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Optimizing Immunomodulatory Drug With Proteasome Inhibitor Combinations in Newly Diagnosed Multiple Myeloma. ACTA ACUST UNITED AC 2020; 25:2-10. [PMID: 30694854 DOI: 10.1097/ppo.0000000000000348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the modern era of multiple myeloma therapeutics, proteasome inhibitor (PI) and immunomodulatory drugs (IMiDs) have replaced chemotherapy regimens for newly diagnosed multiple myeloma patients. Treatment combinations that comprise both first- and next-generation PIs, including bortezomib, carfilzomib, and ixazomib and IMiDs, including thalidomide and lenalidomide, have been evaluated in phases II and III clinical trials and have shown significant efficacy with manageable toxicity profiles. Bortezomib or carfilzomib with lenalidomide and dexamethasone (VRD and KRD) are the most promising regimens resulting in significant survival improvement. Disease and patient characteristics should lead the individualization of treatment, with the eligibility for autologous transplant being of principal importance. The addition of a monoclonal antibody to PI with IMiD combinations is currently under clinical investigation and may lead to further treatment optimization.
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Aprile G, Fontanella C, Bonotto M, Rihawi K, Lutrino SE, Ferrari L, Casagrande M, Ongaro E, Berretta M, Avallone A, Rosati G, Giuliani F, Fasola G. Timing and extent of response in colorectal cancer: critical review of current data and implication for future trials. Oncotarget 2016; 6:28716-30. [PMID: 26308250 PMCID: PMC4745687 DOI: 10.18632/oncotarget.4747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/10/2015] [Indexed: 12/20/2022] Open
Abstract
The identification of new surrogate endpoints for advanced colorectal cancer is becoming crucial and, along with drug development, it represents a research field increasingly studied. Although overall survival (OS) remains the strongest trial endpoint available, it requires larger sample size and longer periods of time for an event to happen. Surrogate endpoints such as progression free survival (PFS) or response rate (RR) may overcome these issues but, as such, they need to be prospectively validated before replacing the real endpoints; moreover, they often bear many other limitations. In this narrative review we initially discuss the role of time-to-event endpoints, objective response and response rate as surrogates of OS in the advanced colorectal cancer setting, discussing also how such measures are influenced by the tumor assessment criteria currently employed. We then report recent data published about early tumor shrinkage and deepness of response, which have recently emerged as novel potential endpoint surrogates, discussing their strengths and weaknesses and providing a critical comment. Despite being very compelling, the role of such novel response measures is yet to be confirmed and their surrogacy with OS still needs to be further investigated within larger and well-designed trials.
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Affiliation(s)
- Giuseppe Aprile
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | - Caterina Fontanella
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | - Marta Bonotto
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | - Karim Rihawi
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | | | - Laura Ferrari
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | | | - Elena Ongaro
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | | | - Antonio Avallone
- Gastrointestinal Medical Oncology Unit, National Cancer Institute, Napoli, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, San Carlo Hospital, Potenza, Italy
| | | | - Gianpiero Fasola
- Department of Medical Oncology, University and General Hospital, Udine, Italy
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Kim C, Lee HS, Min CK, Lee JJ, Kim K, Yoon DH, Eom HS, Lee H, Lee WS, Shin HJ, Lee JH, Park Y, Jo JC, Do YR, Mun YC. The prognostic impact of inflammatory factors in patients with multiple myeloma treated with thalidomide in Korea. Korean J Intern Med 2015; 30:675-83. [PMID: 26354062 PMCID: PMC4578032 DOI: 10.3904/kjim.2015.30.5.675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study was to determine the correlations between inflammatory factors-including absolute lymphocyte count, lactate dehydrogenase, β2-microglobulin, albumin, C-reactive protein, and ferritin-and the prognosis for survival in patients with multiple myeloma (MM) treated with induction chemotherapy containing thalidomide and who underwent autologous stem cell transplantation (ASCT). METHODS Data from patients at 13 university hospitals in South Korea were collected retrospectively between December 2005 and May 2013. RESULTS The median age of the 232 patients was 57 years (range, 33 to 77) and the male to female ratio was 1.09:1. In the multivariate analysis, fewer than two combined abnormal inflammatory factors was the only independent prognostic factor for superior progression-free survival (relative risk [RR], 0.618; 95% confidence interval [CI], 0.409 to 0.933; p = 0.022), and platelet count > 100 × 10(9)/L and fewer than two combined abnormal inflammatory factors were independent prognostic factors for superior overall survival (RR, 4.739; 95% CI, 1.897 to 11.839; p = 0.001 and RR, 0.263; 95% CI, 0.113 to 0.612; p = 0.002, respectively). CONCLUSIONS Patients with two or more than two combined inflammatory factors who were treated with thalidomide induction chemotherapy and who underwent ASCT showed significantly shorter survival compared to those with fewer than two combined inflammatory factors. These results could be helpful for predicting prognosis in patients with MM.
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Affiliation(s)
- Cheolsu Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- Correspondence to Ho Sup Lee, M.D. Division of Hematology and Oncology, Department of Internal Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6363 Fax: +82-51-990-5820 E-mail:
| | - Chang-Ki Min
- Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Je Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kihyun Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeon Seok Eom
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Hyewon Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Ho-Jin Shin
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Yong Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan, Korea
| | - Young Rok Do
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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