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Bi Y, Li F, Ren J, Han X. The safety and efficacy of oxaliplatin-loaded drug-eluting beads transarterial chemoembolization for the treatment of unresectable or advanced lung cancer. Front Pharmacol 2022; 13:1079707. [PMID: 36518678 PMCID: PMC9742261 DOI: 10.3389/fphar.2022.1079707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/17/2022] [Indexed: 08/22/2023] Open
Abstract
Aim: Drug-eluting beads are usually applied for the treatment of advanced hepatocellular carcinoma. Oxaliplatin was suggested as first-line therapy for advanced non-small-cell lung cancer. However, there has been little investigation about the application of drug-eluting beads transarterial chemoembolization (DEB-TACE) with oxaliplatin-loaded CalliSpheres beads (CB) for the treatment of unresectable or advanced lung cancer. We aimed to investigate the safety and efficacy of oxaliplatin-loaded DEB-TACE for the treatment of unresectable or advanced lung cancer. Methods: From January 2019 to December 2021, all patients with primary unresectable or advanced lung cancer who underwent DEB-TACE with oxaliplatin-loaded CB were retrospectively enrolled. This study defined overall survival and objective response rate (ORR) as the primary endpoints, disease control rate (DCR) and progression-free survival (PFS) as the secondary endpoints. Results: A total of 33 sessions of DEB-TACE were performed in 20 patients, with a mean of 1.7 ± 1.0 sessions. A total of 55 arteries were emoblized by CB, including 40 bronchial arteries, 13 intercostal arteries, one suprarenal artery and one inferior phrenical artery. No procedural-related mortality or severe complications were observed. The median tumor diameter was 49.0 [Interquartile range (IQR) 37.8-66.8] mm before DEB-TACE, and decreased to 38.8 (IQR 27.7-56.9), 26.1 (IQR 19.1-48.8), and 20.5 (IQR 13.1-49.7) mm at 1, 3 and 6 months later (p = 0.04). The ORR and DCR at 1, 3, and 6 months after DEB-TACE were 28.6% and 92.9%, 38.5% and 84.6%, 30.8% and 61.5%, respectively. The median PFS and median overall survival was 9.9 and 29.6 months, respectively. Conclusion: DEB-TACE with oxaliplatin-loaded CB is suggested as a safe, effective and well-tolerated treatment for patients with unresectable or advanced lung cancer.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fazhong Li
- Department of Interventional Radiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Development, optimization and in vitro evaluation of oxaliplatin loaded nanoparticles in non-small cell lung cancer. ACTA ACUST UNITED AC 2020; 28:673-684. [PMID: 33089432 DOI: 10.1007/s40199-020-00374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Platinum-based chemotherapy in non-small cell lung cancer (NSCLC) has been demonstrated as a promising approach by many researchers. However, due to low bioavailability and several side effects, drug targeting to lungs by intravenous administration is not a common route of administration. OBJECTIVE In this study, oxaliplatin loaded polycaprolactone (PCL) nanoparticles were prepared to overcome the limitations of the drug. 33 factorial design was used to evaluate the combined effect of the selected variables on the nanoparticle characteristics and to optimize oxaliplatin loaded PCL nanoparticles. METHODS The factorial design was used to study the influence of three different independent variables on the response of nanoparticle particle size, polydispersity index (PDI), zeta potential, and encapsulation efficiency. The cellular uptakes of oxaliplatin loaded nanoparticles with different molecular weights of PCL were evaluated. Moreover, optimized nanoparticles were evaluated for their efficacy in non-small lung cancer using the SK-MES-1 cell line. RESULTS In factorial design, it is found that the homogenization speed and surfactant ratio represented the main factors influencing particle size and PDI and did not seem to depend on the PCL ratio. While the cytotoxicity of free oxaliplatin and oxaliplatin loaded nanoparticles were similar in low drug doses (2.5 and 25 μg/mL), the cytotoxicity of oxaliplatin loaded nanoparticles on SK-MES-1 cell was found higher in higher doses (p < 0.05). Moreover, oxaliplatin nanoparticles formulated with different molecular weights of PCL did not show significant differences in cellular uptake in 1 h and 2 h. However, the uptake of PCL80000 NPs was found significantly greater than free oxaliplatin at 4 h (p < 0.05). CONCLUSION Hence, the development of oxaliplatin loaded PCL nanoparticles can be a useful approach for effective NSCLC therapy. Development, optimization and in vitro evaluation of oxaliplatin loaded nanoparticles in non-small cell lung cancer.
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Meriggi F, Zaniboni A. Gemox: A Widely Useful Therapy Against Solid Tumors-Review and Personal Experience. J Chemother 2013; 22:298-303. [DOI: 10.1179/joc.2010.22.5.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Atmaca A, Al-Batran SE, Werner D, Pauligk C, Güner T, Koepke A, Bernhard H, Wenzel T, Banat AG, Brueck P, Caca K, Prasnikar N, Kullmann F, Günther Derigs H, Koenigsmann M, Dingeldein G, Neuhaus T, Jäger E. A randomised multicentre phase II study with cisplatin/docetaxel vs oxaliplatin/docetaxel as first-line therapy in patients with advanced or metastatic non-small cell lung cancer. Br J Cancer 2013; 108:265-70. [PMID: 23329236 PMCID: PMC3566804 DOI: 10.1038/bjc.2012.555] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: This study was designed to compare cisplatin/docetaxel with oxaliplatin/docetaxel in patients with advanced and metastatic non-small lung cancer as a first-line treatment. Methods: Patients were randomly assigned to receive either cisplatin 75 mg m−2 and docetaxel 75 mg m−2 every 3 weeks or oxaliplatin 85 mg m−2 and docetaxel 50 mg m−2 every 2 weeks. The primary end point was response rate, and secondary end points were toxicity, time to progression and overall survival. Results: A total of 88 patients (median age: 65 (39–86) years; stage IV: 93%) were randomly assigned. Response rate (complete and partial response) was 47% (95% CI: 33–61%) in the cisplatin/docetaxel arm and 28% (95% CI: 17–43%) in the oxaliplatin/docetaxel arm (P=0.118). There was no significant difference in time to progression (6.3 vs 4.9 months, P=0.111) and median overall survival (11.6 vs 7.0 months, P=0.102) with cisplatin/docetaxel vs oxaliplatin/docetaxel, although slight trends favouring cisplatin were seen. Oxaliplatin/docetaxel was associated with significantly less (any grade) renal toxicity (56% vs 11%), any grade fatigue (81% vs 59%), complete alopecia (76% vs 27%), any grade leukopenia (84% vs 61%) and grade 3/4 leukopenia (44% vs 14%) and neutropenia (56% vs 27%). Conclusion: Oxaliplatin/docetaxel has activity in metastatic non-small cell lung cancer, but it seems to be inferior to cisplatin/docetaxel.
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Affiliation(s)
- A Atmaca
- Department of Hematology and Oncology, Institute of Clinical Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, 60488 Frankfurt am Main, Germany.
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Li Z, Hou M, Wang H, Wang Z. [A randomized study of gemcitabine plus oxaliplatin versus gemcitabine plus cisplatin as the 1st line chemotherapy for advanced non-small cell lung cancer in elderly patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2012; 14:588-92. [PMID: 21762628 PMCID: PMC6000267 DOI: 10.3779/j.issn.1009-3419.2011.07.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 以铂类为基础的化疗是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)的标准治疗方案。本研究旨在评价吉西他滨联合奥沙利铂和吉西他滨联合顺铂一线治疗老年晚期NSCLC的疗效及毒副反应。 方法 未经过治疗的经病理学或细胞学确诊的老年晚期NSCLC患者66例随机分成GO(吉西他滨1, 000 mg/m2第1、8天+奥沙利铂130 mg/m2第1天静脉滴注,每3周重复)组33例和GP(吉西他滨1, 000 mg/m2第1、8天+顺铂25 mg/m2第1、2、3天静脉滴注,每3周重复)组33例,至少治疗2周期,评价疗效及不良反应。 结果 GO组与GP组在治疗有效率(36.4% vs 40.6%, P=0.801)、中位无进展生存期(24周vs 18周,P=0.565)、中位生存期(44周vs 36周,P=0.918)等方面的差异无统计学意义,而在3级-4级贫血(0 vs 33.3%, P < 0.001)及3级-4级恶心呕吐(0 vs 27.3%,
P=0.004)等方面的差异有统计学意义。 结论 对于老年晚期NSCLC,一线使用吉西他滨联合奥沙利铂或顺铂两种方案疗效相当,但吉西他滨联合奥沙利铂方案治疗耐受性好,临床应用更安全。
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Affiliation(s)
- Zhixi Li
- Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
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A phase II study to evaluate the efficacy and toxicity of oxaliplatin in combination with gemcitabine in carcinoma of unknown primary. Int J Clin Oncol 2012; 18:226-31. [PMID: 22218909 DOI: 10.1007/s10147-011-0366-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Preclinical and clinical data suggest synergy for gemcitabine and oxaliplatin. These agents were tested in several known cancers that also comprise the common carcinoma of unknown primary (CUP) subtypes; namely, lung and pancreaticobiliary profiles. METHODS The study enrolled 29 patients of whom 28 patients were eligible for treatment. Gemcitabine was given at 1,000 mg/m(2) as a fixed dose rate infusion and oxaliplatin was infused at 100 mg/m(2) every 2 weeks with restaging performed after 3 cycles at 6 weeks. RESULTS The study reported one complete response (CR) (4%), 6 patients with a partial response (PR) (25%), and 13 with stable disease (SD) (54%); and 4 patients had progressive disease (PD) (17%) on restaging. Median overall survival (OS) and progression-free survival were 12.8 months (95% confidence interval [CI] 8.5-18.5) and 3.1 months (95% CI 1.7-6), respectively. The 1-year OS was 54%. The most common grade 3 toxicities were nausea (22%), vomiting (15%), and fatigue (11%). There were no grade 4 toxicities. This study was closed early as we moved from an empiric therapy platform to a more individualized approach. CONCLUSIONS Gemcitabine and oxaliplatin is a well-tolerated regimen in CUP with similar outcomes to previously documented CUP studies. In selected good performance status patients this combination may serve as a first-line doublet chemotherapy option for CUP patients.
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Mitchell PL, Broad A, Rosenthal MA, Galettis P, Abraham R, Burns I, Clarke S, Milner A, Diiulio J, Links M. Randomized phase 2 sequencing and pharmacokinetic study of gemcitabine and oxaliplatin in advanced non-small cell lung cancer. Asia Pac J Clin Oncol 2011; 7:376-84. [PMID: 22151988 DOI: 10.1111/j.1743-7563.2011.01390.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This multicentre phase II trial examined the combination of gemcitabine and oxaliplatin in patients with advanced non-small cell lung cancer (NSCLC). The effect of sequence administration was randomized and pharmacokinetics (PK) assessed. METHODS Eligible patients had stage IIIB or IV or recurrent NSCLC, no prior chemotherapy, World Health Organization performance status ≤2 and measurable disease. Treatment comprised: gemcitabine (1250 mg/m(2)) and oxaliplatin (70 mg/m(2)), each given on days 1 and 8 of a 21-day cycle. Patients were randomized 1:1 to the sequencing of the two drugs for the duration of their treatment. The primary end-point was response rate (RR). Secondary end-points included progression-free survival (PFS), overall survival (OS), toxicity, PK and the effect of drug sequencing. RESULTS A total of 46 patients were enrolled of whom 43 were evaluable for response. Overall 13 patients (30%) achieved a partial response, PFS was 4.2 months (95% CI 2.8-5.8 months), and OS was 6.8 months (95% CI 4.4-10.1 months). There was only one case of grade 3 neurosensory toxicity despite a median cumulative oxaliplatin dose in excess of 500 mg/m(2) . No differences in clinical or PK end-points were observed between the two different sequencing arms. CONCLUSION This oxaliplatin and gemcitabine schedule has shown activity in advanced NSCLC with modest toxicity. Neither clinical nor PK outcomes were influenced by the sequencing of these agents, although definite conclusions are limited by small patient numbers. The favorable toxicity profile of this doublet, in light of an encouraging RR, warrants its further investigation in NSCLC.
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Affiliation(s)
- Paul L Mitchell
- Department of Medical Oncology, Austin Hospital, Queensland, Australia.
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A Phase III Randomized Trial of Gemcitabine–Oxaliplatin versus Carboplatin–Paclitaxel as First-Line Therapy in Patients with Advanced Non-small Cell Lung Cancer. J Thorac Oncol 2011; 6:358-64. [DOI: 10.1097/jto.0b013e3181ffe8ef] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Geoerger B, Chisholm J, Le Deley MC, Gentet JC, Zwaan CM, Dias N, Jaspan T, Mc Hugh K, Couanet D, Hain S, Devos A, Riccardi R, Cesare C, Boos J, Frappaz D, Leblond P, Aerts I, Vassal G. Phase II study of gemcitabine combined with oxaliplatin in relapsed or refractory paediatric solid malignancies: An innovative therapy for children with Cancer European Consortium Study. Eur J Cancer 2010; 47:230-8. [PMID: 20943374 DOI: 10.1016/j.ejca.2010.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 07/05/2010] [Accepted: 09/07/2010] [Indexed: 01/09/2023]
Abstract
AIM To assess objective response rates after 4 cycles of gemcitabine in combination with oxaliplatin in children and adolescents with relapsed or refractory solid tumours. METHODS This multicentre, non-randomised Phase II study included five strata: neuroblastoma, osteosarcoma, medulloblastoma and other CNS tumours strata with two-stage Simon designs and a miscellaneous, extra-cranial solid tumour stratum with descriptive design. Eligibility criteria included: age 6 months to 21 years; measurable, relapsed or refractory solid malignancy; no more than one previous salvage therapy. Gemcitabine was administered intravenously at 1000 mg/m(2) over 100 min followed by oxaliplatin at 100mg/m(2) over 120 min on Day 1 of a 14-d cycle. Tumour response was assessed every 4 cycles according to WHO criteria. RESULTS Ninety-three out of 95 patients enrolled in 25 centres received treatment: 12 neuroblastoma; 12 osteosarcoma; 14 medulloblastoma; 13 other CNS tumours and 42 miscellaneous non-CNS solid tumours. Median age was 11.7 years (range, 1.3-20.8 years). Tumour control (CR+PR+SD) at 4 cycles was obtained in 30/93 evaluable patients (32.3%; 95% confidence interval (CI), 22.9-42.7%), including four PR: 1/12 patients with osteosarcoma, 1/12 with medulloblastoma, 1/12 with rhabdomyosarcoma and 1/4 with other sarcoma. Five out of 12 eligible patients with neuroblastoma experienced stable disease. During a total of 481 treatment cycles (median 4, range 1-24 per patient), the most common treatment-related toxicities were haematologic (leukopenia, neutropenia, thrombocytopenia) and neurological (dysesthesia, paresthesia). CONCLUDING STATEMENT The gemcitabine-oxaliplatin combination administered in a bi-weekly schedule has acceptable safety profile with limited activity in children with relapsed or refractory solid tumours.
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Affiliation(s)
- Birgit Geoerger
- Institut Gustave Roussy, Université Paris-Sud, 39 rue Camille Desmoulins, 94805 Villejuif, France.
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Radhakrishnan A, Bitran JD, Milton DT, Tolzien K, Hallmeyer S, Nabhan C. Docetaxel and oxaliplatin as first-line therapy for advanced non-small cell lung cancer: a phase II trial. J Chemother 2009; 21:439-44. [PMID: 19622464 DOI: 10.1179/joc.2009.21.4.439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We sought to evaluate the safety and efficacy of docetaxel and oxaliplatin combination as first-line therapy for patients with stage IV or wet III(B )non small cell lung cancer. Patients received oxaliplatin at 85 mg/m(2) intravenously over 2 hours on days 1 and 15 along with docetaxel at 30 mg/m(2) intravenously on days 1 and 8; both given every 28 days. Cycles were repeated every 4 weeks for a maximum of 6. Fifteen patients were enrolled for an overall response rate of 50% (95% CI 21-74%). Median progression-free survival was 2.4 months with a 1-year progression free survival of 10%. Median overall survival was 7.9 months with 49% of patients alive at 1 year. Most common toxicities were nausea, vomiting, and dehydration. This combination has notable activity in advanced non-small cell lung cancer with a favorable toxicity profile.
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Affiliation(s)
- A Radhakrishnan
- Department of Medicine, Division of Hematology Oncology, Advocate Lutheran General Hospital, IL 60068, USA
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Ray-Coquard I, Weber B, Cretin J, Haddad-Guichard Z, Lévy E, Hardy-Bessard AC, Gouttebel MC, Geay JF, Aleba A, Orfeuvre H, Agostini C, Provencal J, Ferrero JM, Fric D, Dohollou N, Paraiso D, Salvat J, Pujade-Lauraine E. Gemcitabine-oxaliplatin combination for ovarian cancer resistant to taxane-platinum treatment: a phase II study from the GINECO group. Br J Cancer 2009; 100:601-7. [PMID: 19190632 PMCID: PMC2653739 DOI: 10.1038/sj.bjc.6604878] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Advanced ovarian carcinoma in early progression (<6 months) (AOCEP) is considered resistant to most cytotoxic drugs. Gemcitabine (GE) and oxaliplatin (OXA) have shown single-agent activity in relapsed ovarian cancer. Their combination was tested in patients with AOCEP in phase II study. Fifty patients pre-treated with platinum–taxane received q3w administration of OXA (100 mg m–2, d1) and GE (1000 mg m–2, d1, d8, 100-min infusion). Patient characteristics were a : median age 64 years (range 46–79),and 1 (84%) or 2 (16%) earlier lines of treatment. Haematological toxicity included grade 3–4 neutropaenia (33%), anaemia (8%), and thrombocytopaenia (19%). Febrile neutropaenia occurred in 3%. Non-haematological toxicity included grade 2–3 nausea or vomiting (34%), grade 3 fatigue (25%),and grade 2 alopecia (24%). Eighteen (37%) patients experienced response. Median progression-free (PF) and overall survivals (OS) were 4.6 and 11.4 months, respectively. The OXA–GE combination has high activity and acceptable toxicity in AOCEP patients. A comparison of the doublet OXA–GE with single-agent treatment is warranted.
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Affiliation(s)
- I Ray-Coquard
- Centre Léon Bérard, 28 rue Laennec, 69008 Lyon, France.
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Vinorelbine and oxaliplatin in stage IV nonsmall cell lung cancer patients unfit for cisplatin: a single-center experience. Anticancer Drugs 2009; 20:105-8. [DOI: 10.1097/cad.0b013e32831cdb51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Früh M, Gillessen S, Cerny T, Demmer R, D’Addario G. Two-weekly gemcitabine fixed dose rate and oxaliplatin combination chemotherapy for advanced non-small-cell lung cancer. Lung Cancer 2008; 62:344-50. [DOI: 10.1016/j.lungcan.2008.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 03/30/2008] [Indexed: 11/29/2022]
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Froudarakis ME, Pataka A, Pappas P, Anevlavis S, Argiana E, Nikolaidou M, Kouliatis G, Pozova S, Marselos M, Bouros D. Phase 1 trial of lipoplatin and gemcitabine as a second-line chemotherapy in patients with nonsmall cell lung carcinoma. Cancer 2008; 113:2752-60. [DOI: 10.1002/cncr.23921] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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McLaren V, Graham J, Paul J, Dunlop D. A Phase II Study of Oxaliplatin and Gemcitabine in Advanced Inoperable Stage IIIB/IV Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2008; 20:384-5. [DOI: 10.1016/j.clon.2008.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 03/19/2008] [Indexed: 11/26/2022]
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Oxaliplatin doublets in non-small cell lung cancer: A literature review. Lung Cancer 2008; 60:325-31. [DOI: 10.1016/j.lungcan.2008.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 03/05/2008] [Accepted: 03/08/2008] [Indexed: 11/24/2022]
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Bidoli P, Zilembo N, Cortinovis D, Mariani L, Isa L, Aitini E, Cullurà D, Pari F, Nova P, Mancin M, Formisano B, Bajetta E. Randomized phase II three-arm trial with three platinum-based doublets in metastatic non-small-cell lung cancer. An Italian Trials in Medical Oncology study. Ann Oncol 2007; 18:461-7. [PMID: 17110590 DOI: 10.1093/annonc/mdl415] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients with advanced non-small-cell lung cancer (NSCLC) do not tolerate cisplatin-based regimens because of its nonhemathological toxicity. PATIENTS AND METHODS We evaluated the response rate safety of new platinum analogue regimens, randomizing 147 patients with nonoperable IIIB/IV NSCLC to (i) carboplatin (area under the curve = 5 mg min/ml) on day 1 plus gemcitabine (GEM) (1000 mg/m(2)) on days 1 and 8 for six cycles; (ii) same regimen for three cycles followed by docetaxel (Taxotere) (40 mg/m(2)) on days 1 and 8 plus GEM (1250 mg/m(2)) on days 1 and 8 for three cycles; (iii) oxaliplatin (130 mg/m(2)) on day 1 plus GEM (1250 mg/m(2)) on days 1 and 8 for six cycles. RESULTS Intention-to-treat objective response rates were 25%, 25% and 30.6% in arms A, B and C, respectively. Median survival was 11.9, 9.2 and 11.3 months in arms A, B and C, respectively. Grade 3/4 neutropenia/anemia occurred in 29%/12.5%, 10%/16.5% and 8%/6% of arms A, B and C, respectively; grade 3/4 thrombocytopenia in 20.5%, 16.5% and 6%; grade 1/2 neurological toxicity in 43% of arm C. CONCLUSIONS Oxaliplatin/GEM (arm C) had similar activity to carboplatin/GEM (arm A), but milder hematological toxicity and may be worth testing in a phase III study against carboplatin/GEM in patients not suitable for cisplatin. The sequential regimen gave no additional benefit.
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Affiliation(s)
- P Bidoli
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori i, Milan, Italy
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Shibata S, Chow W, Frankel P, Juhasz A, Leong L, Lim D, Margolin K, Morgan R, Newman E, Somlo G, Yen Y, Synold T, Gandara D, Lenz HJ, Doroshow J. A phase I study of oxaliplatin in combination with gemcitabine: correlation of clinical outcome with gene expression. Cancer Chemother Pharmacol 2006; 59:549-57. [PMID: 17051371 DOI: 10.1007/s00280-006-0297-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 07/19/2006] [Indexed: 12/27/2022]
Abstract
PURPOSE Oxaliplatin has in vitro activity similar to or higher than other platinum agents. Preclinically, gemcitabine has demonstrated synergy when combined with platinum compounds. These facts formed the rationale for determining the maximum tolerated dose (MTD) of gemcitabine in combination with oxaliplatin. METHODS Eligible patients with advanced incurable solid tumors were given oxaliplatin 130 mg/m2 as a 2-h infusion on day 1 followed by escalating doses of gemcitabine given over 30 min on day 1 and 8 of a 21-day cycle. RESULTS A total of 43 patients were enrolled, including 30 patients at the MTD in an expanded cohort. At a gemcitabine dose of 800 mg/m2, 1/6 patients had a dose limiting toxicity (DLT) (grade 3 blurred vision and memory loss). At 1,000 mg/m2, 1/6 patients had a DLT (grade 3 increase in AST). At 1,200 mg/m2, 2/3 patients had a DLT (grade 4 thrombocytopenia and grade 3 confusion). The MTD of gemcitabine with 130 mg/m2 of oxaliplatin was therefore 1,000 mg/m2. The clearances of gemcitabine and ultrafilterable platinum are within the ranges previously reported for single agents. A patient with colon cancer had a partial response, and 21 patients had a best response of stable disease. In patients with tumor biopsies treated at the MTD, decreased ribonucleotide reductase M2 expression correlated with response. CONCLUSION Treatment with gemcitabine and oxaliplatin was well tolerated with primarily hematologic toxicity at the MTD. Study of biochemical correlates of response remain of interest thought current results remain exploratory.
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Affiliation(s)
- Stephen Shibata
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
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Kakolyris S, Ziras N, Vamvakas L, Varthalitis J, Papakotoulas P, Syrigos K, Vardakis N, Kalykaki A, Amarantidis K, Georgoulias V. Gemcitabine plus oxaliplatin combination (GEMOX regimen) in pretreated patients with advanced non-small cell lung cancer (NSCLC): a multicenter phase II study. Lung Cancer 2006; 54:347-52. [PMID: 17030075 DOI: 10.1016/j.lungcan.2006.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 09/01/2006] [Accepted: 09/06/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the activity and tolerance of gemcitabine in combination with oxaliplatin (GEMOX regimen) in pretreated patients with advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Thirty-two patients with advanced NSCLC who had disease progression after a cisplatin- and taxane-based front-line regimen were treated with gemcitabine (1500 mg/m(2) on days 1 and 8) and oxaliplatin (130 mg/m(2) on day 8) every 3 weeks. The patients' median age was 62 years and the performance status (WHO) was 0 for 11, 1 for 17 and 2 for 4 patients. The treatment was second line for 22 (69%) and >or=third line for 10 (31%) patients. RESULTS Partial response was achieved in 5 (16%) patients, stable disease in 8 (25%) and progressive disease in 19 (59%). Two patients with stable disease and one patient with progressive disease while on previous chemotherapy experienced a partial response with GEMOX regimen. The median duration of response was 2.5 months (range, 1-11.5), the median time to tumor progression 3 months (range, 1-18) and the median survival 5.6 months (range, 1-31). Grade III neutropenia occurred in five (16%) patients, grade III thrombocytopenia in two (6%) and grade III anemia in three (9%); moreover, grades II-III asthenia was reported in eight (25%) patients and grades II-III neurotoxicity in three (9%). CONCLUSION The GEMOX combination is a relatively active and well tolerated second-line regimen in NSCLC patients pretreated with a taxane- and/or platinum-based chemotherapy.
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Affiliation(s)
- Stylianos Kakolyris
- Department of Medical Oncology, University General Hospital of Alexandroupolis, Greece
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20
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Abstract
PURPOSE OF REVIEW The treatment of patients with advanced non-small cell lung cancer has changed considerably in the past decade. This paper reviews the most significant changes seen in chemotherapy and the most promising new agents in development for this disease. RECENT FINDINGS Chemotherapy prolongs survival and improves quality of life in patients with a good performance status and appears to alleviate disease-related symptoms in patients with a lower performance status. Platinum-based regimens became standard; none of the third-generation drug combinations seemed to be superior to the others. Nonplatinum combinations are reasonable alternatives now and offer a better toxicity profile in certain populations. Attempts to add molecular-targeted therapy to combination chemotherapy have failed except for bevacizumab. New compounds such as pemetrexed, bortezomib, TLK286, bevacizumab, and the epothilones are currently being evaluated in non-small cell lung cancer. SUMMARY Management of non-small cell lung cancer has improved considerably in the past decade. The overall benefit of chemotherapy over supportive care has been shown, platinum-based doublets have been established, nonplatinum regimens have been developed, chemotherapy has been used more broadly in subgroups of patients who have been previously neglected, and a shorter chemotherapy duration has been shown to be equally effective. After hitting a plateau in the benefit of chemotherapy, new drugs with novel action mechanisms such as the ones described here offer hope to improve therapy for this disease.
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Affiliation(s)
- Luis E Raez
- University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, The Mount Sinai Cancer Center, Florida, USA.
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Raez LE, Santos ES, Lopes G, Rosado MF, Negret LM, Rocha-Lima C, Tolba K, Farfan N, Hamilton-Nelson K, Silva O, Roman E. Efficacy and safety of oxaliplatin and docetaxel in patients with locally advanced and metastatic non-small-cell lung cancer (NSCLC). Lung Cancer 2006; 53:347-53. [PMID: 16844257 DOI: 10.1016/j.lungcan.2006.05.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 05/28/2006] [Accepted: 05/31/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Platinum-based doublets are recommended as treatment for advanced or metastatic non-small-cell lung cancer (NSCLC); however, chemotherapy must be tailored to limit side effects. A phase II study was conducted to evaluate the efficacy and safety of oxaliplatin combined with docetaxel for NSCLC. METHODS Patients with stage IIIB or IV, chemotherapy-naive NSCLC received docetaxel 70 mg/m(2), oxaliplatin 130 mg/m(2), and pegfilgrastim 6 mg every 21 days for up to six cycles. Primary endpoint was overall response rate (ORR), secondary endpoints were progression-free (PFS) and overall survival (OS), and safety. RESULTS Twenty-nine patients were treated; 93% had stage IV disease and 28% had brain metastases. In 27 evaluable patients with follow-up, there were 10 partial responses for an ORR of 37% (90% confidence interval [CI], 22-55%). Median PFS was 4.6 months (95% CI, 2.6-6.5 months); 12-month PFS was 14.8% (95% CI, 3.4-34.0%). Median OS was 10.9 months (95% CI, 8.9-16.8 months); 12-month OS was 40% (95% CI, 19-61%) and 18-month OS was 16% (95% CI, 1-46%). In 29 treated patients, there were no unusual or unexpected adverse events. The most common grade 3 and 4 toxicities were anemia (14% of patients) and hyperglycemia (10%); there were only two reports of neutropenia; both were grade 1 or 2. CONCLUSION These phase II findings suggest that the combination of oxaliplatin and docetaxel is active and well tolerated, and should be further investigated as a feasible treatment alternative for patients with advanced or metastatic NSCLC.
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Affiliation(s)
- Luis E Raez
- Division of Hematology/Oncology, University of Miami Miller School of Medicine, 1475 NW 12 Avenue, Suite 3510, Miami, FL 33136, USA.
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Boni C, Zanelli F, Ambroggi M, Bologna A. Non-small-cell lung cancer: which platinum for gemcitabine? Ann Oncol 2006; 17 Suppl 5:v79-81. [PMID: 16807470 DOI: 10.1093/annonc/mdj956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Boni
- Department of Oncology, S. Maria Nuova Hospital, Reggio Emilia, Italy
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23
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Steer CB, Chrystal K, Cheong KA, Galani E, Marx GM, Strickland AH, Yip D, Lofts F, Gallagher C, Thomas H, Harper PG. Gemcitabine and oxaliplatin followed by paclitaxel and carboplatin as first line therapy for patients with suboptimally debulked, advanced epithelial ovarian cancer. A phase II trial of sequential doublets. The GO-First Study. Gynecol Oncol 2006; 103:439-45. [PMID: 16643993 DOI: 10.1016/j.ygyno.2006.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Revised: 02/24/2006] [Accepted: 03/13/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Gemcitabine and oxaliplatin are active in epithelial ovarian cancer with minimal overlapping toxicity. We studied the efficacy and toxicity of this combination in patients with advanced ovarian cancer when given prior to carboplatin and paclitaxel. METHODS Chemonaive patients with epithelial ovarian cancer and measurable disease were eligible for the study. Treatment consisted of gemcitabine 1250 mg/m2 on days 1 and 8 and oxaliplatin 130 mg/m2 on day 8 every 21 days (GO) for 4 cycles. This was followed by carboplatin AUC = 6 and paclitaxel 175 mg/m2 on day 1 every 21 days (CP) for 4 cycles. RESULTS Twenty patients, median age 62 years (range 39-78), FIGO stages III (16) and IV (4) received treatment. The response rate (RR) after 4 cycles of GO was 80% (95%CI 61-99%) (4 complete responses (CR), 12 partial responses (PR)). Interval debulking surgery was performed in 7 patients (35%). After CP chemotherapy, RR increased to 85% (95%CI 68-100%) (CR = 13, PR = 4). Median time to progression was 14.5 months. Estimated median overall survival was 31.5 months. Toxicities of GO were mild; grade 3/4 nausea in 3 patients (15%) and vomiting in 2 patients (10%), grade 3/4 neutropenia in 5 patients (25%). Grade 2/3 peripheral neuropathy occurred in 5 patients (25%). After sequential administration of CP, grade 2/3 neuropathy occurred in 13 patients (72%). CONCLUSION The sequential doublet regimen of GO followed by CP resulted in unacceptable neurotoxicity and is not recommended for further study; however, the doublet gemcitabine and oxaliplatin has significant activity in the first line treatment of patients with ovarian cancer.
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Affiliation(s)
- C B Steer
- Department Medical Oncology, Guys and St Thomas's NHS Trust, London, UK.
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Gan HK, Mitchell PL, Galettis P, Davis ID, Cebon J, de Souza P, Links M. A phase 1 and pharmacokinetic study of gemcitabine and oxaliplatin in patients with solid tumors. Cancer Chemother Pharmacol 2005; 58:157-64. [PMID: 16328413 DOI: 10.1007/s00280-005-0152-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 11/05/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE This dose escalation study aimed to determine the recommended doses, toxicity and pharmacokinetics of oxaliplatin and gemcitabine given on days 1 and 8 every 21 days. This schedule may maximize dose intensity of both drugs with acceptable or reduced toxicity. PATIENT AND METHODS Eligible patients had solid malignancies, no more than two prior courses of chemotherapy, ECOG performance status 0-2, neurotoxicity < or = NCI-CTC grade 1 and adequate organ function. Dose escalation commenced at oxaliplatin 40 mg/m(2) and gemcitabine 750 mg/m(2), both given on days 1 and 8 every 21 days, and reached oxaliplatin 80 mg/m(2) and gemcitabine 1,500 mg/m(2). The two highest dose levels were each expanded to six patients to gain additional toxicity data. RESULTS There were no dose limiting toxicities related to treatment and an MTD was not reached. Five patients (24%) had grade 3 neutropenia, without associated infection, and seven patients (33%) had grade 3/4 thrombocytopenia. Neurotoxicity was mild and no worse than grade 1. Two patients with mesothelioma (10%) had partial responses and 11 patients (52%) had disease stabilization. No pharmacokinetic interaction between oxaliplatin and gemcitabine was detected. Dose intensity was maximal at level 4 (oxaliplatin 70 mg/m(2) and gemcitabine 1,250 mg/m(2)). CONCLUSIONS This schedule allows oxaliplatin and gemcitabine to be delivered at the full dose intensity of each drug with excellent tolerability and predictable pharmacokinetics. The recommended doses for phase II studies are oxaliplatin 70 mg/m(2) and gemcitabine 1,250 mg/m(2) on days 1 and 8 every 21 days.
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Affiliation(s)
- Hui K Gan
- Department of Medical Oncology and Ludwig Institute for Cancer Research, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.
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Cappuzzo F, Novello S, De Marinis F, Franciosi V, Maur M, Ceribelli A, Lorusso V, Barbieri F, Castaldini L, Crucitta E, Marini L, Bartolini S, Scagliotti GV, Crinò L. Phase II study of gemcitabine plus oxaliplatin as first-line chemotherapy for advanced non-small-cell lung cancer. Br J Cancer 2005; 93:29-34. [PMID: 15956971 PMCID: PMC2361475 DOI: 10.1038/sj.bjc.6602667] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This phase II study evaluated the response rate and tolerability of gemcitabine–oxaliplatin chemotherapy in non-small-cell lung cancer (NSCLC) patients. Chemonaive patients with stage IIIB or IV NSCLC received gemcitabine 1000 mg m−2 on days 1 and 8, followed by oxaliplatin 130 mg m−2 on day 1. Cycles were repeated every 21 days for up to six cycles. From February 2002 to May 2004, 60 patients were enrolled into the study in seven Italian institutions. We observed one complete response (1.7%) and 14 partial responses (23.3%), for an overall response rate of 25.0% (95% confidence interval, 14.7–37.9%). The median duration of response was 5.9 months (range 1.5–17.1 months). With a median follow-up of 6.7 months, median time to progressive disease and overall survival were 2.7 (range 1.9–3.4 months) and 7.3 months (range 7.2–8.6 months), respectively. The main grade 3–4 haematological toxicities were transient neutropenia in 11.7% and thrombocytopenia in 8.3% of the patients. Nausea/vomiting was the main grade 3–4 nonhaematological toxicity, occurring in 10.0% of the patients. Two (3.3%) patients developed grade 3 neurotoxicity. Our results show that gemcitabine–oxaliplatin chemotherapy is active and well tolerated in patients with advanced NSCLC, deserving further study, especially for patients not eligible to receive cisplatin.
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Affiliation(s)
- F Cappuzzo
- Division of Medical Oncology, Bellaria Hospital, Bologna, Via Altura 3, 40139 Bologna, Italy.
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Belani CP. Recent updates in the clinical use of platinum compounds for the treatment of lung, breast, and genitourinary tumors and myeloma. Semin Oncol 2004; 31:25-33. [DOI: 10.1053/j.seminoncol.2004.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2004; 13:49-64. [PMID: 14971123 DOI: 10.1002/pds.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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