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Gebbia V, Martorana F, Scandurra G, Valerio MR, Cufari S, Vigneri P, Sanò MV, Scollo P. A retrospective, real-life analysis of metronomic oral single-agent cyclophosphamide for the treatment of platinum-pretreated advanced ovarian carcinoma in Italy. J Oncol Pharm Pract 2024; 30:853-859. [PMID: 37501558 DOI: 10.1177/10781552231189867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Metronomic oral cyclophosphamide (MOC) presents many potential advantages, such as significantly less severe side effects than standard regimens, ease of administration, and the delivery of a dose-dense but not necessarily dose-intense treatment. These observations prompted us to evaluate in a retrospective, multicenter study the efficacy and toxicity of MOC in a real-life series of pretreated cancer patients. METHODS The study is a multicenter, retrospective analysis of the activity of single-agent MOC in patients with recurrent or residual epithelial ovarian, fallopian tube, or primary. Eligible patients were continuously treated with MOC at 50 mg/day until progression, toxicity, or death. Overall response rate (ORR), stable disease (SD), and disease control rate (DCR) were reported. RESULTS The study included 62 patients. Three patients reached a complete response rate (5%), 11 had a partial response rate (18), and 15 had stabilization of disease (24) for an ORR of 23% and a DCR of 47%. Patients with low-grade indolent tumors showed an ORR and an SD rate higher than that observed in non-indolent ones (33% vs. 18% and 28% vs. 14%, respectively). Overall, progression-free survival was 3.5 months (range 1-9 months). CONCLUSION Single-agent MOC is active and very well tolerated in a significant fraction of patients with refractory, recurrent, or residual epithelial ovarian, fallopian tube, or primary peritoneal cancer. In the vision of a practical approach, single-agent MOC may be a useful palliative treatment option for patients with poor tolerance to high-dose regimens or widely pretreated. Further studies are needed better to characterize the role of such an approach in clinical practice.
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Affiliation(s)
- Vittorio Gebbia
- Casa di Cura Torina, Palermo, Italy
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
| | - Federica Martorana
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | | | | | | | - Paolo Vigneri
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
| | - Paolo Scollo
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
- Gynecological Oncology Unit, Ospedale Cannizzaro, Catania, Italy
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Ilari A, Cogliati V, Sherif N, Grassilli E, Ramazzotti D, Cordani N, Cazzaniga G, Di Bella C, Lavitrano M, Cazzaniga ME, Cerrito MG. Differential Expression of NOTCH-1 and Its Molecular Targets in Response to Metronomic Followed by Conventional Therapy in a Patient with Advanced Triple-Negative Breast Cancer. Biomedicines 2024; 12:272. [PMID: 38397874 PMCID: PMC10886740 DOI: 10.3390/biomedicines12020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
A group of 27 patients diagnosed with metastatic triple-negative breast cancer (mTNBC) was randomly distributed into two groups and underwent different lines of metronomic treatment (mCHT). The former group (N 14) received first-line mCHT and showed a higher overall survival rate than the second group (N 13), which underwent second-line mCHT. Analysis of one patient still alive from the first group, diagnosed with mTNBC in 2019, showed a complete metabolic response (CMR) after a composite approach implicating first-line mCHT followed by second-line epirubicin and third-line nab-paclitaxel, and was chosen for subsequent molecular characterization. We found altered expression in the cancer stemness-associated gene NOTCH-1 and its corresponding protein. Additionally, we found changes in the expression of oncogenes, such as MYC and AKT, along with their respective proteins. Overall, our data suggest that a first-line treatment with mCHT followed by MTD might be effective by negatively regulating stemness traits usually associated with the emergence of drug resistance.
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Affiliation(s)
- Alice Ilari
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Viola Cogliati
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy;
| | - Noorhan Sherif
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Emanuela Grassilli
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Daniele Ramazzotti
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Nicoletta Cordani
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Giorgio Cazzaniga
- Department of Pathology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (G.C.); (C.D.B.)
| | - Camillo Di Bella
- Department of Pathology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (G.C.); (C.D.B.)
| | - Marialuisa Lavitrano
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
| | - Marina Elena Cazzaniga
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
- Phase 1 Research Centre, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy;
| | - Maria Grazia Cerrito
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy; (A.I.); (N.S.); (E.G.); (D.R.); (N.C.); (M.L.); (M.E.C.)
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3
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Martorana F, Scandurra G, Valerio MR, Cufari S, Vigneri P, Sanò MV, Scibilia G, Scollo P, Gebbia V. A review and metanalysis of metronomic oral single-agent cyclophosphamide for treating advanced ovarian carcinoma in the era of precision medicine. J Oncol Pharm Pract 2024; 30:173-181. [PMID: 38018146 DOI: 10.1177/10781552231216689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Oral metronomic cyclophosphamide has been used as a single agent or in combination with other drugs for several solid tumors with interesting results in disease palliation and mild to moderate toxicity, notably in patients with recurrent epithelial ovarian cancer (EOC) progressing after systemic chemotherapy. In this paper, we report a review and a metanalysis of heterogeneous data published up to date. DATA SOURCES The literature search was restricted to single-agent MOC. The analysis was conducted through March 2023 by consulting PubMed, Embase, Google Scholar, and The Cochrane Library databases. Research string and Medical Subject Headings included "ovarian tumor," "ovarian carcinoma," or "ovarian cancer," "fallopian tube cancer," "primary peritoneal cancer," "oral chemotherapy," and "metronomic cyclophosphamide." All articles were assessed for quality by at least two investigators independently, and a < 18 patients sample size cutoff was chosen as a lower limit with a Cohen's kappa statistical coefficient for accuracy and reliability. Metanalysis of selected papers was carried out according to a fixed model. DATA SUMMARY The percentage of agreement between investigators on literature study selection was very high, reaching 96.9% with a Cohen's k of 0.929. MOC pooled objective response rate (ORR) and disease control rate for recurrent or platinum-refractory ovarian cancer were 18.8% (range 4-44%) and 36.2% (range 16-58.8%), respectively. The mean progressive-free survival and overall survival were 3.16 months (range 1.9 to 5.0 months) and 8.7 months (range 8 to 13 months), respectively. The fixed model metanalysis of selected studies showed a 16% median ORR (12-20% CI, p < 0.001). CONCLUSIONS Single-agent oral cyclophosphamide in EOC holds promise as a treatment option, even in the era of precision medicine. Genetic factors, such as DNA repair gene polymorphisms, may influence treatment response. Combining cyclophosphamide with biological agents such as PARP inhibitors or immunotherapy agents is an area of active investigation.
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Affiliation(s)
- Federica Martorana
- Medical Oncology Unit, Humanitas istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | | | | | | | - Paolo Vigneri
- Medical Oncology Unit, Humanitas istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Humanitas istituto Clinico Catanese, Catania, Italy
| | | | - Paolo Scollo
- Gynecological Oncology Unit, Ospedale Cannizzaro, Catania, Italy
- Faculty of Medicine, Chair of Gynecology Kore University, Enna, Italy
| | - Vittorio Gebbia
- Chair of Medical Oncology, Faculty of Medicine, University of Enna Kore, Enna, Italy
- Medical Oncology Unit, CdC Torina, Palermo, Italy
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Joaquin Garcia A, Rediti M, Venet D, Majjaj S, Kammler R, Munzone E, Gianni L, Thürlimann B, Laáng I, Colleoni M, Loi S, Viale G, Regan MM, Buisseret L, Rothé F, Sotiriou C. Differential Benefit of Metronomic Chemotherapy Among Triple-Negative Breast Cancer Subtypes Treated in the IBCSG Trial 22-00. Clin Cancer Res 2023; 29:4908-4919. [PMID: 37733800 DOI: 10.1158/1078-0432.ccr-23-1267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/19/2023] [Accepted: 09/19/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To explore whether specific triple-negative breast cancer (TNBC) molecular subtypes are predictive for a benefit from maintenance low-dose cyclophosphamide and methotrexate (CM) in the adjuvant IBCSG 22-00 phase III clinical trial. EXPERIMENTAL DESIGN RNA sequencing was performed on a selection of 347 TNBC formalin-fixed paraffin-embedded (FFPE) tumor samples following a case-cohort-like sampling. TNBC subtypes were computed on gene expression data. The association between TNBC subtypes and treatment outcome was assessed using a Cox proportional-hazards interaction test. RESULTS Immunomodulatory (IM) and basal-like/immune activated (BLIA) molecular subtypes showed a significant survival benefit when treated with low-dose CM [disease-free survival (DFS): HR, 0.5; 95% confidence interval (CI), 0.28-0.89; Pinteraction = 0.018 and HR, 0.49; 95% CI, 0.27-0.9; Pinteraction = 0.021]. Moreover, a high expression of regulatory T-cell immune signature was associated with a better prognosis in the CM arm, in line with a potential immunomodulating role of cyclophosphamide. In contrast, a worse outcome was observed in tumors with a mesenchymal (M) subtype treated with low-dose CM (DFS: HR, 1.9; 95% CI, 1.2-3; Pinteraction = 0.0044). CONCLUSIONS Our results show a differential benefit of low-dose CM therapy across different TNBC subtypes. Low-dose CM therapy could be considered as a potential strategy for TNBC tumors with IM subtype in the early-disease setting.
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Affiliation(s)
- Andrea Joaquin Garcia
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Mattia Rediti
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - David Venet
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Samira Majjaj
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roswitha Kammler
- Translational Research Coordination International Breast Cancer Study Group, Division of ETOP IBCSG Partners Foundation, Bern, Switzerland
| | | | - Lorenzo Gianni
- Department of Medical Oncology, Ospedale Infermi, Rimini, AUSL della Romagna, Italy
| | | | - István Laáng
- National Institute of Oncology, Budapest, Hungary
| | - Marco Colleoni
- International Breast Cancer Study Group, Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sherene Loi
- International Breast Cancer Study Group, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Meredith M Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Laurence Buisseret
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Françoise Rothé
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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Shi D, Li Y, Liang X, Chen L. Cost-effectiveness of sacituzumab govitecan in hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer. Front Oncol 2023; 13:1162360. [PMID: 37251935 PMCID: PMC10213649 DOI: 10.3389/fonc.2023.1162360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Background The efficiency and safety of sacituzumab govitecan (SG) for the therapy of hormone receptor-positive (HR+)/human epidermal receptor 2-negative (HER2-) metastatic breast cancer (BC) has been demonstrated. The aim of this study is to evaluate its cost-effectiveness on HR+/HER2- metastatic BC from the third-party payer perspective in the United States. Methods We performed the cost-effectiveness of SG and chemotherapy using a partitioned survival model. TROPiCS-02 provided clinical patients for this study. We evaluated the robustness of this study by one-way and probabilistic sensitivity analyses. Subgroup analyses were also conducted. The outcomes were costs, life-years, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), and incremental net monetary benefit (INMB). Results SG treatment was related to an increase of 0.284 life years and 0.217 QALYs over chemotherapy, as well as a cost increase of $132,689, reaching an ICER of $612,772/QALY. The INHB was -0.668 QALYs, and the INMB was -$100,208. SG was not cost-effective at the willingness to pay (WTP) threshold of $150,000/QALY. The outcomes were sensitive to patient body weight and cost of SG. SG may be cost-effective at the WTP threshold of $150,000/QALY if the price is less than $3.997/mg or the weight of patients is under 19.88 kg. Based on the subgroup analysis, SG did not prove cost-effective in all subgroups at the WTP threshold of $150,000/QALY. Conclusion From a third-party payer standpoint in the United States, SG was not cost-effective, even though it had a clinically significant advantage over chemotherapy for the treatment of HR+/HER2- metastatic BC. The cost-effectiveness of SG can be improved if the price is substantially reduced.
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Affiliation(s)
- Demin Shi
- Department of Reproductive Medicine, The People’s Hospital of Hechi, Hechi, Guangxi, China
| | - Yan Li
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xueyan Liang
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Lingyuan Chen
- Department of Pharmacy, The People’s Hospital of Hechi, Hechi, Guangxi, China
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Buda-Nowak A, Kwinta Ł, Potocki P, Michałowska-Kaczmarczyk A, Słowik A, Konopka K, Streb J, Koniewski M, Wysocki PJ. Metronomic Chemo-Endocrine Therapy (FulVEC) as a Salvage Treatment for Patients with Advanced, Treatment-Refractory ER+/HER2-Breast Cancer-A Retrospective Analysis of Consecutive Patients Data. J Clin Med 2023; 12:jcm12041350. [PMID: 36835886 PMCID: PMC9958758 DOI: 10.3390/jcm12041350] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Breast cancer, with 2.3 million new cases and 0.7 million deaths every year, represents a great medical challenge worldwide. These numbers confirm that approx. 30% of BC patients will develop an incurable disease requiring life-long, palliative systemic treatment. Endocrine treatment and chemotherapy administered in a sequential fashion are the basic treatment options in advanced ER+/HER2- BC, which is the most common BC type. The palliative, long-term treatment of advanced BC should not only be highly active but also minimally toxic to allow long-term survival with the optimal quality of life. A combination of metronomic chemotherapy (MC) with endocrine treatment (ET) in patients who failed earlier lines of ET represents an interesting and promising option. METHODS The methodology includes retrospective data analyses of pretreated, metastatic ER+/HER2- BC (mBC) patients who were treated with the FulVEC regimen combining fulvestrant and MC (cyclophosphamide, vinorelbine, and capecitabine). RESULTS Thirty-nine previously treated (median 2 lines 1-9) mBC patients received FulVEC. The median PFS and OS were 8.4 and 21.5 months, respectively. Biochemical responses (CA-15.3 serum marker decline ≥50%) were observed in 48.7%, and any increase in CA-15.3 was observed in 23.1% of patients. The activity of FulVEC was independent of previous treatments with fulvestrant of cytotoxic components of the FulVEC regimen. The treatment was safe and well tolerated. CONCLUSIONS Metronomic chemo-endocrine therapy with FulVEC regimen represents an interesting option and compares favorably with other approaches in patients' refractory to endocrine treatments. A phase II randomized trial is warranted.
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Affiliation(s)
- Anna Buda-Nowak
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
| | - Łukasz Kwinta
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Paweł Potocki
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Anna Michałowska-Kaczmarczyk
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Agnieszka Słowik
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
| | - Kamil Konopka
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Maciej Koniewski
- Institute of Sociology, Jagiellonian University, 30-962 Krakow, Poland
| | - Piotr J. Wysocki
- Department of Oncology, Jagiellonian University Medical College, University Hospital, 30-501 Krakow, Poland
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Correspondence:
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8
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Scagliotti A, Capizzi L, Cazzaniga ME, Ilari A, De Giorgi M, Cordani N, Gallazzi M, Bruno A, Pelosi G, Albini A, Lavitrano M, Grassilli E, Cerrito MG. Co-targeting triple-negative breast cancer cells and endothelial cells by metronomic chemotherapy inhibits cell regrowth and migration via downregulation of the FAK/VEGFR2/VEGF axis and autophagy/apoptosis activation. Front Oncol 2022; 12:998274. [PMID: 36531071 PMCID: PMC9749857 DOI: 10.3389/fonc.2022.998274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/14/2022] [Indexed: 12/07/2023] Open
Abstract
High-dose standard-of-care chemotherapy is the only option for triple-negative breast cancer (TNBC) patients, which eventually die due to metastatic tumors. Recently, metronomic chemotherapy (mCHT) showed advantages in treating TNBCs leading us to investigate the anti-metastatic and anti-angiogenic potential of metronomic 5-Fluorouracil plus Vinorelbine (5-FU+VNR) on endothelial cells (ECs) and TNBCs in comparison to standard treatment (STD). We found that 10-fold lower doses of 5-FU+VNR given mCHT vs. STD inhibits cell proliferation and survival of ECs and TNBC cells. Both schedules strongly affect ECs migration and invasion, but in TNBC cells mCHT is significantly more effective than STD in impairing cell migration and invasion. The two treatments disrupt FAK/VEGFR/VEGF signaling in both ECs and TNBC cells. mCHT, and to a much lesser extent STD treatment, induces apoptosis in ECs, whereas it switches the route of cell death from apoptosis (as induced by STD) to autophagy in TNBC cells. mCHT-treated TNBCs-derived conditioned medium also strongly affects ECs' migration, modulates different angiogenesis-associated proteins, and hampers angiogenesis in matrix sponge in vivo. In conclusion, mCHT administration of 5-FU+VNR is more effective than STD schedule in controlling cell proliferation/survival and migration/invasion of both ECs and TNBC cells and has a strong anti-angiogenic effect. Our data suggest that the stabilization of tumor growth observed in TNBC patients treated with mCHT therapy schedule is likely due not only to direct cytotoxic effects but also to anti-metastatic and anti-angiogenic effects.
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Affiliation(s)
- Arianna Scagliotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laura Capizzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Phase 1 Research Center, Azienda Socio Sanitaria Territoriale (ASST) di Monza, Monza, Italy
| | - Alice Ilari
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco De Giorgi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicoletta Cordani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Matteo Gallazzi
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Antonino Bruno
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Laboratory of Innate Immunity, Unit of Molecular Pathology, Biochemistry and Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Giuseppe Pelosi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Adriana Albini
- IRCCS European Institute of Oncology (IEO), Milan, Italy
| | | | - Emanuela Grassilli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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9
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Rugo HS, Bardia A, Marmé F, Cortes J, Schmid P, Loirat D, Trédan O, Ciruelos E, Dalenc F, Pardo PG, Jhaveri KL, Delaney R, Fu O, Lin L, Verret W, Tolaney SM. Sacituzumab Govitecan in Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer. J Clin Oncol 2022; 40:3365-3376. [PMID: 36027558 DOI: 10.1200/jco.22.01002] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/15/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) endocrine-resistant metastatic breast cancer is treated with sequential single-agent chemotherapy with poor outcomes. Sacituzumab govitecan (SG) is a first-in-class antibody-drug conjugate with an SN-38 payload targeting trophoblast cell-surface antigen 2, an epithelial antigen expressed in breast cancer. METHODS In this global, randomized, phase III study, SG was compared with physician's choice chemotherapy (eribulin, vinorelbine, capecitabine, or gemcitabine) in endocrine-resistant, chemotherapy-treated HR+/HER2- locally recurrent inoperable or metastatic breast cancer. The primary end point was progression-free survival (PFS) by blinded independent central review. RESULTS Patients were randomly assigned to receive SG (n = 272) or chemotherapy (n = 271). The median age was 56 years, 95% had visceral metastases, and 99% had a prior cyclin-dependent kinase 4/6 inhibitor, with three median lines of chemotherapy for advanced disease. Primary end point was met with a 34% reduction in risk of progression or death (hazard ratio, 0.66 [95% CI, 0.53 to 0.83; P = .0003]). The median PFS was 5.5 months (95% CI, 4.2 to 7.0) with SG and 4.0 months (95% CI, 3.1 to 4.4) with chemotherapy; the PFS at 6 and 12 months was 46% (95% CI, 39 to 53) v 30% (95% CI, 24 to 37) and 21% (95% CI, 15 to 28) v 7% (95% CI, 3 to 14), respectively. Median overall survival (first planned interim analysis) was not yet mature (hazard ratio, 0.84; P = .14). Key grade ≥ 3 treatment-related adverse events (SG v chemotherapy) were neutropenia (51% v 38%) and diarrhea (9% v 1%). CONCLUSION SG demonstrated statistically significant PFS benefit over chemotherapy, with a manageable safety profile in patients with heavily pretreated, endocrine-resistant HR+/HER2- advanced breast cancer and limited treatment options.
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Affiliation(s)
- Hope S Rugo
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Aditya Bardia
- Medical Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University, University Hospital Mannheim, Heidelberg, Germany
| | - Javier Cortes
- Medical Oncology Department, International Breast Cancer Center, Pangaea Oncology, Quironsalud Group, Madrid and Barcelona, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Delphine Loirat
- Medical Oncology Department and D3i, Institut Curie, Paris, France
| | - Olivier Trédan
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - Eva Ciruelos
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Rosemary Delaney
- Department of Clinical Development, Gilead Sciences Inc, Foster City, CA
| | - Olivia Fu
- Department of Global Patient Safety, Gilead Sciences Inc, Foster City, CA
| | - Lanjia Lin
- Department of Biostatistics, Gilead Sciences Inc, Foster City, CA
| | - Wendy Verret
- Department of Clinical Development, Gilead Sciences Inc, Foster City, CA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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10
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Pepe FF, Cazzaniga ME, Baroni S, Riva F, Cicchiello F, Capici S, Cogliati V, Maggioni C, Cordani N, Cerrito MG, Malandrin S. Immunomodulatory effects of metronomic vinorelbine (mVRL), with or without metronomic capecitabine (mCAPE), in hormone receptor positive (HR+)/HER2-negative metastatic breast cancer (MBC) patients: final results of the exploratory phase 2 Victor-5 study. BMC Cancer 2022; 22:956. [PMID: 36068484 PMCID: PMC9446532 DOI: 10.1186/s12885-022-10031-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Tregs are able of suppressing tumor-specific effector cells, such as lymphocytes CD8+, CD4+ and Natural Killer cells. Different drugs, especially different schedules of administration, like metronomic chemotherapy (mCHT), seem to be able to increase anticancer immunity, by acting on downregulation of Tregs. Most of the data available regarding the immunomodulating effect of mCHT have been obtained with Cyclophosphamide (CTX). Aim of the present study was to explore the effects of mVRL and mCAPE administration, alone or in combination, on T cells. Observation of 13 metastatic breast cancer patients lasted controlling for 56 days, where Treg frequencies and function, spontaneous anti-tumor T-cell responses were monitored, as well as the clinical outcome. No depletion in Treg absolute numbers, or percentage of T lymphocytes, was observed. Only in 5 patients, a modest and transient depletion of Tregs was observed during the first 14 days of treatment. To better describe the effect on Tregs, we subsequently looked at the variations in Memory, Naïve and Activated Treg subpopulations: we observed a trend in reduction for memory Treg (Treg MEM) and an increase for Treg Naïve (Treg NAIVE) and Treg Activated (Treg ACT) components. We finally analyzed the average trend of Treg in the Treg depleted patients and non-depleted ones, without fiding any significant differences. The trend of the Treg MEM appeared different, showing a reduction during the first 14 days, followed by an increase at the levels before treatment at Day 56 in the group of depleted patients and a progressive substantial reduction in the group of non-depleted patients along the entire course of treatment. Opposed to the data known, treatment with mVRL w/o mCAPE did not show any effect on Tregs.
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Affiliation(s)
- F F Pepe
- Phase 1 Research Centre, ASST Monza, Monza, Italy
| | - M E Cazzaniga
- Phase 1 Research Centre, ASST Monza, Monza, Italy. .,School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.
| | - S Baroni
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - F Riva
- Oncology Unit, ASST Monza, Monza, Italy
| | | | - S Capici
- Phase 1 Research Centre, ASST Monza, Monza, Italy
| | - V Cogliati
- Phase 1 Research Centre, ASST Monza, Monza, Italy
| | | | - N Cordani
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - M G Cerrito
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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11
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Cazzaniga ME, Capici S, Cordani N, Cogliati V, Pepe FF, Riva F, Cerrito MG. Metronomic Chemotherapy for Metastatic Breast Cancer Treatment: Clinical and Preclinical Data between Lights and Shadows. J Clin Med 2022; 11:jcm11164710. [PMID: 36012949 PMCID: PMC9410269 DOI: 10.3390/jcm11164710] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Metronomic chemotherapy (mCHT), defined as continuous administration of low-dose chemotherapeutic agents with no or short regular treatment-free intervals, was first introduced to the clinic in international guidelines in 2017, and, since then, has become one of the available strategies for the treatment of advanced breast cancer (ABC). Despite recent successes, many unsolved practical and theoretical issues remain to be addressed. The present review aims to identify the “lights and shadows” of mCHT in preclinical and clinical settings. In the preclinical setting, several findings indicate that one of the most noticeable effects of mCHT is on the tumor microenvironment, which, over the last twenty years, has been demonstrated to be pivotal in supporting tumor cell survival and proliferation. On the other hand, the direct effects on tumor cells have been less well-defined. In addition, critical items to be addressed are the lack of definition of an optimal biological dose (OBD), the method of administration of metronomic schedules, and the recognition and validation of predictive biomarkers. In the clinical context—where mCHT has mainly been used in a metastatic setting—low toxicity is the most well-recognised light of mCHT, whereas the type of study design, the absence of randomised trials and uncertainty in terms of doses and drugs remain among the shadows. In conclusion, growing evidence indicates that mCHT is a suitable treatment option for selected metastatic breast cancer (MBC) patients. Moreover, given its multimodal mechanisms of action, its addition to immunological and targeted therapies might represent a promising new approach to the treatment of MBC. More preclinical data are needed in this regard, which can only be obtained through support for translational research as the key link between basic science and patient care.
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Affiliation(s)
- Marina Elena Cazzaniga
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
- Phase 1 Research Centre, ASST Monza, 20900 Monza, Italy
| | - Serena Capici
- Phase 1 Research Centre, ASST Monza, 20900 Monza, Italy
| | - Nicoletta Cordani
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
| | | | | | | | - Maria Grazia Cerrito
- School of Medicine and Surgery, Milano-Bicocca University, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-039-2339037
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12
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Kweon S, Jeong YS, Chung SW, Lee H, Lee HK, Park SJ, Choi JU, Park J, Chung SJ, Byun Y. Metronomic dose-finding approach in oral chemotherapy by experimentally-driven integrative mathematical modeling. Biomaterials 2022; 286:121584. [DOI: 10.1016/j.biomaterials.2022.121584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/02/2022]
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13
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Montagna E, Pagan E, Cancello G, Sangalli C, Bagnardi V, Munzone E, Salè EO, Malengo D, Cazzaniga ME, Negri M, Peruzzotti G, Veronesi P, Viale G, Colleoni M. The prolonged clinical benefit with metronomic chemotherapy (VEX regimen) in metastatic breast cancer patients. Anticancer Drugs 2022; 33:e628-e634. [PMID: 34407044 DOI: 10.1097/cad.0000000000001209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metronomic chemotherapy is a treatment option for metastatic breast cancer (MBC) patients who require prolonged disease control without cumulative toxicity. Data available on the efficacy and tolerability of prolonged usage of metronomic therapy are limited. We analyzed patients with MBC, enrolled in a clinical trial, who obtained a prolonged clinical benefit for a duration of at least 12 months with vinorelbine 30 or 40 mg orally three times a week, cyclophosphamide 50 mg daily and capecitabine 500 mg three times a day (VEX regimen). The patients were treated at the European Institute of Oncology, Milan. We identified 67 MBC patients. The median age before starting the VEX regimen was 53 years. There were 59 patients (88%) who had hormone-receptors positive and HER2 negative BC. We had 37 patients who received VEX as the first-line treatment for MBC, while 30 patients were pretreated. The objective response rate was 49% (95% CI, 37-62). The median duration of VEX treatment after the first year was 14 months (min-max range 0.3-81.3 months). The progression-free survival at 3 years was 25.4% (95% CI, 15.7-36.2) and at 4 years was 18.5% (95% CI, 10.1-28.8 time 0 corresponds to 1 year after starting VEX). A total of 25 patients required a dose reduction, 7% of patients experienced G3 hand and foot syndrome. Metronomic VEX regimen can induce prolonged clinical benefit in MBC. On the basis of this long-term safety evaluation, there is no evidence of specific cumulative or delayed toxicities with metronomic chemotherapy.
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Affiliation(s)
- Emilia Montagna
- Division of Medical Senology, Istituto Europeo di Oncologia, IRCCS
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca
| | | | | | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca
| | | | | | - Daniela Malengo
- Division of pharmacy, Istituto Europeo di Oncologia, IRCCS Milan
| | | | | | | | - Paolo Veronesi
- Division of Senology
- Division of Pathology, Istituto Europeo di Oncologia, IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, Istituto Europeo di Oncologia, IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, Istituto Europeo di Oncologia, IRCCS
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14
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Krajnak S, Battista MJ, Hasenburg A, Schmidt M. Metronomic Chemotherapy for Metastatic Breast Cancer. Oncol Res Treat 2021; 45:12-17. [PMID: 34794154 DOI: 10.1159/000520236] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND As disease control and quality of life play a leading role in metastatic breast cancer (MBC), metronomic chemotherapy (MCT) is gaining popularity alongside conventional chemotherapy (CCT) and targeted therapies. SUMMARY MCT, defined as continuous administration of low-dose chemotherapeutic agents, is accepted as a therapy that exerts its effects via immunomodulation, anti-angiogenesis and direct cytotoxic effects. Oral administration of MCT is safe, easy to handle, and allows for flexible drug dosing. Dose accumulations associated with non-tolerable side effects are rare, so the medication can be administered for longer periods of time. Patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic disease resistant to endocrine-based therapy and not requiring rapid tumor response are generally suitable for MCT. However, MCT may also be promising in patients with triple-negative and HER2-positive tumors without aggressive disease who prefer a lower toxicity profile compared to CCT. The most commonly used agents are cyclophosphamide (CTX), methotrexate (MTX), capecitabine (CAPE), and vinorelbine (VRL), whereby a combination of agents is frequently applied. Key Messages: Based on the growing body of evidence, MCT can be considered as a suitable treatment option in selected MBC patients. Nevertheless, there is an urgent need for randomized controlled trials comparing MCT with CCT, but also with best supportive care. Due to the multimodal mechanisms of action, the combination with targeted and immunological therapies may represent a new promising approach for the treatment of MBC.
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Affiliation(s)
- Slavomir Krajnak
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marco J Battista
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marcus Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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15
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Gupta S, Biswas G, Babu S, Maksud TM, Lakshmaiah KC, Patel JG, Raja G, Boya RR, Patil P, Choudhury K, Bondarde SA, Neve RS, Bhat G, Mamillapalli G, Patel AA, Patel P, Joshi N, Bajaj V, Khan MA. Fixed dose combination of capecitabine and cyclophosphamide in metastatic breast cancer: Results from THE ENCLOSE phase 2/3 randomized multicenter study. Breast 2021; 60:147-154. [PMID: 34624757 PMCID: PMC8503662 DOI: 10.1016/j.breast.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022] Open
Abstract
Aim To evaluate pharmacokinetics, efficacy and safety of fixed-dose combination (FDC) of oral capecitabine + cyclophosphamide in metastatic breast cancer (MBC) patients progressing after anthracycline and/or taxane chemotherapy. Methods In this prospective, adaptive, phase-2/3, open-label study (CTRI/2014/12/005234), patients were randomized (1:1:1) to three FDC doses (doses/day: D1, capecitabine + cyclophosphamide 1400 mg + 60 mg; D2, 1800 mg + 80 mg; D3, 2200 mg + 100 mg) for 14 days, in 21-day cycles. In Part-I, multiple-dose pharmacokinetics and optimal dose(s) were evaluated with futility analysis. Group(s) with <3 responders based on best overall response rate (BOR, complete response [CR]+partial response [PR]), were discontinued. Efficacy (BOR, disease control rates [DCR; CR + PR + stable disease]) and safety of optimal dose(s) were evaluated in Part-II. Results Of 66 patients (n = 22/group) in Part-I, pharmacokinetics (D1 = 7/22, D2 = 9/22, D3 = 8/22) showed dose-proportionality for cyclophosphamide and greater than dose-proportionality for capecitabine. Modified intent-to-treat (mITT) analysis showed BOR of 7.14% (1/14) in D1 (discontinued), and 22.22% (4/18) each in D2 and D3, respectively. In Part-II, 50 additional patients were randomized in D2 and D3 (n = 144; total 72 [22 + 50] patients/group). mITT analysis in D2 (n = 54) and D3 (n = 58) showed BOR of 29.63% (16/54, 95%CI: 17.45–41.81%) and 22.41% (13/58, 95%CI: 11.68–33.15%), respectively. DCR in D2 and D3 were 87.04% (47/54, 95%CI: 78.08–96.00%) and 82.76% (48/58; 95%CI: 73.04–92.48%) after 3 and 57.41% (31/54; 95%CI: 52.41–79.50%) and 50.00% (29/58; 95%CI: 40.40–67.00%), after 6-cycles, respectively. Hand-foot syndrome (16.67%), vomiting (9.72%) in D2, and hand-foot syndrome (18.06%), asthenia (15.28%) in D3 were most-common adverse events. Conclusion FDC of capecitabine + cyclophosphamide (1800 + 80 mg/day) showed high disease control rates and good safety profile in MBC patients. Oral fixed dose combination (FDC) of capecitabine + cyclophosphamide developed. FDC showed high efficacy and good safety profiles. Effective in MBC patients progressing post anthracycline and/or taxane exposure. Oral FDC formulation may reduce pill burden and improve patient compliance.
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Affiliation(s)
- Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India.
| | - Ghanashyam Biswas
- Sparsh Hospital and Critical Care Pvt. Ltd., Bhubaneshwar, 751007, Odisha, India
| | - Suresh Babu
- Life Care Hospital, Bangalore, 560029, Karnataka, India
| | - Tanveer M Maksud
- Unique Hospital - Multispeciality & Research Institute, Surat, 395002, Gujarat, India
| | | | | | - Gopal Raja
- Madras Medical College and Rajiv Gandhi Govt. General Hospital, Chennai, 600003, Tamil Nadu, India
| | - Rakesh R Boya
- Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam, 530017, Andhra Pradesh, India
| | - Pramod Patil
- Kailash Cancer Hospital & Research Centre, Vadodara, 391760, Gujarat, India
| | | | | | - Rakesh S Neve
- P.D.E.A's Ayurved Rugnalay & Sterling Multispeciality Hospital, Pune, 411044, Maharashtra, India
| | - Guruprasad Bhat
- Mallikatta Neuro Centre, Mangalore, 575003, Karnataka, India
| | | | - Apurva A Patel
- The Gujarat Cancer & Research Institute (M.P. Shah Cancer Hospital), Ahmedabad, 380016, Gujarat, India
| | - Piyush Patel
- Medical Affairs and Clinical Development, Intas Pharmaceuticals Ltd., Ahmedabad, 380054, Gujarat, India
| | - Nisarg Joshi
- Medical Affairs and Clinical Development, Intas Pharmaceuticals Ltd., Ahmedabad, 380054, Gujarat, India
| | - Vinay Bajaj
- Medical Affairs and Clinical Development, Intas Pharmaceuticals Ltd., Ahmedabad, 380054, Gujarat, India
| | - Mujtaba A Khan
- Medical Affairs and Clinical Development, Intas Pharmaceuticals Ltd., Ahmedabad, 380054, Gujarat, India
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16
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Cazzaniga ME, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Di Mauro P, Cogliati V, Capici S, Clivio L, Torri V. Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study. Breast Cancer Res Treat 2021; 190:415-424. [PMID: 34546500 PMCID: PMC8558172 DOI: 10.1007/s10549-021-06375-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting. Methods We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%). Results Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines. Conclusion This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.
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Affiliation(s)
- M E Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Oncology Unit, ASST Monza, Monza, MB, Italy.
| | - I Vallini
- Medical Oncology, ASST Sette Laghi Ospedale Di Circolo E Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Versilia, ATNO, Lido Di Camaiore, LU, Italy
| | - R Berardi
- Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, Bolzano, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese Legnano, Legnano, Italy
| | - A Baldelli
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology 2, Az. Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - O Garrone
- Breast Unit Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - F Giovanardi
- AUSL IRCCS Reggio Emilia Provincial Oncology Unit, Reggio Emilia, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, Italy
| | - S Sarti
- IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - A Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University of Parma and University Hospital of Parma, Parma, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, Italy
| | - D Santini
- Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria degli Angeli, Pordenone, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus-Messina, Messina, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città della Salute e della Scienza, Osp. Molinette, Torino, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense, Ospedale di Circolo Rho, Rho, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, Italy
| | - M R Valerio
- Department of Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- Phase IV trials, IRCCS, INT Regina Elena, Rome, Italy
| | - P Di Mauro
- Oncology Unit, ASST Monza, Monza, MB, Italy
| | - V Cogliati
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Capici
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - L Clivio
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
| | - V Torri
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
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17
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Mouabbi JA, Osborne CK, Schiff R, Rimawi MF. Management of hormone receptor-positive, human epidermal growth factor 2-negative metastatic breast cancer. Breast Cancer Res Treat 2021; 190:189-201. [PMID: 34515904 DOI: 10.1007/s10549-021-06383-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
Estrogen receptor (ER) is the major driver of most metastatic breast cancers (mBCs). Endocrine therapy (ET) is the most effective treatment for ER + mBC, but its effectiveness is limited by high rates of de novo and acquired resistance. A growing understanding of the biological characteristics and complexity of the ER pathway and the mechanisms of ET resistance has led to the development of a new generation of targeted therapies. One such mechanism is the cell cycle signaling pathways, which lead to the development of cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) that have, in turn, transformed the management of such tumors. Another important mechanism is the alteration of the phosphatidylinositol 3'-kinase/AKT/mammalian target of rapamycin pathway. Drugs targeting each component of these pathways are currently used in clinical practice, and several more are in development. As a result, a myriad of new targeted therapies are consistently being added to the clinical oncologist armamentarium. Navigating the evolving and highly complex treatment landscape of HR + /HER2- mBC remains both an art and a challenge. In this review, we discuss the biological features of HR + /HER2- mBC and the different mechanisms of resistance to ET. We also discuss the management of mBC as the disease changes from endocrine-sensitive to endocrine-resistant.
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Affiliation(s)
- Jason A Mouabbi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
| | - C Kent Osborne
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, 7200 Cambridge St., Suite 7A, Houston, TX, 77030, USA
| | - Rachel Schiff
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, 7200 Cambridge St., Suite 7A, Houston, TX, 77030, USA
| | - Mothaffar F Rimawi
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, 7200 Cambridge St., Suite 7A, Houston, TX, 77030, USA
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18
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Hsu MY, Hsieh CH, Huang YT, Chu SY, Chen CM, Lee WJ, Liu SJ. Enhanced Paclitaxel Efficacy to Suppress Triple-Negative Breast Cancer Progression Using Metronomic Chemotherapy with a Controlled Release System of Electrospun Poly-d-l-Lactide-Co-Glycolide (PLGA) Nanofibers. Cancers (Basel) 2021; 13:cancers13133350. [PMID: 34283075 PMCID: PMC8268060 DOI: 10.3390/cancers13133350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Treatment of metastatic triple-negative breast cancer (TNBC) relies on chemotherapy. To improve the efficacy of chemotherapy and avoid systemic toxicity, metronomic chemotherapy using continuous administration of low-dose chemotherapy could be a solution. The paclitaxel-loaded PLGA nanofibers allow for continuous and prolonged drug release, which is compatible with the concept of metronomic chemotherapy. The animal study revealed that the strategy successfully inhibited the growth of the primary tumor and distant metastasis without sarcopenia. These data offer new insights into the role of drug-loaded nanofibers in the treatment of metastatic TNBC. Abstract Triple-negative breast cancer (TNBC) is highly aggressive and responds poorly to conventional chemotherapy. The challenge of TNBC therapy is to maximize the efficacies of conventional chemotherapeutic agents and reduce their toxicities. Metronomic chemotherapy using continuous low-dose chemotherapy has been proposed as a new treatment option, but this approach is limited by the selection of drugs. To improve antitumor therapeutic effects, we developed electrospun paclitaxel-loaded poly-d-l-lactide-co-glycolide (PLGA) nanofibers as a topical implantable delivery device for controlled drug release and site-specific treatment. The subcutaneously implanted paclitaxel-loaded nanofibrous membrane in mice was compatible with the concept of metronomic chemotherapy; it significantly enhanced antitumor activity, inhibited local tumor growth, constrained distant metastasis, and prolonged survival compared with intraperitoneal paclitaxel injection. Furthermore, under paclitaxel-loaded nanofiber treatment, systemic toxicity was low with a persistent increase in lean body weight in mice; in contrast, body weight decreased in other groups. The paclitaxel-loaded nanofibrous membranes provided sustained drug release and site-specific treatment by directly targeting and changing the tumor microenvironment, resulting in low systemic toxicity and a significant improvement in the therapeutic effect and safety compared with conventional chemotherapy. Thus, metronomic chemotherapy with paclitaxel-loaded nanofibrous membranes offers a promising strategy for the treatment of TNBC.
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Affiliation(s)
- Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan; (M.-Y.H.); (Y.-T.H.); (S.-Y.C.); (C.-M.C.)
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Cheng-Hsien Hsieh
- Department of Emergency Medicine, En-Chu-Kong Hospital, New Taipei City 23741, Taiwan;
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yu-Ting Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan; (M.-Y.H.); (Y.-T.H.); (S.-Y.C.); (C.-M.C.)
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan; (M.-Y.H.); (Y.-T.H.); (S.-Y.C.); (C.-M.C.)
| | - Chien-Ming Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan; (M.-Y.H.); (Y.-T.H.); (S.-Y.C.); (C.-M.C.)
| | - Wei-Jiunn Lee
- Department of Medical Education and Research, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: (W.-J.L.); (S.-J.L.); Tel.: +886-2-2930-7930 (ext. 2551/2547) (W.-J.L.); +886-3-2118166 (S.-J.L.)
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
- Correspondence: (W.-J.L.); (S.-J.L.); Tel.: +886-2-2930-7930 (ext. 2551/2547) (W.-J.L.); +886-3-2118166 (S.-J.L.)
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19
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Liu CT, Hsieh MC, Su YL, Hung CM, Pei SN, Liao CK, Tsai YF, Liao HY, Liu WC, Chiu CC, Wu SC, Wang SH, Wei CT, Rau KM. Metronomic vinorelbine is an excellent and safe treatment for advanced breast cancer: a retrospective, observational study. J Cancer 2021; 12:5355-5364. [PMID: 34335952 PMCID: PMC8317530 DOI: 10.7150/jca.60682] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/20/2021] [Indexed: 12/11/2022] Open
Abstract
Advanced breast cancer (ABC) has become a chronic disease. In such a situation, an effective therapy with low toxicities and economically acceptable is needed. Metronomic vinorelbine (mVNR) has been proved to be effective on the control of MBC. The aim of this study is to evaluate the efficacy and safety of mVNR as the salvage therapy for patients with ABC. Oral vinorelbine (VNR) was administered at 70 mg/m2, fractionated on days 1, 3, and 5, for 3 weeks on and 1 week off. Once the mVNR was combined with trastuzumab, or was combined with bevacizumab, the schedule was changed to 2 weeks on and 1 week off. Clinical data of patients with ABC who had received treatment with mVNR and tumor characteristics were collected and analyzed. From Mar. 2013 to Dec, 2020, there were 90 patients with ABC received mVNR. The overall response rate was 53.3% and overall disease control rate (DCR) was 78.9% in this study, including 4 (4.4%) cases reached complete response, 44 (48.9%) cases reached partial response and 23 (25.6%) cases were table disease. The median time to treatment failure (TTF) of the Lumina A patients was 13.3 months, Lumina B patients was 9.1 months, Her-2 enrich patients was 8.9 months, and triple negative breast cancer (TNBC) patients was 5.6 months. Median overall survival time for Lumina A, Lumina B, Her-2 enrich and TNBC were 54.6 months, 53.3 months, 59.5 months and 24.5 months separately. Side effects were minimal and manageable. Metronomic VNR can be an effective treatment for ABC either works as a switch maintenance or salvage therapy. In combination with target therapy or hormonal therapy, mVNR can further improve TTF and DCR with minimal toxicities. Further study should focus on the optimal dosage, schedule and combination regimen.
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Affiliation(s)
- Chien-Ting Liu
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.,Chang Gung University, College of Medicine, Tao-Yuan 333, Taiwan
| | - Meng-Che Hsieh
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 822, Taiwan.,College of Medicine, I-Shou University, Kaohsiung 822, Taiwan
| | - Yu-Li Su
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.,Chang Gung University, College of Medicine, Tao-Yuan 333, Taiwan
| | - Chaio-Ming Hung
- College of Medicine, I-Shou University, Kaohsiung 822, Taiwan.,Department of Surgery, E-Da Cancer Hospital, Kaohsiung 822, Taiwan
| | - Sung-Nan Pei
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 822, Taiwan.,College of Medicine, I-Shou University, Kaohsiung 822, Taiwan
| | - Chun-Kai Liao
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yu-Fen Tsai
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 822, Taiwan.,College of Medicine, I-Shou University, Kaohsiung 822, Taiwan
| | - Hsiu-Yun Liao
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 822, Taiwan
| | - Wei-Ching Liu
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 822, Taiwan
| | - Chong-Chi Chiu
- College of Medicine, I-Shou University, Kaohsiung 822, Taiwan.,Department of Surgery, E-Da Cancer Hospital, Kaohsiung 822, Taiwan
| | - Shih-Chung Wu
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Shih-Ho Wang
- Chang Gung University, College of Medicine, Tao-Yuan 333, Taiwan.,Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Ching-Ting Wei
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, 822 Taiwan
| | - Kun-Ming Rau
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung 822, Taiwan.,College of Medicine, I-Shou University, Kaohsiung 822, Taiwan
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20
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Cazzaniga ME, Cordani N, Capici S, Cogliati V, Riva F, Cerrito MG. Metronomic Chemotherapy. Cancers (Basel) 2021; 13:cancers13092236. [PMID: 34066606 PMCID: PMC8125766 DOI: 10.3390/cancers13092236] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The present article reviews the state of the art of metronomic chemotherapy use to treat the principal types of cancers, namely breast, non-small cell lung cancer and colorectal ones, and of the most recent progresses in understanding the underlying mechanisms of action. Areas of novelty, in terms of new regimens, new types of cancer suitable for Metronomic chemotherapy (mCHT) and the overview of current ongoing trials, along with a critical review of them, are also provided. Abstract Metronomic chemotherapy treatment (mCHT) refers to the chronic administration of low doses chemotherapy that can sustain prolonged, and active plasma levels of drugs, producing favorable tolerability and it is a new promising therapeutic approach in solid and in hematologic tumors. mCHT has not only a direct effect on tumor cells, but also an action on cell microenvironment, by inhibiting tumor angiogenesis, or promoting immune response and for these reasons can be considered a multi-target therapy itself. Here we review the state of the art of mCHT use in some classical tumour types, such as breast and no small cell lung cancer (NSCLC), see what is new regarding most recent data in different cancer types, such as glioblastoma (GBL) and acute myeloid leukemia (AML), and new drugs with potential metronomic administration. Finally, a look at the strategic use of mCHT in the context of health emergencies, or in low –and middle-income countries (LMICs), where access to adequate healthcare is often not easy, is mandatory, as we always need to bear in in mind that equity in care must be a compulsory part of our medical work and research.
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Affiliation(s)
- Marina Elena Cazzaniga
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy;
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.)
- Correspondence: (M.E.C.); (M.G.C.); Tel.: +39-0392-339-037 (M.E.C.)
| | - Nicoletta Cordani
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy;
| | - Serena Capici
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.)
| | - Viola Cogliati
- Phase 1 Research Centre, ASST-Monza (MB), 20900 Monza, Italy; (S.C.); (V.C.)
| | - Francesca Riva
- Unit of Clinic Oncology, ASST-Monza (MB), 20900 Monza, Italy;
| | - Maria Grazia Cerrito
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza (MB), Italy;
- Correspondence: (M.E.C.); (M.G.C.); Tel.: +39-0392-339-037 (M.E.C.)
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21
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Krajnak S, Decker T, Schollenberger L, Rosé C, Ruckes C, Fehm T, Thomssen C, Harbeck N, Schmidt M. Phase II study of metronomic treatment with daily oral vinorelbine as first-line chemotherapy in patients with advanced/metastatic HR+/HER2- breast cancer resistant to endocrine therapy: VinoMetro-AGO-B-046. J Cancer Res Clin Oncol 2021; 147:3391-3400. [PMID: 33743073 PMCID: PMC8484172 DOI: 10.1007/s00432-021-03599-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
Purpose Metronomic chemotherapy (MCT) is an increasingly used treatment option in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced/metastatic breast cancer (MBC) after failure of endocrine-based therapies. Methods VinoMetro was a multicentre, open-label, single-arm, phase II study of metronomic oral vinorelbine (VRL; 30 mg/day) as a first-line chemotherapy (CT) in patients with HR+/HER2− MBC after endocrine failure. The primary endpoint was the clinical benefit rate (CBR) at 24 weeks. Results Between January 2017 and April 2019, nine patients were enrolled. The CBR was 22.2% (90% confidence interval [CI] 4.1–55.0), p = 0.211. The median progression-free survival (PFS) was 12.0 weeks (95% CI 11.3–12.7). Grade 3–4 adverse events (AEs) occurred in 22.2% of patients. One patient died of febrile neutropenia. Conclusion VinoMetro (AGO-B-046) was closed early after nine patients and occurrence of one grade 5 toxicity in agreement with the lead institutional review board (IRB). Metronomic dosing of oral VRL in HR+/HER2− MBC as first-line CT after failure of endocrine therapies showed only limited benefit in this population. Trial registration number and date of registration ClinicalTrials.gov Identifier: NCT03007992; December 15, 2016.
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Affiliation(s)
- Slavomir Krajnak
- Department of Gynaecology and Obstetrics, University Medical Centre, Mainz, Germany
| | - Thomas Decker
- Haematology and Oncology Outpatient Clinic, Ravensburg, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Mainz, Germany
| | | | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Mainz, Germany
| | - Tanja Fehm
- Department of Gynaecology and Obstetrics, University Medical Centre, Düsseldorf, Germany
| | - Christoph Thomssen
- Department of Gynaecology, University Medical Centre, Halle (Saale), Germany
| | - Nadia Harbeck
- Breast Centre, Department of Gynaecology and Obstetrics and CCC Munich LMU, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Schmidt
- Department of Gynaecology and Obstetrics, University Medical Centre, Mainz, Germany.
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22
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Pellegrino B, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Schirone A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Todeschini R, Tognetto M, Naldi N, Bortesi B, Montemurro F, Ardizzoni A, Boni L, Musolino A. Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). ESMO Open 2020; 6:100019. [PMID: 33399082 PMCID: PMC7808100 DOI: 10.1016/j.esmoop.2020.100019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background The combination of a microtubule inhibitor (eribulin) with a nucleoside analog (gemcitabine) may synergistically induce tumor cell death, particularly in triple negative breast cancer (TNBC) characterized by high cell proliferation, aggressive behavior, and chemo-resistance. Patients and methods This is an open-label, multicenter phase II study evaluating the combination of eribulin (0.88 mg/m2) plus gemcitabine (1000 mg/m2) on days 1 and 8 of a 21-day cycle as either first- or second-line treatment of locally advanced or metastatic TNBC. The primary endpoint was the objective response for evaluable patients. A prospective, molecular correlative study was carried out to assess the role of germinal BRCA pathogenic variants and single nucleotide polymorphisms (SNPs) in predicting efficacy and toxicity of the combination regimen. Results From July 2013 to September 2016, 83 evaluable patients were enrolled. They received a median number of six cycles of treatment. An overall response rate (ORR) of 37.3% (31 patients) was observed, with a complete response rate of 2.4% and a partial response rate of 34.9%; the clinical benefit rate was 48.8%. With a median follow-up of 28.8 months, the median response duration was 6.6 months, the median progression-free survival (PFS) was 5.1 months, and the median overall survival (OS) was 14.5 months. The most common grade 3-4 adverse events were aminotransferase elevation (in 25% of the patients) and neutropenia (in 23.8%). Women with BRCA1/2 pathogenic variants were associated with worse ORR, PFS, and OS than BRCA1/2 wild-type carriers. CYP3A4 and FGD4 SNPs were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS. Conclusions The combination of eribulin and gemcitabine showed promising activity and a moderate toxicity profile in metastatic TNBC. BRCA status and pharmacogenetics tests may help identify patients with high probability of response with negligible toxicity. EudraCT number 2012-003505-10. Eribulin plus gemcitabine showed a remarkable best ORR of 37.3% and a clinical benefit rate of 48.8%. The most common grade 3/4 toxicities were liver toxicity and neutropenia without febrile neutropenia. The study regimen partially lost its efficacy in patients harboring BRCA1/2 pathogenic variants. SNPs in CYP3A4 and FGD4 genes were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS.
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Affiliation(s)
- B Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Cavanna
- Hospital of Piacenza, Piacenza, Italy
| | - D Boggiani
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Frassoldati
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Schirone
- Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Caldara
- Medical Oncology Unit, Ospedale Santa Chiara, Trento, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - S Gori
- Sacro Cuore-Don Calabria Hospital, Negrar (VR), Italy
| | - F Piacentini
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | - R Berardi
- Ancona University Hospital, Ancona, Italy
| | - A A Brandes
- Department of Medical Oncology, Azienda USL, Bologna, Italy
| | | | - F Villa
- Hospital of Lecco, Lecco, Italy
| | - R Todeschini
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - M Tognetto
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - N Naldi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - B Bortesi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - F Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - A Ardizzoni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - L Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
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23
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Kalinsky K, Diamond JR, Vahdat LT, Tolaney SM, Juric D, O'Shaughnessy J, Moroose RL, Mayer IA, Abramson VG, Goldenberg DM, Sharkey RM, Maliakal P, Hong Q, Goswami T, Wegener WA, Bardia A. Sacituzumab govitecan in previously treated hormone receptor-positive/HER2-negative metastatic breast cancer: final results from a phase I/II, single-arm, basket trial. Ann Oncol 2020; 31:1709-1718. [PMID: 32946924 DOI: 10.1016/j.annonc.2020.09.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Trophoblast cell-surface antigen-2 (Trop-2) is expressed in epithelial cancers, including hormone receptor-positive (HR+) metastatic breast cancer (mBC). Sacituzumab govitecan (SG; Trodelvy®) is an antibody-drug conjugate composed of a humanized anti-Trop-2 monoclonal antibody coupled to SN-38 at a high drug-to-antibody ratio via a unique hydrolyzable linker that delivers SN-38 intracellularly and in the tumor microenvironment. SG was granted accelerated FDA approval for metastatic triple-negative BC treatment in April 2020. PATIENTS AND METHODS We analyzed a prespecified subpopulation of patients with HR+/human epidermal growth factor receptor 2-negative (HER2-) HR+/HER2- mBC from the phase I/II, single-arm trial (NCT01631552), who received intravenous SG (10 mg/kg) and whose disease progressed on endocrine-based therapy and at least one prior chemotherapy for mBC. End points included objective response rate (ORR; RECIST version 1.1) assessed locally, duration of response (DOR), clinical benefit rate, progression-free survival (PFS), overall survival (OS), and safety. RESULTS Fifty-four women were enrolled between 13 February 2015 and 1 June 2017. Median (range) age was 54 (33-79) years and all received at least two prior lines of therapy for mBC. At data cut-off (1 March 2019), 12 patients were still alive. Key grade ≥3 treatment-related toxicities included neutropenia (50.0%), anemia (11.1%), and diarrhea (7.4%). Two patients discontinued treatment due to treatment-related adverse events. No treatment-related deaths occurred. At a median follow-up of 11.5 months, the ORR was 31.5% [95% confidence interval (CI), 19.5%-45.6%; 17 partial responses]; median DOR was 8.7 months (95% CI 3.7-12.7), median PFS was 5.5 months (95% CI 3.6-7.6), and median OS was 12 months (95% CI 9.0-18.2). CONCLUSIONS SG shows encouraging activity in patients with pretreated HR+/HER2- mBC and a predictable, manageable safety profile. Further evaluation in a randomized phase III trial (TROPiCS-02) is ongoing (NCT03901339). TRIAL REGISTRATION ClinicalTrials.gov NCT01631552; https://clinicaltrials.gov/ct2/show/NCT01631552.
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Affiliation(s)
- K Kalinsky
- Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center-Herbert Irving Comprehensive Cancer Center, New York, USA.
| | - J R Diamond
- Department of Medicine, Medical Oncology, University of Colorado Cancer Center, Aurora, USA
| | - L T Vahdat
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - S M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - D Juric
- Department of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - J O'Shaughnessy
- Department of Medical Oncology, Texas Oncology, Baylor University Medical Center, US Oncology, Dallas, USA
| | - R L Moroose
- Department of Hematology/Oncology, Orlando Health UF Health Cancer Center, Orlando, USA
| | - I A Mayer
- Department of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - V G Abramson
- Department of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - D M Goldenberg
- Clinical Development, Immunomedics, Inc., Morris Plains, USA
| | - R M Sharkey
- Clinical Development, Immunomedics, Inc., Morris Plains, USA
| | - P Maliakal
- Clinical Development, Immunomedics, Inc., Morris Plains, USA
| | - Q Hong
- Clinical Development, Immunomedics, Inc., Morris Plains, USA
| | - T Goswami
- Clinical Development, Immunomedics, Inc., Morris Plains, USA
| | - W A Wegener
- Clinical Development, Immunomedics, Inc., Morris Plains, USA
| | - A Bardia
- Department of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
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Khan KA, Ponce de Léon JL, Benguigui M, Xu P, Chow A, Cruz-Muñoz W, Man S, Shaked Y, Kerbel RS. Immunostimulatory and anti-tumor metronomic cyclophosphamide regimens assessed in primary orthotopic and metastatic murine breast cancer. NPJ Breast Cancer 2020; 6:29. [PMID: 32704531 PMCID: PMC7371860 DOI: 10.1038/s41523-020-0171-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022] Open
Abstract
The impressive successes of immune checkpoint blockade antibodies to treat various types of cancer are limited to minor subsets of patients. Combination therapy strategies, including with chemotherapy, are being explored to possibly improve the efficacy of immunotherapies. Here we report results regarding the use of an immunostimulatory regimen of metronomic cyclophosphamide (CTX). We show that in orthotopic models of syngeneic murine triple-negative breast cancer (EMT6), CTX administered at 140 mg/kg every 6 days (CTX140 1q6d) is superior at inhibiting primary tumor growth when compared to maximum tolerated dose or daily oral (continuous) low-dose CTX. In SCID or SCID beige mice, anti-tumor effects of CTX140 1q6d are reduced, reinforcing the therapeutic contribution of the adaptive and innate immune systems. In a second breast cancer model (SP1-AC2M2), CTX140 1q6d again showed clear superiority in anti-tumor effects, causing complete tumor regressions; however, these mice were not protected from subsequent tumor re-challenge, suggesting absence of immune memory. We also show that in an aggressive and metastatic cisplatin-resistant variant (EMT6-CDDP), CTX140 1q6d is superior and invokes an influx of intra-tumoral CD4+ and CD8+ T cells. CTX increases expression of tumor cell PD-L1; however, when combined with concomitant PD-L1 antibody therapy none of the CTX regimens showed increased benefit. This work sheds light on the potential use of metronomic CTX for the treatment of breast cancer, in particular using the quasi-weekly regimen, but also underscores the complexity of the anti-tumor mechanisms and potential to improve immune checkpoint therapy efficacy.
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Affiliation(s)
- Kabir A. Khan
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | | | - Madeleine Benguigui
- Cell Biology and Cancer Science, Rappaport Faculty of Medicine, Technion, Haifa Israel
| | - Ping Xu
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Annabelle Chow
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - William Cruz-Muñoz
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Shan Man
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Yuval Shaked
- Cell Biology and Cancer Science, Rappaport Faculty of Medicine, Technion, Haifa Israel
| | - Robert S. Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
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25
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Caparica R, De Angelis C, Fêde Â, Werutsky G, de Azambuja E. Metronomic chemotherapy combined with endocrine therapy: are we challenging some dogmas? Expert Rev Anticancer Ther 2020; 20:563-573. [PMID: 32536212 DOI: 10.1080/14737140.2020.1782200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Metronomic chemotherapy exerts its effects via inhibition of angiogenesis, immune modulation of the tumoral stroma, induction of senescence and apoptosis of tumor cells. Due to its favorable toxicity profile and its oral administration, metronomic chemotherapy arises as a promising alternative to be combined with endocrine therapy for the treatment of patients with luminal breast cancer. AREAS COVERED The present manuscript reviews the rationale supporting the combination of metronomic chemotherapy and endocrine therapy, discussing the studies that evaluated this regimen in the treatment of early-stage and metastatic breast cancer patients. Finally, we conclude by providing an expert opinion on the current role and perspectives for the combination of metronomic chemotherapy and endocrine therapy in the management of patients with luminal breast cancer. EXPERT OPINION Retrospective series and early-phase clinical trials have shown promising signs of activity and a favorable toxicity profile with this regimen, which warrants further investigation as a treatment option for luminal breast cancer patients.
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Affiliation(s)
- Rafael Caparica
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.) , Brussels, Belgium
| | - Claudia De Angelis
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.) , Brussels, Belgium.,Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana , Pisa, Italy
| | - Ângelo Fêde
- Medical Oncology department, AC Camargo Cancer Center , Sao Paulo, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG) , Porto Alegre, Brazil
| | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.) , Brussels, Belgium
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26
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Metronomic chemotherapy for patients with metastatic breast cancer: Review of effectiveness and potential use during pandemics. Cancer Treat Rev 2020; 89:102066. [PMID: 32769038 DOI: 10.1016/j.ctrv.2020.102066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
Metronomic chemotherapy (M-CT) is defined as dose dense administration of chemotherapy at lower doses than maximum tolerated dose but at shorter free intervals, to obtain a near continuous exposure of cancer cells to those potentially effective drugs. M-CT is a useful strategy to obtain response, overcome resistance and reduce side effects, with low costs. This review will focus on the use of M-CT in advanced breast cancer (ABC). Cytostatic and cytotoxic effect on cancer cells, the anti-angiogenic and the immunomodulatory effects are its main mechanisms of actions. Many clinical trials proved the efficacy and tolerability of different monotherapies and combinations of chemotherapeutic agents administered in metronomic doses and frequencies in ABC. M-CT is a reasonable option for second and later lines of chemotherapy in metastatic breast cancer including those with prior anthracycline or taxane exposure, older patients and patients with comorbidities, and even as first-line in certain groups of patients. The acceptable efficacy and low toxicity of oral metronomic chemotherapy makes it a reasonable option during COVID-19 pandemic as well as in the post-COVID era which is projected to last for some time.
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27
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Low-dose metronomic chemotherapy as an efficient treatment option in metastatic breast cancer-results of an exploratory case-control study. Breast Cancer Res Treat 2020; 182:389-399. [PMID: 32495001 PMCID: PMC7297707 DOI: 10.1007/s10549-020-05711-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/26/2020] [Indexed: 12/23/2022]
Abstract
Purpose There is growing interest in low-dose metronomic chemotherapy (LDMC) in metastatic breast cancer (MBC). In this retrospective case–control analysis, we compared the efficacy of LDMC and conventional chemotherapy (CCT) in MBC. Methods Each LDMC patient receiving oral cyclophosphamide (CTX) (50 mg daily) and methotrexate (MTX) (2.5 mg every other day) was matched with two controls who received CCT. Age, number of chemotherapy lines and metastatic sites as well as hormone receptor (HR) status were considered as matching criteria. Primary endpoint was disease control rate longer than 24 weeks (DCR). Secondary endpoints were progression-free survival (PFS), duration of response (DoR) and subgroup analyses using the matching criteria. Results 40 cases and 80 controls entered the study. 30.0% patients with LDMC and 22.5% patients with CCT showed DCR (p = 0.380). The median PFS was 12.0 weeks in both groups (p = 0.218) and the median DoR was 31.0 vs. 20.5 weeks (p = 0.383), respectively. Among younger patients, DCR was 40.0% in LDMC vs. 25.0% in the CCT group (p = 0.249). DCR was achieved in 33.3% vs. 26.2% non-heavily pretreated patients (p = 0.568) and in 36.0% vs. 18.0% patients without multiple metastases (p = 0.096), respectively. In the HR-positive group, 30.0% LDMC vs. 28.3% CCT patients showed DCR (p = 1.000). Among triple-negative patients, DCR was achieved in 30.0% LDMC and 5.0% CCT patients (p = 0.095). Conclusions We demonstrated a similar efficacy of LDMC compared to CCT in the treatment of MBC. Thus, LDMC may be a valuable treatment option in selected MBC patients.
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28
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Untch M, Würstlein R, Lüftner D, Haidinger R, Fasching PA, Augustin D, Briest S, Ettl J, Förster F, Kurbacher CM, Lück HJ, Marschner N, Müller L, Müller V, Radke I, Ruckhäberle E, Scheffen I, Schumacher-Wulf E, Schwoerer M, Steinfeld-Birg D, Ziegler-Löhr K, Thomssen C, Harbeck N. ABC5 International Consensus Conference on Advanced Breast Cancer, Lisbon, 16 November 2019: Commentary by the German panel of experts on the ABC5 voting results. Geburtshilfe Frauenheilkd 2020; 80:588-600. [PMID: 32565549 PMCID: PMC7299684 DOI: 10.1055/a-1139-9380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022] Open
Abstract
The Advanced Breast Cancer Fifth International Consensus Conference (ABC5) which focuses on the diagnosis and treatment of advanced breast cancer was held in Lisbon on November 14 - 16, 2019. The aim of the conference is to standardize the treatment of advanced breast cancer worldwide using evidence-based data and to ensure that patients with advanced breast disease anywhere in the world are treated appropriately and have access to the latest therapies. This year, the emphasis was on new developments and study results from patients with advanced breast cancer as well as precision medicine. The collaboration with patient advocates from all over the globe is also an important goal of the ABC Conference, which is why the international ABC panel also included a number of patient advocates. We present a commentary on the voting results of the ABC5 panelists in Lisbon by a working group of German breast cancer specialists together with the implications for routine clinical care in Germany. The commentary is based on the recommendations of the Breast Commission of the German Gynecological Oncology Working Group (AGO). This commentary is useful, it includes country-specific features for the ABC consensus.
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Affiliation(s)
- Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Brustzentrum und Gynäkologisch Onkologisches Zentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Rachel Würstlein
- Brustzentrum und Comprehensive Cancer Center (CCC) München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München (LMU), München, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Peter A. Fasching
- Universitätsfrauenklinik Erlangen, Comprehensive Cancer Center (CCC) Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Doris Augustin
- Mammazentrum Ostbayern, DONAUISAR Klinikum Deggendorf, Deggendorf, Germany
| | - Susanne Briest
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Johannes Ettl
- Frauenklinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum rechts der Isar, München, Germany
| | - Frank Förster
- Praxis für Gynäkologie und Geburtshilfe, Gynäkologische Onkologie und Palliativmedizin, Poliklinik gGmbH, Chemnitz, Germany
| | - Christian M. Kurbacher
- Gynäkologie I (Gynäkologische Onkologie), Gynäkologisches Zentrum, Bonn-Friedensplatz, Bonn, Germany
| | | | - Norbert Marschner
- Gemeinschaftspraxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - Lothar Müller
- Onkologische Schwerpunktpraxis Leer-Emden-Papenburg, Leer, Emden, Papenburg, Germany
| | - Volkmar Müller
- Universitätsfrauenklinik Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Radke
- Brustzentrum, Universitätsklinikum Münster, Münster, Germany
| | | | - Iris Scheffen
- Brustzentrum am St. Elisabeth-Krankenhaus GmbH, Köln, Germany
| | | | - Moritz Schwoerer
- Frauenklinik, Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Germany
| | | | | | - Christoph Thomssen
- Universitätsklinik und Poliklinik für Gynäkologie, Martin-Luther-Universität, Halle an der Saale; ABC panel member, ABC scientific committee member, Germany
| | - Nadia Harbeck
- Brustzentrum und Comprehensive Cancer Center (CCC) München, Universität München (LMU), München; ABC panel member, Germany
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29
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Lu Q, Lee K, Xu F, Xia W, Zheng Q, Hong R, Jiang K, Zhai Q, Li Y, Shi Y, Yuan Z, Wang S. Metronomic chemotherapy of cyclophosphamide plus methotrexate for advanced breast cancer: Real-world data analyses and experience of one center. Cancer Commun (Lond) 2020; 40:222-233. [PMID: 32390331 PMCID: PMC7238669 DOI: 10.1002/cac2.12029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/02/2020] [Accepted: 04/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background Real‐world data of the CM regimen [cyclophosphamide (CTX) plus methotrexate (MTX)] in metronomic pattern for advanced breast cancer is limited to small‐sample or retrospective studies. This study was aimed to determine the effectiveness and safety of CM regimen in treating advanced breast cancer and to identify which patients are most likely to benefit from metronomic CM regimen. Methods Patients with advanced breast cancer who received the metronomic CM regimen at least once between January 2009 and February 2019 in Sun Yat‐sen University Cancer Center were included. Clinicopathological characteristics were collected. Overall survival (OS) and progression‐free survival (PFS) were assessed using Kaplan‐Meier estimates. Characteristics between patients with PFS < 6 months and ≥6 months were compared using the Chi‐square test. Univariate and multivariate Cox regression model was used to estimate the prognostic factors for PFS and OS. Results A total of 186 patients were included. The median age and follow‐up were 49 years and 13.3 months, respectively. Over 50% of the patients were estrogen receptor/progesterone receptor‐positive, and 60.8% had been heavily treated (≥3 lines). The objective response rate was 3.8%, the disease control rate at 12 weeks was 41.4%, and the clinical benefit rate at 24 weeks was 31.2% (58/186). The median PFS was 4.0 months [95% confidence interval (CI): 3.6‐4.7 months], the median duration of clinical benefit was 9.5 months (95% CI: 8.2‐10.8 months), and the median OS was 26.8 months (95% CI: 20.9‐37.7 months). Multivariate analysis for PFS revealed the CM regimen as maintenance therapy and no liver metastasis as favorable prognostic factors. Furthermore, patients without liver metastasis were more likely to have a PFS over 6 months than those with liver involvement (P = 0.022). Liver, lymph node, and brain metastases were unfavorable prognostic factors for OS. The CM regimen was well‐tolerated without newly reported adverse events. Conclusions The CM regimen was effective in selected patients. In clinical practice, it would be better used as maintenance therapy and in patients without liver metastasis. Further follow‐up investigation should be performed to examine its effect when used in combination with other treatments and determine predictive biomarkers.
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Affiliation(s)
- Qianyi Lu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Kaping Lee
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Fei Xu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Wen Xia
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Qiufan Zheng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Ruoxi Hong
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Kuikui Jiang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Qinglian Zhai
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Yuan Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Yanxia Shi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Zhongyu Yuan
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Shusen Wang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
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30
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Rugo HS, Bardia A, Tolaney SM, Arteaga C, Cortes J, Sohn J, Marmé F, Hong Q, Delaney RJ, Hafeez A, André F, Schmid P. TROPiCS-02: A Phase III study investigating sacituzumab govitecan in the treatment of HR+/HER2- metastatic breast cancer. Future Oncol 2020; 16:705-715. [PMID: 32223649 DOI: 10.2217/fon-2020-0163] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patients with HR+/HER2- metastatic breast cancer (MBC) whose cancers have progressed despite conventional therapies represent an unmet clinical need. Trop-2, a transmembrane calcium signal transducer, is highly expressed in MBC and plays a role in tumor growth and progression. Sacituzumab govitecan (SG) is a novel antibody-drug conjugate comprising an Trop-2 antibody coupled to SN-38, the active metabolite of irinotecan, via a unique hydrolyzable linker. SG has demonstrated promising activity in a Phase I/II IMMU-132-01 basket study in heavily pretreated solid tumors, including HR+/HER2- MBC. We describe the registrational Phase III TROPiCS-02 study (NCT03901339), evaluating SG versus treatment of physician's choice in HR+/HER2- MBC. Trial registration number: NCT03901339.
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Affiliation(s)
- Hope S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94115, USA
| | - Aditya Bardia
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sara M Tolaney
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Carlos Arteaga
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Javier Cortes
- Medical Oncology Department, IOB Institute of Oncology, Quirosalud Group, Madrid & Barcelona, Spain and Senior clinical Researcher, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University, University Hospital Mannheim, Germany
| | - Quan Hong
- Immunomedics, Morris Plains, NJ 07950, USA
| | | | | | - Fabrice André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, UK
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31
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Thomssen C, Lüftner D, Untch M, Haidinger R, Würstlein R, Harbeck N, Augustin D, Briest S, Ettl J, Fasching PA, Förster F, Kurbacher CM, Lück HJ, Marschner N, Müller L, Müller V, Perlova-Griff L, Radke I, Ruckhäberle E, Scheffen I, Schumacher-Wulf E, Schwoerer M, Steinfeld-Birg D, Ziegler-Löhr K. International Consensus Conference for Advanced Breast Cancer, Lisbon 2019: ABC5 Consensus - Assessment by a German Group of Experts. Breast Care (Basel) 2020; 15:82-95. [PMID: 32231503 PMCID: PMC7098316 DOI: 10.1159/000505957] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
Abstract
The 5th International Consensus Conference for Advanced Breast Cancer (ABC5) took place on November 14-16, 2019, in Lisbon, Portugal. Its aim is to standardize the treatment of advanced breast cancer based on the available evidence and to ensure that all breast cancer patients worldwide receive adequate treatment and access to new therapies. This year, the conference focused on developments and study results in the treatment of patients with hormone receptor-positive/HER2-negative breast cancer as well as precision medicine. As in previous years, patient advocates from around the world were integrated into the ABC conference and had seats on the ABC consensus panel. In the present paper, a working group of German breast cancer experts comments on the results of the on-site ABC5 consensus votes by ABC panelists regarding their applicability for routine treatment in Germany. These comments take the recommendations of the Breast Committee of the Gynecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie; AGO) into account. The report and assessment presented here pertain to the preliminary results of the ABC5 consensus. The final version of the statements will be published in Annals of Oncology and The Breast.
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Affiliation(s)
- Christoph Thomssen
- Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle an der Saale, Germany
| | - Diana Lüftner
- Medical Department of Hematology, Oncology, and Tumor Immunology, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Untch
- Clinic of Gynecology and Obstetrics, Multidisciplinary Breast Cancer Center, Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Renate Haidinger
- Brustkrebs Deutschland (German Breast Cancer Association) e.V., Hohenbrunn, Germany
| | - Rachel Würstlein
- Breast Center and Comprehensive Cancer Center (CCC) Munich, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany
| | - Nadia Harbeck
- Breast Center and Comprehensive Cancer Center (CCC) Munich, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany
| | - Doris Augustin
- Breast Center of Eastern Bavaria, DONAUISAR Hospital of Deggendorf, Deggendorf, Germany
| | - Susanne Briest
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Ettl
- Department of Gynecology and Obstetrics, University Hospital Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Women's Hospital at the University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Frank Förster
- Practice for Gynecology and Obstetrics, Gynecological Oncology and Palliative Care, Poliklinik gGmbH, Chemnitz, Germany
| | - Christian M. Kurbacher
- Practice − Gynecology I (Gynecologic Oncology), Gynecologic Center Bonn-Friedensplatz, Bonn, Germany
| | | | - Norbert Marschner
- Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany
| | - Lothar Müller
- Oncology Specialist Practice of Leer-Emden-Papenburg, Leer-Emden-Papenburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital, Hamburg-Eppendorf, Germany
| | - Lidia Perlova-Griff
- Gynecological Oncology of Wilmersdorf, Treatment Center II of the St. Gertrude Hospital, Berlin, Germany
| | - Isabel Radke
- Breast Center, University Hospital of Münster, Münster, Germany
| | - Eugen Ruckhäberle
- Department of Obstetrics and Gynecology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Iris Scheffen
- Breast Center at St. Elisabeth Hospital, Cologne, Germany
| | | | - Moritz Schwoerer
- Department of Gynecology, Hospital Fürstenfeldbruck, Fürstenfeldbruck, Germany
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Dhanushkodi M, Raj H. Chemotherapy and Hormone Refractory Advanced Breast Cancer: Excellent Response to Oral Etoposide. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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