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Lamarca A, Ronot M, Moalla S, Crona J, Opalinska M, Lopez Lopez C, Pezzutti D, Najran P, Carvhalo L, Bezerra ROF, Borg P, Vietti Violi N, Vidal Trueba H, de Mestier L, Scaefer N, Baudin E, Sundin A, Costa F, Pavel M, Dromain C. Tumor Growth Rate as a Validated Early Radiological Biomarker Able to Reflect Treatment-Induced Changes in Neuroendocrine Tumors: The GREPONET-2 Study. Clin Cancer Res 2019; 25:6692-6699. [PMID: 31375514 DOI: 10.1158/1078-0432.ccr-19-0963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/23/2019] [Accepted: 07/30/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Tumor growth rate (TGR) represents the percentage change in tumor volume per month (%/m). Previous results from the GREPONET study showed that TGR measured after 3 months (TGR3m) of starting systemic treatment (ST) or watch and wait (WW) was an early biomarker predicting progression-free survival (PFS) in neuroendocrine tumors (NET). EXPERIMENTAL DESIGN Patients from 7 centers with advanced grade (G) 1/2 NETs from the pancreas (P)/small bowel (SB) initiating ST/WW were eligible. Computed tomography (CT)/MRI performed at prebaseline, baseline, and 3(±1) months of study entry were retrospectively reviewed. Aim-1: explore treatment-induced changes in TGR (ΔTGR3m-BL; paired T test), and Aim-2: validate TGR3m (<0.8%/m vs. ≥0.8%/m) as an early biomarker in an independent cohort (Kaplan-Meier/Cox regression). RESULTS Of 785 patients screened, 127 were eligible. Mean (SD) TGR0 and TGR3m were 5.4%/m (14.9) and -1.4%/m (11.8), respectively. Mean (SD) ΔTGR3m-BL paired-difference was -6.8%/m (19.3; P < 0.001). Most marked ΔTGR3m-BL [mean (SD)] were identified with targeted therapies [-11.3%/m (4.7); P = 0.0237] and chemotherapy [-7.9%/m (3.4); P = 0.0261]. Multivariable analysis confirmed the absence of previous treatment (OR = 4.65; 95% CI, 1.31-16.52; P = 0.018) and low TGR3m (continuous variable; OR 1.09; 95% CI, 1.01-1.19; P = 0.042) to be independent predictors of radiologic objective response. When the multivariable survival analysis for PFS (Cox regression) was adjusted to grade (P = 0.004) and stage (P = 0.017), TGR3m ≥ 0.8 (vs. <0.8) maintained its significance as a prognostic factor (P < 0.001), whereas TGR0 and ΔTGR3m-BL did not. TGR3m ≥ 0.8%/m was confirmed as an independent prognostic factor for PFS [external validation; Aim-2; multivariable HR 2.21 (95% CI, 1.21-3.70; P = 0.003)]. CONCLUSIONS TGR has a role as a biomarker for monitoring response to therapy for early identification of treatment-induced changes and for early prediction of PFS and radiologic objective response.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Maxime Ronot
- Department of Radiology, Beaujon University Hospital, Clichy, France
| | - Salma Moalla
- Department of Radiology, Institute Gustave Roussy, Paris, France
| | - Joakim Crona
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Marta Opalinska
- Nuclear Medicine Unit, Department of Endocrinology, University Hospital, Krakow, Poland
| | - Carlos Lopez Lopez
- Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Daniela Pezzutti
- Department of Radiology, Israelita Albert Einstein Hospital, São Paulo, Brazil
| | - Pavan Najran
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Luciana Carvhalo
- Department of Medical Oncology, Sirio-Libanes Hospital, São Paulo, Brazil
| | - Regis Otaviano Franca Bezerra
- Department of Radiology, Sirio-Libanes Hospital, São Paulo, Brazil and São Paulo Cancer Institute Octavio Frias de Oliveira (ICESP), São Paulo, Brazil
| | - Philip Borg
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Naik Vietti Violi
- Department of Radiology, CHUV University Hospital, Lausanne, Switzerland
| | - Hector Vidal Trueba
- Department of Radiology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Louis de Mestier
- Department of Gastroenterology, Beujon University Hospital, Clichy, France
| | - Niklaus Scaefer
- Department of Medical Oncology, CHUV University Hospital, Lausanne, Switzerland
| | - Eric Baudin
- Department of Nuclear Medicine, Institute Gustave Roussy, Paris, France
| | - Anders Sundin
- Department of Radiology, Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Frederico Costa
- Department of Medical Oncology; Sirio-Libanes Hospital, São Paulo, Brazil
| | - Marianne Pavel
- Department of Endocrinology, Universitatsklinikum Erlangen, Erlangen, Germany
| | - Clarisse Dromain
- Department of Radiology, CHUV University Hospital, Lausanne, Switzerland
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Reck M, Mellemgaard A, Novello S, Postmus PE, Gaschler-Markefski B, Kaiser R, Buchner H. Change in non-small-cell lung cancer tumor size in patients treated with nintedanib plus docetaxel: analyses from the Phase III LUME-Lung 1 study. Onco Targets Ther 2018; 11:4573-4582. [PMID: 30122949 PMCID: PMC6084077 DOI: 10.2147/ott.s170722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Nintedanib in combination with docetaxel is approved in the European Union and other countries for the treatment of patients with advanced non-small-cell lung cancer (NSCLC) of adenocarcinoma histology after first-line chemotherapy, based on the overall survival findings of Phase III LUME-Lung 1 study. Change in target lesion size over time as a treatment effect was assessed in patients from this study. Methods Tumor size was evaluated using predefined tumor measurements. Mixed-effects models were used to quantify individual relationships between time from randomization and tumor burden, measured as the sum of longest diameter (SLD) of target lesions and assessed by an independent review (Response Evaluation Criteria In Solid Tumors [RECIST] v1.0). Exploratory analyses were conducted on the overall adenocarcinoma population, adenocarcinoma patients with time from start of first-line therapy <9 months (TSFLT <9), adenocarcinoma patients who had progressive disease as best response to first-line therapy (PD-FLT), and in squamous cell carcinoma patients. Results Estimated mean baseline SLD was 82.5 mm in the adenocarcinoma (n=658), 88.3 mm in the TSFLT <9 (n=405), 98.1 mm in the PD-FLT (n=117), and 94.3 mm in the squamous cell carcinoma (n=555) populations. Treatment with nintedanib/docetaxel showed a significant reduction in tumor size over time (P<0.0001) in patients with adenocarcinoma compared with placebo/docetaxel, and in patients with squamous cell carcinoma (P=0.0049). Treatment difference at 6 months was 9.7 mm in the overall adenocarcinoma population, 16.8 mm in the TSFLT <9 population, 19.7 mm in the PD-FLT population, and 6.8 mm in the squamous cell carcinoma population. SLD at 2 months post-randomization was identified as a surrogate endpoint for overall survival, in addition to progression-free survival, for all except the PD-FLT population. Conclusion Treatment with nintedanib/docetaxel significantly decreased tumor burden and decelerated tumor size over time compared with placebo/docetaxel in the overall adenocar-cinoma population, including in patients with the poorest prognosis due to aggressive tumor dynamics.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany,
| | - Anders Mellemgaard
- Department of Internal Medicine and Oncology, Bornholms Hospital, Ronne, Denmark
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Hospital, Torino, Italy
| | | | | | - Rolf Kaiser
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany.,Institute of Pharmacology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Dillon PM, Petroni GR, Horton BJ, Moskaluk CA, Fracasso PM, Douvas MG, Varhegyi N, Zaja-Milatovic S, Thomas CY. A Phase II Study of Dovitinib in Patients with Recurrent or Metastatic Adenoid Cystic Carcinoma. Clin Cancer Res 2017; 23:4138-4145. [PMID: 28377480 PMCID: PMC5540767 DOI: 10.1158/1078-0432.ccr-16-2942] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/28/2016] [Accepted: 03/30/2017] [Indexed: 12/20/2022]
Abstract
Purpose: Genetic and preclinical studies have implicated FGFR signaling in the pathogenesis of adenoid cystic carcinoma (ACC). Dovitinib, a suppressor of FGFR activity, may be active in ACC.Experimental Design: In a two-stage phase II study, 35 patients with progressive ACC were treated with dovitinib 500 mg orally for 5 of 7 days continuously. The primary endpoints were objective response rate and change in tumor growth rate. Progression-free survival, overall survival, metabolic response, biomarker, and quality of life were secondary endpoints.Results: Of 34 evaluable patients, 2 (6%) had a partial response and 22 (65%) had stable disease >4 months. Median PFS was 8.2 months and OS was 20.6 months. The slope of the overall TGR fell from 1.95 to 0.63 on treatment (P < 0.001). Toxicity was moderate; 63% of patients developed grade 3-4 toxicity, 94% required dose modifications, and 21% stopped treatment early. An early metabolic response based on 18FDG-PET scans was seen in 3 of 15 patients but did not correlate with RECIST response. MYB gene translocation was observed and significantly correlated with overexpression of MYB but did not correlate with FGFR1 phosphorylation or clinical response to dovitinib.Conclusions: Dovitinib produced few objective responses in patients with ACC but did suppress the TGR with a PFS that compares favorably with those reported with other targeted agents. Future studies of more potent and selective FGFR inhibitors in biomarker-selected patients will be required to determine whether FGFR signaling is a valid therapeutic target in ACC. Clin Cancer Res; 23(15); 4138-45. ©2017 AACR.
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Affiliation(s)
- Patrick M Dillon
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia.
| | - Gina R Petroni
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Bethany J Horton
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | | | - Paula M Fracasso
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Michael G Douvas
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Nikole Varhegyi
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
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Grande E, Martínez-Sáez O, Gajate-Borau P, Alonso-Gordoa T. Translating new data to the daily practice in second line treatment of renal cell carcinoma: The role of tumor growth rate. World J Clin Oncol 2017; 8:100-105. [PMID: 28439491 PMCID: PMC5385431 DOI: 10.5306/wjco.v8.i2.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/26/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
The therapeutic options for patients with metastatic renal cell carcinoma (mRCC) have completely changed during the last ten years. With the sequential use of targeted therapies, median overall survival has increased in daily practice and now it is not uncommon to see patients surviving kidney cancer for more than four to five years. Once treatment fails with the first line targeted therapy, head to head comparisons have shown that cabozantinib, nivolumab and the combination of lenvatinib plus everolimus are more effective than everolimus alone and that axitinib is more active than sorafenib. Unfortunately, it is very unlikely that we will ever have prospective data comparing the activity of axitinib, cabozantinib, lenvatinib or nivolumab. It is frustrating to observe the lack of biomarkers that we have in this field, thus there is no firm recommendation about the optimal sequence of treatment in the second line. In the absence of reliable biomarkers, there are several clinical endpoints that can help physicians to make decisions for an individual patient, such as the tumor burden, the expected response rate and the time to achieve the response to each agent, the prior response to the agent administered, the toxicity profile of the different compounds and patient preference. Here, we propose the introduction of the tumor-growth rate (TGR) during first-line treatment as a new tool to be used to select the second line strategy in mRCC. The rapidness of TGR before the onset of the treatment reflects the variability between patients in terms of tumor growth kinetics and it could be a surrogate marker of tumor aggressiveness that may guide treatment decisions.
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