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Chong IY, Chau I. Is there still a place for radiotherapy in gastric cancer? Curr Opin Pharmacol 2023; 68:102325. [PMID: 36610101 DOI: 10.1016/j.coph.2022.102325] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 01/07/2023]
Abstract
Stomach cancer is an aggressive disease and represents a global health problem. The majority of patients with localised disease present with locally advanced cancer that requires multimodality treatment. Chemoradiotherapy delivered after D2 gastrectomy has been evaluated in a number of clinical studies and best evidence, thus far, does not support its use in the post-operative setting. Data from currently recruiting and ongoing trials with exploratory translational endpoints are eagerly awaited to direct the use of chemoradiotherapy in the neoadjuvant setting. Radiotherapy can be effective in the palliation of symptoms associated with advanced gastric cancer. Furthermore, Stereotactic Body Radiotherapy has the potential to provide long term disease control in a proportion of gastric cancer patients with oligometastatic liver disease.
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Affiliation(s)
- Irene Y Chong
- Consultant Clinical Oncologist, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Ian Chau
- Consultant Medical Oncologist, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Turkes F, Bryant A, Begum R, Davidson M, Kalaitzaki E, Aresu M, Lazaro-Alcausi R, Bryant J, Rana I, Chua S, Aronson L, Hulkki-Wilson S, Fribbens C, Watkins D, Rao S, Starling N, Cunningham D, Chong IY, Chau I. Ibrutinib in c-MYC and HER2 Amplified Oesophagogastric Carcinoma: Results of the Proof-of-Concept iMYC Study. Curr Oncol 2022; 29:2174-2184. [PMID: 35448150 PMCID: PMC9029374 DOI: 10.3390/curroncol29040176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Oesophagogastric (OG) cancer is a highly lethal disease requiring novel treatment options. c-MYC and/or HER-2 amplified oesophageal cancer models have demonstrated sensitivity to BTK inhibition with ibrutinib. We evaluated the safety and efficacy of ibrutinib in patients with c-MYC and/or HER2 amplified pre-treated advanced OG cancer. c-MYC and HER2 amplification status were determined by FISH. The primary endpoint was overall response rate (ORR). Secondary endpoints were disease control rate (DC) at 8 weeks, safety, progression-free survival (PFS) and overall survival (OS). Eleven patients were enrolled. Eight patients had c-MYC amplified tumours, six were HER2 amplified and three were c-MYC and HER2 co-amplified. Grade ≥ 3 adverse events were fever, neutropenia, and vomiting. Grade ≥ 3 gastrointestinal haemorrhage occurred in three patients and was fatal in two cases. Among seven evaluable patients, three patients (43%) achieved a best response of SD at 8 weeks. No PR or CR was observed. Disease control was achieved for 32 weeks in one patient with a dual c-MYC and HER2 highly co-amplified tumour. The median PFS and OS were 1.5 (95% CI: 0.8–5.1) and 5.1 (95% CI: 0.8–14.5) months, respectively. Ibrutinib had limited clinical efficacy in patients with c-MYC and/or HER2 amplified OG cancer. Unexpected gastrointestinal bleeding was observed in 3 out of 8 treated patients which was considered a new safety finding for ibrutinib in this population.
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Affiliation(s)
- Fiona Turkes
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Annette Bryant
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Ruwaida Begum
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Michael Davidson
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Eleftheria Kalaitzaki
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Maria Aresu
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Retchel Lazaro-Alcausi
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Jane Bryant
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Isma Rana
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Sue Chua
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Lauren Aronson
- Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK; (L.A.); (I.Y.C.)
| | - Sanna Hulkki-Wilson
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Charlotte Fribbens
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - David Watkins
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Sheela Rao
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - David Cunningham
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
| | - Irene Y. Chong
- Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK; (L.A.); (I.Y.C.)
| | - Ian Chau
- Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK; (F.T.); (A.B.); (R.B.); (M.D.); (E.K.); (M.A.); (R.L.-A.); (J.B.); (I.R.); (S.C.); (S.H.-W.); (C.F.); (D.W.); (S.R.); (N.S.); (D.C.)
- Correspondence:
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