pujol E, Perez-Gracia J, González Larriba J, Collado R, Los M, Maciá S, De Wit R. A randomized phase II/III study of cabazitaxel versus vinflunine in metastatic or locally advanced transitional cell carcinoma of the urothelium (SECAVIN). Ann Oncol 2017; 28:1517-1522. [DOI: 10.1093/annonc/mdx186] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Indexed: 12/17/2022] Open
|
54
|
Cumberbatch K, He T, Thorogood Z, Gartrell BA. Emerging drugs for urothelial (bladder) cancer. Expert Opin Emerg Drugs 2017; 22:149-164. [PMID: 28556678 DOI: 10.1080/14728214.2017.1336536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Metastatic urothelial carcinoma has been associated with poor prognosis and a median survival of approximately 12-14 months with standard therapy. Treatment options for decades have been limited to platinum based chemotherapy as first line with few therapeutic options available to the majority who will ultimately progress beyond platinum. Areas covered: This review focuses on the various targeted, antiangiogenic, chemotherapeutic and immunotherapeutic agents currently being developed for the treatment of urothelial carcinoma. Expert opinion: Incorporation of systemic immunotherapy into the treatment of urothelial carcinoma has already fundamentally changed the treatment of this disease. The landscape is rapidly changing and it is likely that immunotherapy will be incorporated into therapy in earlier disease states and in novel combinations. Outcomes in urothelial carcinoma have improved and likely to improve further with ongoing and future clinical research that is discussed in this review.
Collapse
Affiliation(s)
- Kerwin Cumberbatch
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Tianfang He
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Zachary Thorogood
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Benjamin A Gartrell
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| |
Collapse
|
55
|
Jones RJ, Hussain SA, Protheroe AS, Birtle A, Chakraborti P, Huddart RA, Jagdev S, Bahl A, Stockdale A, Sundar S, Crabb SJ, Dixon-Hughes J, Alexander L, Morris A, Kelly C, Stobo J, Paul J, Powles T. Randomized Phase II Study Investigating Pazopanib Versus Weekly Paclitaxel in Relapsed or Progressive Urothelial Cancer. J Clin Oncol 2017; 35:1770-1777. [PMID: 28402747 DOI: 10.1200/jco.2016.70.7828] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose Two previous single-arm trials have drawn conflicting conclusions regarding the activity of pazopanib in urothelial cancers after failure of platinum-based chemotherapy. Patients and Methods This randomized (1:1) open-label phase II trial compared the efficacy of pazopanib 800 mg orally with paclitaxel (80 mg/m2 days 1, 8, and 15 every 28 days) in the second-line setting. The primary end point was overall survival (OS). Results Between August 2012 and October 2014, 131 patients, out of 140 planned, were randomly assigned. The study was terminated early on the recommendation of the independent data monitoring committee because of futility. Final analysis after the preplanned number of deaths (n = 110) occurred after a median follow-up of 18 months. One hundred fifteen deaths had occurred at the final data extract presented here. Median OS was 8.0 months for paclitaxel (80% CI, 6.9 to 9.7 months) and 4.7 months for pazopanib (80% CI, 4.2 to 6.4 months). The hazard ratio (HR) adjusted for baseline stratification factors was 1.28 (80% CI, 0.99 to 1.67; one-sided P = .89). Median progression-free survival was 4.1 months for paclitaxel (80% CI, 3.0 to 5.6 months) and 3.1 months for pazopanib (80% CI, 2.7 to 4.6 months; HR, 1.09; 80% CI, 0.85 to 1.40; one-sided P = .67). Discontinuations for toxicity occurred in 7.8% and 23.1% for paclitaxel and pazopanib, respectively. Conclusion Pazopanib did not have greater efficacy than paclitaxel in the second-line treatment of urothelial cancers. There was a trend toward superior OS for paclitaxel.
Collapse
Affiliation(s)
- Robert J Jones
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Syed A Hussain
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Andrew S Protheroe
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Alison Birtle
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Prabir Chakraborti
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Robert A Huddart
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Satinder Jagdev
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Amit Bahl
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Andrew Stockdale
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Santhanam Sundar
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Simon J Crabb
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Judith Dixon-Hughes
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Laura Alexander
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Anna Morris
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Caroline Kelly
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Jon Stobo
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - James Paul
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| | - Thomas Powles
- Robert J. Jones, Judith Dixon-Hughes, Laura Alexander, Anna Morris, Caroline Kelly, Jon Stobo, and James Paul, University of Glasgow, Glasgow; Syed A. Hussain, University of Liverpool, Liverpool; Andrew S. Protheroe, Churchill Hospital, Oxford; Alison Birtle, Royal Preston Hospital, Preston; Prabir Chakraborti, Royal Derby Hospital, Derby; Robert A. Huddart, Institute of Cancer Research, Sutton; Satinder Jagdev, St James's University Hospital, Leeds; Amit Bahl, Bristol Haematology and Oncology Centre, Bristol; Andrew Stockdale, University Hospital, Coventry; Santhanam Sundar, Nottingham University Hospitals National Health Service Trust, Nottingham; Simon J. Crabb, University of Southampton, Southampton; and Thomas Powles, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
56
|
Aoun F, Rassy EE, Assi T, Albisinni S, Katan J. Advances in urothelial bladder cancer immunotherapy, dawn of a new age of treatment. Immunotherapy 2017; 9:451-460. [PMID: 28357911 DOI: 10.2217/imt-2017-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Urothelial bladder cancer displays a high number of somatic mutations that render these tumors more responsive to immunotherapy. Several immunotherapeutic agents were examined in patients with advanced stage urothelial bladder cancer and recently atezolizumab - an (PDL-1) immune checkpoint inhibitor antibody - was approved for the treatment of patients with metastatic disease progressing after platinum combination therapy. Despite the great success, there are still some unanswered questions and ongoing trials that are in progress to define the role of combination therapy and sequencing strategies. The objective of our manuscript is to summarize the most recent data on immunotherapy in advanced urothelial cancer. Current challenges and future perspectives of immunotherapy as a monotherapy or in combination strategies will also be analyzed.
Collapse
Affiliation(s)
- Fouad Aoun
- Department of Urology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon.,Department of Urology, Jules Bordet Institute, 1 Rue Héger Bordet, 1000 Brussels, Belgium
| | - Elie El Rassy
- Department of Oncology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Department of Oncology, Gustave Roussy Institute, Paris, France
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute, 1 Rue Héger Bordet, 1000 Brussels, Belgium
| | - Joseph Katan
- Department of Oncology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
57
|
Ning YM, Suzman D, Maher VE, Zhang L, Tang S, Ricks T, Palmby T, Fu W, Liu Q, Goldberg KB, Kim G, Pazdur R. FDA Approval Summary: Atezolizumab for the Treatment of Patients with Progressive Advanced Urothelial Carcinoma after Platinum-Containing Chemotherapy. Oncologist 2017; 22:743-749. [PMID: 28424325 PMCID: PMC5469588 DOI: 10.1634/theoncologist.2017-0087] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/31/2022] Open
Abstract
Until recently in the United States, no products were approved for second-line treatment of advanced urothelial carcinoma. On May 18, 2016, the U.S. Food and Drug Administration approved atezolizumab for the treatment of patients with locally advanced or metastatic urothelial carcinoma whose disease progressed during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy. Atezolizumab is a programmed death-ligand 1 (PD-L1) blocking antibody and represents the first approved product directed against PD-L1. This accelerated approval was based on results of a single-arm trial in 310 patients with locally advanced or metastatic urothelial carcinoma who had disease progression after prior platinum-containing chemotherapy. Patients received atezolizumab 1,200 mg intravenously every 3 weeks until disease progression or unacceptable toxicity. Key efficacy measures were objective response rate (ORR), as assessed by Independent Review per RECIST 1.1, and duration of response (DoR). With a median follow-up of 14.4 months, confirmed ORR was 14.8% (95% CI: 11.1, 19.3) in all treated patients. Median DoR was not reached and response durations ranged from 2.1+ to 13.8+ months. Of the 46 responders, 37 patients had an ongoing response for ≥ 6 months. The most common adverse reactions (≥20%) were fatigue, decreased appetite, nausea, urinary tract infection, pyrexia, and constipation. Infection and immune-related adverse events also occurred, including pneumonitis, hepatitis, colitis, endocrine disorders, and rashes. Overall, the benefit-risk assessment was favorable to support accelerated approval. The observed clinical benefits need to be verified in confirmatory trial(s). IMPLICATIONS FOR PRACTICE This accelerated approval of atezolizumab for second-line use in advanced urothelial carcinoma provides patients with an effective, novel treatment option for the management of their disease. This represents the first immunotherapy approved in this disease setting.
Collapse
Affiliation(s)
- Yang-Min Ning
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Daniel Suzman
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - V Ellen Maher
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Lijun Zhang
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Shenghui Tang
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Tiffany Ricks
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Todd Palmby
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Wentao Fu
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Qi Liu
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Kirsten B Goldberg
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Geoffrey Kim
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| | - Richard Pazdur
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Springs, Maryland, USA
| |
Collapse
|
58
|
Aragon-Ching JB, Trump DL. Targeted therapies in the treatment of urothelial cancers. Urol Oncol 2017; 35:465-472. [PMID: 28366271 DOI: 10.1016/j.urolonc.2017.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 01/29/2023]
Abstract
Progress has been slow in systemic management of locally advanced and metastatic bladder cancer over the past 20 years. However, the recent approval of immunotherapy with atezolizumab and nivolumab for second-line salvage therapy may usher in an era of more rapid improvement. Systemic treatment is suboptimal and is an area of substantial unmet medical need. The recent findings from The Cancer Genome Atlas project revealed promising pathways that may be amenable to targeted therapies. Promising results with treatment using vascular endothelial growth factor inhibitors such as ramucirumab, sunitinib or bevacizumab, and human epidermal growth factor receptor 2 targeted therapies, epidermal growth factor receptor inhibitors, and fibroblast growth factor receptor inhibitors, are undergoing clinical trials and are discussed later.
Collapse
Affiliation(s)
| | - Donald L Trump
- GU Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA
| |
Collapse
|
59
|
BCG-unresponsive non-muscle-invasive bladder cancer: recommendations from the IBCG. Nat Rev Urol 2017; 14:244-255. [DOI: 10.1038/nrurol.2017.16] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
60
|
Sharma P, Retz M, Siefker-Radtke A, Baron A, Necchi A, Bedke J, Plimack ER, Vaena D, Grimm MO, Bracarda S, Arranz JÁ, Pal S, Ohyama C, Saci A, Qu X, Lambert A, Krishnan S, Azrilevich A, Galsky MD. Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol 2017; 18:312-322. [PMID: 28131785 DOI: 10.1016/s1470-2045(17)30065-7] [Citation(s) in RCA: 1187] [Impact Index Per Article: 169.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/09/2016] [Accepted: 11/16/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with metastatic urothelial carcinoma have a dismal prognosis and few treatment options after first-line chemotherapy. Responses to second-line treatment are uncommon. We assessed nivolumab, a fully human IgG4 PD-1 immune checkpoint inhibitor antibody, for safety and activity in patients with metastatic or surgically unresectable urothelial carcinoma whose disease progressed or recurred despite previous treatment with at least one platinum-based chemotherapy regimen. METHODS In this multicentre, phase 2, single-arm study, patients aged 18 years or older with metastatic or surgically unresectable locally advanced urothelial carcinoma, measurable disease (according to Response Evaluation Criteria In Solid Tumors v1.1), Eastern Cooperative Oncology Group performance statuses of 0 or 1, and available tumour samples for biomarker analysis received nivolumab 3 mg/kg intravenously every 2 weeks until disease progression and clinical deterioration, unacceptable toxicity, or other protocol-defined reasons. The primary endpoint was overall objective response confirmed by blinded independent review committee in all treated patients and by tumour PD-L1 expression (≥5% and ≥1%). This trial is registered with ClinicalTrials.gov, number NCT02387996, and is completed. Follow-up is still ongoing. FINDINGS Between March 9, 2015, and Oct 16, 2015, 270 patients from 63 sites in 11 countries received nivolumab, and 265 were evaluated for activity. Median follow-up for overall survival was 7·00 months (IQR 2·96-8·77). Confirmed objective response was achieved in 52 (19·6%, 95% CI 15·0-24·9) of 265 patients. Confirmed objective response was achieved in 23 (28·4%, 95% CI 18·9-39·5) of the 81 patients with PD-L1 expression of 5% or greater, 29 (23·8%, 95% CI 16·5-32·3) of the 122 patients with PD-L1 expression of 1% or greater, and 23 (16·1%, 95% CI 10·5-23·1) of the 143 patients with PD-L1 expression of less than 1%. Grade 3-4 treatment-related adverse events occurred in 48 (18%) of 270 patients-most commonly grade 3 fatigue and diarrhoea, which each occurred in five patients. Three deaths were attributed to treatment (pneumonitis, acute respiratory failure, and cardiovascular failure). INTERPRETATION Nivolumab monotherapy provided meaningful clinical benefit, irrespective of PD-L1 expression, and was associated with an acceptable safety profile in previously treated patients with metastatic or surgically unresectable urothelial carcinoma. FUNDING Bristol-Myers Squibb.
Collapse
Affiliation(s)
- Padmanee Sharma
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA; Department of Immunology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
| | - Margitta Retz
- Department of Urology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Arlene Siefker-Radtke
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Ari Baron
- Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jens Bedke
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Elizabeth R Plimack
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Daniel Vaena
- Division of Hematology, Oncology, and Bone Marrow Transplantation/Department of Medicine and Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | | | - Sergio Bracarda
- Department of Oncology and Medical Oncology Unit, Ospedale San Donato, Azienda USL Toscana Sud-Est, Istituto Toscano Tumori, Arezzo, Italy
| | - José Ángel Arranz
- Genitourinary and Gynecologic Section, Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sumanta Pal
- Kidney Cancer Program, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Chikara Ohyama
- Department of Urology, Hirosaki University, Hirosaki, Aomori, Japan
| | - Abdel Saci
- Exploratory Clinical & Translational Research Department, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Xiaotao Qu
- Translational Bioinformatics Department, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Alexandre Lambert
- Biometrics Department, Bristol-Myers Squibb, Braine-l'Alleud, Belgium
| | - Suba Krishnan
- Global Clinical Research Oncology Department, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Alex Azrilevich
- Global Clinical Research Oncology Department, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Matthew D Galsky
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai/Tisch Cancer Institute, New York, NY, USA
| |
Collapse
|
61
|
Chen CH, Tsai YS, Tzai TS. Significance of HER2 expression in patients with upper tract urothelial carcinoma: A meta-analysis. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2015.04.002] [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
|
62
|
Metastatic Bladder Cancer: Second-Line Treatment and Recommendations of the Genitourinary Tumor Division of the Galician Oncologic Society (SOG-GU). Curr Oncol Rep 2016; 18:72. [DOI: 10.1007/s11912-016-0556-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
63
|
Powles T, Huddart RA, Elliott T, Sarker SJ, Ackerman C, Jones R, Hussain S, Crabb S, Jagdev S, Chester J, Hilman S, Beresford M, Macdonald G, Santhanam S, Frew JA, Stockdale A, Hughes S, Berney D, Chowdhury S. Phase III, Double-Blind, Randomized Trial That Compared Maintenance Lapatinib Versus Placebo After First-Line Chemotherapy in Patients With Human Epidermal Growth Factor Receptor 1/2-Positive Metastatic Bladder Cancer. J Clin Oncol 2016; 35:48-55. [PMID: 28034079 DOI: 10.1200/jco.2015.66.3468] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To establish whether maintenance lapatinib after first-line chemotherapy is beneficial in human epidermal growth factor receptor (HER) 1/HER2-positive metastatic urothelial bladder cancer (UBC). Methods Patients with metastatic UBC were screened centrally for HER1/HER2 overexpression. Patients who screened positive for HER1/2 and who did not have progressive disease during chemotherapy (four to eight cycles) were randomly assigned one to one to lapatinib or placebo after completion of first-line/initial chemotherapy for metastatic disease. The primary end point was progression-free survival (PFS). Results Between 2007 and 2013, 446 patients with UBC were screened, and 232 with HER1- or HER2-positive disease were randomly assigned. The median PFS for lapatinib and placebo was 4.5 (95% CI, 2.8 to 5.4) and 5.1 (95% CI, 3.0 to 5.8) months, respectively (hazard ratio, 1.07; 95% CI, 0.81 to 1.43; P = .63). The overall survival for lapatinib and placebo was 12.6 (95% CI, 9.0 to 16.2) and 12.0 (95% CI, 10.5 to 14.9) months, respectively (hazard ratio, 0.96; 95% CI, 0.70 to 1.31; P = .80). Discontinuation due to adverse events were similar in both arms (6% lapatinib and 5% placebo). The rate of grade 3 to 4 adverse events for lapatinib and placebo was 8.6% versus 8.1% ( P = .82). Preplanned subset analysis of patients strongly positive for HER1/HER2 (3+ on immunohistochemistry; n = 111), patients positive for only HER1 (n = 102), and patients positive for only HER2 (n = 42) showed no significant benefit with lapatinib in terms of PFS and overall survival ( P > .05 for each). Conclusion This trial did not find significant improvements in outcome by the addition of maintenance lapatinib to standard of care.
Collapse
Affiliation(s)
- Thomas Powles
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Robert A Huddart
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Tony Elliott
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Shah-Jalal Sarker
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Charlotte Ackerman
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Robert Jones
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Syed Hussain
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Simon Crabb
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Satinder Jagdev
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - John Chester
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Serena Hilman
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Mark Beresford
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Graham Macdonald
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Sundar Santhanam
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - John A Frew
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Andrew Stockdale
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Simon Hughes
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Daniel Berney
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| | - Simon Chowdhury
- Thomas Powles, Shah-Jalal Sarker, Charlotte Ackerman, and Daniel Berney, Queen Mary University of London; Simon Hughes and Simon Chowdhury, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London; Robert A. Huddart, Institute of Cancer Research, Sutton; Tony Elliott, Christie Hospital NHS Foundation Trust, Manchester; Robert Jones, University of Glasgow, Glasgow; Syed Hussain, University of Liverpool, Liverpool; Simon Crabb, University of Southampton, Southampton; Satinder Jagdev, St James's University Hospital, Leeds; John Chester, Cardiff University, Cardiff; Serena Hilman, Bristol Haematology and Oncology Centre, Bristol; Mark Beresford, Royal United Hospitals Bath, Bath; Graham Macdonald, Aberdeen Royal Infirmary, Aberdeen; Sundar Santhanam, Nottingham University Hospitals NHS Trust, Nottingham; John A. Frew, Northern Centre for Cancer Care, Newcastle upon Tyne; and Andrew Stockdale, University Hospital, Coventry, United Kingdom
| |
Collapse
|
64
|
Sharma P, Callahan MK, Bono P, Kim J, Spiliopoulou P, Calvo E, Pillai RN, Ott PA, de Braud F, Morse M, Le DT, Jaeger D, Chan E, Harbison C, Lin CS, Tschaika M, Azrilevich A, Rosenberg JE. Nivolumab monotherapy in recurrent metastatic urothelial carcinoma (CheckMate 032): a multicentre, open-label, two-stage, multi-arm, phase 1/2 trial. Lancet Oncol 2016; 17:1590-1598. [PMID: 27733243 PMCID: PMC5648054 DOI: 10.1016/s1470-2045(16)30496-x] [Citation(s) in RCA: 518] [Impact Index Per Article: 64.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/27/2016] [Accepted: 09/02/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few effective treatments exist for patients with advanced urothelial carcinoma that has progressed after platinum-based chemotherapy. We assessed the activity and safety of nivolumab in patients with locally advanced or metastatic urothelial carcinoma whose disease progressed after previous platinum-based chemotherapy. METHODS In this phase 1/2, multicentre, open-label study, we enrolled patients (age ≥18 years) with urothelial carcinoma of the renal pelvis, ureter, bladder, or urethra at 16 sites in Finland, Germany, Spain, the UK, and the USA. Patients were not selected by PD-L1 expression, but tumour PD-L1 membrane expression was assessed retrospectively. Patients received nivolumab 3 mg/kg intravenously every 2 weeks until disease progression or treatment discontinuation because of unacceptable toxicity or other protocol-defined reasons, whichever occurred later. The primary endpoint was objective response by investigator assessment. All patients who received at least one dose of the study drug were included in the analyses. We report an interim analysis of this ongoing trial. CheckMate 032 is registered with ClinicalTrials.gov, NCT01928394. FINDINGS Between June 5, 2014, and April 24, 2015, 86 patients with metastatic urothelial carcinoma were enrolled in the nivolumab monotherapy group and 78 received at least one dose of treatment. At data cutoff (March 24, 2016), the minimum follow-up was 9 months (median 15·2 months, IQR 12·9-16·8). A confirmed investigator-assessed objective response was achieved in 19 (24·4%, 95% CI 15·3-35·4) of 78 patients. Grade 3-4 treatment-related adverse events occurred in 17 (22%) of 78 patients; the most common were elevated lipase (four [5%]), elevated amylase (three [4%]), and fatigue, maculopapular rash, dyspnoea, decreased lymphocyte count, and decreased neutrophil count (two [3%] each). Serious adverse events were reported in 36 (46%) of 78 patients and eight (10%) had a serious adverse event judged to be treatment related. Two (3%) of 78 patients discontinued because of treatment-related adverse events (grade 4 pneumonitis and grade 4 thrombocytopenia) and subsequently died. INTERPRETATION Nivolumab monotherapy was associated with a substantial and durable clinical response and a manageable safety profile in previously treated patients with locally advanced or metastatic urothelial carcinoma. These data support further investigation of nivolumab monotherapy in advanced urothelial carcinoma. FUNDING Bristol-Myers Squibb.
Collapse
Affiliation(s)
- Padmanee Sharma
- Department of Genitourinary Medical Oncology, Department of Immunology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Petri Bono
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph Kim
- Prostate and Urologic Cancers Program and Early Drug Development Program, Yale Cancer Center, New Haven, CT, USA
| | - Pavlina Spiliopoulou
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Emiliano Calvo
- Medical Oncology Division, START Madrid, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Rathi N Pillai
- Department of Hematology and Oncology, Emory Winship Cancer Institute, Atlanta, GA, USA
| | - Patrick A Ott
- Melanoma Center, Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Filippo de Braud
- Department of Medical Oncology, Istituto Nazionale dei Tumori-Università degli Studi di Milano, Milan, Italy
| | - Michael Morse
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Dung T Le
- Division of Oncology-Gastrointestinal Cancer, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Dirk Jaeger
- National Center for Tumor Diseases, Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Emily Chan
- Department of Medicine, Division of Hematology and Medical Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Chris Harbison
- NIVO/IPI LCM Biomarkers, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Chen-Sheng Lin
- Clinical Biostatistics, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Marina Tschaika
- Global Clinical Research/Oncology, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Alex Azrilevich
- Global Clinical Research/Oncology, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
65
|
Vallo S, Michaelis M, Gust KM, Black PC, Rothweiler F, Kvasnicka HM, Blaheta RA, Brandt MP, Wezel F, Haferkamp A, Cinatl J. Dasatinib enhances tumor growth in gemcitabine-resistant orthotopic bladder cancer xenografts. BMC Res Notes 2016; 9:454. [PMID: 27677700 PMCID: PMC5039786 DOI: 10.1186/s13104-016-2256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/20/2016] [Indexed: 01/04/2023] Open
Abstract
Background Systemic chemotherapy with gemcitabine and cisplatin is standard of care for patients with metastatic urothelial bladder cancer. However, resistance formation is common after initial response. The protein Src is known as a proto-oncogene, which is overexpressed in various human cancers. Since there are controversial reports about the role of Src in bladder cancer, we evaluated the efficacy of the Src kinase inhibitor dasatinib in the urothelial bladder cancer cell line RT112 and its gemcitabine-resistant sub-line RT112rGEMCI20 in vitro and in vivo. Methods RT112 urothelial cancer cells were adapted to growth in the presence of 20 ng/ml gemcitabine (RT112rGEMCI20) by continuous cultivation at increasing drug concentrations. Cell viability was determined by MTT assay, cell growth kinetics were determined by cell count, protein levels were measured by western blot, and cell migration was evaluated by scratch assays. In vivo tumor growth was tested in a murine orthotopic xenograft model using bioluminescent imaging. Results Dasatinib exerted similar effects on Src signaling in RT112 and RT112rGEMCI20 cells but RT112rGEMCI20 cells were less sensitive to dasatinib-induced anti-cancer effects (half maximal inhibitory concentration (IC50) of dasatinib in RT112 cells: 349.2 ± 67.2 nM; IC50 of dasatinib in RT112rGEMCI20 cells: 1081.1 ± 239.2 nM). Dasatinib inhibited migration of chemo-naive and gemcitabine-resistant cells. Most strikingly, dasatinib treatment reduced RT112 tumor growth and muscle invasion in orthotopic xenografts, while it was associated with increased size and muscle-invasive growth in RT112rGEMCI20 tumors. Conclusion Dasatinib should be considered with care for the treatment of urothelial cancer, in particular for therapy-refractory cases.
Collapse
Affiliation(s)
- Stefan Vallo
- Institute of Medical Virology, Goethe University Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany.,Department of Urology, Goethe University Frankfurt, Frankfurt, Germany
| | - Martin Michaelis
- Centre for Molecular Processing and School of Biosciences, University of Kent, Canterbury, UK
| | - Kilian M Gust
- Department of Urology, Goethe University Frankfurt, Frankfurt, Germany.,Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Peter C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Florian Rothweiler
- Institute of Medical Virology, Goethe University Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany
| | - Hans-Michael Kvasnicka
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Roman A Blaheta
- Department of Urology, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Felix Wezel
- Department of Urology, University Hospital Ulm, Ulm, Germany
| | - Axel Haferkamp
- Department of Urology, Goethe University Frankfurt, Frankfurt, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, Goethe University Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany.
| |
Collapse
|
66
|
Narayanan S, Srinivas S. Incorporating VEGF-targeted therapy in advanced urothelial cancer. Ther Adv Med Oncol 2016; 9:33-45. [PMID: 28203296 DOI: 10.1177/1758834016667179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Patients with relapsed or refractory urothelial carcinoma (UC) have poor prognosis coupled with few options for systemic treatment. The role of angiogenesis in the evolution of cancers has been established, and studies have shown that it plays a key role in the pathogenesis of UC. Many targeted agents have been used in phase I-II trials for the treatment of UC, with encouraging but modest results. Recently, studies combining angiogenesis inhibitors with other chemotherapeutic agents were able to achieve objective responses higher than most commonly used second-line therapies in UC. Future efforts in investigating these therapies in UC rely on identification of biomarkers and other predictors of response to anti-VEGF therapy.
Collapse
Affiliation(s)
| | - Sandy Srinivas
- Division of Medical Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| |
Collapse
|
67
|
Domingo-Domenech J, Niglio S, Galsky MD. Development of target specific agents for bladder cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1208049] [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]
Affiliation(s)
| | - Scot Niglio
- Division of Hematology/Oncology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew D. Galsky
- Division of Hematology/Oncology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
68
|
Holmsten K, Dohn L, Jensen NV, Shah CH, Jäderling F, Pappot H, Ullén A. Vinflunine treatment in patients with metastatic urothelial cancer: A Nordic retrospective multicenter analysis. Oncol Lett 2016; 12:1293-1300. [PMID: 27446429 PMCID: PMC4950730 DOI: 10.3892/ol.2016.4775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 04/18/2016] [Indexed: 11/20/2022] Open
Abstract
In 2009, vinflunine was introduced as a second-line treatment to be used after the failure of platinum therapy in patients with metastatic urothelial carcinoma (mUC). The present study investigated the administered vinflunine to patients with mUC in standard clinical practice with the aim of evaluating treatment patterns, response, survival parameters and side-effects. Data were collected retrospectively from the first 100 mUC patients treated with vinflunine at three Nordic cancer centers associated with the Nordic Urothelial Cancer Oncology Group. The overall response rate was 23% and complete response was observed in one patient. The median progression-free survival (mPFS) and median overall survival (mOS) were 2.8 (range, 0.5–34.3) and 6.3 (range, 0.3–39.7) months, respectively. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2 was present in 20% of the patients, and those patients exhibited significantly shorter mOS (4.1 vs. 7.0 months, P=0.001) and a significantly higher degree of grade 3/4 toxicity (P=0.026) compared with ECOG PS 0–1 patients. Furthermore, patients without visceral metastases had significantly longer mOS than patients with visceral metastases (10.6 vs. 6.0 months, P=0.008). The median number of cycles of vinflunine was 3 (range, 1–28). The current data confirms that vinflunine is an active agent for second-line treatment in an unselected clinical cohort of patients with mUC. ECOG PS and presence of visceral metastases were significant prognostic parameters. In particular, patients with ECOG PS 2 receiving vinflunine had a shorter mOS and a higher frequency of severe toxicity, and, thus, should be treated with caution. Furthermore, the present study observed large inter-individual differences in radiological response and OS, indicating the need for further development of improved patient selection tools to optimize vinflunine treatment in platinum-refractory mUC patients.
Collapse
Affiliation(s)
- Karin Holmsten
- Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Line Dohn
- Department of Oncology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Niels Viggo Jensen
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark
| | - Carl-Henrik Shah
- Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Fredrik Jäderling
- Department of Radiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Anders Ullén
- Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| |
Collapse
|
69
|
Sonpavde G, Bellmunt J. Bladder cancer: Angiogenesis as a therapeutic target in urothelial carcinoma. Nat Rev Urol 2016; 13:306-7. [PMID: 27071455 DOI: 10.1038/nrurol.2016.69] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Guru Sonpavde
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, 1720 2nd Avenue South, Birmingham, Alabama 35294, USA
| | - Joaquim Bellmunt
- Dana Farber Cancer Institute and Harvard Medical School, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| |
Collapse
|
70
|
Plimack ER, Geynisman DM. Targeted Therapy for Metastatic Urothelial Cancer: A Work in Progress. J Clin Oncol 2016; 34:2088-92. [PMID: 27161964 DOI: 10.1200/jco.2016.67.1420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 64-year-old man presented to the clinic to discuss treatment options for progressive metastatic urothelial carcinoma (UC). At age 57 years, he underwent cystoprostatectomy for bacillus Calmette-Guérin-refractory, high-grade noninvasive UC. He was well until age 61 years, when he developed a left upper-tract UC. He underwent left nephroureterectomy, revealing locally advanced high-grade UC invading the renal parenchyma (pT3). Postoperatively, his renal function precluded adjuvant cisplatin-based chemotherapy. He enrolled onto a clinical trial of autologous cellular immunotherapy targeting human epidermal growth factor receptor 2, for which he was eligible on the basis of human epidermal growth factor receptor 2 positivity (≥ 1+ by immunohistochemistry) in his nephrectomy tumor specimen. He was randomly assigned to observation. Two years later, he developed a left pelvic mass. Biopsy confirmed metastatic high-grade UC. He was briefly treated with gemcitabine and carboplatin, but this was discontinued as a result of rapid symptomatic and radiographic progression at 8 weeks. He underwent palliative radiation to the left pelvic mass to relieve symptoms of pain and leg edema and subsequently elected to enroll onto a clinical trial of a programmed death 1 inhibitor. Concurrently, his previously obtained pelvic mass biopsy sample was sent for panel-based genomic profiling. He now returns for his first restaging evaluation. Imaging shows marked progression on study with new metastases to the liver as well as progressive edema and pain in the left leg, limiting ambulation. Review of his now-available genomic testing results reveals alterations in HRAS (G12D) and ATR (S296, Q257). He elected to enroll onto a single-arm, open-label trial of a farnesyl transferase inhibitor for patients with HRAS mutations.
Collapse
|
71
|
Rosenberg JE, Hoffman-Censits J, Powles T, van der Heijden MS, Balar AV, Necchi A, Dawson N, O'Donnell PH, Balmanoukian A, Loriot Y, Srinivas S, Retz MM, Grivas P, Joseph RW, Galsky MD, Fleming MT, Petrylak DP, Perez-Gracia JL, Burris HA, Castellano D, Canil C, Bellmunt J, Bajorin D, Nickles D, Bourgon R, Frampton GM, Cui N, Mariathasan S, Abidoye O, Fine GD, Dreicer R. Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet 2016; 387:1909-20. [PMID: 26952546 PMCID: PMC5480242 DOI: 10.1016/s0140-6736(16)00561-4] [Citation(s) in RCA: 2748] [Impact Index Per Article: 343.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with metastatic urothelial carcinoma have few treatment options after failure of platinum-based chemotherapy. In this trial, we assessed treatment with atezolizumab, an engineered humanised immunoglobulin G1 monoclonal antibody that binds selectively to programmed death ligand 1 (PD-L1), in this patient population. METHODS For this multicentre, single-arm, two-cohort, phase 2 trial, patients (aged ≥18 years) with inoperable locally advanced or metastatic urothelial carcinoma whose disease had progressed after previous platinum-based chemotherapy were enrolled from 70 major academic medical centres and community oncology practices in Europe and North America. Key inclusion criteria for enrolment were Eastern Cooperative Oncology Group performance status of 0 or 1, measurable disease defined by Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST v1.1), adequate haematological and end-organ function, and no autoimmune disease or active infections. Formalin-fixed paraffin-embedded tumour specimens with sufficient viable tumour content were needed from all patients before enrolment. Patients received treatment with intravenous atezolizumab (1200 mg, given every 3 weeks). PD-L1 expression on tumour-infiltrating immune cells (ICs) was assessed prospectively by immunohistochemistry. The co-primary endpoints were the independent review facility-assessed objective response rate according to RECIST v1.1 and the investigator-assessed objective response rate according to immune-modified RECIST, analysed by intention to treat. A hierarchical testing procedure was used to assess whether the objective response rate was significantly higher than the historical control rate of 10% at an α level of 0·05. This study is registered with ClinicalTrials.gov, number NCT02108652. FINDINGS Between May 13, 2014, and Nov 19, 2014, 486 patients were screened and 315 patients were enrolled into the study. Of these patients, 310 received atezolizumab treatment (five enrolled patients later did not meet eligibility criteria and were not dosed with study drug). The PD-L1 expression status on infiltrating immune cells (ICs) in the tumour microenvironment was defined by the percentage of PD-L1-positive immune cells: IC0 (<1%), IC1 (≥1% but <5%), and IC2/3 (≥5%). The primary analysis (data cutoff May 5, 2015) showed that compared with a historical control overall response rate of 10%, treatment with atezolizumab resulted in a significantly improved RECIST v1.1 objective response rate for each prespecified immune cell group (IC2/3: 27% [95% CI 19-37], p<0·0001; IC1/2/3: 18% [13-24], p=0·0004) and in all patients (15% [11-20], p=0·0058). With longer follow-up (data cutoff Sept 14, 2015), by independent review, objective response rates were 26% (95% CI 18-36) in the IC2/3 group, 18% (13-24) in the IC1/2/3 group, and 15% (11-19) overall in all 310 patients. With a median follow-up of 11·7 months (95% CI 11·4-12·2), ongoing responses were recorded in 38 (84%) of 45 responders. Exploratory analyses showed The Cancer Genome Atlas (TCGA) subtypes and mutation load to be independently predictive for response to atezolizumab. Grade 3-4 treatment-related adverse events, of which fatigue was the most common (five patients [2%]), occurred in 50 (16%) of 310 treated patients. Grade 3-4 immune-mediated adverse events occurred in 15 (5%) of 310 treated patients, with pneumonitis, increased aspartate aminotransferase, increased alanine aminotransferase, rash, and dyspnoea being the most common. No treatment-related deaths occurred during the study. INTERPRETATION Atezolizumab showed durable activity and good tolerability in this patient population. Increased levels of PD-L1 expression on immune cells were associated with increased response. This report is the first to show the association of TCGA subtypes with response to immune checkpoint inhibition and to show the importance of mutation load as a biomarker of response to this class of agents in advanced urothelial carcinoma. FUNDING F Hoffmann-La Roche Ltd.
Collapse
Affiliation(s)
- Jonathan E Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Tom Powles
- Barts Cancer Institute ECMC, Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK
| | | | - Arjun V Balar
- Genitourinary Cancers Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, USA
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nancy Dawson
- Medstar Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Peter H O'Donnell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Yohann Loriot
- Department of Cancer Medicine, Gustave-Roussy Cancer Campus, Villejuif, University of Paris Sud, Paris, France
| | - Sandy Srinivas
- Division of Oncology/Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Margitta M Retz
- Department of Urology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petros Grivas
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard W Joseph
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew D Galsky
- Division of Hematology/Oncology, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Mark T Fleming
- Virginia Oncology Associates, US Oncology Research, Norfolk, VA, USA
| | | | - Jose Luis Perez-Gracia
- Department of Oncology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Navarre, Spain
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, TN, USA; Tennessee Oncology, Nashville, TN, USA
| | - Daniel Castellano
- Medical Oncology Department, Genitourinary Oncology Unit, University Hospital 12 de Octubre, Madrid, Spain
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Joaquim Bellmunt
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Dean Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Na Cui
- Genentech Inc, 1 DNA Way, South San Francisco, CA, USA
| | | | | | - Gregg D Fine
- Genentech Inc, 1 DNA Way, South San Francisco, CA, USA
| | - Robert Dreicer
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| |
Collapse
|
72
|
Petrylak DP, Tagawa ST, Kohli M, Eisen A, Canil C, Sridhar SS, Spira A, Yu EY, Burke JM, Shaffer D, Pan CX, Kim JJ, Aragon-Ching JB, Quinn DI, Vogelzang NJ, Tang S, Zhang H, Cavanaugh CT, Gao L, Kauh JS, Walgren RA, Chi KN. Docetaxel As Monotherapy or Combined With Ramucirumab or Icrucumab in Second-Line Treatment for Locally Advanced or Metastatic Urothelial Carcinoma: An Open-Label, Three-Arm, Randomized Controlled Phase II Trial. J Clin Oncol 2016; 34:1500-9. [PMID: 26926681 DOI: 10.1200/jco.2015.65.0218] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE This trial assessed the efficacy and safety of docetaxel monotherapy or docetaxel in combination with ramucirumab (vascular endothelial growth factor receptor 2 antibody) or icrucumab (vascular endothelial growth factor receptor 1 antibody) after progression during or within 12 months of platinum-based regimens for patients with locally advanced or metastatic urothelial carcinoma. PATIENTS AND METHODS Patients were randomly assigned (1:1:1) to receive docetaxel 75 mg/m(2) intravenously (IV) on day 1 of a 3-week cycle (arm A), docetaxel 75 mg/m(2) IV plus ramucirumab 10 mg/kg IV on day 1 of a 3-week cycle (arm B), or docetaxel 75 mg/m(2) IV on day 1 plus icrucumab 12 mg/kg IV on days 1 and 8 of a 3-week cycle (arm C). Treatment continued until disease progression or unacceptable toxicity. The primary end point was investigator-assessed progression-free survival (PFS). RESULTS A total of 140 patients were randomly assigned and treated in arms A (n = 45), B (n = 46), or C (n = 49). PFS was significantly longer in arm B compared with arm A (median, 5.4 months; 95% CI, 3.1 to 6.9 months v 2.8 months; 95% CI, 1.9 to 3.6 months; stratified hazard ratio, 0.389; 95% CI, 0.235 to 0.643; P = .0002). Arm C did not experience improved PFS compared with arm A (1.6 months; 95% CI, 1.4 to 2.9; stratified hazard ratio, 0.863; 95% CI, 0.550 to 1.357; P = .5053). The most common grade 3 or worse adverse events (arms A, B, and C) were neutropenia (36%, 33%, and 39%), fatigue (13%, 30%, and 20%), febrile neutropenia (13%, 17%, and 6.1%), and anemia (6.7%, 13%, and 14%, respectively). CONCLUSION The addition of ramucirumab to docetaxel met the prespecified efficacy end point for prolonging PFS in patients with locally advanced or metastatic urothelial carcinoma receiving second-line treatment and warrants further investigation in the phase III setting.
Collapse
Affiliation(s)
- Daniel P Petrylak
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN.
| | - Scott T Tagawa
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Manish Kohli
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Andrea Eisen
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Christina Canil
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Srikala S Sridhar
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Alexander Spira
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Evan Y Yu
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - John M Burke
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - David Shaffer
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Chong-Xian Pan
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Jenny J Kim
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Jeanny B Aragon-Ching
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - David I Quinn
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Nicholas J Vogelzang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Shande Tang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Hui Zhang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Christopher T Cavanaugh
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Ling Gao
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - John S Kauh
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Richard A Walgren
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Kim N Chi
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| |
Collapse
|
73
|
|
74
|
Narayanan S, Lam A, Vaishampayan U, Harshman L, Fan A, Pachynski R, Poushnejad S, Haas D, Li S, Srinivas S. Phase II Study of Pazopanib and Paclitaxel in Patients With Refractory Urothelial Cancer. Clin Genitourin Cancer 2016; 14:432-437. [PMID: 27068017 DOI: 10.1016/j.clgc.2016.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Currently, no standard treatments are available for relapsed or refractory urothelial carcinoma (UC). Paclitaxel has demonstrated efficacy in the treatment of UC when used alone or combined with other cytotoxic therapies. We designed a phase II trial combining paclitaxel with pazopanib, a commonly used antiangiogenic agent with significant antitumor activity in various solid tumors. PATIENTS AND METHODS We enrolled 32 patients with refractory UC who had demonstrated disease progression after 2 previous chemotherapeutic regimens. The patients received paclitaxel 80 mg/m2 on days 1, 8, and 15 of a 28-day cycle and oral pazopanib 800 mg daily. The primary endpoint was the overall response rate (ORR). The secondary endpoints included progression-free survival, overall survival, and a safety assessment of the combination. RESULTS Of the 28 evaluable patients, a complete response was observed in 3 patients and a partial response in 12, with an ORR of 54% (95% confidence interval, 33.9-72.5). The median progression-free and overall survival was 6.2 and 10 months, respectively. The most frequent side effects noted (all grades) were fatigue (63%), diarrhea (44%), and nausea and vomiting (41%). Hematologic toxicities were common and included (all grades) anemia (69%), neutropenia (38%), and thrombocytopenia (47%). Growth factor support was required for 44% of the patients. CONCLUSION The combination of paclitaxel and pazopanib resulted in a promising ORR of 54% in patients with advanced pretreated UC. This represents a greater response rate and median survival than found with other existing second-line regimens for UC and is worthy of further study.
Collapse
Affiliation(s)
| | | | | | | | - Alice Fan
- Stanford Cancer Center, Stanford, CA
| | | | | | | | | | | |
Collapse
|
75
|
Bellmunt J, Mottet N, De Santis M. Urothelial carcinoma management in elderly or unfit patients. EJC Suppl 2016; 14:1-20. [PMID: 27358584 PMCID: PMC4917740 DOI: 10.1016/j.ejcsup.2016.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicolas Mottet
- Department of Urology, CHU de Saint-Etienne, University Jean Monnet, St Etienne, France
| | | |
Collapse
|
76
|
Collazo-Lorduy A, Galsky MD. Systemic therapy for metastatic bladder cancer in 2016 and beyond. Future Oncol 2016; 12:1179-92. [PMID: 26922914 DOI: 10.2217/fon-2015-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Metastatic urothelial cancer is generally associated with poor outcomes. In the first-line setting, platinum-based chemotherapy is the standard of care but resistance rapidly develops and the vast majority of patients ultimately experience disease progression. Despite several decades of clinical drug development focused on the treatment of platinum-resistant metastatic urothelial cancer, as of late 2015 there are no standard therapies approved by the US FDA in this setting. However, preliminary results from a series of recent trials exploring innovative approaches forecast a 'sea change' in the management of this difficult to treat malignancy. Herein, we review new approaches for the management of patients with metastatic urothelial cancer focused on three key therapeutic target areas: recurrent somatic alterations, the tumor neovasculature and tumor-associated immune escape.
Collapse
Affiliation(s)
- Ana Collazo-Lorduy
- Icahn School of Medicine at Mount Sinai, Department of Pathology, 1 Gustave L Levy Place, New York, NY 10029, USA.,Spanish Society of Medical Oncology, Velazquez 7, Madrid 28001, Spain
| | - Matthew D Galsky
- Icahn School of Medicine at Mount Sinai, Division of Hematology & Medical Oncology, Tisch Cancer Institute, 1 Gustave L Levy Place, New York, NY 10029, USA
| |
Collapse
|
77
|
Ghasemzadeh A, Bivalacqua TJ, Hahn NM, Drake CG. New Strategies in Bladder Cancer: A Second Coming for Immunotherapy. Clin Cancer Res 2016; 22:793-801. [PMID: 26683632 PMCID: PMC4825862 DOI: 10.1158/1078-0432.ccr-15-1135] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/24/2015] [Indexed: 12/21/2022]
Abstract
Urothelial bladder cancer (UBC) remains one of the most common and deadly cancers worldwide, and platinum-based chemotherapy, which has been the standard-of-care in metastatic bladder cancer, has had limited success in improving outcomes for patients. The recent development and translation of therapeutic strategies aimed at harnessing the immune system have led to durable and prolonged survival for patients with several different cancers, including UBC. In this review, we discuss new findings in bladder cancer immunotherapy, including recent successes with immune checkpoint blockade. We also discuss therapeutic cancer vaccines and highlight several additional immunotherapy modalities in early stages of development.
Collapse
Affiliation(s)
- Ali Ghasemzadeh
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Trinity J Bivalacqua
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. Department of Surgery, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. The Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Noah M Hahn
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. The Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Charles G Drake
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. The Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
| |
Collapse
|
78
|
Di Lorenzo G, Pagliuca M, Perillo T, Zarrella A, Verde A, De Placido S, Buonerba C. Complete Response and Fatigue Improvement With the Combined Use of Cyclophosphamide and Quercetin in a Patient With Metastatic Bladder Cancer: A Case Report. Medicine (Baltimore) 2016; 95:e2598. [PMID: 26844468 PMCID: PMC4748885 DOI: 10.1097/md.0000000000002598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bladder cancer is a major cause of cancer-related mortality, with an estimated 74,000 new cases and 16,000 deaths in the United States in 2015. In patients with metastatic disease, vinflunine and taxanes are the most widely used chemotherapy agents in the second-line setting after failure of platinum-based treatment. Cyclophosphamide has been used in combination with paclitaxel in urothelial carcinoma of the bladder, but there are no data about the effectiveness of cyclophosphamide administered as a single agent.We here describe the first case of an advanced bladder cancer patient suffering from grade 2 fatigue.He benefited from administration of third-line single-agent metronomic oral cyclophosphamide plus oral doses of quercetin. A complete, prolonged radiologic response according to the RECIST criteria 1.1 was achieved with minimal toxicity and an improvement in fatigue.Further studies are required to assess the potential benefits associated with the combined use of cyclophosphamide plus quercetin in advanced bladder cancer patients.
Collapse
Affiliation(s)
- Giuseppe Di Lorenzo
- From the Medical Oncology Unit, Department of Clinical Medicine, Federico II University, Naples, Italy
| | | | | | | | | | | | | |
Collapse
|
79
|
Di Lorenzo G, Buonerba C, Bellelli T, Romano C, Montanaro V, Ferro M, Benincasa A, Ribera D, Lucarelli G, De Cobelli O, Sonpavde G, De Placido S. Third-Line Chemotherapy for Metastatic Urothelial Cancer: A Retrospective Observational Study. Medicine (Baltimore) 2015; 94:e2297. [PMID: 26705213 PMCID: PMC4697979 DOI: 10.1097/md.0000000000002297] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The prognosis of locally advanced (T3/T4 or N1) and metastatic disease urothelial carcinoma is poor. In this retrospective study, we reviewed data about patients receiving third-line chemotherapy for metastatic disease, in view of the lack of data in this setting.We retrospectively analyzed medical records of patients with a pathologic diagnosis of urothelial carcinoma treated with systemic chemotherapy for metastatic disease at 4 participating Institutions between January, 2010, and January, 2015. Cox proportional hazards regression was used to evaluate the association of the chemotherapy agent used versus others with overall survival, adjusted for 5 externally validated prognostic factors in advanced urothelial carcinoma.Of 182 patients that received first-line chemotherapy/adjuvant chemotherapy as defined above, 116 patients (63.73%) received second-line salvage treatment. Fifty-two patients were finally included in this analysis, whereas 9 were excluded due to missing data. Third-line chemotherapy was based on cyclophosphamide, platinum, vinflunine, taxanes, and gemcitabine in 16, 12, 11, 10, and 3 patients, respectively. Median PFS (progression-free survival) and OS (overall survival) of the population were 13 (10-17) and 31 (28-36) weeks. Single-agent cyclophosphamide was associated with a PFS of 18 (13-22) and an OS of 38 (33-41) weeks, whereas platinum-based combinations were associated with a PFS of 5 weeks and an OS of 8 weeks. Multivariate analysis showed improved survival in patients treated with cyclophosphamide (hazard ratio (HR) = 0.42; 95% CI: 0.20-0.89; P = 0.025) and a worse survival in those treated with platinum-based regimens (HR: 4.37; 95% CI = 1.95-9.77; P < 0.01).We observed a significantly longer overall survival in patients receiving single-agent cyclophosphamide, with few grade 3 to 4 toxicities. Further studies should assess the efficacy of metronomic single-agent cyclophosphamide in advanced lines of treatment, as it may yield a survival benefit with low costs and no detrimental effects on quality of life.
Collapse
Affiliation(s)
- Giuseppe Di Lorenzo
- From the Medical Oncology, University Federico II of Naples, Naples (GDL, CB, DR, SDP); Medical Oncology, Hospital "San Luca," Vallo della Lucania, Salerno (TB); ASL Napoli 3 SUD, Naples (CR); Istituto Oncologico del Sud, Naples (VM); Division of Urology, European Institute of Oncology, Milan (MF, ODC); Division of Urology, Hospital "San Luca," Vallo della Lucania, Salerno (AB); Department of Emergency and Organ Transplantation, Urology and Kidney Transplantation Unit, University of Bari, Bari, Italy (GL); Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania (ODC); and Department of Medicine, Section of Hematology-Oncology, University of Alabama, Birmingham School of Medicine, Birmingham, AL (GS)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
80
|
Abstract
INTRODUCTION Docetaxel has had a significant impact on the management of urothelial carcinoma (UC). Multiple phase II trials have been conducted to evaluate the efficacy of docetaxel in the treatment of metastatic UC. Docetaxel is an accepted community standard for the therapy of platinum-treated patients with metastatic UC. AREAS COVERED This review focuses on the data supporting a role for docetaxel in the therapy of advanced UC. It also explores the future development of docetaxel and describes the ongoing clinical trials in the treatment of UC. EXPERT OPINION Docetaxel plays an important role as one of the standard agents used in the comparator arms of randomized trials evaluating new agents as salvage therapy for metastatic UC. Furthermore, biologic agents are being developed in chemo-biologic regimens using docetaxel as the platform. In the context of emerging novel agents such as T-cell checkpoint inhibitors, docetaxel may continue to play a role as a salvage therapy in select patients ineligible for immunotherapy or following checkpoint inhibitors.
Collapse
Affiliation(s)
- Costantine Albany
- a Department of Medicine, Section of Hematology-Oncology , Indiana University Simon Cancer Center , Indianapolis , IN 46202 , USA
| | - Guru Sonpavde
- b Department of Medicine, Section of Hematology-Oncology , Veterans Affairs Medical Center, Birmingham , AL , USA.,c Department of Medicine, Section of Hematology-Oncology , University of Alabama at Birmingham (UAB) Comprehensive Cancer Center , Birmingham , AL 35294 , USA
| |
Collapse
|
81
|
Raggi D, Miceli R, Sonpavde G, Giannatempo P, Mariani L, Galsky MD, Bellmunt J, Necchi A. Second-line single-agent versus doublet chemotherapy as salvage therapy for metastatic urothelial cancer: a systematic review and meta-analysis. Ann Oncol 2015; 27:49-61. [PMID: 26487582 DOI: 10.1093/annonc/mdv509] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The efficacy and safety of a combination of chemotherapeutic agent compared with single-agent chemotherapy in the second-line setting of advanced urothelial carcinoma (UC) are unclear. We aimed to study the survival impact of single-agent compared with doublet chemotherapy as second-line chemotherapy of advanced UC. PATIENTS AND METHODS Literature was searched for studies including single-agent or doublet chemotherapy in the second-line setting after platinum-based chemotherapy. Random-effects models were used to pool trial-level data according to treatment arm, including median progression-free survival (PFS), overall survival (OS), objective response rate (ORR) probability, and grade 3-4 toxicity. Univariable and multivariable analyses, including sensitivity analyses, were carried out, adjusting for the percent of patients with ECOG performance status ≥1 and hepatic metastases. RESULTS Forty-six arms of trials including 1910 patients were selected: 22 arms with single agent (n = 1202) and 24 arms with doublets (n = 708). The pooled ORR with single agents was 14.2% [95% confidence interval (CI) 11.1-17.9] versus 31.9% [95% CI 27.3-36.9] with doublet chemotherapy. Pooled median PFS was 2.69 and 4.05 months, respectively. The pooled median OS was 6.98 and 8.50 months, respectively. Multivariably, the odds ratio for ORR and the pooled median difference of PFS were statistically significant (P < 0.001 and P = 0.002) whereas the median difference in OS was not (P = 0.284). When including single-agent vinflunine or taxanes only, differences were significant only for ORR (P < 0.001) favoring doublet chemotherapy. No statistically significant differences in grade 3-4 toxicity were seen between the two groups. CONCLUSIONS Despite significant improvements in ORR and PFS, doublet regimens did not extend OS compared with single agents for the second-line chemotherapy of UC. Prospective trials are necessary to elucidate the role of combination chemotherapy, with or without targeted agents, in the salvage setting. Currently, improvements in this field should be pursued considering single-agent chemotherapy as the foundation for new more active combinations.
Collapse
Affiliation(s)
- D Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Sonpavde
- UAB Comprehensive Cancer Center, Birmingham
| | - P Giannatempo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M D Galsky
- Mount Sinai School of Medicine, Tisch Cancer Institute, New York
| | - J Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - A Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
82
|
Kurtoglu M, Davarpanah NN, Qin R, Powles T, Rosenberg JE, Apolo AB. Elevating the Horizon: Emerging Molecular and Genomic Targets in the Treatment of Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2015; 13:410-20. [PMID: 25862322 PMCID: PMC4561017 DOI: 10.1016/j.clgc.2015.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/20/2015] [Accepted: 02/27/2015] [Indexed: 12/31/2022]
Abstract
Despite recent advances in the identification of genomic alterations that lead to urothelial oncogenesis in vitro, patients with advanced urothelial carcinomas continue to have poor clinical outcomes. In the present review, we focus on targeted therapies that have yielded the most promising results alone or combined with traditional chemotherapy, including the antiangiogenesis agent bevacizumab, the human epidermal growth factor receptor 2 antibody trastuzumab, and the tyrosine kinase inhibitor cabozantinib. We also describe ongoing and developing clinical trials that use innovative approaches, including dose-dense scheduling of singular chemotherapy combinations, prospective screening of tumor tissues for mutational targets and biomarkers to predict chemosensitivity before the determination of the therapeutic regimen, and novel agents that target proteins in the immune checkpoint regulation pathway (programmed cell death protein 1 [PD-1] and anti-PD-ligand 1) that have shown significant potential in preclinical models and early clinical trials. New agents and targeted therapies, alone or combined with traditional chemotherapy, will only be validated through accrual to developing clinical trials that aim to translate these therapies into individualized treatments and improved survival rates in urothelial carcinoma.
Collapse
Affiliation(s)
- Metin Kurtoglu
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nicole N Davarpanah
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rui Qin
- Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Thomas Powles
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, St. Bartholomew's Hospital, London, UK
| | - Jonathan E Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| |
Collapse
|
83
|
Oing C, Rink M, Oechsle K, Seidel C, von Amsberg G, Bokemeyer C. Second Line Chemotherapy for Advanced and Metastatic Urothelial Carcinoma: Vinflunine and Beyond-A Comprehensive Review of the Current Literature. J Urol 2015; 195:254-63. [PMID: 26410730 DOI: 10.1016/j.juro.2015.06.115] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE We comprehensively reviewed current efforts and advances in the field of chemotherapeutic and biologically targeted treatment options after the failure of cisplatin based, first line regimens for urothelial carcinoma. MATERIALS AND METHODS We searched MEDLINE®, Central®, and meeting abstracts of ASCO (American Society of Clinical Oncology) and ESMO (European Society for Medical Oncology) to identify original articles, reviews and retrospective analyses on second line treatment of urothelial carcinoma. Articles were included in analysis if they described prospective phase II/III studies or larger high quality retrospective studies of second line treatment of urothelial carcinoma. RESULTS Although considered a chemosensitive disease, most patients with advanced or metastatic urothelial carcinoma relapse after cisplatin based first line treatment. Today none of the commonly used drugs, ie paclitaxel, carboplatin and/or gemcitabine, are approved by the FDA (Food and Drug Administration) for second line systemic treatment. In Europe vinflunine plus best supportive care is the only option approved by the EMA (European Medicines Agency) with moderate clinical efficacy. Responses to combined chemotherapy approaches are often better but associated with remarkable toxicity. In patients who respond well to first line treatment and, thus, are considered cisplatin sensitive readministration of a platinum based combination regimen may be an option. To date targeted therapies do not have a role in second line treatment of urothelial cancer. Immunotherapeutic strategies to target the PD-1/PD-L1 axis are emerging. In a recent phase I trial evaluating the PD-L1 targeted monoclonal antibody MPDL3280A a promising 43% response rate with good tolerability was achieved, which led to an immediate breakthrough therapy designation by the FDA. Combining chemotherapy with targeted agents, eg weekly paclitaxel and pazopanib, also shows promising activity in this prognostically poor treatment situation. CONCLUSIONS Response rates and survival are poor after second line chemotherapy for advanced or metastatic urothelial carcinoma. To improve outcomes of salvage treatment novel biologically targeted drugs as monotherapy or as part of a combination with conventional cytostatics are urgently needed.
Collapse
Affiliation(s)
- Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany; Department of Urology (MR), University Medical Center Eppendorf, Hamburg, Germany.
| | - Michael Rink
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany; Department of Urology (MR), University Medical Center Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany; Department of Urology (MR), University Medical Center Eppendorf, Hamburg, Germany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany; Department of Urology (MR), University Medical Center Eppendorf, Hamburg, Germany
| | - Gunhild von Amsberg
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany; Department of Urology (MR), University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Eppendorf, Hamburg, Germany; Department of Urology (MR), University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
84
|
Kim YS, Lee SI, Park SH, Park S, Hwang IG, Lee SC, Sun JM, Lee J, Lim HY. A Phase II Study of Weekly Docetaxel as Second-Line Chemotherapy in Patients With Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2015; 14:76-81. [PMID: 26454620 DOI: 10.1016/j.clgc.2015.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/13/2015] [Accepted: 09/11/2015] [Indexed: 11/18/2022]
Abstract
UNLABELLED The present multicenter phase II study evaluated the efficacy and safety of weekly docetaxel as second-line chemotherapy for metastatic urothelial carcinoma. Weekly docetaxel was well tolerated but demonstrated modest activity, with a response rate of 6%, a median progression-free survival (PFS) of 1.4 months, and a median overall survival (OS) of 8.3 months. The dichotomy between PFS and OS was likely associated with subsequent platinum-based chemotherapy received by 58% of the patients. BACKGROUND Docetaxel is commonly used for second-line therapy for metastatic urothelial carcinoma (UC). However, myelosuppression is a substantial concern when the traditional 3-week docetaxel cycle is used. The present multicenter phase II study evaluated the efficacy and safety of weekly docetaxel as second-line chemotherapy for metastatic UC. PATIENTS AND METHODS Patients with progression after previous platinum-based chemotherapy for advanced or metastatic disease were treated with docetaxel 30 mg/m(2) on days 1 and 8 every 21 days. The primary endpoint was the response rate. RESULTS The study enrolled 31 patients. Their median age was 64 years (range, 40-79 years). An Eastern Cooperative Oncology Group performance status of 1, liver metastasis, and a hemoglobin level < 10 g/dL were observed in 100%, 32%, and 23% of patients, respectively. Previous platinum-based chemotherapy had been administered for metastatic disease in 29 patients (94%). Although fatigue (13%) and anorexia (6%) were the most frequently observed grade 3 to 4 toxicities, the safety profiles were generally mild and manageable. Two patients (6%) achieved an objective response, which was maintained for 3.0 to 7.8 months. Eight patients experienced disease stabilization (disease control rate, 32%). The median progression-free survival (PFS) and overall survival (OS) were 1.4 months (95% confidence interval [CI], 1.3-1.6) and 8.3 months (95% CI, 5.9-10.6), respectively. A relatively long OS was associated with further salvage platinum-based chemotherapy (n = 18, 58%) showing an encouraging activity (response rate, 44%; median PFS, 4.0 months). CONCLUSION Second-line chemotherapy with weekly docetaxel was well tolerated but demonstrated modest activity in patients with metastatic UC. A platinum-based combination as second-line treatment might be considered for selected patients.
Collapse
Affiliation(s)
- Young Saing Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Il Lee
- Division of Hematology-Oncology, Department of Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea.
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Gyu Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Yeong Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
85
|
Buti S, Ciccarese C, Zanoni D, Santoni M, Modena A, Maines F, Gilli A, Bria E, Brunelli M, Rimanti A, Cascinu S, Ardizzoni A, Tortora G, Massari F. Prognostic and predictive factors in patients treated with chemotherapy for advanced urothelial cancer: where do we stand? Future Oncol 2015; 11:107-19. [PMID: 25572786 DOI: 10.2217/fon.14.172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The standard of care for patients with local advanced or metastatic urothelial carcinoma is chemotherapy. However, results with this are rather disappointing, and validated prognostic factors and biomarkers of tumor response, which are useful in the decision-making process, are still lacking. PubMed databases were searched for articles published until November 2013. Several promising clinical and biological candidate prognostic factors or markers of tumor response to first- or second-line therapy, such as hemoglobin, performance status, visceral metastasis and ERCC1, hENT1 and EMT markers, have been identified and described in this article. In summary, clinical parameters and molecular profiling could revolutionize the management of local advanced or metastatic urothelial cancer, but an improvement in individualized therapeutic approaches still seems distant.
Collapse
Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
86
|
Ma Q, Gu LY, Ren YY, Zeng LL, Gong T, Zhong DS. Increased risk of severe infections in cancer patients treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors: a meta-analysis. Onco Targets Ther 2015; 8:2361-74. [PMID: 26355897 PMCID: PMC4559247 DOI: 10.2147/ott.s87298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) have been widely used in a variety of solid malignancies. Concerns have arisen regarding the risk of severe infections (≥grade 3) with use of these drugs, but the contribution of VEGFR-TKIs to infections is still unknown. Methods The databases of PubMed and abstracts presented at oncology conferences’ proceedings were searched for relevant studies from January 2000 to December 2014. Summary incidences, Peto odds ratio (Peto OR), and 95% confidence intervals (CIs) were calculated by using either random-effects or fixed-effects models according to the heterogeneity of included studies. Results A total of 16,488 patients from 27 randomized controlled trials were included. The risk of developing severe (Peto OR 1.69, 95% CI: 1.45–1.96, P<0.001) and fatal infections (Peto OR 1.78, 95% CI: 1.13–2.81, P=0.013) was significantly increased in patients treated with VEGFR-TKIs when compared to controls. Exploratory subgroup analysis showed no effect of tumor types, phase of trials, or agent used on the Peto OR of severe infections. When stratified according to specific infectious events, the risks of high-grade febrile neutropenia, pneumonia, fever, and sepsis were increased compared with controls, with Peto ORs of 1.57 (95% CI: 1.30–1.88, P<0.001), 1.79 (95% CI: 1.29–2.49, P<0.001), 5.35 (95% CI: 1.47–19.51, P=0.011), and 3.68 (95% CI: 1.51–8.99, P=0.004), respectively. Additionally, VEGFR-TKIs significantly increased the risk of fatal sepsis (OR 3.66, 95% CI: 1.47–9.13, P=0.005) but not fatal pneumonia (OR 1.34, 95% CI: 0.80–2.25, P=0.26). Conclusion The use of VEGFR-TKIs significantly increases the risk of developing severe and fatal infectious events in cancer patients. A close monitoring for any signs of infections is recommended for patients treated with VEGFR-TKIs.
Collapse
Affiliation(s)
- Qing Ma
- Department of Oncology, The General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Li-Yan Gu
- Department of Oncology, The General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Yao-Yao Ren
- Department of Oncology, The General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Li-Li Zeng
- Department of Oncology, The General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Ting Gong
- Department of Oncology, The General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Dian-Sheng Zhong
- Department of Oncology, The General Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| |
Collapse
|
87
|
Rose TL, Milowsky MI. A Small Step Toward Improving Systemic Treatment for Metastatic Bladder Cancer--At What Cost? Eur Urol 2015; 69:642-644. [PMID: 26346677 DOI: 10.1016/j.eururo.2015.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Tracy L Rose
- Department of Medicine, Division of Hematology and Medical Oncology, University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, NC, USA
| | - Matthew I Milowsky
- Department of Medicine, Division of Hematology and Medical Oncology, University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, NC, USA.
| |
Collapse
|
88
|
|
89
|
Hahn NM, Dinney CP, Sonpavde G. Multi-targeted agents in the treatment of urothelial carcinoma. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
90
|
Iyer G, Calabró F, Bajorin DF. Treatment of metastatic bladder cancer. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
91
|
Risk of Gastrointestinal Events During Vandetanib Therapy in Patients With Cancer: A Systematic Review and Meta-analysis of Clinical Trials. Am J Ther 2015; 24:e351-e360. [PMID: 26280290 DOI: 10.1097/mjt.0000000000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vandetanib, a tyrosine kinase inhibitor used as an anticancer therapeutic agent, has adverse events associated with treatment resulting in noncompliance and withdrawal from the therapy. Here, we performed meta-analysis of published clinical trials to determine relative risk (RR) and incidence of gastrointestinal events during vandetanib therapy in patients with cancer. A comprehensive literature search was performed and summary incidence, RR, and 95% confidence intervals (CIs) were calculated employing fixed- or random-effects models, depending on the heterogeneity of trials. Twenty-two trials with 6382 patients were included summary incidences of all-grade gastrointestinal events in patients with cancer were anorexia 24% (95% CI, 20%-28%), constipation 17% (95% CI, 13%-20%), diarrhea 46% (95% CI, 40%-53%), nausea 29% (95% CI, 25%-33%), and vomiting 17% (95% CI, 14%-21%). Incidences of vandetanib-associated gastrointestinal events stratified by tumor histology were statistically insignificant. Vandetanib was associated with a significant risk of all-grade diarrhea (RR 1.75, 95% CI, 1.42-2.16) and high-grade diarrhea (RR 1.94, 95% CI, 1.43-2.64) and significantly decreased risk of all-grade constipation (RR 0.80, 95% CI, 0.71-0.91). Summary RR showed a significant risk of vandetanib-associated constipation (RR 0.82, 95% CI, 0.72-0.93) and diarrhea (all-grade: RR 1.68, 95% CI, 1.31-2.14 and high-grade: RR 1.57, 95% CI, 1.14-2.17) in patients with non-small-cell lung cancer. This study revealed a significantly increased risk of diarrhea and a reduced risk of constipation in patients with cancer receiving vandetanib, suggesting that appropriate and frequent clinical monitoring should be emphasized.
Collapse
|
92
|
Sonpavde G, Pond GR, Rosenberg JE, Bajorin DF, Choueiri TK, Necchi A, Di Lorenzo G, Bellmunt J. Improved 5-Factor Prognostic Classification of Patients Receiving Salvage Systemic Therapy for Advanced Urothelial Carcinoma. J Urol 2015; 195:277-82. [PMID: 26292040 DOI: 10.1016/j.juro.2015.07.111] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Prognostic factors in patients receiving salvage systemic therapy for advanced urothelial carcinoma include performance status, liver metastasis, hemoglobin and time since chemotherapy. We investigated the impact of albumin, and neutrophil, lymphocyte and platelet counts. MATERIALS AND METHODS Patient level data from 10 phase II trials were used. Cox proportional hazards regression was applied to evaluate associations with overall survival. An optimal regression model was constructed using forward stepwise selection and risk groups were defined using the number of adverse factors. Trial was a stratification factor. External validation was done in a separate data set of 5 salvage phase II trials. RESULTS Discovery data were obtained on 708 patients. After adjustment for the 4 known factors a platelet count of the upper limit of normal or greater and albumin less than the lower limit of normal were significant poor prognostic factors. Only the addition of albumin was externally validated. For 0 or 1, 2 and 3 or greater risk factors median overall survival was 8.9, 6.4 and 4.5 months in 207, 171 and 113 patients in the discovery data set of 491, and 10.6, 10.0 and 7.0 months in 73, 47 and 47 patients, respectively, in the validation data set of 167. By adding albumin the c-index improved from 0.610 to 0.639 in the discovery set and from 0.616 to 0.646 in the validation set. CONCLUSIONS Albumin was externally validated as a prognostic factor for overall survival after accounting for time from prior chemotherapy, hemoglobin, performance status and liver metastasis status in patients receiving salvage systemic therapy for advanced urothelial carcinoma. The discovery of molecular prognostic factors is a priority to further enhance this new preferred 5-factor clinical prognostic model.
Collapse
Affiliation(s)
- Guru Sonpavde
- University of Alabama-Birmingham Comprehensive Cancer Center, Birmingham, Alabama.
| | | | | | - Dean F Bajorin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
93
|
Sonpavde G, Pond GR, Choueiri TK, Mullane S, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Buonerba C, Rozzi A, Matsumoto K, Lee JL, Kitamura H, Kume H, Bellmunt J. Single-agent Taxane Versus Taxane-containing Combination Chemotherapy as Salvage Therapy for Advanced Urothelial Carcinoma. Eur Urol 2015; 69:634-641. [PMID: 26264159 DOI: 10.1016/j.eururo.2015.07.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Single-agent taxanes are commonly used as salvage systemic therapy for patients with advanced urothelial carcinoma (UC). OBJECTIVE To study the impact of combination chemotherapy delivering a taxane plus other chemotherapeutic agents compared with single-agent taxane as salvage therapy. DESIGN, SETTING, AND PARTICIPANTS Individual patient-level data from phase 2 trials of salvage systemic therapy were used. INTERVENTIONS Trials evaluating either single agents (paclitaxel or docetaxel) or combination chemotherapy (taxane plus one other chemotherapeutic agent or more) following prior platinum-based therapy were used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Information regarding the known major baseline prognostic factors was required: time from prior chemotherapy, hemoglobin, performance status, albumin, and liver metastasis status. Cox proportional hazards regression was used to evaluate the association of prognostic factors and combination versus single-agent chemotherapy with overall survival (OS). RESULTS AND LIMITATIONS Data were available from eight trials including 370 patients; two trials (n=109) evaluated single-agent chemotherapy with docetaxel (n=72) and cremophor-free paclitaxel (n=37), and six trials (n=261) evaluated combination chemotherapy with gemcitabine-paclitaxel (two trials, with n=99 and n=24), paclitaxel-cyclophosphamide (n=32), paclitaxel-ifosfamide-nedaplatin (n=45), docetaxel-ifosfamide-cisplatin (n=26), and paclitaxel-epirubicin (n=35). On multivariable analysis after adjustment for baseline prognostic factors, combination chemotherapy was independently and significantly associated with improved OS (hazard ratio: 0.60; 95% confidence interval, 0.45-0.82; p=0.001). The retrospective design of this analysis and the trial-eligible population were inherent limitations. CONCLUSIONS Patients enrolled in trials of combination chemotherapy exhibited improved OS compared with patients enrolled in trials of single-agent chemotherapy as salvage therapy for advanced UC. Prospective randomized trials are required to validate a potential role for rational and tolerable combination chemotherapeutic regimens for the salvage therapy of advanced UC. PATIENT SUMMARY This retrospective study suggests that a combination of chemotherapy agents may extend survival compared with single-agent chemotherapy in selected patients with metastatic urothelial cancer progressing after prior chemotherapy.
Collapse
Affiliation(s)
- Guru Sonpavde
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Stephanie Mullane
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Carlo Buonerba
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero In Vulture, Italy
| | - Antonio Rozzi
- Istituto Neurotraumatologico Italiano, Grottaferrata, Italy
| | | | | | | | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
94
|
Mazzola CR, Chin J. Targeting the VEGF pathway in metastatic bladder cancer. Expert Opin Investig Drugs 2015; 24:913-27. [DOI: 10.1517/13543784.2015.1041588] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Clarisse R Mazzola
- Western University, Division of Urology and Division of Surgical Oncology, London, Ontario, Canada ;
| | - Joseph Chin
- Western University, Division of Urology and Division of Surgical Oncology, London, Ontario, Canada ;
| |
Collapse
|
95
|
Miller K, Morant R, Stenzl A, Zuna I, Wirth M. A Phase II Study of the Central European Society of Anticancer-Drug Research (CESAR) Group: Results of an Open-Label Study of Gemcitabine plus Cisplatin with or without Concomitant or Sequential Gefitinib in Patients with Advanced or Metastatic Transitional Cell Carcinoma of the Urothelium. Urol Int 2015; 96:5-13. [PMID: 26068576 DOI: 10.1159/000381589] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/10/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This phase II trial evaluated the efficacy and safety of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, gefitinib, in combination with first-line chemotherapy in advanced urothelial cancer. METHODS Chemotherapy-naïve patients with advanced or metastatic urothelial carcinoma were randomized 1:1:1 to receive six cycles of chemotherapy (gemcitabine 1,250 mg/m2 on days 1 and 8, and cisplatin 70 mg/m2 on day 1 of every cycle) concomitantly with gefitinib 250 mg/day (arm A); or with sequential gefitinib (arm B); or alone (arm C). The primary endpoint was the time to progression (TTP). RESULTS A total of 105 patients received study treatment. Median TTP for arms A, B, and C were 6.1, 6.3, and 7.8 months, respectively. There were no significant differences between treatment arms for any outcomes measured. The most common adverse events were nausea and vomiting. CONCLUSION Gefitinib in combination with chemotherapy did not improve efficacy in advanced urothelial cancer.
Collapse
Affiliation(s)
- Kurt Miller
- Department of Urology, University Hospital Charitx00E9;, Berlin, Germany
| | | | | | | | | |
Collapse
|
96
|
Sonpavde G, Pond GR, Mullane S, Qu AQ, Di Lorenzo G, Federico P, Necchi A, Rosenberg JE, Bellmunt J, Choueiri TK. Incomplete Cross-Resistance Between Taxanes for Advanced Urothelial Carcinoma: Implications for Clinical Practice and Trial Design. Clin Genitourin Cancer 2015; 13:250-6. [DOI: 10.1016/j.clgc.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 02/02/2023]
|
97
|
Mitra AP, Lerner SP. Potential Role for Targeted Therapy in Muscle-Invasive Bladder Cancer. Urol Clin North Am 2015; 42:201-15, viii. [DOI: 10.1016/j.ucl.2015.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
98
|
Buchwald ZS, Efstathiou JA. Immunotherapy and Radiation - A New Combined Treatment Approach for Bladder Cancer? Bladder Cancer 2015; 1:15-27. [PMID: 30561443 PMCID: PMC6218185 DOI: 10.3233/blc-150014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recently, immunotherapy with checkpoint inhibitors has been showing promise in clinical trials for stage IV bladder cancer. Herein, we review the literature regarding the role for radiation therapy, the role for immunotherapy, and the potential synergy of these treatments combined in bladder cancer. There is ample pre-clinical data in a number of different tumor models, coupled with a growing body of clinical evidence in melanoma and other malignancies to suggest combining radiation and immunotherapy could lead to substantial advances in treatment outcomes for bladder cancer. Yet, these data for bladder cancer remain at the pre-clinical stage, and further study is needed.
Collapse
Affiliation(s)
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
99
|
Sonpavde G, Pond GR, Rosenberg JE, Bajorin DF, Regazzi AM, Choueiri TK, Qu AQ, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Fougeray R, Dreicer R, Chen YH, Wong YN, Sridhar SS, Ko YJ, Milowsky MI, Galsky MD, Bellmunt J. Complete Response as an Intermediate End Point in Patients Receiving Salvage Systemic Therapy for Urothelial Carcinoma. Clin Genitourin Cancer 2015; 13:185-92. [DOI: 10.1016/j.clgc.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/25/2014] [Indexed: 12/01/2022]
|
100
|
Jordan EJ, Iyer G. Targeted therapy in advanced bladder cancer: what have we learned? Urol Clin North Am 2015; 42:253-62, ix. [PMID: 25882566 DOI: 10.1016/j.ucl.2015.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite advances in the treatment of other genitourinary malignancies, no novel therapies have been approved by the US Food and Drug Administration for urothelial carcinoma (UC) in the last 20 years. To date, no clinical trials of targeted agents in UC have led to improvements in survival compared with cytotoxic therapy. This article outlines representative trials of targeted therapies in UC and discusses the significance of genetic preselection in trial design as a method to optimize responses to these agents, thus, hopefully expanding the armamentarium of treatment options against this lethal disease.
Collapse
Affiliation(s)
- Emmet J Jordan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| |
Collapse
|