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Lorusso D, Pignata S, Tamberi S, Mangili G, Bologna A, Nicoloso MS, Giolitto S, Salutari V, Mantero M, Pisano C, Bergamini A, Musacchio L, Ronzulli D, Raspagliesi F, Scambia G. Efficacy and safety of trabectedin for the treatment of advanced uterine or ovarian carcinosarcoma: Results of a phase II multicenter clinical trial (MITO-26). Gynecol Oncol 2022; 167:436-443. [PMID: 36220670 DOI: 10.1016/j.ygyno.2022.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This open-label phase II clinical trial evaluated the antitumor activity and safety of trabectedin in patients with advanced ovarian (OC) or uterine carcinosarcomas (UC). METHODS Eligible patients were adults (≥18 years) with histologically proven recurrent OC/UC not amenable to surgery or radiotherapy who received up to two prior chemotherapy lines. Trabectedin 1.3 mg/m2 was administered as a 3-h infusion every three weeks. The primary endpoint was objective response rate (ORR) as per RECIST v.1.1. If at least 8 of 43 patients (18.6%) achieve an objective response, trabectedin would be declared worthy for further investigations. RESULTS Forty-five patients with either OC (n = 32) or UC (n = 13) from seven MITO centers across Italy were enrolled. The ORR was 11.9% (90% CI: 6-23) and included two patients with a complete response and three with a partial response. Eight patients (19.0%) had disease stabilization for a disease control rate of 31.0% (90% CI: 20-44). Median progression-free survival was 2.01 months (95% CI: 1.78-2.30) and median overall survival was 4.64 months (95% CI: 3.19-8.29). Neutrophil count decreases (n = 8, 18.2%) and transaminase increases (n = 6, 13.6%) were the most common grade 3-5 adverse events related with trabectedin. Two patients died due to trabectedin-related grade 5 hematological toxicity. CONCLUSION Although trabectedin did not meet the prespecified activity criteria, it confers modest but clinically meaningful benefit to patients with advanced OC/UC as being as effective as any other available treatment for this indication. The toxicity profile appears in line with that previously reported for the drug.
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Affiliation(s)
- Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy.
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale Napoli, Naples, Italy
| | | | - Giorgia Mangili
- Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Italy
| | | | | | - Serena Giolitto
- Gynecologic Oncology Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vanda Salutari
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Mara Mantero
- Fondazione IRCCS National Cancer Institute Milan, Italy
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale Napoli, Naples, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Italy
| | - Lucia Musacchio
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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Gadducci A, Cosio S. Trabectedin and lurbinectedin: Mechanisms of action, clinical impact, and future perspectives in uterine and soft tissue sarcoma, ovarian carcinoma, and endometrial carcinoma. Front Oncol 2022; 12:914342. [PMID: 36408147 PMCID: PMC9671549 DOI: 10.3389/fonc.2022.914342] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
The ecteinascidins trabectedin and lurbinectedin are very interesting antineoplastic agents, with a favorable toxicity profile and peculiar mechanisms of action. These drugs form adducts in the minor groove of DNA, which produce single-strand breaks (SSBs) and double-strand breaks (DSBs) and trigger a series of events resulting in cell cycle arrest and apoptosis. Moreover, the ecteinascidins interact with the tumor microenvironment, reduce the number of tumor-associated macrophages, and inhibit the secretion of cytokines and chemokines. Trabectedin has been approved by the Federal Drug Administration (FDA) for patients with unresectable or metastatic liposarcoma or leiomyosarcoma who received a prior anthracycline-based regimen. Moreover, trabectedin in combination with pegylated liposomal doxorubicin (PLD) has been approved in the European Union for the treatment of platinum-sensitive recurrent ovarian cancer. Lurbinectedin has been approved by the FDA for patients with metastatic small cell lung cancer with disease progression on or after platinum-based chemotherapy. The review assesses in vitro and in vivo experimental studies on the antineoplastic effects of both ecteinascidins as well as the clinical trials on the activity of trabectedin in uterine sarcoma and ovarian carcinoma and of lurbinectedin in ovarian carcinoma and endometrial carcinoma.
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Souid S, Aissaoui D, Srairi-Abid N, Essafi-Benkhadir K. Trabectedin (Yondelis®) as a Therapeutic Option in Gynecological Cancers: A Focus on its Mechanisms of Action, Clinical Activity and Genomic Predictors of Drug Response. Curr Drug Targets 2021; 21:996-1007. [PMID: 31994460 DOI: 10.2174/1389450121666200128161733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023]
Abstract
The use of predictive biomarkers provides potential individualized cancer therapeutic options to prevent therapy failure as well as serious toxicities. Several recent studies showed that predictive and prognostic biomarkers are a notable personalized strategy to improve patients' care in several cancers. Trabectedin (Yondelis®) is a cytotoxic agent, derived from a marine organism, harbouring a significant antitumor activity against several cancers such as soft tissue sarcoma, ovarian, and breast cancers. Recently and with the advent of molecular genetic testing, BRCA mutational status was found as an important predictor of response to this anticancer drug, especially in gynecological cancers. The aim of this updated review is to discuss the mechanisms of action of trabectedin against the wellknown cancer hallmarks described until today. The current advances were also examined related to genomic biomarkers that can be used in the future to predict the efficacy of this potent anticancer natural molecule in various gynecological cancers.
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Affiliation(s)
- Soumaya Souid
- Universite de Tunis El Manar, Institut Pasteur de Tunis, LR16IPT04 Epidemiologie Moleculaire et Pathologie Experimentale appliquee aux Maladies infectieuses, 1002, Tunis, Tunisia
| | - Dorra Aissaoui
- Universite de Tunis El Manar, Institut Pasteur de Tunis, LR16IPT08 Venins et biomolecules therapeutiques, 1002, Tunis, Tunisia
| | - Najet Srairi-Abid
- Universite de Tunis El Manar, Institut Pasteur de Tunis, LR16IPT08 Venins et biomolecules therapeutiques, 1002, Tunis, Tunisia
| | - Khadija Essafi-Benkhadir
- Universite de Tunis El Manar, Institut Pasteur de Tunis, LR16IPT04 Epidemiologie Moleculaire et Pathologie Experimentale appliquee aux Maladies infectieuses, 1002, Tunis, Tunisia
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Casado A, Callata HR, Manzano A, Marquina G, Alonso T, Gajate P, Sotelo M, Cabezas S, Fernández C, Díaz-Rubio E. Trabectedin for reversing platinum resistance and resensitization to platinum in patients with recurrent ovarian cancer. Future Oncol 2019; 15:271-280. [DOI: 10.2217/fon-2018-0554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aims: We evaluated trabectedin in patients with platinum-resistant/refractory and partially platinum-sensitive recurrent ovarian cancer and the outcomes after reintroduction of platinum. Methods: Twenty-seven patients (platinum-resistant/refractory n = 24/PPS; n = 3) treated with trabectedin were retrospectively analyzed. Results: Trabectedin resulted in an objective response rate (ORR) of 18.2% with a 59.1% of disease control rate (ORR plus stable disease). The median progression-free and overall survival were 3.0 and 21.3 months, respectively. Subsequently, 17 patients were retreated with platinum and yield an ORR of 41.2% and DCR of 47.0%. The median progression-free and overall survival after platinum rechallenge were 5.0 and 14.7 months, respectively. Conclusion: Our results suggest that trabectedin may contribute to resensitize tumor cells to platinum rechallenge.
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Affiliation(s)
- Antonio Casado
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Hector R Callata
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Aranzazu Manzano
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Gloria Marquina
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Teresa Alonso
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Pablo Gajate
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Miguel Sotelo
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Santiago Cabezas
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
| | - Cristina Fernández
- Department of Public Health & Preventive Medicine, University Hospital San Carlos, Madrid, Spain
| | - Eduardo Díaz-Rubio
- Department of Medical Oncology, University Hospital San Carlos, Madrid, Spain
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Ventriglia J, Paciolla I, Cecere S, Pisano C, Di Napoli M, Arenare L, Setola S, Losito N, Califano D, Orditura M, Pignata S. Trabectedin in Ovarian Cancer: is it now a Standard of Care? Clin Oncol (R Coll Radiol) 2018; 30:498-503. [DOI: 10.1016/j.clon.2018.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023]
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El Bairi K, Amrani M, Afqir S. Starvation tactics using natural compounds for advanced cancers: pharmacodynamics, clinical efficacy, and predictive biomarkers. Cancer Med 2018; 7:2221-2246. [PMID: 29732738 PMCID: PMC6010871 DOI: 10.1002/cam4.1467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 02/05/2023] Open
Abstract
The high mortality associated with oncological diseases is mostly due to tumors in advanced stages, and their management is a major challenge in modern oncology. Angiogenesis is a defined hallmark of cancer and predisposes to metastatic invasion and dissemination and is therefore an important druggable target for cancer drug discovery. Recently, because of drug resistance and poor prognosis, new anticancer drugs from natural sources targeting tumor vessels have attracted more attention and have been used in several randomized and controlled clinical trials as therapeutic options. Here, we outline and discuss potential natural compounds as salvage treatment for advanced cancers from recent and ongoing clinical trials and real-world studies. We also discuss predictive biomarkers for patients' selection to optimize the use of these potential anticancer drugs.
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Affiliation(s)
- Khalid El Bairi
- Faculty of Medicine and PharmacyMohamed Ist UniversityOujdaMorocco
| | - Mariam Amrani
- Equipe de Recherche en Virologie et Onco‐biologieFaculty of MedicinePathology DepartmentNational Institute of OncologyUniversité Mohamed VRabatMorocco
| | - Said Afqir
- Department of Medical OncologyMohamed VI University HospitalOujdaMorocco
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Grisanti S, Cosentini D, Tovazzi V, Bianchi S, Lazzari B, Consoli F, Roca E, Berruti A, Ferrari VD. Hepatoprotective effect of N-acetylcysteine in trabectedin-induced liver toxicity in patients with advanced soft tissue sarcoma. Support Care Cancer 2018; 26:2929-2935. [PMID: 29546526 DOI: 10.1007/s00520-018-4129-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/20/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Trabectedin is one of the few active agents in soft tissue sarcoma (STS) but hepatotoxicity is frequent and represents a dose-limiting factor. Protective strategies aiming at counteracting this important side effect have a crucial clinical impact. Due to its antioxidant properties, N-acetylcysteine (NAC) has a recognized hepatoprotective effect and this provides the rationale for testing NAC in the management of trabectedin-induced hepatotoxicity. METHODS Patients with recurrent or metastatic soft tissue sarcoma, consecutively observed at our institution, who were considered eligible to trabectedin, received concomitant NAC if they had impaired hepatic or renal function at baseline or developed hepatotoxicity during treatment. The study aim was to retrospectively explore trabectedin administration in terms of number of cycles, mean dose, and dose intensity (DI) in patients who received NAC as compared with those who did not. Secondary end points were progression-free survival (PFS) and overall survival (OS). RESULTS A total number of 18 patients were enrolled in this study. Nine received NAC and nine did not. The median number of administered trabectedin cycles, mean trabectedin dose/cycles, and median DI was comparable in the two groups (p = 0.450, p = 0.534, and p = 0.450, respectively). The PFS and OS curves overlapped. CONCLUSION This explorative study suggests that NAC can have a hepatoprotective activity in patients receiving trabectedin allowing to maintain an adequate dose intensity and continuative administration in patients with impaired liver and renal function or developing treatment-induced hepatotoxicity. A prospective randomized trial is warranted.
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Affiliation(s)
- Salvatore Grisanti
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Deborah Cosentini
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Valeria Tovazzi
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Susanna Bianchi
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Barbara Lazzari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Francesca Consoli
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Elisa Roca
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy. .,Oncologia Medica, ASST Spedali Civili, Piazzale Spedali Civili 1, 20123, Brescia, Italy.
| | - Vittorio D Ferrari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
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Adam JP, Boumedien F, Letarte N, Provencher D. Single agent trabectedin in heavily pretreated patients with recurrent ovarian cancer. Gynecol Oncol 2017; 147:47-53. [DOI: 10.1016/j.ygyno.2017.07.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
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9
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Tomao F, Marchetti C, Romito A, Di Pinto A, Di Donato V, Capri O, Palaia I, Monti M, Muzii L, Benedetti Panici P. Overcoming platinum resistance in ovarian cancer treatment: from clinical practice to emerging chemical therapies. Expert Opin Pharmacother 2017; 18:1443-1455. [PMID: 28521614 DOI: 10.1080/14656566.2017.1328055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective of this review is to summarize results from clinical trials that tested cytotoxic drugs and target strategies for the treatment of platinum resistant (PR) recurrent ovarian cancer (ROC) with particular attention to Phase III and ongoing trials. Areas covered: Since platinum free interval (PFI) represents the most important predictive factor for response to platinum re-treatment in ROC, non-platinum regimens are conventionally considered the most appropriate approaches. Impressive progress has been made in recent decades, resulting in the identification of most effective cytotoxic agents and in the development of new target strategies. However, the efficacy of most of these drugs for the treatment of PR disease is still limited. Expert opinion: The most favorable benefit for the treatment of PR disease, has been described by the AURELIA trial that showed a 3.3 months increase in progression free survival (PFS) when bevacizumab was combined with non-platinum single agent chemotherapy in bevacizumab-naïve patients. Nevertheless, the use of novel agents is associated to important costs for just little gains in survival. Thus, in our opinion the economic evaluation, such as the incorporation of quality of life into the clinical studies is crucial for the development of future trials for PR-ROC.
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Affiliation(s)
- Federica Tomao
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Claudia Marchetti
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Alessia Romito
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Anna Di Pinto
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Violante Di Donato
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Oriana Capri
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Innocenza Palaia
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Marco Monti
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
| | - Ludovico Muzii
- a Department of Gynaecology and Obstetrics , "Sapienza" University of Rome , Rome , Italy
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Tomao F, D'Incalci M, Biagioli E, Peccatori FA, Colombo N. Restoring platinum sensitivity in recurrent ovarian cancer by extending the platinum-free interval: Myth or reality? Cancer 2017; 123:3450-3459. [PMID: 28678350 DOI: 10.1002/cncr.30830] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/11/2017] [Accepted: 05/19/2017] [Indexed: 11/08/2022]
Abstract
The platinum-free interval is the most important predictive factor of a response to subsequent lines of chemotherapy and the most important prognostic factor for progression-free and overall survival in patients with recurrent epithelial ovarian cancer. A nonplatinum regimen is generally considered the most appropriate approach when the disease recurs very early after the end of chemotherapy, whereas platinum-based chemotherapy is usually adopted when the platinum-free interval exceeds 12 months. However, the therapeutic management of patients with intermediate sensitivity (ie, when the relapse occurs between 6 and 12 months) remains debatable. Preclinical and clinical data suggest that the extension of platinum-free interval (using a nonplatinum-based regimen) might restore platinum sensitivity, thus allowing survival improvement. The objective of this review was to critically analyze preclinical and clinical evidences supporting this hypothesis. Cancer 2017;123:3450-9. © 2017 American Cancer Society.
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Affiliation(s)
- Federica Tomao
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University, Rome, Italy
| | - Maurizio D'Incalci
- Department of Oncology, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS), Milan, Italy
| | - Elena Biagioli
- Department of Oncology, Mario Negri Institute for Pharmacological Research, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS), Milan, Italy
| | - Fedro A Peccatori
- Fertility and Procreation Unit, European Institute of Oncology, Institute for Treatment and Research (IRCCS), Milan, Italy
| | - Nicoletta Colombo
- Department of Gynecologic Oncology, European Institute of Oncology, Institute for Treatment and Research (IRCCS), Milan, Italy.,Department of Surgical Sciences, University of Milan Bicocca, Milan, Italy
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Real-World Management of Trabectedin/Pegylated Liposomal Doxorubicin in Platinum-Sensitive Recurrent Ovarian Cancer Patients: A National Survey. Int J Gynecol Cancer 2017; 27:1141-1148. [PMID: 28574933 DOI: 10.1097/igc.0000000000001058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Trabectedin (T) plus pegylated liposomal doxorubicin (PLD) is approved for treatment of platinum-sensitive recurrent ovarian cancer (ROC). Despite the recommendations and guidelines, variations in managing T/PLD administration in routine clinical practice cannot be excluded. We aimed at setting up an Italian survey collecting data about management of T/PLD administration in ROC patients. METHODS We carried out the development of a questionnaire-based survey on routine clinical practice in the management of ROC patients administered T/PLD. The survey registered the physicians' approach to modification/discontinuation of treatment, type of modifications, reasons why, and so on. The survey was transmitted to medical oncologists and gynecologic oncologists practicing in national centers/institutions. RESULTS Fifty-eight Italian centers/institutions returned the compiled questionnaire; participants practiced at community cancer centers or hospitals (56.9%), academic institutions (36.2%), and other settings (private clinics, etc) (6.9%). There was no statistically significant difference in the distribution of practice setting according to geographic areas. Most responders were medical oncologists (84.5%) and were members (82.8%) of at least 1 scientific society or cooperative group. Almost 31.5% of responders reported interruption of the whole treatment, mostly because of toxicity (41.2%), followed by patients' choice (29.4%), or achievement of clinical benefit (23.5%). Dose reduction was referred by 47.4% of responders. Reduction of dose for both drugs was referred by 88.5% of responders, and the extent of dose reduction ranged between 10% and 30%. CONCLUSIONS This survey highlights the gaps in transposing evidence-based or consensus guidelines in the real-world management of T/PLD administration; these findings could be useful in order to focus the attention on specific knowledge and/or experience gaps and plan pertinent educational programs.
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Teplinsky E, Herzog TJ. The efficacy of trabectedin in treating ovarian cancer. Expert Opin Pharmacother 2017; 18:313-323. [DOI: 10.1080/14656566.2017.1285282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eleonora Teplinsky
- Don Monti Division of Hematology & Medical Oncology, Hofstra Northwell School of Medicine, Monter Cancer Center, Lake Success, NY, USA
| | - Thomas J. Herzog
- Paul & Carolyn Flory Endowed Professor, University of Cincinnati Cancer Institute, Cincinnati, OH, USA
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
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Tan DSP, Kaye SB. Chemotherapy for Patients with BRCA1 and BRCA2-Mutated Ovarian Cancer: Same or Different? Am Soc Clin Oncol Educ Book 2016:114-21. [PMID: 25993149 DOI: 10.14694/edbook_am.2015.35.114] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retrospective studies have shown an improved prognosis, higher response rates to platinum-containing regimens, and longer treatment-free intervals between relapses in patients with BRCA 1 and BRCA 2 (BRCA1/2)-mutated ovarian cancer (BMOC) compared with patients who are not carriers of this mutation. These features of BMOC are attributed to homologous-recombination repair (HR) deficiency in the absence of BRCA1/2 function, which results in an impaired ability of tumor cells to repair platinum-induced double-strand breaks (DSBs), thereby conferring increased chemosensitivity and increased sensitivity to poly(ADP-ribose) polymerase (PARP) enzyme inhibition and other DNA-damaging chemotherapeutic agents such as pegylated liposomal doxorubicin (PLD). Therefore, the chemotherapeutic approach for patients with BMOC should focus on treatment with platinum-based chemotherapy at first-line and recurrent-disease settings and measures to increase the platinum-free interval following early platinum-resistant relapse (i.e., progression-free survival of less than 6 months from last platinum-based chemotherapy) by using nonplatinum cytotoxic agents, with the aim of reintroducing platinum again at a later date. The role of first-line intraperitoneal platinum-based therapy in the specific context of BMOC also merits further analysis. Other than platinum, alternative DNA-damaging agents (including PLD and trabectedin) also may have a therapeutic role in patients with recurrent BMOC. The recent approval of olaparib for clinical use in Europe and the United States will also affect chemotherapeutic strategies for these patients. Further work to clarify the precise relationship between BRCA1/2 mutation genotype and clinical phenotype is crucial to delineating the optimal therapeutic choices in the future for patients with BMOC.
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Affiliation(s)
- David S P Tan
- From the National University Cancer Institute, Singapore; National University Hospital, Singapore; The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Stanley B Kaye
- From the National University Cancer Institute, Singapore; National University Hospital, Singapore; The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
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Blum JL, Gonçalves A, Efrat N, Debled M, Conte P, Richards PD, Richards D, Lardelli P, Nieto A, Cullell-Young M, Delaloge S. A phase II trial of trabectedin in triple-negative and HER2-overexpressing metastatic breast cancer. Breast Cancer Res Treat 2016; 155:295-302. [DOI: 10.1007/s10549-015-3675-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/01/2022]
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Lorusso D, Scambia G, Pignata S, Sorio R, Amadio G, Lepori S, Mosconi A, Pisano C, Mangili G, Maltese G, Sabbatini R, Artioli G, Gamucci T, Di Napoli M, Capoluongo E, Ludovini V, Raspagliesi F, Ferrandina G. Prospective phase II trial of trabectedin in BRCA-mutated and/or BRCAness phenotype recurrent ovarian cancer patients: the MITO 15 trial. Ann Oncol 2015; 27:487-93. [PMID: 26681678 DOI: 10.1093/annonc/mdv608] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/09/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Current evidence suggest that trabectedin is particularly effective in cells lacking functional homologous recombination repair mechanisms. A prospective phase II trial was designed to evaluate the activity of trabectedin in the treatment of recurrent ovarian cancer patients presenting BRCA mutation and/or BRCAness phenotype. PATIENTS AND METHODS A total of 100 patients with recurrent BRCA-mutated ovarian cancer and/or BRCAness phenotype (≥2 previous responses to platinum) were treated with trabectedin 1.3 mg/mq i.v. q 3 weeks. The activity of the drug with respect to BRCA mutational status and to a series of polymorphisms [single-nucleotide polymorphisms (SNPs)] involved in DNA gene repair was analyzed. RESULTS Ninety-four were evaluable for response; in the whole population, 4 complete and 33 partial responses were registered for an overall response rate (ORR) of 39.4. In the platinum-resistant (PR) and -sensitive (PS) population, an ORR of 31.2% and 47.8%, and an overall clinical benefit of 54.2% and 73.9%, respectively, were registered. In the whole series, the median progression-free survival (PFS) was 18 weeks and the median overall survival (OS) was 72 weeks; PS patients showed a more favorable PFS and OS compared with PR patients. BRCA gene mutational status was available in 69 patients. There was no difference in ORR, PFS and OS according to BRCA 1-2 status nor any association between SNPs of genes involved in DNA repair and NER machinery and response to trabectedin was reported. CONCLUSIONS Our data prospectively confirmed that the signature of 'repeated platinum sensitivity' identifies patients highly responsive to trabectedin. In this setting, the activity of trabectedin seems comparable to what could be obtained using platinum compounds and the drug may represent a valuable alternative option in patients who present contraindication to receive platinum. EUDRACT NUMBER 2011-001298-17.
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Affiliation(s)
- D Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of Rome
| | - S Pignata
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - R Sorio
- Department of Oncology, CRO Aviano, Aviano
| | - G Amadio
- Department of Obstetrics and Gynecology, Catholic University of Rome
| | - S Lepori
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - A Mosconi
- Medical Oncology Unit, University Hospital S. Maria della Misericordia, Perugia
| | - C Pisano
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - G Mangili
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan
| | - G Maltese
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - R Sabbatini
- Department of Oncology Haematology and Respiratory Disease, AOU Policlinico di Modena, Modena
| | - G Artioli
- Medical Oncology Unit, Hospital of Mirano, Mirano
| | - T Gamucci
- Medical Oncology Unit, Hospital 'SS. Trinità', Sora
| | - M Di Napoli
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - E Capoluongo
- Department of Molecular Biology, Catholic University of Rome
| | - V Ludovini
- Molecular Biology Unit, University Hospital S. Maria della Misericordia, Perugia, Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - G Ferrandina
- Department of Obstetrics and Gynecology, Catholic University of Rome
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Phase II trial of salvage therapy with trabectedin in metastatic pancreatic adenocarcinoma. Cancer Chemother Pharmacol 2015; 77:477-84. [PMID: 26666646 DOI: 10.1007/s00280-015-2932-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/24/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE No standard salvage chemotherapy has been identified for metastatic pancreatic adenocarcinoma (mPA), and there is an urgent need for active agents against this disease. This phase II trial explored the activity of trabectedin in mPA progressing after gemcitabine-based first-line chemotherapy. METHODS Patients with gemcitabine-resistant disease received trabectedin 1.3 mg/m(2) as a 3-h intravenous continuous infusion every 3 weeks until disease progression or unacceptable toxicity or for a maximum of 6 months. The primary endpoint was progression-free survival rate at 6 months (PFS-6). Since trabectedin modulates the production of selected inflammatory mediators, this study also aimed to identify inflammatory biomarkers predictive for response to trabectedin. RESULTS Between February 2011 and February 2012, 25 patients received trabectedin. PFS-6 was 4%, median PFS 1.9 months (range 0.8-7.4), and median overall survival 5.2 months (range 1.1-24.3). Grade >2 toxicity consisted of neutropenia in 44% of patients, febrile neutropenia and thrombocytopenia both in 12%, anemia in 8%, fatigue in 12%, and AST and ALT increase in 8 and 4%, respectively. Trabectedin was shown to modulate the production of inflammatory mediators, and at disease progression, levels of a subgroup of cytokines/chemokines were modified. Furthermore, tissue analysis identified 30 genes associated with better prognosis. CONCLUSIONS Although it has shown some ability to modulate inflammatory process, single-agent trabectedin had no activity as salvage therapy for mPA.
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A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters: a multicentric Italian experience. Anticancer Drugs 2015; 26:990-4. [PMID: 26241804 DOI: 10.1097/cad.0000000000000275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The European Medicines Agency strongly recommends administration of trabectedin through a central venous catheter (CVC) to minimize the risk of extravasation. However, CVCs place patients at risk of catheter-related complications and have a significant budgetary impact for oncology departments. The most frequently used CVCs are subcutaneously implanted PORT-chamber catheters (PORTs); peripherally inserted central venous catheters (PICCs) are relatively new. We reviewed data of trabectedin-treated patients to evaluate the relative cost-effectiveness of the use of PORTs and PICCs in six Italian centres. Data on 102 trabectedin-treated patients (20 with sarcoma, 80 with ovarian cancer and two with cervical cancer) were evaluated. Forty-five patients received trabectedin by a PICC, inserted by trained nurses using an ultrasound-guided technique at the bedside, whereas 57 patients received trabectedin infusion by a PORT, requiring a day surgery procedure in the hospital by a surgeon. Device dislocation and infections were reported in four patients, equally distributed between PORT or PICC users. Thrombosis occurred in a single patient with a PORT. Complications requiring devices removal were not reported during any of the 509 cycles of therapy (median 5; range 1-20). PICC misplacement or early malfunctions were not reported during trabectedin infusion. The cost-efficiency ratio favours PORT over PICC only when the device is used for more than 1 year. Our data suggest that trabectedin infusion by PICC is safe and well accepted, with a preferable cost-efficiency ratio compared with PORT in patients requiring short-term use of the device (≤1 year).
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18
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Trabectedin plus pegylated liposomal doxorubicin: retrospective analysis in heavily pretreated platinum-sensitive ovarian cancer. TUMORI JOURNAL 2015; 101:506-10. [PMID: 26108247 PMCID: PMC6166415 DOI: 10.5301/tj.5000371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2015] [Indexed: 12/13/2022]
Abstract
Purpose This retrospective analysis evaluated treatment with trabectedin plus
pegylated liposomal doxorubicin (PLD) in 34 heavily pretreated patients
(median number of previous lines, 3; range, 2-10) with platinum-sensitive
relapsed ovarian cancer (ROC) at a single center in Italy. Methods Trabectedin/PLD treatment consisted of trabectedin administered every 3 weeks
as a 3-hour intravenous (i.v.) infusion at a dose of 1.1 mg/m2,
immediately after PLD 30 mg/m2 i.v. infusion. Study objectives
were the evaluation of the objective response rate (ORR), progression-free
survival (PFS) and overall survival (OS). Results Three complete responses and 8 partial responses were observed, with an ORR
of 32.4% (95% CI, 17.450.5%). Median PFS was 6.1 months (95% CI, 4.4-8.9
months). Median OS was 16.3 months (95% CI, 6.8-23.5). Most responses (9 of
11) were found in patients with partially platinum-sensitive disease (ORR
40.9% in this subset; median PFS 6.8 months and median OS 20.8 months).
Grade 3 treatment-related adverse events consisted of nausea/vomiting (n =
5; 14.7%), mucositis (n = 2; 5.9%), alanine aminotransferase increase,
anemia and neutropenia (n = 1 each; 2.9%). Conclusions The overall findings appear consistent with those previously observed in a
randomized controlled clinical trial, and support the use of trabectedin/PLD
in heavily pretreated patients with platinum-sensitive ROC, especially those
with partially platinum-sensitive disease.
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López-Guerrero JA, Romero I, Poveda A. Trabectedin therapy as an emerging treatment strategy for recurrent platinum-sensitive ovarian cancer. CHINESE JOURNAL OF CANCER 2015; 34:41-9. [PMID: 25556617 PMCID: PMC4302088 DOI: 10.5732/cjc.014.10278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 01/14/2023]
Abstract
Epithelial ovarian cancer (OC) is a common gynecologic malignancy in women. The standard treatment for OC is maximal cytoreductive surgical debulking followed by platinum-based chemotherapy. Despite the high response rate to primary therapy, approximately 85% of patients will develop recurrent ovarian cancer (ROC). This review identifies the clinical use of trabectedin in the treatment algorithm for ROC, with specific emphasis on platinum-sensitive ROC, for which trabectedin in combination with pegylated liposomal doxorubicin has been approved as a treatment protocol. The main mechanisms of action of trabectedin at the cellular level and in the tumor microenvironment is also discussed as bases for identifying biomarkers for selecting patients who may largely benefit from trabectedin-based therapies.
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Delaloge S, Cullell-Young M. Reply to the letter to the editor ‘Treating breast cancer with trabectedin: a new arsenal’ by L. Malik. Ann Oncol 2014; 25:2095. [DOI: 10.1093/annonc/mdu263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Mascilini F, Amadio G, Di Stefano MG, Ludovisi M, Di Legge A, Conte C, De Vincenzo R, Ricci C, Masciullo V, Salutari V, Scambia G, Ferrandina G. Clinical utility of trabectedin for the treatment of ovarian cancer: current evidence. Onco Targets Ther 2014; 7:1273-84. [PMID: 25050069 PMCID: PMC4103925 DOI: 10.2147/ott.s51550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Among the pharmaceutical options available for treatment of ovarian cancer, attention has been increasingly focused on trabectedin (ET-743), a drug which displays a unique mechanism of action and has been shown to be active in several human malignancies. Currently, single agent trabectedin is approved for treatment of patients with advanced soft tissue sarcoma after failure of anthracyclines and ifosfamide, and in association with pegylated liposomal doxorubicin for treatment of patients with relapsed partially platinum-sensitive ovarian cancer. This review aims at summarizing the available evidence about the clinical role of trabectedin in the management of patients with epithelial ovarian cancer. Novel perspectives coming from a better understanding of trabectedin mechanisms of action and definition of patients subgroups likely susceptible to benefit of trabectedin treatment are also presented.
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Affiliation(s)
- Floriana Mascilini
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Giulia Amadio
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | | | - Manuela Ludovisi
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Alessia Di Legge
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Carmine Conte
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Rosa De Vincenzo
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Caterina Ricci
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Valeria Masciullo
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Vanda Salutari
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Oncology, Catholic University of Rome, Italy
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Abstract
More than 50% of patients with ovarian cancer have genetic alterations in the homologous repair pathway. Trabectedin appears to induce damage more readily in tumor cells with defects in the homologous repair system. Moreover, trabectedin inhibits monocyte differentiation into tumor-associated macrophages and inhibits the production of inflammatory mediators such as IL-6. In patients with platinum-sensitive, relapsed ovarian cancer, trabectedin plus pegylated liposomal doxorubicin was associated with a trend towards improved overall survival by extending the platinum-free interval. These clinical effects could possibly be attributed to actions of trabectedin on the tumor microenvironment (e.g., a reduction of IL-6). Thus, trabectedin is an agent with mechanisms of action especially appropriate for targeting key processes in the biology of ovarian cancer.
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23
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Trabectedin, a drug acting on both cancer cells and the tumour microenvironment. Br J Cancer 2014; 111:646-50. [PMID: 24755886 PMCID: PMC4134488 DOI: 10.1038/bjc.2014.149] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/08/2022] Open
Abstract
Trabectedin is the first marine-derived anti-neoplastic drug approved for the treatment of advanced soft tissue sarcoma and, in combination with pegylated liposomal doxorubicin, for the treatment of patients with relapsed platinum-sensitive ovarian cancer. From the beginning of its development, trabectedin showed some peculiar properties that clearly distinguished it from other anti-cancer drugs. In this mini-review, we will outline the current state of knowledge regarding the mode of action of trabectedin, which appears to represent a new class of anti-neoplastic drugs acting both on cancer cells and on the tumour microenvironment.
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Delaloge S, Wolp-Diniz R, Byrski T, Blum JL, Gonçalves A, Campone M, Lardelli P, Kahatt C, Nieto A, Cullell-Young M, Lubinski J. Activity of trabectedin in germline BRCA1/2-mutated metastatic breast cancer: results of an international first-in-class phase II study. Ann Oncol 2014; 25:1152-8. [PMID: 24692579 DOI: 10.1093/annonc/mdu134] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast cancer is a heterogeneous disease defined by both germline and somatic abnormalities. In preclinical models, tumors carrying homologous recombination defects are highly sensitive to trabectedin. This phase II trial evaluated the efficacy and safety of trabectedin in BRCA1/2 germline mutation carriers with pretreated metastatic breast cancer (MBC). PATIENTS AND METHODS Trabectedin 1.3 mg/m(2) as a 3-h i.v. infusion was administered every 3 weeks until progression or intolerance. The primary efficacy end point was the objective response rate (ORR) as per RECIST. Secondary efficacy end points comprised time-to-event end points, and changes in tumor volume and expression of tumor marker CA15.3. Safety was evaluated using the NCI-CTCAE. RESULTS Forty BRCA1/2 germline mutation carriers with MBC were included. Confirmed partial response (PR) occurred in 6 of 35 assessable patients [ORR = 17%; 95% confidence interval (CI) 7% to 34%] and lasted 1.4-6.8 months. Median PFS was 3.9 months (95% CI 1.6-5.5 months). Eight patients (21%) showed changes in tumor volume, and 14 (40%) a clinical benefit. Trabectedin-related adverse events were generally mild/moderate, the most common being fatigue, nausea, constipation and anorexia. Severe laboratory abnormalities (neutropenia, transaminase increases) were mostly transient and noncumulative, and were managed by dose adjustments. CONCLUSIONS With the caveat of the limited patient number, trabectedin monotherapy showed activity and was well tolerated in heavily pretreated MBC patients selected for germline BRCA mutation. These results prompt further evaluation of trabectedin alone or combined with other specific drugs in this indication. CLINICALTRIALSGOV NCT00580112.
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Affiliation(s)
- S Delaloge
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - R Wolp-Diniz
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - T Byrski
- Department of Medical Oncology, International Hereditary Cancer Center, Sczeczin, Poland
| | - J L Blum
- Department of Oncology, Baylor-Charles A. Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, USA
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille
| | - M Campone
- Department of Medical Oncology, Institut de Cancérologie de l'OUEST, Nantes, France
| | - P Lardelli
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - C Kahatt
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A Nieto
- Clinical R&D, PharmaMar, Colmenar Viejo, Madrid, Spain
| | | | - J Lubinski
- Department of Medical Oncology, International Hereditary Cancer Center, Sczeczin, Poland
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Ferrandina G, Salutari V, Vincenzi B, Marinaccio M, Naglieri E, Loizzi V, Carpano S, Amadio G, Tonini G, Scambia G, Lorusso D. Trabectedin as single agent in the salvage treatment of heavily treated ovarian cancer patients: a retrospective, multicenter study. Gynecol Oncol 2013; 130:505-10. [PMID: 23774301 DOI: 10.1016/j.ygyno.2013.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/01/2013] [Accepted: 06/06/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this multicenter, retrospective study was to evaluate the efficacy and the safety of single agent Trabectedin (ET-743, Yondelis) in very heavily treated, relapsed ovarian cancer (ROC) patients. PATIENTS AND METHODS Response to treatment was classified according to RECIST criteria. Progression-free (PFS), and overall survival (OS) were also assessed. RESULTS 98 patients were analyzed (originally 67 platinum sensitive, and 31 platinum refractory/resistant). Median number of previous regimens was 4 (range: 1-6). In the whole population, overall response rate (ORR) was 27.5%; stable disease (SD) was observed in 33 patients (33.6%), and clinical benefit was achieved in 60 cases (61.2%). ORR was 38.6% in fully platinum sensitive population, and 26.1% in partially platinum sensitive patients. In platinum refractory/resistant disease, ORR was 12.9%. Overall, median PFS and OS were 5, and 13 months, respectively. Patients responding to Trabectedin showed a more favorable PFS (median = 9 months) than patients with SD (median = 6 months), or progression (median = 2 months). Median OS of responding patients was 18 months compared to 14 months in SD patients, and 9 months in progressing patients. Grade 3-4 neutropenia was observed in 17 (17.3%) patients. Transient and non-cumulative Grade 3-4 AST and ALT level elevation was found in 7 (7.1%), and 13 (13.3%) cases, respectively. There was 1 case of Grade 3, and 1 case of Grade 4 cardiac toxicity. CONCLUSIONS Trabectedin, as a single agent, retains its efficacy in terms of rate of ORR and clinical benefit in heavily treated ROC patients, especially in the group of platinum sensitive disease.
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