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Miolo G, Buonadonna A, Lombardi D, Scalone S, Lauretta A, Della Puppa L, Corona G. Trabectedin may be a valuable treatment option for elderly patients with metastatic soft tissue sarcomas. Front Oncol 2024; 14:1437732. [PMID: 39119092 PMCID: PMC11306058 DOI: 10.3389/fonc.2024.1437732] [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: 05/24/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Background In the landscape of metastatic soft tissue sarcoma (mSTS) treatment, anthracyclines have shown efficacy; however, their associated toxicity imposes significant limitations, especially in frail elderly patients with mSTS who are highly susceptible to severe adverse effects. In this context, trabectedin, due to its distinct pharmacological profile and safety profile, may represent an interesting alternative being demonstrated to be active in treating mSTS. These features hold particular significance for elderly and unfit patients with mSTS, where balancing treatment benefits with potential adverse effects represents the pivotal objective. Methods The investigation was focused on a specific group of 11 elderly patients with mSTS aged ≥70, all undergoing first-line treatment with trabectedin, and it was supported by comprehensive pharmacokinetic and pharmacodynamic studies. Among these patients, 9 out of 11 started the treatment at a dose of 1.5 mg/m2. Results The primary objective of this investigation is to highlight trabectedin as a valuable first-line treatment option for elderly and unfit patients with mSTS. Additionally, this investigation seeks to explore whether higher administered doses of trabectedin can enhance clinical outcomes while maintaining the same toxicity profiles. The median progression-free survival (PFS) was 77 days (95% CI, 53-89), the median overall survival (OS) was 397 days (95% CI, 66-2,102), while the overall toxicity of grade 3-4 severity amounted to 43%. Conclusion These findings provide new insights into the clinical outcomes and toxicity associated with trabectedin in an elderly patient population, enhancing our understanding of better treatment approaches for a specific population of patients with mSTS.
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Affiliation(s)
- Gianmaria Miolo
- Medical Oncology and Cancer Prevention Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Angela Buonadonna
- Medical Oncology and Cancer Prevention Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Davide Lombardi
- Medical Oncology and Cancer Prevention Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Simona Scalone
- Medical Oncology and Cancer Prevention Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Andrea Lauretta
- Unit of General Oncologic Surgery, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Lara Della Puppa
- Oncogenetics and Functional Oncogenomics Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Giuseppe Corona
- Immunopathology and Cancer Biomarkers Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
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2
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Marquez L, Raheja R, Chan-Liston M, Marcinak J, Estilo A, Pineda Salgado L, Jiang J, Chang C, Beninger P. Industry Review of Best Practices for Risk Management of Drug-Induced Liver Injury from Development to Real-World Use. Drug Saf 2024; 47:1-22. [PMID: 37874451 DOI: 10.1007/s40264-023-01360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/25/2023]
Abstract
The relative treatment benefit of a drug for patients during development, marketing authorization review, or after approval includes an assessment of the risk of drug-induced liver injury (DILI). In this article, the Pharmacovigilance and Risk Mitigation Working Group of the IQ-DILI Initiative launched in June 2016 within the International Consortium for Innovation and Quality in Pharmaceutical Development presents and reviews three key topics for essential risk management activities to identify, characterize, monitor, mitigate, and communicate DILI risk associated with small molecules during drug development. The three topics are: (1) Current best practices for characterizing the DILI phenotype and the severity and incidence of DILI in the treatment population, including DILI identification, prediction and recovery. (2) Characterization of the relative treatment benefit for patients who will be exposed to a drug and the attendant risk of DILI in conjunction with existing global risk mitigation strategies. (3) Implementation of risk mitigation strategies during drug development highlighting patient factors, healthcare settings and site of product administration, and prescriber and healthcare provider factors. Industry guidance is provided for assessing whether the product labeling is sufficient to minimize the risk of DILI or whether a United States Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) or European Medicines Agency (EMA) Risk Management Plan (RMP) with additional Risk Minimization Measures (aRMM) is needed.
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Affiliation(s)
- Loreta Marquez
- Janssen Research and Development, LLC, Raritan, NJ, USA.
| | | | | | | | - Alvin Estilo
- Otsuka Pharmaceutical Development, Inc. (OPDC), Princeton, NJ, USA
| | | | - Jason Jiang
- Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | | | - Paul Beninger
- Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
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3
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Gadducci A, Cosio S. Trabectedin and lurbinectedin: Mechanisms of action, clinical impact, and future perspectives in uterine and soft tissue sarcoma, ovarian carcinoma, and endometrial carcinoma. Front Oncol 2022; 12:914342. [PMID: 36408147 PMCID: PMC9671549 DOI: 10.3389/fonc.2022.914342] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
The ecteinascidins trabectedin and lurbinectedin are very interesting antineoplastic agents, with a favorable toxicity profile and peculiar mechanisms of action. These drugs form adducts in the minor groove of DNA, which produce single-strand breaks (SSBs) and double-strand breaks (DSBs) and trigger a series of events resulting in cell cycle arrest and apoptosis. Moreover, the ecteinascidins interact with the tumor microenvironment, reduce the number of tumor-associated macrophages, and inhibit the secretion of cytokines and chemokines. Trabectedin has been approved by the Federal Drug Administration (FDA) for patients with unresectable or metastatic liposarcoma or leiomyosarcoma who received a prior anthracycline-based regimen. Moreover, trabectedin in combination with pegylated liposomal doxorubicin (PLD) has been approved in the European Union for the treatment of platinum-sensitive recurrent ovarian cancer. Lurbinectedin has been approved by the FDA for patients with metastatic small cell lung cancer with disease progression on or after platinum-based chemotherapy. The review assesses in vitro and in vivo experimental studies on the antineoplastic effects of both ecteinascidins as well as the clinical trials on the activity of trabectedin in uterine sarcoma and ovarian carcinoma and of lurbinectedin in ovarian carcinoma and endometrial carcinoma.
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4
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Grignani G, Le Cesne A, Martín-Broto J. Trabectedin as second-line treatment in advanced soft tissue sarcoma: quality of life and safety outcomes. Future Oncol 2022; 18:13-22. [PMID: 36200954 DOI: 10.2217/fon-2022-0518] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The choice of second- and later-line options for advanced soft tissue sarcoma (aSTS) should always be considered from the patient's perspective, taking into account the potential impact of treatment on daily activities and quality of life. This review examines data on the safety of trabectedin in the management of patients with aSTS as reported in clinical trials and real-world studies. Evidence indicates that trabectedin exhibits an acceptable and manageable safety profile and is compatible with daily activities. Trabectedin is associated with low rates of toxicity-related discontinuations, few potentially life-threatening toxicities, a lack of apparent cumulative toxicities and low rates of grade 3/4 nausea, vomiting and fatigue. Trabectedin represents a valuable second-line option for aSTS, including in elderly patients.
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Affiliation(s)
- Giovanni Grignani
- Candiolo Cancer Institute, FPO-IRCCS, SP 142 Km 3.95, 10060 Candiolo, Italy
| | - Axel Le Cesne
- International Department of Medical Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Javier Martín-Broto
- Department of Medical Oncology, University Hospital Fundación Jimenez Diaz, 28040 Madrid, Spain.,University Hospital General de Villalba, 28400 Collado Villalba, Madrid, Spain.,Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), 28015 Madrid, Spain
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5
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Nakamura T, Sudo A. The Role of Trabectedin in Soft Tissue Sarcoma. Front Pharmacol 2022; 13:777872. [PMID: 35281940 PMCID: PMC8904719 DOI: 10.3389/fphar.2022.777872] [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: 09/16/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Systemic chemotherapy for advanced disease is another therapeutic option in the management of metastases in soft tissue sarcoma (STS). Doxorubicin either alone or in combination with ifosfamide has been used as first-line chemotherapy. Furthermore, in the past decade, new drugs have been shown to be effective in the treatment of advanced STS after the failure of first-line anthracycline-based chemotherapy: trabectedin, pazopanib and eribulin. However, the appropriate usage of these agents has not been established. Methods: We summarized clinical trials of trabectedin focusing on the efficacy and toxicity of trabectedin in the treatment of STS. Results: Trabectedin can be administered safely and effectively to the patients with advanced STS at second line setting or later. Although trabectedin may be effective as first-line treatment in selected patients, anthracycline-based chemotherapy should be recommended because no regimen in addition to trabectedin has proved to be unequivocally superior to doxorubicin as the first-line treatment for locally advanced or metastatic STS. Nucleotide excision repair (NER) and homologous recombination (HRe) repair may be of particular importance as efficacy of trabectedin. Conclusion: Trabectedin has shown a favorable toxicity profile and is an alternative therapeutic option in patients with advanced STS.
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Affiliation(s)
- Tomoki Nakamura
- Departmemt of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Departmemt of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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6
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Comandone A, Boglione A, Comandone T, Petrelli F. A Pharmacological Analysis of the Activity and Failure of the Medical Treatment of High-Grade Osteosarcoma. ACTA ACUST UNITED AC 2021; 57:medicina57020141. [PMID: 33562455 PMCID: PMC7915093 DOI: 10.3390/medicina57020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
Osteosarcomas (OSs) are a group of neoplasms originating from bone cells, usually presenting in three specific age groups: children, young adults, and the elderly. High-grade OS is an extremely malignant tumor mainly due to evolution into metastatic disease, usually in the lungs. Survival of these patients has improved since the 1980s thanks to close cooperation between oncologists, oncological surgeons and orthopedic surgeons. Unfortunately, no progress has been made in the last 30 years and new, more effective drugs are needed. This article reviews the biological and pharmacological basis of the treatment of OS. Models of clinical pharmacology of the active drugs, toxic effects and reasons for primary and secondary resistance to old and new drugs are discussed.
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Affiliation(s)
- Alessandro Comandone
- Department of Medical Oncology, ASL Città di Torino, 10128 Torino, Italy;
- Italian Group of Rare Tumors, Corso Galileo Ferraris 54, 10129 Torino, Italy; (T.C.); (F.P.)
- Correspondence:
| | - Antonella Boglione
- Department of Medical Oncology, ASL Città di Torino, 10128 Torino, Italy;
- Italian Group of Rare Tumors, Corso Galileo Ferraris 54, 10129 Torino, Italy; (T.C.); (F.P.)
| | - Tiziana Comandone
- Italian Group of Rare Tumors, Corso Galileo Ferraris 54, 10129 Torino, Italy; (T.C.); (F.P.)
- School of Specialization of Hospital Pharmacy, University of Torino, 10125 Torino, Italy
| | - Fausto Petrelli
- Italian Group of Rare Tumors, Corso Galileo Ferraris 54, 10129 Torino, Italy; (T.C.); (F.P.)
- Department of Medical Oncology, Ospedale di Treviglio, 24047 Treviglio, Italy
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7
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Mondaca SP, Liu D, Flynn JR, Badson S, Hamaway S, Gounder MM, Khalil DN, Drilon AE, Li BT, Jhaveri KL, Schram AM, Kargus KE, Kasler MK, Blauvelt NM, Segal NH, Capanu M, Callahan MK, Hyman DM, Gambarin-Gelwan M, Harding JJ. Clinical implications of drug-induced liver injury in early-phase oncology clinical trials. Cancer 2020; 126:4967-4974. [PMID: 32809222 DOI: 10.1002/cncr.33153] [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] [Received: 04/22/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Data on drug-induced liver injury (DILI) and acute liver failure (ALF) in modern phase 1 oncology trials are limited, specifically with respect to the incidence and resolution of DILI and the safety of drug rechallenge. METHODS This study reviewed all patients who were recruited to phase 1 oncology trials between 2013 and 2017 at Memorial Sloan Kettering Cancer Center. Clinicopathologic data were extracted to characterize DILI, and attribution was assessed on the basis of data prospectively generated during the studies. Logistic regression models were used to explore factors related to DILI and DILI recurrence after drug rechallenge. RESULTS Among 1670 cases recruited to 85 phase 1 trials, 81 (4.9%) developed DILI. The rate of DILI occurrence was similar for patients in immune-based trials and patients in targeted therapy trials (5.0% vs 4.9%), as was the median time to DILI (5.5 vs 6.5 weeks; P = .48). Two patients (0.12%) met the criteria of Hy's law, although none developed ALF. The DILI resolved in 96% of the patients. Pretreatment factors were not predictive for DILI development. Thirty-six of the 81 patients underwent a drug rechallenge, and 28% of these patients developed DILI recurrence. Peak alanine aminotransferase during the initial DILI was associated with DILI recurrence (odds ratio, 1.04; 95% confidence interval, 1.0-1.09; P = .035). CONCLUSIONS In modern phase 1 oncology trials, DILI is uncommon, may occur at any time, and often resolves with supportive measures. Rechallenging after DILI is feasible; however, the high rate of DILI recurrence suggests that clinicians should consider the severity of the DILI episode and treatment alternatives.
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Affiliation(s)
- Sebastian P Mondaca
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dazhi Liu
- Department of Pharmacy Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica R Flynn
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandy Badson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stefan Hamaway
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mrinal M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Danny N Khalil
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Alexander E Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Bob T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Komal L Jhaveri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Alison M Schram
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Katherine E Kargus
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary Kate Kasler
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Natalie M Blauvelt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Marinela Capanu
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Maya Gambarin-Gelwan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - James J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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8
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Grosso F, D’Ambrosio L, Zucchetti M, Ibrahim T, Tamberi S, Matteo C, Rulli E, Comandini D, Palmerini E, Baldi GG, DeCensi A, Bergaglio M, Marra D, Marchesi E, Siri G, D’Incalci M, Grignani G. Pharmacokinetics, safety, and activity of trabectedin as first‐line treatment in elderly patients who are affected by advanced sarcoma and are unfit to receive standard chemotherapy: A phase 2 study (TR1US study) from the Italian Sarcoma Group. Cancer 2020; 126:4726-4734. [DOI: 10.1002/cncr.33120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Federica Grosso
- Mesothelioma and Rare Cancer Unit Azienda Ospedaliera SS Antonio e Biagio General Hospital Alessandria Italy
| | - Lorenzo D’Ambrosio
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
- Department of Oncology University of Torino Orbassano Italy
| | - Massimo Zucchetti
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Italy
| | | | - Cristina Matteo
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Eliana Rulli
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | | | | | | | - Andrea DeCensi
- Division of Medical Oncology Unit EO Ospedali Galliera Genova Italy
| | | | - Domenico Marra
- Division of Medical Oncology Unit EO Ospedali Galliera Genova Italy
| | - Emanuela Marchesi
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
| | - Giacomo Siri
- Department of Mathematics University of Genoa Genova Italy
- E.O. Ospedali GallieraScientific Directorate Genova Italy
| | - Maurizio D’Incalci
- Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano Italy
| | - Giovanni Grignani
- Division of Medical Oncology Candiolo Cancer Institute, FPO–IRCCS Candiolo Italy
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9
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Cortinovis D, Grosso F, Carlucci L, Zucali PA, Pasello G, Tiseo M, Sperandi F, Hollander L, Galli F, Torri V, Rulli E, Canova S, Maconi A, Bidoli P, Ceresoli GL, D'Incalci M. Trabectedin in Malignant Pleural Mesothelioma: Results From the Multicentre, Single Arm, Phase II ATREUS Study. Clin Lung Cancer 2020; 22:361-370.e3. [PMID: 32732073 DOI: 10.1016/j.cllc.2020.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION New therapeutic approaches in unresectable malignant pleural mesothelioma (MPM) are eagerly awaited. Trabectedin is an antitumor agent with an effect on cancer cell proliferation and a modulating action on tumor microenvironment. The ATREUS study explored the activity and safety of trabectedin in patients with unresectable MPM. METHODS Epithelioid patients with MPM received trabectedin as second-line while biphasic/sarcomatoid patients with MPM as first- or second-line therapy. Treatment was given intravenously at an initially planned dose of 1.3 mg/m2 every 3 weeks, until progression or unacceptable toxicity. The primary endpoint was progression-free survival rate at 12 weeks (PFS12wks). RESULTS Overall, 78 patients (54%) had epithelioid and 67 (46%) nonepithelioid MPM. PFS12wks in 62 evaluable patients with epithelioid MPM was 43.5% (80% confidence interval 34.9%-52.5%); median progression-free and overall survival were 2.4 and 9.0 months, respectively. PFS12wks in 52 evaluable patients with nonepithelioid MPM was 30.8% (90% confidence interval 20.3%-42.9%); median progression-free and overall survival were 1.7 and 5.4 months. Trabectedin starting dose was amended due to excess of liver toxicity. Eighty-four (64%) and 48 (36%) patients received 1.3 mg/m2 and 1.1. mg/m2, respectively. The most common grade 3-4 toxicities were hepatotoxicity, leukopenia/neutropenia, and fatigue. Grade 3-4 hepatotoxicity was reported in 59 (70%) patients treated at 1.3 mg/m2, and in 19 (40%) treated at 1.1 mg/m2. CONCLUSIONS Trabectedin showed modest clinical activity, at the expense of relevant liver toxicity. Further development of this drug in MPM at full doses is not warranted.
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Affiliation(s)
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Luciano Carlucci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Paolo Andrea Zucali
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giulia Pasello
- Department of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | | | - Lital Hollander
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesca Galli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Valter Torri
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Eliana Rulli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Stefania Canova
- Medical Oncology Unit, ASST Ospedale San Gerardo, Monza, Italy
| | - Antonio Maconi
- Scientific Research and Development Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Bidoli
- Medical Oncology Unit, ASST Ospedale San Gerardo, Monza, Italy
| | | | - Maurizio D'Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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10
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Manda K, Präkelt T, Schröder T, Kriesen S, Hildebrandt G. Radiosensitizing effects of trabectedin on human A549 lung cancer cells and HT-29 colon cancer cells. Invest New Drugs 2019; 38:967-976. [PMID: 31482373 DOI: 10.1007/s10637-019-00852-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/30/2019] [Indexed: 01/31/2023]
Abstract
Background and Purpose Trabectedin is a unique alkylating agent with promising effects against a range of solid tumors. In this study, we aimed to examine the cytotoxic and radiosensitizing effects of trabectedin on two human epithelial tumor cell lines in vitro, and its effects on DNA repair capacity. Methods Cancer cells (A549: human lung cancer cells, HT-29: colon cancer cells) were treated with either trabectedin alone for the determination of their growth, or in combination with radiation for the determination of their metabolic activity, proliferation, and clonogenic survival. Besides, the γH2AX foci assay was performed for the assessment of ionizing radiation-induced DNA damage and to evaluate the influence of trabectedin on DNA damage repair. Results Treatment with trabectedin resulted in a growth-inhibiting effect on both cell lines, with the IC50 values remaining within a low nanomolar range. Analyses of metabolic activity confirmed a cytotoxic influence of trabectedin and a BrdU assay demonstrated an antiproliferative effect. When combined with radiation, incubation with trabectedin was found to enhance the radiosensitivity of the tumor cells. The γH2AX foci assay resulted in an increased number of DNA double-strand breaks (DSBs) in cells treated with trabectedin. Conclusion The results of this study underline the antitumor activity of trabectedin at low nanomolar concentrations. We demonstrated that trabectedin enhanced radiation response in human lung (A549) cancer cells and colon (HT-29) cancer cells. Further studies are necessary to examine trabectedin as a potential candidate for future applications in radiotherapy.
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Affiliation(s)
- Katrin Manda
- Department of Radiotherapy and Radiation Oncology, University Medical Center Rostock, 18059 Rostock, Südring 75, 18059, Rostock, Germany.
| | - Tina Präkelt
- Department of Radiotherapy and Radiation Oncology, University Medical Center Rostock, 18059 Rostock, Südring 75, 18059, Rostock, Germany
| | - Tonja Schröder
- Department of Radiotherapy and Radiation Oncology, University Medical Center Rostock, 18059 Rostock, Südring 75, 18059, Rostock, Germany
| | - Stephan Kriesen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Rostock, 18059 Rostock, Südring 75, 18059, Rostock, Germany
| | - Guido Hildebrandt
- Department of Radiotherapy and Radiation Oncology, University Medical Center Rostock, 18059 Rostock, Südring 75, 18059, Rostock, Germany
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11
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Gronchi A, Hindi N, Cruz J, Blay JY, Lopez-Pousa A, Italiano A, Alvarez R, Gutierrez A, Rincón I, Sangalli C, Pérez Aguiar JL, Romero J, Morosi C, Sunyach MP, Sanfilippo R, Romagosa C, Ranchere-Vince D, Dei Tos AP, Casali PG, Martin-Broto J. Trabectedin and RAdiotherapy in Soft Tissue Sarcoma (TRASTS): Results of a Phase I Study in Myxoid Liposarcoma from Spanish (GEIS), Italian (ISG), French (FSG) Sarcoma Groups. EClinicalMedicine 2019; 9:35-43. [PMID: 31143880 PMCID: PMC6510725 DOI: 10.1016/j.eclinm.2019.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Myxoid liposarcoma (ML) exhibits a special sensitivity to trabectedin (T) and radiation therapy (RT). Preclinical data suggest a synergistic effect. We aimed to study safety, feasibility and activity of the administration of pre-operative concurrent T and RT in patients affected by localized resectable ML. METHODS Patients received 3 cycles (C) of T in combination with RT (45 Gy) in 25 fractions (1.8 Gy/fraction). Dose Levels for T were: - 1 (1.1 mg/m2), 0 (1.3 mg/m2) and 1 (1.5 mg/m2). Primary endpoint was safety; antitumor activity was assessed by RECIST and Choi criteria. This study is registered at ClinicalTrials.gov, number NCT02275286. The phase 1 part of the study is complete and phase 2 is ongoing. FINDINGS From February 2015 to May 2016, 14 patients (M/F 7/7), median age 36 years (range 24-70) and median tumor size 12.5 cm (range 7-17 cm), were enrolled. One dose limiting toxicity (G3 transaminitis) occurred at Level 0 and one (sepsis due to catheter infection) at Level 1. All patients completed RT. Five patients achieved PR (36%), 8 SD (57%), 1 distant PD (7%) by RECIST, while 12 achieved PR (86%), 1 SD (7%) and 1 distant PD (7%) by Choi criteria. Twelve patients underwent surgery. Median viable residual tumor was 5% (0-60). INTERPRETATION T in combination with RT showed a favorable safety profile and antitumor activity in localized ML. T dose of 1.5 mg/m2 is the recommended dose for the phase 2 study, which is ongoing. FUNDING This study was partially supported by Pharmamar.
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Affiliation(s)
| | - Nadia Hindi
- Biomedicine Institute of Seville (IBIS), Spain
- University Hospital Virgen del Rocio, Seville, Spain
| | | | | | | | | | - Rosa Alvarez
- University Hospital Gregorio Marañon, Madrid, Spain
| | - Antonio Gutierrez
- Son Espases University Hospital/IdISBa, Palma, Illes Baleares, Spain
| | | | | | | | - Jesús Romero
- Puerta de Hierro University Hospital, Madrid, Spain
| | - Carlo Morosi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | - Angelo P. Dei Tos
- Treviso General Hospital, Treviso, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Paolo G. Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Biomedicine Institute of Seville (IBIS), Spain
- University Hospital Virgen del Rocio, Seville, Spain
- University Hospital Canarias, Tenerife, Spain
- Center Leon Berard, Lyon, France
- Hospital Sant Pau, Barcelona, Spain
- Institute Bergonie – Bourdeaux, France
- University Hospital Gregorio Marañon, Madrid, Spain
- Son Espases University Hospital/IdISBa, Palma, Illes Baleares, Spain
- Puerta de Hierro University Hospital, Madrid, Spain
- Vall d'Hebron University Hospital, Barcelona, Spain
- Treviso General Hospital, Treviso, Italy
- Department of Medicine, University of Padova, Padova, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Javier Martin-Broto
- Biomedicine Institute of Seville (IBIS), Spain
- University Hospital Virgen del Rocio, Seville, Spain
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Gadducci A, Grosso F, Scambia G, Raspagliesi F, Colombo N, Grignani G, Casali P, Sanfilippo R, Buonadonna A, Santoro A, Bruzzone M, Artioli G, Lorusso D, Biagioli E, Fossati R, Galli F, Negri E, Rulli E, Torri V, D'Incalci M. A phase II randomised (calibrated design) study on the activity of the single-agent trabectedin in metastatic or locally relapsed uterine leiomyosarcoma. Br J Cancer 2018; 119:565-571. [PMID: 30057406 PMCID: PMC6162262 DOI: 10.1038/s41416-018-0190-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/05/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with recurrent/metastatic uterine leiomyosarcoma (U-LMS) have a dismal prognosis. This phase II study aims to evaluate trabectedin efficacy and safety in advanced U-LMS. METHODS Eligible patients had received ≥ one line of chemotherapy. Gemcitabine ± docetaxel naive patients were randomised to Arm A: trabectedin 1.3 mg/m2 or calibration Arm B: gemcitabine 900 mg/m2 and docetaxel 75 mg/m2. Patients who had already received gemcitabine ± docetaxel directly entered Arm A. Primary end-point: 6-month progression-free rate (PFS-6). The null hypothesis that the true PFS-6 = 14% was tested against a one-sided alternative. This design yielded a 5% type I error rate and 90% power when the true PFS-6 is 25%. RESULTS Overall, 126 patients entered Arm A (45 from randomisation and 81 directly) and 42 Arm B. Arm A patients characteristics: median age = 57; ≥2 previous chemotherapy lines = 37.4%; metastatic disease = 93%. The study met the condition for trabectedin activity: PFS-6 = 35.2% (95% CI: 26.2-45). No difference in PFS by the number of previous chemotherapy lines emerged. Median OS = 20.6 months (IQR: 8-36.4). In Arm B, the PFS-6 = 51.5% (95% CI: 33.5-69.2). No toxic deaths occurred. In Arm A, only 4 patients interrupted treatment for toxicity. CONCLUSIONS Trabectedin is active and well tolerated, retaining similar efficacy across one to three previous lines of chemotherapy.
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Affiliation(s)
| | - Federica Grosso
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica, Rome, Italy
| | | | - Nicoletta Colombo
- Istituto Europeo di Oncologia, Milan, Italy
- Università di Milano-Bicocca, Milan, Italy
| | | | - Paolo Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | | | | | - Elena Biagioli
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Roldano Fossati
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy.
| | - Francesca Galli
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Emanuele Negri
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Eliana Rulli
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Valter Torri
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Maurizio D'Incalci
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
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Grisanti S, Cosentini D, Tovazzi V, Bianchi S, Lazzari B, Consoli F, Roca E, Berruti A, Ferrari VD. Hepatoprotective effect of N-acetylcysteine in trabectedin-induced liver toxicity in patients with advanced soft tissue sarcoma. Support Care Cancer 2018; 26:2929-2935. [PMID: 29546526 DOI: 10.1007/s00520-018-4129-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/20/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Trabectedin is one of the few active agents in soft tissue sarcoma (STS) but hepatotoxicity is frequent and represents a dose-limiting factor. Protective strategies aiming at counteracting this important side effect have a crucial clinical impact. Due to its antioxidant properties, N-acetylcysteine (NAC) has a recognized hepatoprotective effect and this provides the rationale for testing NAC in the management of trabectedin-induced hepatotoxicity. METHODS Patients with recurrent or metastatic soft tissue sarcoma, consecutively observed at our institution, who were considered eligible to trabectedin, received concomitant NAC if they had impaired hepatic or renal function at baseline or developed hepatotoxicity during treatment. The study aim was to retrospectively explore trabectedin administration in terms of number of cycles, mean dose, and dose intensity (DI) in patients who received NAC as compared with those who did not. Secondary end points were progression-free survival (PFS) and overall survival (OS). RESULTS A total number of 18 patients were enrolled in this study. Nine received NAC and nine did not. The median number of administered trabectedin cycles, mean trabectedin dose/cycles, and median DI was comparable in the two groups (p = 0.450, p = 0.534, and p = 0.450, respectively). The PFS and OS curves overlapped. CONCLUSION This explorative study suggests that NAC can have a hepatoprotective activity in patients receiving trabectedin allowing to maintain an adequate dose intensity and continuative administration in patients with impaired liver and renal function or developing treatment-induced hepatotoxicity. A prospective randomized trial is warranted.
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Affiliation(s)
- Salvatore Grisanti
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Deborah Cosentini
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Valeria Tovazzi
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Susanna Bianchi
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Barbara Lazzari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Francesca Consoli
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Elisa Roca
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy. .,Oncologia Medica, ASST Spedali Civili, Piazzale Spedali Civili 1, 20123, Brescia, Italy.
| | - Vittorio D Ferrari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Oncologia Medica, Università degli Studi di Brescia, ASST Spedali Civili, Brescia, Italy
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Grosso F, D'incalci M. Problems in Dealing with very rare Adverse Effects of New Anticancer Drugs: The Example of Trabectedin. TUMORI JOURNAL 2018; 97:256. [DOI: 10.1177/030089161109700224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Federica Grosso
- SC Oncologia, ASO SS Antonio & Biagio & C Arrigo, Alessandria, Italy
| | - Maurizio D'incalci
- Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
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Grohar PJ, Glod J, Peer CJ, Sissung TM, Arnaldez FI, Long L, Figg WD, Whitcomb P, Helman LJ, Widemann BC. A phase I/II trial and pharmacokinetic study of mithramycin in children and adults with refractory Ewing sarcoma and EWS-FLI1 fusion transcript. Cancer Chemother Pharmacol 2017; 80:645-652. [PMID: 28735378 DOI: 10.1007/s00280-017-3382-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/30/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE In a preclinical drug screen, mithramycin was identified as a potent inhibitor of the Ewing sarcoma EWS-FLI1 transcription factor. We conducted a phase I/II trial to determine the dose-limiting toxicities (DLT), maximum tolerated dose (MTD), and pharmacokinetics (PK) of mithramycin in children with refractory solid tumors, and the activity in children and adults with refractory Ewing sarcoma. PATIENTS AND METHODS Mithramycin was administered intravenously over 6 h once daily for 7 days for 28 day cycles. Adult patients (phase II) initially received mithramycin at the previously determined recommended dose of 25 µg/kg/dose. The planned starting dose for children (phase I) was 17.5 µg/kg/dose. Plasma samples were obtained for mithramycin PK analysis. RESULTS The first two adult patients experienced reversible grade 4 alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation exceeding the MTD. Subsequent adult patients received mithramycin at 17.5 µg/kg/dose, and children at 13 µg/kg/dose with dexamethasone pretreatment. None of the four subsequent adult and two pediatric patients experienced cycle 1 DLT. No clinical responses were observed. The average maximal mithramycin plasma concentration in four patients was 17.8 ± 4.6 ng/mL. This is substantially below the sustained mithramycin concentrations ≥50 nmol/L required to suppress EWS-FLI1 transcriptional activity in preclinical studies. Due to inability to safely achieve the desired mithramycin exposure, the trial was closed to enrollment. CONCLUSIONS Hepatotoxicity precluded the administration of a mithramycin at a dose required to inhibit EWS-FLI1. Evaluation of mithramycin in patients selected for decreased susceptibility to elevated transaminases may allow for improved drug exposure.
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Affiliation(s)
- Patrick J Grohar
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Department of Pediatrics, Van Andel Research Institute, Helen DeVos Children's Hospital, Michigan State University, East Lansing, USA
| | - John Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
| | - Cody J Peer
- Clinical Pharmacology Program, National Cancer Institute, Bethesda, MD, USA
| | - Tristan M Sissung
- Department of Pediatrics, Van Andel Research Institute, Helen DeVos Children's Hospital, Michigan State University, East Lansing, USA
| | - Fernanda I Arnaldez
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lauren Long
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - William D Figg
- Clinical Pharmacology Program, National Cancer Institute, Bethesda, MD, USA
| | - Patricia Whitcomb
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lee J Helman
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Stable disease in a patient with metastatic leiomyosarcoma treated with trabectedin. Anticancer Drugs 2017; 28:465-468. [DOI: 10.1097/cad.0000000000000485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Recine F, Bongiovanni A, Riva N, Fausti V, De Vita A, Mercatali L, Liverani C, Miserocchi G, Amadori D, Ibrahim T. Update on the role of trabectedin in the treatment of intractable soft tissue sarcomas. Onco Targets Ther 2017; 10:1155-1164. [PMID: 28260930 PMCID: PMC5328291 DOI: 10.2147/ott.s127955] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Soft tissue sarcomas (STS) represent a variety of tumors of mesenchymal origin, accounting for about 1% of all adult cancers. This group of tumors comprises over 60 different histotypes with different biology showing different sensitivity to therapeutic agents. For decades, the standard first-line systemic treatment of metastatic STS has comprised anthracycline based-chemotherapy. Second-line therapy options include agents such as ifosfamide, gemcitabine, and pazopanib, but the optimal sequential therapy for the management of metastatic disease has yet to be defined. Trabectedin is one of the new molecules approved for patients in progression after first-line chemotherapy with anthracyclines or for those unfit for these agents. The compound is characterized by multiple potential mechanisms of action combining cytotoxic, targeted, and immunological effects. This article takes an in-depth look at the role of trabectedin in the management of metastatic STS, including L-sarcoma and non-L-sarcoma.
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Affiliation(s)
- Federica Recine
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandro De Vita
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Chiara Liverani
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giacomo Miserocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Itai S, Suga Y, Hara Y, Izumi K, Maeda Y, Kitagawa Y, Ishizaki J, Shimada T, Mizokami A, Sai Y. Co-administration of dexamethasone increases severity and accelerates onset day of neutropenia in bladder cancer patients on methotrexate, vinblastine, adriamycin and cisplatin chemotherapy: a retrospective cohort study. J Pharm Health Care Sci 2017; 3:3. [PMID: 28097015 PMCID: PMC5225533 DOI: 10.1186/s40780-016-0072-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/27/2016] [Indexed: 11/22/2022] Open
Abstract
Background Bladder cancer patients receiving methotrexate, vinblastine, adriamycin and cisplatin (MVAC) chemotherapy are co-administered with dexamethasone as an anti-emetic. We examined whether or not dexamethasone affects the severity and onset day of MVAC-induced severe neutropenia. Methods This was a retrospective study of bladder cancer patients treated with MVAC chemotherapy with or without dexamethasone as an antiemetic at Kanazawa University Hospital during January 2005 - December 2009. Patients were categorized into three groups; no dexamethasone use (Dex (−)), dexamethasone on day 2 (Dex 1 day), and dexamethasone on days 2, 3 and 4 (Dex multiday). We evaluated the incidence of grade 3/4 neutropenia and the day of onset of first severe neutropenic episode during the first course of MVAC chemotherapy. Logistic regression was used to investigate whether co-administration of dexamethasone was a risk factor for severe neutropenia. Results Episodes of grade 3/4 neutropenia occurred in 3 out of 6 (50.0%), 11 out of 12 (91.7%) and 6 out of 6 (100%) patients in the Dex (−), Dex 1 day, and Dex multiday groups, respectively. The appearance day of first severe neutropenia in the Dex multiday group (13.2 ± 1.0) was significantly accelerated compared to the Dex (−) group (17.7 ± 2.1). Univariate logistic regression analysis revealed that dexamethasone is a risk factor for severe neutropenia (OR 17.0; 95%CI: 1.3–223.1). Conclusions Co-administration of dexamethasone for anti-emesis brings forward the first appearance of neutropenia, and increases the severity of neutropenia, in bladder cancer patients receiving MVAC chemotherapy.
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Affiliation(s)
- Shingo Itai
- Division of Life Sciences, Graduate School of Natural Science and Technology, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan ; Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Yukio Suga
- Department of Clinical Drug Informatics, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan
| | - Yusuke Hara
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Kouji Izumi
- Department of Urology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Yuji Maeda
- Department of Urology, Public Central Hospital of Matto Ishikawa, 3-8 Kuramitsu, Hakusan, 924-8588 Japan
| | - Yasuhide Kitagawa
- Department of Urology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Junko Ishizaki
- Department of Clinical Drug Informatics, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan
| | - Tsutomu Shimada
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan ; Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Atsushi Mizokami
- Department of Urology, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Yoshimichi Sai
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan ; Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
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Abstract
INTRODUCTION Trabectedin (ET-743) is a synthetic marine derived alkylating agent, extracted originally from a Caribbean Sea sponge. It is approved for the treatment of Soft Tissue sarcomas (STS) in Europe and recently by the FDA for liposarcomas and leiomyosarcomas. AREAS COVERED Trabectedin has multiple mechanisms of action, including one targeting the FUS-CHOP oncogene in Myxoid/Round cell Liposarcomas. Numerous Phase I, II and III clinical trials have been conducted with Trabectedin. It has been studied as monotherapy or in combination with other chemotherapeutic agents. The recommended dose based on clinical trials is 1.5 milligrams/m(2) continuous infusion over 24 hours once every 3 weeks for STS with evidence of disease control in multiple clinical trials at this dose. The most common Grade 3/4 toxicities include neutropenia and transient noncumulative elevations of ALT and AST. Steroid pretreatment has shown efficacy in reducing liver and bone marrow toxicity. In phase III testing comparing trabectedin to dacarbazine, trabectedin was associated with a significantly improved progression free survival rate in patients with advanced lipo- and leiomyosarcomas. EXPERT OPINION Trabectedin is an important new addition to the limited treatment options currently available for STS, especially for patients with liposarcoma that have progressed on standard chemotherapeutic regimens.
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Affiliation(s)
- Ritika Zijoo
- a PGY-2 Resident, Department of Internal Medicine , Seton Hall University, Saint Francis Medical Center , Trenton , NJ , USA
| | - Margaret von Mehren
- b Department of Hematology and Medical Oncology , Fox Chase Cancer Center , Philadelphia , PA , USA
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Hernando-Cubero J, Sanz-Moncasi P, Hernández-García A, Pajares-Bernard I, Martínez-Trufero J. Metastatic extraskeletal Ewing's sarcoma treated with trabectedin: A case report. Oncol Lett 2016; 12:2936-2941. [PMID: 27698882 PMCID: PMC5038563 DOI: 10.3892/ol.2016.4950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/27/2016] [Indexed: 11/05/2022] Open
Abstract
The Ewing's sarcoma family of tumors (ESFT) comprises a number of rare malignant tumors. Standard first-line treatment for patients with these tumors includes chemotherapy with a five-drug regimen of vincristine, doxorubicin (Adriamycin®) and cyclophosphamide, alternating with ifosfamide and etoposide (VAC/IE). In cases of inadequate response, there are a number of second-line regimens available. However, further treatment options are required for those patients with disease unresponsive to standard treatment. Trabectedin is a novel treatment option for patients with ESFT. The present study reports the case of a Caucasian 69-year-old female patient who presented with a soft tissue mass on the chest wall that had developed 7 months earlier. A computed tomography scan revealed a 9×8×7-cm mass on the anterior chest wall above the pectoral muscle. Histopathological evaluations and molecular analysis indicated that it was consistent with a metastatic extraskeletal Ewing's sarcoma. The patient was treated with an alternating VAC/IE regimen; however, an inadequate response was observed. The patient received second-line treatment with a gemcitabine and dacarbazine combination regimen, but the disease progressed. Subsequently, treatment with trabectedin (1.5 mg/m2 as a 24-h continuous infusion every 3 weeks) was initiated. Trabectedin treatment resulted in long-lasting (18 months) progression-free survival. It is vital that novel drugs continue to being developed for patients with ESFT following progression subsequent to standard chemotherapy. The current report presents a case of a patient with metastatic, pre-treated Ewing's sarcoma achieving disease stabilization with trabectedin. Based on these results and the observed tolerability profile, trabectedin represents an alternative treatment for patients with ESFT. Further studies are required in order to determine the efficacy of trabectedin as monotherapy or in combination with other drugs. It is also important to identify which tumor subtypes, specific translocations and patient profiles will benefit the most from treatment with trabectedin.
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Affiliation(s)
- Jorge Hernando-Cubero
- Department of Medical Oncology and Pathology, University Hospital Miguel Servet, 50008 Zaragoza, Spain
| | - Pilar Sanz-Moncasi
- Department of Medical Oncology and Pathology, University Hospital Miguel Servet, 50008 Zaragoza, Spain
| | - Alba Hernández-García
- Department of Medical Oncology and Pathology, University Hospital Miguel Servet, 50008 Zaragoza, Spain
| | - Isabel Pajares-Bernard
- Department of Medical Oncology and Pathology, University Hospital Miguel Servet, 50008 Zaragoza, Spain
| | - Javier Martínez-Trufero
- Department of Medical Oncology and Pathology, University Hospital Miguel Servet, 50008 Zaragoza, Spain
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De Sanctis R, Marrari A, Santoro A. Trabectedin for the treatment of soft tissue sarcomas. Expert Opin Pharmacother 2016; 17:1569-77. [PMID: 27328277 DOI: 10.1080/14656566.2016.1204295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Trabectedin, a marine-derived DNA-binding antineoplastic agent, has been registered by the EMA and recently also by the FDA for the treatment of patients with advanced soft-tissue sarcoma (STS), a rare and heterogeneous disease. AREAS COVERED The antitumor activity of trabectedin is related both to direct effects on cancer cells, such as growth inhibition, cell death and differentiation, and indirect effects related to its anti-inflammatory and anti-angiogenic properties. Furthermore, trabectedin is the first compound that targets an oncogenic transcription factor with high selectivity in mixoid liposarcomas. This peculiar mechanism of action is the basis of its clinical development. The clinical pharmacology of trabectedin, the subsequent phase I, II and III trials are summarized and put into perspectives in this review. EXPERT OPINION Trabectedin is a relevant pleiotropic antitumoral agent within the complex scenario of the management of STS. It can be used in advanced STS, either after failure of anthracyclines and ifosfamide or in patients unfit for these drugs, especially when reaching a high-tumor control and a long-term benefit is a priority. Toxicity profile is acceptable and manageable with no reported cumulative toxicities. Therefore, trabectedin has become one relevant therapeutic option in metastatic STS, especially in selected histologies.
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Affiliation(s)
- Rita De Sanctis
- a Department of Medical Oncology and Hematology , Humanitas Cancer Center IRCCS , Rozzano , Milan , Italy.,b Molecular and Cellular Networks Lab, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics , "Sapienza" University , Rome , Italy
| | - Andrea Marrari
- a Department of Medical Oncology and Hematology , Humanitas Cancer Center IRCCS , Rozzano , Milan , Italy
| | - Armando Santoro
- a Department of Medical Oncology and Hematology , Humanitas Cancer Center IRCCS , Rozzano , Milan , Italy.,c Humanitas University , Rozzano , Milan , Italy
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Abstract
Trabectedin (ET743, Yondelis®, manufactured by Baxter Oncology GmbH, Halle/Westfalen, Germany, for Janssen Products, LP, Horsham, PA), derived from the marine ascidian, Ecteinascidia turbinata, is a natural alkaloid with multiple complex mechanisms of action. On 23 October 2015, 15 years after the results of the first Phase 1 clinical trial using trabectedin for chemotherapy-resistant solid malignancies was reported, and 8 years after its approval in Europe, the United States Food and Drug Administration (USFDA) finally approved trabectedin for the treatment of unresectable or metastatic liposarcoma or leiomyosarcoma that has failed a prior anthracycline-containing regimen. Approval was based on the results of a pivotal Phase 3 trial involving a 2:1 randomization of 518 patients (who were further stratified by soft tissue sarcoma subtype), in which a significant improvement in progression-free survival was reported in the trabectedin-treated group vs. the dacarbazine-treated group (p < 0.001). In this trial, the most common adverse reactions were nausea, fatigue, vomiting, constipation, anorexia, diarrhea, peripheral edema, dyspnea, and headache, while the most serious were neutropenic sepsis, rhabdomyolysis, cardiomyopathy, hepatotoxicity, and extravasation leading to tissue necrosis. The most common grade 3–4 adverse events were laboratory abnormalities of myelosuppression in both arms and transient transaminitis in the trabectedin arm. In a recent Phase 2 trial, trabectedin had a similar outcome as doxorubicin when given as a single agent in the first-line setting. Studies are also being conducted to expand the use of trabectedin not only as a first-line cancer drug, but also for a number of other clinical indications, for example, in the case of mesenchymal chondrosarcoma, for which trabectedin has been reported to be exceptionally active. The possibility of combining trabectedin with targeted therapies, immune checkpoint inhibitors or virotherapy would also be an interesting concept. In short, trabectedin is an old new drug with proven potential to impact the lives of patients with soft tissue sarcoma and other solid malignancies. Funding: Sarcoma Oncology Center, Santa Monica, CA 90405.
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Long-term response to first-line trabectedin in an elderly female patient with a metastatic leiomyosarcoma unfit for anthracycline. Anticancer Drugs 2016; 27:264-7. [PMID: 26629769 PMCID: PMC4736294 DOI: 10.1097/cad.0000000000000326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Systemic chemotherapy comprising anthracycline monotherapy is the standard regimen for metastatic soft tissue sarcomas, particularly leiomyosarcomas, which have limited sensitivity to ifosfamide. However, the optimal chemotherapy regimen for elderly patients, especially those considered unfit for anthracyclines, is undefined. Trabectedin is a potent marine-derived antineoplastic drug with documented activity in liposarcomas and leiomyosarcomas. It is registered in Europe for the treatment of adult patients with advanced soft tissue sarcoma, after failure of anthracyclines and ifosfamide, or who are unsuited to receive these agents. We report the long-term response to first-line trabectedin therapy in an elderly patient with metastatic leiomyosarcoma unfit for standard therapy. A 66-year-old woman underwent resection of a pelvic epithelioid leiomyosarcoma with positive margins in December 2002, followed by postoperative radiotherapy. In February 2012, she was diagnosed with multiple lung lesions and local relapse in the pelvis. As she was considered unsuitable for both anthracycline and ifosfamide because of cardiovascular comorbidities and because she was highly anxious at the prospect of developing alopecia, vomiting, and fatigue, we commenced treatment with trabectedin at 75% of the standard dose of 1.5 mg/m2 every 3 weeks. Treatment was well tolerated, and the patient continued treatment for 25 cycles, with disease stabilization according to the RECIST criteria and a partial response according to the Choi criteria. Disease progression was observed in November 2013 and the patient died 20 months after the diagnosis of metastases. Trabectedin may represent an alternative option for highly selected elderly patients with metastatic sarcoma and unfit for anthracyclines; careful monitoring of toxicities is strongly recommended.
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Vincenzi B, Armento G, Spalato Ceruso M, Catania G, Leakos M, Santini D, Minotti G, Tonini G. Drug-induced hepatotoxicity in cancer patients - implication for treatment. Expert Opin Drug Saf 2016; 15:1219-38. [PMID: 27232067 DOI: 10.1080/14740338.2016.1194824] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION All anticancer drugs can cause idiosyncratic liver injury. Therefore, hepatoprotective agents assume particular importance to preserve liver function. Hepatic injury represents 10% of cases of acute hepatitis in adults; drug-related damage is still misjudged because of relative clinical underestimation and difficult differential diagnosis. Chemotherapeutic agents can produce liver toxicity through different pathways, resulting in different categories of liver injuries, but these drugs are not homogeneously hepatotoxic. Frequently, anticancer-induced hepatotoxicity is idiosyncratic and influenced by multiple factors. AREAS COVERED The aim of this paper is to perform a review of the literature regarding anticancer-induced liver toxicity. We described hepatotoxicity mechanisms of principal anticancer agents and respective dose reductions. Furthermore, we reviewed studies on hepatoprotectors and their optimal use. Tiopronin, magnesium isoglycyrrhizinate and S-Adenosylmethionine (AdoMet) demonstrated, in some small studies, a potential hepatoprotective activity. EXPERT OPINION Actually, in the literature only small experiences are reported. Even though hepatoprotective agents seem to be useful in the oncologic setting, the lack of well-designed prospective Phase III randomized controlled trials is a major limit in the introduction of hepatoprotectors in cancer patients and these kind of studies are warranted to support their use and to give further recommendations for the clinical practice.
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Affiliation(s)
- Bruno Vincenzi
- a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy
| | - Grazia Armento
- a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy
| | | | - Giovanna Catania
- a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy.,b Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences , University of Palermo , Palermo , Italy
| | - Mark Leakos
- a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy
| | - Daniele Santini
- a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy
| | - Giorgio Minotti
- c Clinical Pharmacology Department , Campus Bio-Medico, University of Rome , Rome , Italy
| | - Giuseppe Tonini
- a Medical Oncology Department, Campus Bio-Medico , University of Rome , Rome , Italy
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Martin-Broto J, Pousa AL, de Las Peñas R, García Del Muro X, Gutierrez A, Martinez-Trufero J, Cruz J, Alvarez R, Cubedo R, Redondo A, Maurel J, Carrasco JA, López-Martin JA, Sala Á, Meana JA, Ramos R, Martinez-Serra J, Lopez-Guerrero JA, Sevilla I, Balaña C, Vaz Á, De Juan A, Alemany R, Poveda A. Randomized Phase II Study of Trabectedin and Doxorubicin Compared With Doxorubicin Alone as First-Line Treatment in Patients With Advanced Soft Tissue Sarcomas: A Spanish Group for Research on Sarcoma Study. J Clin Oncol 2016; 34:2294-302. [PMID: 27185843 DOI: 10.1200/jco.2015.65.3329] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Doxorubicin and trabectedin are considered active drugs in soft tissue sarcoma (STS). The combination of both drugs was hypothesized to be advantageous and safe on the basis of preclinical evidence and a previous phase I trial, respectively. The aim of this study was to compare the clinical outcome of trabectedin plus doxorubicin with doxorubicin as first-line treatment of advanced STS patients. PATIENTS AND METHODS In this open-label randomized phase II trial, the main end point was progression-free survival (PFS). Trabectedin 1.1 mg/m(2) in a 3-hour infusion plus doxorubicin 60 mg/m(2) as the experimental arm and doxorubicin 75 mg/m(2) as the control arm were administered for up to six cycles. Translational research was planned to correlate the expression of apoptotic and DNA repair genes with clinical outcome. RESULTS In 115 randomly assigned patients, the median PFS was 5.5 months in the control arm and 5.7 months in the experimental arm (hazard ratio, 1.16; 95% CI, 0.79 to 1.71; P = .45) in the intent-to-treat analysis. The trial was stopped for futility after the interim analysis, because the results in the experimental arm showed the risk reduction for the main end point to be < 9.64%. The proportion of patients with grade 3 or 4 thrombocytopenia, asthenia, and liver toxicity was significantly higher in the experimental arm. FAS and p53 were shown to be prognostic factors for PFS (7.0 months if FAS+ and p53-; 3.4 months if FAS+/p53+ or FAS-/p53-; and 0.7 months if FAS- and p53+; P < .001) and for overall survival. CONCLUSION Trabectedin plus doxorubicin did not show superiority over doxorubicin alone as first-line treatment of advanced STS. The prognostic role of apoptotic key genes, FAS and p53, was shown to be robust enough to continue this research line.
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Affiliation(s)
- Javier Martin-Broto
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain.
| | - Antonio López Pousa
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ramón de Las Peñas
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Xavier García Del Muro
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Antonio Gutierrez
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Javier Martinez-Trufero
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Josefina Cruz
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Rosa Alvarez
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ricardo Cubedo
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Andrés Redondo
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Joan Maurel
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Juan A Carrasco
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - José A López-Martin
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ángeles Sala
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - José Andrés Meana
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Rafael Ramos
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Jordi Martinez-Serra
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - José A Lopez-Guerrero
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Isabel Sevilla
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Carmen Balaña
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ángeles Vaz
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Ana De Juan
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Regina Alemany
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
| | - Andrés Poveda
- Javier Martin-Broto, Virgen del Rocio Hospital and Biomedicine Institute, Sevilla; Antonio López Pousa, Sant Pau Hospital; Xavier García del Muro, Institut Català d'Oncologia; and Joan Maurel, CIBERehd, IDIBAPS, Hospital Clinic, Barcelona; Ramón de las Peñas, Provincial Hospital, Castellón; Antonio Gutierrez, Rafael Ramos, and Jordi Martinez-Serra, Son Espases Hospital; and Regina Alemany, Balearic Islands University, Palma de Mallorca; Javier Martinez-Trufero, Miguel Servet Hospital, Zaragoza; Josefina Cruz, University Hospital Canarias, Tenerife; Rosa Alvarez, Gregorio Marañón Hospital; Ricardo Cubedo, Puerta de Hierro Hospital; Andrés Redondo, La Paz University Hospital; José A. López-Martin, 12 de Octubre Hospital; and Ángeles Vaz, Ramón y Cajal Hospital, Madrid; Juan A. Carrasco, Xeral Cies Hospital, Vigo; Ángeles Sala and Ana De Juan, Basurto Hospital, Bilbao; José Andrés Meana, University General Hospital, Alicante; José A. Lopez-Guerrero and Andrés Poveda, Valencian Oncologic Institute, Valencia; Isabel Sevilla, Virgen de la Victoria Hospital, Málaga; and Carmen Balaña, Insitut Català d'Oncologia, Badalona, Spain
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Duffaud F, Maki RG, Jones RL. Treatment of advanced soft tissue sarcoma: efficacy and safety of trabectedin, a multitarget agent, and update on other systemic therapeutic options. Expert Rev Clin Pharmacol 2016; 9:501-512. [DOI: 10.1586/17512433.2016.1152179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Nakamura T, Matsumine A, Sudo A. The value of trabectedin in the treatment of soft tissue sarcoma. Ther Clin Risk Manag 2016; 12:73-9. [PMID: 26834480 PMCID: PMC4716771 DOI: 10.2147/tcrm.s84789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Soft tissue sarcomas (STSs) are a group of rare tumors accounting for less than 1% of all adult malignant tumors, a heterogeneous group of more than 50 histological subtypes. Five percent to 30% of STS patients experience local recurrence and 10%–38% present with clinically detectable metastases. Doxorubicin either alone or in combination with ifosfamide has been used as first-line chemotherapy for advanced disease. After failure of first-line chemotherapy, high-dose ifosfamide, gemcitabine + docetaxel, and dacarbazine may be applicable, although high-level evidence is lacking. Trabectedin is a synthetic, marine-derived alkylating agent derived from the Caribbean tunicate, Ecteinascidia turbinata. Several clinical trials have shown that trabectedin has a favorable toxicity profile and is an alternative therapeutic option in adult patients with advanced STS who have not responded to treatment with doxorubicin and ifosfamide. Several clinical trials also recommend the 24-hour intravenous infusion every 3 weeks regimen. The most frequently reported grade 3/4 adverse events were neutropenia and elevated serum levels of AST/ALT. Steroid pretreatment is an effective way of reducing the extent of hepatotoxicity, and steroids are now given routinely before trabectedin administration. Further studies are ongoing to evaluate the efficacy and safety of combination therapy of trabectedin with other agents.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiko Matsumine
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
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Lorusso D, Scambia G, Pignata S, Sorio R, Amadio G, Lepori S, Mosconi A, Pisano C, Mangili G, Maltese G, Sabbatini R, Artioli G, Gamucci T, Di Napoli M, Capoluongo E, Ludovini V, Raspagliesi F, Ferrandina G. Prospective phase II trial of trabectedin in BRCA-mutated and/or BRCAness phenotype recurrent ovarian cancer patients: the MITO 15 trial. Ann Oncol 2015; 27:487-93. [PMID: 26681678 DOI: 10.1093/annonc/mdv608] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/09/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Current evidence suggest that trabectedin is particularly effective in cells lacking functional homologous recombination repair mechanisms. A prospective phase II trial was designed to evaluate the activity of trabectedin in the treatment of recurrent ovarian cancer patients presenting BRCA mutation and/or BRCAness phenotype. PATIENTS AND METHODS A total of 100 patients with recurrent BRCA-mutated ovarian cancer and/or BRCAness phenotype (≥2 previous responses to platinum) were treated with trabectedin 1.3 mg/mq i.v. q 3 weeks. The activity of the drug with respect to BRCA mutational status and to a series of polymorphisms [single-nucleotide polymorphisms (SNPs)] involved in DNA gene repair was analyzed. RESULTS Ninety-four were evaluable for response; in the whole population, 4 complete and 33 partial responses were registered for an overall response rate (ORR) of 39.4. In the platinum-resistant (PR) and -sensitive (PS) population, an ORR of 31.2% and 47.8%, and an overall clinical benefit of 54.2% and 73.9%, respectively, were registered. In the whole series, the median progression-free survival (PFS) was 18 weeks and the median overall survival (OS) was 72 weeks; PS patients showed a more favorable PFS and OS compared with PR patients. BRCA gene mutational status was available in 69 patients. There was no difference in ORR, PFS and OS according to BRCA 1-2 status nor any association between SNPs of genes involved in DNA repair and NER machinery and response to trabectedin was reported. CONCLUSIONS Our data prospectively confirmed that the signature of 'repeated platinum sensitivity' identifies patients highly responsive to trabectedin. In this setting, the activity of trabectedin seems comparable to what could be obtained using platinum compounds and the drug may represent a valuable alternative option in patients who present contraindication to receive platinum. EUDRACT NUMBER 2011-001298-17.
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Affiliation(s)
- D Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of Rome
| | - S Pignata
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - R Sorio
- Department of Oncology, CRO Aviano, Aviano
| | - G Amadio
- Department of Obstetrics and Gynecology, Catholic University of Rome
| | - S Lepori
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - A Mosconi
- Medical Oncology Unit, University Hospital S. Maria della Misericordia, Perugia
| | - C Pisano
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - G Mangili
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan
| | - G Maltese
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - R Sabbatini
- Department of Oncology Haematology and Respiratory Disease, AOU Policlinico di Modena, Modena
| | - G Artioli
- Medical Oncology Unit, Hospital of Mirano, Mirano
| | - T Gamucci
- Medical Oncology Unit, Hospital 'SS. Trinità', Sora
| | - M Di Napoli
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples
| | - E Capoluongo
- Department of Molecular Biology, Catholic University of Rome
| | - V Ludovini
- Molecular Biology Unit, University Hospital S. Maria della Misericordia, Perugia, Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan
| | - G Ferrandina
- Department of Obstetrics and Gynecology, Catholic University of Rome
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Trabectedin in advanced synovial sarcomas: a multicenter retrospective study from four European institutions and the Italian Rare Cancer Network. Anticancer Drugs 2015; 26:678-81. [PMID: 25763543 PMCID: PMC4730787 DOI: 10.1097/cad.0000000000000228] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment options for patients with metastatic synovial sarcoma are limited. Over recent years, trabectedin has emerged as an effective agent for patients with advanced soft tissue sarcomas resistant to anthracyclines and ifosfamide. The aim of this retrospective analysis was to study the efficacy of trabectedin in the subgroup of synovial sarcomas. A retrospective analysis was carried out on patients with advanced synovial sarcoma treated with trabectedin at four European reference sarcoma centers and within the Italian Rare Cancer Network between 2000 and 2013. Radiological response, progression-free, and overall survival, as well as serious and unexpected adverse events were retrospectively assessed. Sixty-one patients with metastatic synovial sarcoma were identified. The median number of previous chemotherapy regimens was 2 (range 1-6). Nine patients had a partial response, in addition to two minor responses, and 19 patients had stable disease, for an overall response rate of 15% and a tumor control rate of 50%. The median progression-free survival was 3 months, with 23% of patients free from progression at 6 months. The median progression-free survival in responding patients was 7 months. Trabectedin is a therapeutic option for palliative treatment of a subset of patients with metastatic synovial sarcoma.
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Harris SJ, Benson C, Jones RL. Current and advancing systemic treatment options for soft tissue sarcomas. Expert Opin Pharmacother 2015; 16:2023-37. [PMID: 26255951 DOI: 10.1517/14656566.2015.1074176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Soft tissue sarcomas are a collection of rare malignancies, the treatment of which has evolved over time. Although cytotoxic chemotherapy remains the cornerstone of management of metastatic disease, many new treatments have been developed or show great promise in the treatment of soft tissue sarcoma. Research into the different underlying pathogenesis of individual subtypes has driven progress in treatment. This has allowed development of treatments targeted to specific subtypes of sarcoma. AREAS COVERED We provide a review of the current field of systemic therapy in soft tissue sarcoma. This is followed by an in-depth analysis of recent developments in treatment, as well as new treatments that are aimed at specific subtypes of sarcoma, and the biological rationale behind these therapies. We also look in detail at the promising new agents currently in development. EXPERT OPINION Much progression has been made in treatment of soft tissue sarcomas with multiple exciting new treatments in development. However outcomes in general remain poor. Further research into the underlying pathogenesis of soft tissue sarcomas may help deliver more effective systemic therapies. Increased collaboration between basic science, translational and clinical investigators is required at national and international levels to maximise progress.
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Affiliation(s)
- Samuel J Harris
- The Royal Marsden NHS Foundation Trust , Sarcoma Unit , Fulham Road, London, SW3 6JJ , UK
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A comprehensive safety evaluation of trabectedin and drug-drug interactions of trabectedin-based combinations. BioDrugs 2015; 28:499-511. [PMID: 25209722 DOI: 10.1007/s40259-014-0100-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Trabectedin (Yondelis(®)) is a potent marine-derived antineoplastic drug with high activity against various soft tissue sarcoma (STS) subtypes as monotherapy, and in combination with pegylated liposomal doxorubicin (PLD) for the treatment of patients with relapsed platinum-sensitive ovarian cancer. This article reviews the safety and pharmacokinetic profiles of trabectedin. Records were identified using predefined search criteria using electronic databases (e.g. PubMed, Cochrane Library Database of Systematic Reviews). Primary peer-reviewed articles published between 1 January 2006 and 1 April 2014 were included. The current safety and tolerability profile of trabectedin, based on the evaluation in clinical trials of patients treated with the recommended treatment regimens for STS and recurrent ovarian cancer, was reviewed. Trabectedin as monotherapy or in combination with PLD, was not associated with cumulative and/or irreversible toxicities, such as cardiac, pulmonary, renal, or oto-toxicities, often observed with other common chemotherapeutic agents. The most common adverse drug reactions (ADRs) were myelosuppression and transient hepatic transaminase increases that were usually not clinically relevant. However, trabectedin administration should be avoided in patients with severe hepatic impairment. Serious and fatal ADRs were likely to be related to pre-existing conditions. Doxorubicin or PLD, carboplatin, gemcitabine, or paclitaxel when administered before trabectedin, did not seem to influence its pharmacokinetics. Cytochrome P450 (CYP) 3A4 has an important role in the metabolism of trabectedin, suggesting a risk of drug-drug interactions with trabectedin used in combination with other CYP3A4 substrates. Trabectedin has a favorable risk/efficacy profile, even during extended treatment in pretreated patients.
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Jordan K, Jahn F, Jordan B, Kegel T, Müller-Tidow C, Rüssel J. Trabectedin: Supportive care strategies and safety profile. Crit Rev Oncol Hematol 2015; 94:279-90. [PMID: 25794812 DOI: 10.1016/j.critrevonc.2015.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 12/21/2014] [Accepted: 02/26/2015] [Indexed: 12/14/2022] Open
Abstract
Trabectedin is an approved antineoplastic agent for the treatment of adult patients with advanced soft tissue sarcomas or in combination with pegylated liposomal doxorubicin (PLD) in patients with relapsed platinum sensitive ovarian cancer. The mechanism of action is still not fully understood but many typical side effects seen with other chemotherapy drugs are less common, mild or unreported. Although this apparent favorable safety profile suggests a well-tolerated and manageable therapeutic option in the palliative care setting, trabectedin does have specific adverse side effects which can be hazardous for individual patients. The most commonly observed toxicities with trabectedin include neutropenia, nausea, vomiting, and increases in liver transaminases, anemia, fatigue, thrombocytopenia, anorexia and diarrhea. However, for most patients the appropriate use of supportive care strategies can reduce or overcome these side effects. We present a concise review of the safety data of trabectedin with the corresponding overview of the supportive care strategies.
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Affiliation(s)
- Karin Jordan
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany.
| | - Franziska Jahn
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Berit Jordan
- Department of Neurology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Thomas Kegel
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Carsten Müller-Tidow
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
| | - Jörn Rüssel
- Department of Hematology/Oncology, University of Halle, Ernst-Grube-Str. 40, Halle 06120, Germany
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Reid A, Martin-Liberal J, Benson C. Trabectedin for advanced soft tissue sarcomas: optimizing use. Ther Clin Risk Manag 2014; 10:1003-11. [PMID: 25540587 PMCID: PMC4270297 DOI: 10.2147/tcrm.s49330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with locally advanced or metastatic soft tissue sarcoma have a poor outlook with median survival in the order of 1 year. There is therefore an urgent need for novel agents to impact this disease. Trabectedin is one such novel agent that has demonstrated activity for patients with advanced soft tissue sarcoma and it was licensed in Europe in 2007 for patients in the second-line setting or first-line in those patients deemed unsuitable to receive cytotoxics. In order to best serve patients with novel agents, it is imperative to understand the mechanism or mechanisms of action and the best ways of assessing response in order to optimize antitumor activity. Frequently, the mechanism of action and the optimal means of assessing response will be different from those of traditional cytotoxics. Trial design should reflect these factors to ensure that active drugs are not wrongly marked as futile. This review discusses a number of factors that may influence the optimization of trabectedin use. These factors include the administration schedule, the optimal timing of trabectedin administration in the disease process, the histopathological and molecular subtypes that may be most sensitive to trabectedin, the challenge of assessing response, particularly using radiology, and, finally, the safety considerations with this agent.
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Affiliation(s)
- Alison Reid
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Charlotte Benson
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
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Abstract
INTRODUCTION Pharmacological treatment plays a major role in the management of advanced, persistent or recurrent uterine leiomyosarcoma (LMS), whereas its usefulness in the adjuvant setting is still debated. A thorough literature search was undertaken using the Pubmed databases. Systematic reviews and controlled trials on medical treatment of uterine LMS were collected and critically analyzed. Other study types were secondarily considered when pertinent. AREAS COVERED Doxorubicin (DOX), ifosfamide and dacarbazine have been long used in the treatment of this malignancy. Novel active agents are represented by gemcitabine, docetaxel, trabectedin, pazopanib and aromatase inhibitors, whereas the role of eribulin, bevacizumab, aflibercept and mammalian target of rapamycin inhibitors is still investigational. EXPERT OPINION DOX alone, gemcitabine alone, DOX + dacarbazine and gemcitabine + docetaxel may be treatment options for first-line and second-line therapies. However, the clinical benefit of the combination chemotherapy versus single-agent chemotherapy is still debated. Trabectedin is a promising agent for recurrent uterine LMS, able to obtain a prolonged disease control, with 3-month and 6-month progression-free survival rates exceeding 50 and 30%, respectively, and with sometimes unexpectedly durable responses. Pazopanib is the only approved targeted therapy. Hormone therapy with aromatase inhibitors may be a therapeutic option in heavily treated patients with slowly progressive, steroid receptor-positive tumors. Whenever possible, women with recurrent uterine LMS should be encouraged to enter well-designed clinical trials aimed to detect novel active agents.
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Affiliation(s)
- Angiolo Gadducci
- University of Pisa, Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine , Via Roma 56, Pisa, 56127 , Italy +39 50 992609 ; +39 50 992354 ;
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Goldstein LJ, Gurtler J, Del Prete SA, Tjulandin S, Semiglazov VF, Bayever E, Michiels B. Trabectedin as a single-agent treatment of advanced breast cancer after anthracycline and taxane treatment: a multicenter, randomized, phase II study comparing 2 administration regimens. Clin Breast Cancer 2014; 14:396-404. [PMID: 25239225 DOI: 10.1016/j.clbc.2014.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/23/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to assess the efficacy and safety of trabectedin for advanced breast cancer. PATIENTS AND METHODS In an open-label, phase II, multicenter study, women with advanced breast cancer previously treated with ≤ 2 lines of chemotherapy for advanced disease, including both anthracyclines and taxanes, were randomized (1:1) to 3-hour infusions of trabectedin 1.3 mg/m(2) once every 3 weeks (1/3 treatment arm) or 0.58 mg/m(2) every week for 3 of 4 weeks (3/4 treatment arm). The primary end point was objective response. Secondary end points included time to progression (TTP), progression-free survival (PFS), and overall survival (OS). RESULTS Fifty-two women (median age, 50 years; median chemotherapy agents, 4) were enrolled. Relative trabectedin dose intensities were 81% and 76% in the 1/3 and 3/4 treatment arms, respectively. Objective response rates were 12% (3 of 25) and 4% (1 of 27), respectively. Stable disease was observed in 14 (56%) and 11 (41%) patients in the 1/3 and 3/4 treatment arms, respectively, with median durations of 3.5 and 3.7 months. Median TTP and PFS were higher in the 1/3 treatment arm (3.1 months each) than in the 3/4 treatment arm (2.0 months each). At a median follow-up of 7 months in both treatment arms, median OS was not reached in the 1/3 treatment arm and was 9.4 months in the 3/4 treatment arm. The most frequent drug-related adverse events in the 1/3 and 3/4 treatment arms, respectively, were alanine aminotransferase (ALT) level increases (68% vs. 63%), nausea (56% vs. 59%), and asthenia (56% vs. 48%). Neutropenia and increases in ALT levels were the most frequent grade 3/4 events. Both types of events were usually transient and reversible. CONCLUSION In the population studied, trabectedin showed a manageable safety profile for both regimens analyzed. There were higher objective response rates and a longer PFS in the 1/3 treatment arm compared with the 3/4 treatment arm.
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Affiliation(s)
| | - Jayne Gurtler
- Oncology/Hematology, East Jefferson General Hospital, Metaire, LA
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Blay JY, Leahy MG, Nguyen BB, Patel SR, Hohenberger P, Santoro A, Staddon AP, Penel N, Piperno-Neumann S, Hendifar A, Lardelli P, Nieto A, Alfaro V, Chawla SP. Randomised phase III trial of trabectedin versus doxorubicin-based chemotherapy as first-line therapy in translocation-related sarcomas. Eur J Cancer 2014; 50:1137-47. [PMID: 24512981 DOI: 10.1016/j.ejca.2014.01.012] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 02/03/2023]
Abstract
AIM This randomised phase III trial evaluated first-line trabectedin versus doxorubicin-based chemotherapy (DXCT) in patients with advanced/metastatic translocation-related sarcomas (TRS). METHODS Patients were randomly assigned (1:1) to receive trabectedin 1.5mg/m2 24-h intravenous (i.v.) infusion every 3 weeks (q3wk) (Arm A), or doxorubicin 75 mg/m2 i.v., q3wk, or doxorubicin 60 mg/m2 i.v. plus ifosfamide (range, 6-9 g/m2) i.v. q3wk (Arm B). Progression-free survival (PFS) by independent review was the primary efficacy end-point. RESULTS One hundred and twenty-one patients were randomised; 88 of them had TRS confirmed by central pathology review (efficacy population). Twenty-nine PFS events were assessed by independent review (16 with trabectedin; 13 with DXCT). PFS showed non-significant difference between arms (stratified log rank test, p=0.9573; hazard ratio=0.86, p=0.6992). At the time of this analysis, 63.9% and 58.3% of patients were alive in trabectedin and DXCT arms, respectively. There was no statistically significant difference in survival curves. Response rate according to Response Evaluation Criteria in Solid Tumours (RECIST) v.1.0 was significantly higher in DXCT arm (27.0% versus 5.9%), but response according to Choi criteria showed fewer differences between treatment arms (45.9% versus 37.3%). Safety profile was as expected for both arms, with higher incidence of severe neutropenia, alopecia and mucositis in the DXCT arm. CONCLUSION Neither trabectedin nor doxorubicin-based chemotherapy showed significant superiority in the first-line treatment of patients with advanced translocation-related sarcoma.
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Affiliation(s)
| | - Michael G Leahy
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Armando Santoro
- Humanitas Cancer Center, Istituto Clinico Humanitas IRCCS, Rozzano, Italy
| | | | | | | | | | | | - Antonio Nieto
- PharmaMar, Clinical R&D, Colmenar Viejo, Madrid, Spain
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Gounaris I, Hatcher HM, Davidson D, Sherbourne K, Alam S, Zaki KA, Horan G, Earl HM. Trabectedin for advanced soft tissue sarcomas: a single institution experience. Future Oncol 2014; 10:1843-51. [PMID: 24450573 DOI: 10.2217/fon.14.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We retrospectively analyzed data from patients who had been treated with trabectedin at our institution between April 2009 and August 2011. PATIENTS & METHODS Data from 25 patients with recurrent soft tissue sarcoma (leiomyosarcoma: n = 8; liposarcoma: n = 5) were used to assess the efficacy and safety of trabectedin 1.5 mg/m(2) given every 3 weeks. RESULTS Most patients (n = 14) had been heavily pretreated with ≥ 2 previous chemotherapy lines. Eight (32%) patients achieved a partial response according to dimensional and tumor density changes, and seven (28%) patients had stable disease for ≥ 3 months (clinical benefit rate = 60%; n = 15). Median progression-free survival was 6.4 months and overall survival 19.3 months. Common adverse events were fatigue, nausea, anemia and transient transaminase increases. CONCLUSION Treatment with trabectedin is effective and well tolerated in heavily pretreated soft tissue sarcoma patients. Tapering dexamethasone courses and switching trabectedin administration to an every 4 weeks schedule effectively dealt with persistent fatigue without compromising effectiveness.
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Affiliation(s)
- Ioannis Gounaris
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
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Boudou L, Baconnier M, Blay JY, Lombard-Bohas C, Cassier PA. Trabectedin for the management of soft-tissue sarcoma. Expert Rev Anticancer Ther 2014; 9:727-37. [DOI: 10.1586/era.09.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Trabectedin is a tetrahydroisoquinoline molecule that binds to the N2 of guanine in the minor groove, causing DNA damage and affecting transcription regulation in a promoter- and gene-specific manner. The antitumor activity of trabectedin appears to be not only related to its direct effects on cancer cells, but also on the tumor microenvironment. In cancer cells, the drug induces cell cycle arrest and cell death that is not dependent on p53 status, and it is increased dramatically in cells deficient in homologous recombination (e.g., cells with mutations of BRCA1/2). Trabectedin also has potent immunomodulatory effects, being selectively cytotoxic against monocytes and tumor-associated macrophages. In addition, it inhibits production of proinflammatory and angiogenic mediators, which induces changes in the tumor microenvironment and contributes to its antitumor activity. The opportunity to combine direct cytotoxic activity with a capacity to favorably modify the tumor microenvironment, using either single-agent or combination therapy, is an especially appealing therapeutic option for a diverse range of cancers.
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Affiliation(s)
- Maurizio D’Incalci
- Department of Oncology, IRCCS – Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Laurenty AP, Thomas F, Chatelut E, Bétrian S, Guellec CL, Hennebelle I, Guellec SL, Chevreau C. Irreversible hepatotoxicity after administration of trabectedin to a pleiomorphic sarcoma patient with a rare ABCC2 polymorphism: a case report. Pharmacogenomics 2013; 14:1389-96. [DOI: 10.2217/pgs.13.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We describe here the case of a 60-year old male patient treated for an extensive local progression of a pleiomorphic sarcoma on the right tibial crest with second-line trabectedin. Two cycles were administrated before a major liver toxicity was retrieved, with both cytolytic and cholestatic hepatitis quickly associated with irreversible jaundice. The radiological, histological, chemistry and pharmacogenetic investigations led us to diagnose chronic hepatobiliary toxicity with portal fibrosis, cholangiolitis damages and chronic hepatopathy. The patient had a deficient variant genotype of ABCC2 (c.-24TT, c.4488CT and c.4544GA), which has been suggested to play a role in excretion of toxic metabolites of trabectedin. This case report is, to our knowledge, the first description of trabectedin‘s irreversible liver toxicity in a human patient. Supported by a thorough review of the literature, this hepatitis is thought to have resulted from a multihit process involving genetic variants of ABC proteins and comedication.
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Affiliation(s)
| | - Fabienne Thomas
- Department of Pharmacology & EA4553, Institut Claudius Regaud, 20–24, rue du Pont St Pierre, 31052 Toulouse Cedex, France
| | - Etienne Chatelut
- Department of Pharmacology & EA4553, Institut Claudius Regaud, 20–24, rue du Pont St Pierre, 31052 Toulouse Cedex, France
| | - Sarah Bétrian
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Chantal Le Guellec
- Department of Molecular Biology, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Isabelle Hennebelle
- Department of Pharmacology & EA4553, Institut Claudius Regaud, 20–24, rue du Pont St Pierre, 31052 Toulouse Cedex, France
| | - Sophie Le Guellec
- Department of Anatomopathology, Institut Claudius Regaud, Toulouse Cedex, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
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Martin-Liberal J, Judson I. Safety evaluation of trabectedin in treatment of soft-tissue sarcomas. Expert Opin Drug Saf 2013; 12:905-11. [PMID: 23937190 DOI: 10.1517/14740338.2013.829037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Trabectedin gained the approval by the European Medicines Agency (EMA) in 2007 for the treatment of patients affected by soft-tissue sarcomas (STS). Its safety and activity profiles have been assessed in many clinical trials as well as in standard clinical practice for > 10 years. AREAS COVERED This article extensively reviews the most common and specific adverse events associated with trabectedin. Moreover, we compare these toxicity data with other drugs active in STS such as doxorubicin and ifosfamide. Also, we provide a comprehensive view of the special mechanism of action of this drug and its clinical applications. Additionally, we discuss the current role of trabectedin in the treatment of STS and give a future perspective with the review of ongoing clinical trials and potential new indications. EXPERT OPINION Trabectedin is, in general, a well-tolerated drug with a favorable toxicity profile. The majority of its side effects are mild and easily manageable. Specific adverse events such as liver toxicity and rhabdomyolysis do not usually have a significant clinical impact. Overall, trabectedin is a safe and active treatment option in STS.
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Affiliation(s)
- Juan Martin-Liberal
- The Royal Marsden Hospital, Sarcoma Unit , Fulham Road, London, SW3 6JJ , UK
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Somaiah N, von Mehren M. New drugs and combinations for the treatment of soft-tissue sarcoma: a review. Cancer Manag Res 2012; 4:397-411. [PMID: 23226072 PMCID: PMC3514064 DOI: 10.2147/cmar.s23257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sarcomas are a heterogeneous group of solid tumors arising from either soft tissues or bone, accounting for approximately 1% of all cancers in adults. Management of these diseases has changed little over the past 10 years, with the exception of treatment of gastrointestinal stromal tumors. Reasons for this stagnation include multiple histologies commonly grouped together in clinical trials limiting the understanding of benefit of treatment and limited investigation of molecular targeted therapies. More recently, advances in molecular pathogenesis, the advent of novel and targeted therapeutics, and increasing collaborations between sarcoma investigators has helped move the field forward in the right direction. Here, we review the recent data on novel agents tested for the management of adult soft-tissue sarcomas, excluding gastrointestinal stromal tumors.
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Affiliation(s)
- Neeta Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Chuk MK, Aikin A, Whitcomb T, Widemann BC, Zannikos P, Bayever E, Balis FM, Fox E. A phase I trial and pharmacokinetic study of a 24-hour infusion of trabectedin (Yondelis®, ET-743) in children and adolescents with relapsed or refractory solid tumors. Pediatr Blood Cancer 2012; 59:865-9. [PMID: 22847981 PMCID: PMC3442122 DOI: 10.1002/pbc.24201] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/25/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objectives of this phase I study were to determine the maximum tolerated dose (MTD), toxicity profile, and pharmacokinetics of a 24-hour continuous intravenous infusion of trabectedin administered to children and adolescents with refractory or relapsed solid tumors. PROCEDURE Patients between the ages of 4 and 16 years old with refractory solid tumors received trabectedin as a 24-hour infusion every 21 days. Dexamethasone and prophylactic growth factor support were administered with each cycle. Pharmacokinetic studies were conducted during cycle 1. RESULTS Patients (n = 12) median (range) age 14.5 (8-16) years received trabectedin at 1.1 (n = 3), 1.5 (n = 6), or 1.7 (n = 3) mg/m(2). At the 1.5 mg/m(2) dose level, one patient had dose limiting anorexia and fatigue. At 1.7 mg/m(2), two patients experienced dose limiting toxicity, dehydration, and gamma-glutamyl transpeptidase elevation. Non-dose limiting toxicities included elevated serum transaminases, myelosuppression, nausea, emesis, and fatigue. Plasma pharmacokinetic parameters were similar to historical data in adults. One partial response was observed in a patient with neuroendocrine carcinoma. Stable disease (≥6 cycles) was achieved in three patients (osteosarcoma n = 2, desmoplastic small round cell tumor n = 1). CONCLUSIONS The MTD of trabectedin in pediatric patients with refractory solid tumors is 1.5 mg/m(2) IV over 24 hours every 21 days. Dexamethasone to ameliorate hepatic toxicity and prophylactic growth factor support are required.
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Affiliation(s)
- Meredith K Chuk
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224, USA.
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Galizia D, Palesandro E, Nuzzo AM, Pignochino Y, Aliberti S, Aglietta M, Grignani G. Prolonged Disease Stability With Trabectedin in a Heavily Pretreated Elderly Patient With Metastatic Leiomyosarcoma of the Thigh and Renal Failure: A Case Report and Review of the Literature. Oncol Res 2012; 20:483-90. [DOI: 10.3727/096504013x13685487925130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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A retrospective analysis of antitumour activity with trabectedin in translocation-related sarcomas. Eur J Cancer 2012; 48:3036-44. [PMID: 22749255 DOI: 10.1016/j.ejca.2012.05.012] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/10/2012] [Accepted: 05/10/2012] [Indexed: 02/07/2023]
Abstract
AIMS Approximately 20% of soft tissue sarcomas (STS) have subtype-specific chromosomal translocations; these generate chimeric oncoproteins which can act as abnormal transcription factors. Since trabectedin can bind to DNA and displace transcription factors, antitumour activity was explored in translocation-related sarcoma (TRS) subtypes. METHODS The current retrospective pooled analysis includes data from 81 patients with TRS treated in 8 phase II trials. RESULTS TRS subtypes were: synovial sarcoma (SS, n=45), myxoid-round cell liposarcoma (MRC-L-sarcoma, n=27), alveolar soft part sarcoma (ASPS, n=4), endometrial stromal sarcoma (ESS, n=3) and clear cell sarcoma (CCS, n=2). All but one patient had received prior chemotherapy (median of 2 lines). Patients received a median of 4 trabectedin cycles (range, 1-48; median dose intensity=0.40 mg/m(2)/week). Partial responses according to Response Evaluation Criteria in Solid Tumours (RECIST) occurred in 8 patients (ORR=10%; 95% CI, 4-19%): four in MRC-L-sarcoma; three in SS and one in ESS. Tumour control rate (ORR plus stable disease) was 59% (95% CI, 48-70%). Median PFS was 4.1 months (6-month PFS rate=40%). Median overall survival was 17.4 months (survival rate at 12 months=60%). Trabectedin had a manageable safety profile. CONCLUSION Trabectedin demonstrates encouraging disease control in TRS. Since these promising results were generally noted in patients following chemotherapy, a phase III randomised trial in first-line is ongoing to compare trabectedin with doxorubicin-based chemotherapy in patients with TRS.
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Grosso F, D'Incalci M, Cartoafa M, Nieto A, Fernández-Teruel C, Alfaro V, Lardelli P, Roy E, Gómez J, Kahatt C, Soto-Matos A, Judson I. A comprehensive safety analysis confirms rhabdomyolysis as an uncommon adverse reaction in patients treated with trabectedin. Cancer Chemother Pharmacol 2012; 69:1557-65. [PMID: 22484722 PMCID: PMC3362698 DOI: 10.1007/s00280-012-1864-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/22/2012] [Indexed: 01/04/2023]
Abstract
PURPOSE This analysis determined the incidence of serious rhabdomyolysis events reported during trabectedin treatment since the first phase I clinical trial in April 1996 up to September 2010. METHODS Search was done in the Yondelis(®) Pharmacovigilance and Clinical Trials databases using a list of terms according to the Medical Dictionary for Regulatory Activities (MedDRA, v. 13.1), followed by a medical review of all cases retrieved. Total estimated sample was 10,841 patients: 2,789 from clinical trials; 3,926 from compassionate use programs; and 4,126 treated in the marketplace. Two groups were identified: (1) rhabdomyolysis and (2) clinically relevant creatine phosphokinase (CPK) increases without acute renal failure (ARF). Descriptive analysis included demographic, clinical/laboratory data, and contributing/confounding factors. Potential predictive factors were evaluated by multivariate stepwise logistic regression analysis. Possible changes of pharmacokinetics (PK) in patients with rhabdomyolysis were explored using a population PK model. RESULTS The global incidence of rhabdomyolysis was 0.7%, and most cases occurred in Cycle 2 of treatment. The incidence of fatal cases was 0.3%. None of the variables evaluated to detect potential risk factors of rhabdomyolysis were predictive. Additionally, CPK increases (without ARF) were detected in 0.4% of patients as an incidental finding with good prognosis. CONCLUSIONS Rhabdomyolysis is an uncommon event during trabectedin treatment. Multivariate analyses did not show any potential factor that could be predictive or represent a significantly higher risk of developing rhabdomyolysis. Nevertheless, close patient monitoring and adherence to drug administration guidelines may help to limit the incidence of this event.
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Affiliation(s)
- Federica Grosso
- SC Oncologia, SS Antonio and Biagio and C Arrigo General Hospital, Alessandria, Italy.
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Peters G, Chatelut E, Larsen A, Zaffaroni N. EORTC-related new drug discovery and development activities: role of the Pharmacology and Molecular Mechanisms Group. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Cioffi A, Italiano A. Clinical and pharmacokinetic evaluation of trabectedin for the treatment of soft-tissue sarcoma. Expert Opin Drug Metab Toxicol 2011; 8:113-22. [DOI: 10.1517/17425255.2012.636353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sanfilippo R, Grosso F, Jones RL, Banerjee S, Pilotti S, D'Incalci M, Dei Tos AP, Raspagliesi F, Judson I, Casali PG. Trabectedin in advanced uterine leiomyosarcomas: a retrospective case series analysis from two reference centers. Gynecol Oncol 2011; 123:553-6. [PMID: 21917307 DOI: 10.1016/j.ygyno.2011.08.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment options for patients with metastatic uterine leiomyosarcoma are limited. Over the last few years, trabectedin has emerged as an effective agent for patients with advanced soft tissue sarcomas resistant to anthracyclines and ifosfamide. The aim of this retrospective analysis was to look at the efficacy of trabectedin in the subgroup of uterine leiomyosarcoma. PATIENTS AND METHODS A retrospective analysis was carried out on patients with uterine leiomyosarcoma treated with trabectedin at two reference sarcoma centers between 2000 and 2010. Radiological response, progression-free and overall survival, as well as serious and unexpected adverse events, were assessed. RESULTS Sixty-six patients with metastatic uterine leiomyosarcoma were identified. The median number of previous chemotherapy regimens was 3 (range 1-5). Eleven patients (16%) achieved a partial response and 23 (35%) had a stable disease. The progression-free survival of the entire cohort was 3.3 months (CI 95% 2-5), and the progression-free rate at 3 and 6 months was 53% and 33%, respectively. CONCLUSIONS Trabectedin is a therapeutic option in the palliative approach to the metastatic uterine leiomyosarcoma patient.
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Affiliation(s)
- Roberta Sanfilippo
- Cancer Medicine Department, Adult Sarcoma Medical Oncology Unit, Istituto Nazionale Tumori, Milan, Italy.
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Trabectedin in pre-treated patients with advanced or metastatic soft tissue sarcoma: a phase II study evaluating co-treatment with dexamethasone. Invest New Drugs 2010; 30:729-40. [DOI: 10.1007/s10637-010-9561-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 10/03/2010] [Indexed: 10/18/2022]
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