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Natalie K, Razvan C, Alexandru G, Daniela M, Florina P, Vladimir P, Ariana R, Patriciu AC, Florian S. Constricting Gaps: Protocol development, implementation challenges and lessons learned for the reality m ap of un met needs for Palliative Care Interventions in advanced cancer patient s study in Romania and Switzerland. Contemp Clin Trials Commun 2024; 42:101360. [PMID: 39351079 PMCID: PMC11440238 DOI: 10.1016/j.conctc.2024.101360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/07/2024] [Accepted: 08/28/2024] [Indexed: 10/04/2024] Open
Abstract
Background Patients with advanced cancer experience many symptoms and needs requiring a Palliative Care Intervention (PCI). Identifying gaps between needs for PCIs and experienced delivery may improve health care, furthermore the association of gaps with quality indicators (QI). The multicentre Romanian (RO)-Swiss (CH) reality map study implemented a novel protocol based on needs concepts and culturally adapted quality indicators (QI). Methods An interactive mapping guide measuring unmet needs for PCIs monthly over six months, patient characteristics (cognition, EAPC basic data set, Cofactors) and QI (Inappropriate Anticancer Treatment, High Symptom Burden [IPOS, EQ5D], Repeated ER Admissions, Aggressive End-of-Life Care, and Quality of Death-and-Dying) were developed, applying swiss standards for quality assurance. A composite endpoint (QI, cofactors) was planned. Finally, local solutions responding to gaps were piloted. Results From 308 patients (RO: 262, CH: 46, age 62j [mean], 74 % ECOG PS 1&2, 81 % current anticancer treatment) baseline and first follow-up data revealed main gaps (symptom management, spiritual needs, family support), country differences (e.g. illness understanding, spiritual needs) and a significant association of the number of gaps with depression. Later data become less, and data quality on QI variable, revealing gaps in research conduct competences, resources, and applicability of over-sophisticated quality assurance tools. Nevertheless, the unmet needs data promoted local initiatives, 81 patients participated in feasibility studies. Finally, the joint experience stimulated academic developments and national integration of palliative care into oncology. Conclusions Pairing motivation and enthusiasm with more modest aims, feasibility testing of all outcomes and investment in research competences may disperse gaps.
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Affiliation(s)
- Kalbermatten Natalie
- Clinic Medical Oncology and Hematology, Cantonal Hospital, St.Gallen, Switzerland
| | - Curca Razvan
- Spitalul Judetean de Urgenta, Alba Iulia, Romania
| | | | - Mosoiu Daniela
- Transylvania University, Brasov, Romania
- Hospice Casa Sperantei, Brasov, Romania
| | - Pop Florina
- "Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Poroch Vladimir
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Regional Institute of Oncology Iasi, Romania
| | | | - Achimas-Cadariu Patriciu
- "Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
- University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Romania
| | - Strasser Florian
- Clinic Medical Oncology and Hematology, Cantonal Hospital, St.Gallen, Switzerland
- University of Bern, Switzerland
| | - Swiss-Romanian Partnership IZERZO
- Clinic Medical Oncology and Hematology, Cantonal Hospital, St.Gallen, Switzerland
- Spitalul Judetean de Urgenta, Alba Iulia, Romania
- Institute of Oncology, Bucharest, Romania
- Transylvania University, Brasov, Romania
- Hospice Casa Sperantei, Brasov, Romania
- "Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
- Regional Institute of Oncology Iasi, Romania
- Hospice Eliana, Hapria, Alba, Romania
- University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Romania
- University of Bern, Switzerland
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Ren R, Zhang Z, Zhai S, Yang J, Tusong B, Wang J. Efficacy and safety of ramucirumab for gastric or gastro-esophageal junction adenocarcinoma: a systematic review and meta-analysis. Eur J Clin Pharmacol 2024; 80:1697-1714. [PMID: 39102039 DOI: 10.1007/s00228-024-03734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Based on the comparison of ramucirumab monoclonal antibody with control treatments in randomized controlled trials, this study aims to elucidate the role of ramucirumab monoclonal antibody in cancer therapy and its potential side effects, providing scientific evidence for clinical treatment. METHODS PubMed, Embase, Cochrane, and Web of Science were searched systematically to obtain the trials on ramucirumab in the treatment of gastric or gastroesophageal junction (GEJ) adenocarcinoma up to April 13, 2023. We included randomized controlled trials (RCTs) evaluating the efficacy and safety of ramucirumab as monotherapy and in combination with other chemotherapy agents as interventions for treating gastric or gastroesophageal junction (GEJ) adenocarcinoma. RESULTS After screening 2200 studies, we finally included 8 eligible studies (involving a total of 3,283 participants). Meta-analysis results showed that compared to the control group, ramucirumab monotherapy significantly improved overall survival (OS) (hazard ratio [HR] = 0.77, 95% confidence interval [CI] [0.67, 0.89]) and progression-free survival (PFS) (HR = 0.48, 95% CI [0.40, 0.58]). Similar results were obtained for ramucirumab combined with paclitaxel. In the treatment combining ramucirumab with paclitaxel, compared to monotherapy, three severe adverse reactions (grade ≥ 3) were observed with significantly increased risks (OR > 2). These include proteinuria (OR = 5.37, 95% CI [1.22, 23.54]), hypertension (OR = 4.02, 95% CI [2.63, 6.14]), and gastrointestinal perforation (OR = 4.64, 95% CI [1.00, 21.60]). Subgroup analysis further indicated that ramucirumab is effective in both non-East Asian and East Asian populations, with East Asian patients more prone to developing proteinuria, while having a lower incidence of hypertension. Additionally, ramucirumab demonstrated comparable efficacy between first-line and second-line treatments, with a higher incidence of proteinuria observed in second-line therapy. CONCLUSION Ramucirumab significantly improves the prognosis of patients with gastric or gastroesophageal junction adenocarcinoma. When used in combination with paclitaxel, close monitoring of adverse reactions such as proteinuria (especially in East Asian populations), hypertension (especially in non-East Asian populations), and gastrointestinal perforation is essential.
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Affiliation(s)
- Ruiqi Ren
- Shihezi University School of Medicine, Bei-Er-Lu, Shihezi, 832000, Xinjiang, China
| | - Zhewei Zhang
- Shihezi University School of Medicine, Bei-Er-Lu, Shihezi, 832000, Xinjiang, China
| | - Shaokun Zhai
- Shihezi University School of Medicine, Bei-Er-Lu, Shihezi, 832000, Xinjiang, China
| | - Jiahui Yang
- Shihezi University School of Medicine, Bei-Er-Lu, Shihezi, 832000, Xinjiang, China
| | - BaihaiTihan Tusong
- Shihezi University School of Medicine, Bei-Er-Lu, Shihezi, 832000, Xinjiang, China
| | - Jingzhou Wang
- Shihezi University School of Medicine, Bei-Er-Lu, Shihezi, 832000, Xinjiang, China.
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Morris MJ, Castellano D, Herrmann K, de Bono JS, Shore ND, Chi KN, Crosby M, Piulats JM, Fléchon A, Wei XX, Mahammedi H, Roubaud G, Študentová H, Nagarajah J, Mellado B, Montesa-Pino Á, Kpamegan E, Ghebremariam S, Kreisl TN, Wilke C, Lehnhoff K, Sartor O, Fizazi K. 177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): a phase 3, randomised, controlled trial. Lancet 2024; 404:1227-1239. [PMID: 39293462 DOI: 10.1016/s0140-6736(24)01653-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/10/2024] [Accepted: 08/09/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) prolongs radiographic progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer previously treated with androgen receptor pathway inhibitor (ARPI) and taxane therapy. We aimed to investigate the efficacy of 177Lu-PSMA-617 in patients with taxane-naive metastatic castration-resistant prostate cancer. METHODS In this phase 3, randomised, controlled trial conducted at 74 sites across Europe and North America, taxane-naive patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer who had progressed once on a previous ARPI were randomly allocated (1:1) to open-label, intravenous 177Lu-PSMA-617 at a dosage of 7·4 GBq (200 mCi) ± 10% once every 6 weeks for six cycles, or a change of ARPI (to abiraterone or enzalutamide, administered orally on a continuous basis per product labelling). Crossover from ARPI change to 177Lu-PSMA-617 was allowed after centrally confirmed radiographic progression. The primary endpoint was radiographic progression-free survival, defined as the time from randomisation until radiographic progression or death, assessed in the intention-to-treat population. Safety was a secondary endpoint. This study is registered with ClinicalTrials.gov (NCT04689828) and is ongoing. In this primary report of the study, we present primary (first data cutoff) and updated (third data cutoff) analyses of radiographic progression-free survival; all other data are based on the third data cutoff. FINDINGS Overall, of the 585 patients screened, 468 met all eligibility criteria and were randomly allocated between June 15, 2021 and Oct 7, 2022 to receive 177Lu-PSMA-617 (234 [50%] patients) or ARPI change (234 [50%]). Baseline characteristics were mostly similar between groups; median number of 177Lu-PSMA-617 cycles was 6·0 (IQR 4·0-6·0). Of patients assigned to ARPI change, 134 (57%) crossed over to receive 177Lu-PSMA-617. In the primary analysis (median time from randomisation to first data cutoff 7·26 months [IQR 3·38-10·55]), the median radiographic progression-free survival was 9·30 months (95% CI 6·77-not estimable) in the 177Lu-PSMA-617 group versus 5·55 months (4·04-5·95) in the ARPI change group (hazard ratio [HR] 0·41 [95% CI 0·29-0·56]; p<0·0001). In the updated analysis at time of the third data cutoff (median time from randomisation to third data cutoff 24·11 months [IQR 20·24-27·40]), median radiographic progression-free survival was 11·60 months (95% CI 9·30-14·19) in the 177Lu-PSMA-617 group versus 5·59 months (4·21-5·95) in the ARPI change group (HR 0·49 [95% CI 0·39-0·61]). The incidence of grade 3-5 adverse events was lower in the 177Lu-PSMA-617 group (at least one event in 81 [36%] of 227 patients; four [2%] grade 5 [none treatment related]) than the ARPI change group (112 [48%] of 232; five [2%] grade 5 [one treatment related]). INTERPRETATION 177Lu-PSMA-617 prolonged radiographic progression-free survival relative to ARPI change, with a favourable safety profile. For patients with PSMA-positive metastatic castration-resistant prostate cancer who are being considered for a change of ARPI after progression on a previous ARPI, 177Lu-PSMA-617 may be an effective treatment alternative. FUNDING Novartis.
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Affiliation(s)
- Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, I+12 Research Institute, Madrid, Spain
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, German Cancer Consortium-University Hospital Essen, Essen, Germany; National Center for Tumor Diseases, NCT West, Heidelberg, Germany
| | - Johann S de Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - Neal D Shore
- Carolina Urologic Research Center, AU Clinics, Myrtle Beach, SC, USA
| | | | | | | | | | - Xiao X Wei
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Hana Študentová
- Department of Oncology, Palacký University, Faculty of Medicine and Dentistry, University Hospital, Olomouc, Czech Republic
| | - James Nagarajah
- Radboud University Medical Centre, Nijmegen, Netherlands; Roentgeninstitut Düsseldorf, Düsseldorf, Germany
| | - Begoña Mellado
- Medical Oncology Department, Hospital Clínic de Barcelona, Institut d' Investigacions Biomèdiques Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Álvaro Montesa-Pino
- UGCI Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, IBIMA, Málaga, Spain
| | | | | | - Teri N Kreisl
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Karim Fizazi
- Gustave Roussy Institute, Paris-Saclay University, Paris, France
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Goldschmidt JH, Tseng WY, Wang Y, Espirito J, Vasudevan A, Silver M, Kwong J, Shah R, Marrett E. Treatment Patterns and Clinical Outcomes Among Patients with Metastatic Non-small Cell Lung Cancer Without Actionable Genomic Alterations Previously Treated with Platinum-Based Chemotherapy and Immunotherapy. Drugs Real World Outcomes 2024; 11:425-439. [PMID: 38896198 PMCID: PMC11365910 DOI: 10.1007/s40801-024-00440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND For patients with metastatic non-small cell lung cancer, timely molecular testing is essential to determine the appropriate course of therapy. Initial treatment with platinum chemotherapy and/or an immune checkpoint inhibitor (ICI) is the standard of care for patients without actionable genomic alterations. OBJECTIVE We aimed to assess treatment patterns and clinical outcomes among patients with metastatic non-small cell lung cancer, no actionable genomic alterations, and with prior ICI and platinum-based chemotherapy in a community oncology setting. METHODS This retrospective observational study examined electronic health records from adult patients with an initial metastatic non-small cell lung cancer diagnosis without actionable genomic alterations from 2017 to 2019. Patients had received a subsequent line of therapy (LOT) [index] after discontinuing platinum-based chemotherapy plus an ICI in the previous one or two LOTs. Patient demographics and clinical characteristics were analyzed descriptively. Clinical outcomes were evaluated using Kaplan-Meier analyses. RESULTS Among the study population (n = 961), the most common index LOT regimens were non-platinum-based chemotherapies (57.3%), platinum-based chemotherapies (12.9%), ICI-based chemotherapies (12.7%), platinum + ICI-based chemotherapies (9.4%), and other (7.7%). The most common post-index LOT regimens were non-platinum based (61.2%), ICI based (15.3%), platinum based (10.7%), platinum + ICI based (3.2%), and other (2.5%). Median time to treatment discontinuation, time to next treatment, and overall survival were numerically longest with index LOT ICI-based regimens (6.5, 9.9, and 18.9 months, respectively) and shortest with platinum-based regimens (2.8, 5.3, and 8.0 months, respectively) and non-platinum-based regimens (2.6, 5.0, and 7.8 months, respectively). CONCLUSIONS Among patients with metastatic non-small cell lung cancer without actionable genomic alterations previously treated with platinum + ICIs, non-platinum chemotherapy agents were most commonly prescribed in the index LOT. Clinical outcomes including time to treatment discontinuation, time to next treatment, and overall survival were short, highlighting the unmet need for more effective later-line treatments.
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Affiliation(s)
- Jerome H Goldschmidt
- Oncology and Hematology Associates of Southwest Virginia, US Oncology Research, Blacksburg, VA, USA
| | | | | | | | | | | | - Jackie Kwong
- Daiichi Sankyo, Inc., 211 Mt. Airy Road, Basking Ridge, NJ, 07910-2311, USA
| | - Ruchit Shah
- Daiichi Sankyo, Inc., 211 Mt. Airy Road, Basking Ridge, NJ, 07910-2311, USA.
| | - Elizabeth Marrett
- Daiichi Sankyo, Inc., 211 Mt. Airy Road, Basking Ridge, NJ, 07910-2311, USA
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Alibhai SMH, Puts M, Jin R, Godhwani K, Antonio M, Abdallah S, Feng G, Krzyzanowska MK, Soto-Perez-de-Celis E, Papadopoulos E, Mach C, Nasiri F, Sridhar SS, Glicksman R, Moody L, Bender J, Clarke H, Matthew A, McIntosh D, Klass W, Emmenegger U. TOward a comPrehensive supportive Care intervention for Older men with metastatic Prostate cancer (TOPCOP3): A pilot randomized controlled trial and process evaluation. J Geriatr Oncol 2024; 15:101750. [PMID: 38521641 DOI: 10.1016/j.jgo.2024.101750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Current management of metastatic prostate cancer (mPC) includes androgen receptor axis-targeted therapy (ARATs), which is associated with substantial toxicity in older adults. Geriatric assessment and management and remote symptom monitoring have been shown to reduce toxicity and improve quality of life in patients undergoing chemotherapy, but their efficacy in patients being treated with ARATs has not been explored. The purpose of this study is to examine whether these interventions, alone or in combination, can improve treatment tolerability and quality of life (QOL) for older adults with metastatic prostate cancer on ARATs. MATERIALS AND METHODS TOPCOP3 is a multi-centre, factorial pilot clinical trial coupled with an embedded process evaluation. The study includes four treatment arms: geriatric assessment and management (GA + M); remote symptom monitoring (RSM); geriatric assessment and management plus remote symptom monitoring; and usual care and will be followed for six months. The aim is to recruit 168 patients between two cancer centres in Toronto, Canada. Eligible participants will be randomized equally via REDCap. Participants in all arms will complete a comprehensive baseline assessment upon enrollment following the Geriatric Core dataset, as well as follow-up assessments at 1.5, 3, 4.5, and 6 months. The co-primary outcomes will be grade 3-5 toxicity and QOL. Toxicities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. QOL will be measured by patient self-reporting using the EuroQol 5 dimensions of health questionnaire. Secondary outcomes include fatigue, insomnia, and depression. Finally, four process evaluation outcomes will also be observed, namely feasibility, fidelity, and acceptability, along with implementation barriers and facilitators. DISCUSSION Data will be collected to observe the effects of GA + M and RSM on QOL and toxicities experienced by older adults receiving ARATs for metastatic prostate cancer. Data will also be collected to help the design and conduct of a definitive multicentre phase III randomized controlled trial. This study will extend supportive care interventions for older adults with cancer into new areas and inform the design of larger trials. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (registration number: NCT05582772).
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Affiliation(s)
- Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rana Jin
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kian Godhwani
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Maryjo Antonio
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Soha Abdallah
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Calvin Mach
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ferozah Nasiri
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rachel Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Department of Radiation Oncology, University of Toronto, Canada
| | - Lesley Moody
- Varian Medical Systems, Winnipeg, Manitoba, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Tulipan A, Kratochwil C, Lilleby J, Lilleby W. A case of severe side effects to androgen receptor inhibitor and consequently switch to radioligand therapy in early castration resistant prostate cancer. Urol Case Rep 2024; 54:102752. [PMID: 38779691 PMCID: PMC11109734 DOI: 10.1016/j.eucr.2024.102752] [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: 03/26/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
The development of potent novel androgen receptor inhibitors (ARi) such as apalutamide have improved the life expectancy in men with castration-resistant prostate cancer (CRPCa). However, some serious toxicity can occur limiting the choice of treatment in CRPCa. In our case, the patient experienced severe toxicity after initiation of apalutamide. Diagnostic PSMA-PET/CT confirmed the recurrence and tailored the treatment with 177Lu-PSMA-617 (RLT), a beta emitter radionuclide. RLT resulted in prolonged progression-free survival, thus postponing the commonly seen additional toxicity of chemotherapy. The case highlights the possibility of early RLT in PSMA avid tumors, a treatment with minimal side-effects.
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Affiliation(s)
- Andreas Tulipan
- Oslo University Hospital, Dept of Nuclear Medicine, Oslo, Norway
| | - Clemens Kratochwil
- Heidelberg University Hospital, Dept. of Nuclear Medicine, Heidelberg, Germany
| | - Jacob Lilleby
- Riga Stradins University, Faculty of Medicine, Riga, Latvia
| | - Wolfgang Lilleby
- Oslo University Hospital, Cancer Clinic-Radiumhospitalet, Oslo, Norway
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Heist RS, Sands J, Bardia A, Shimizu T, Lisberg A, Krop I, Yamamoto N, Kogawa T, Al-Hashimi S, Fung SSM, Galor A, Pisetzky F, Basak P, Lau C, Meric-Bernstam F. Clinical management, monitoring, and prophylaxis of adverse events of special interest associated with datopotamab deruxtecan. Cancer Treat Rev 2024; 125:102720. [PMID: 38502995 DOI: 10.1016/j.ctrv.2024.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
Antibody drug conjugates (ADCs) are an emerging class of treatments designed to improve efficacy and decrease toxicity compared with other systemic therapies through the selective delivery of cytotoxic agents to tumor cells. Datopotamab deruxtecan (Dato-DXd) is a novel ADC comprising a topoisomerase I inhibitor payload and a monoclonal antibody directed to trophoblast cell-surface antigen 2 (TROP2), a protein that is broadly expressed in several types of solid tumors. Dato-DXd is being investigated across multiple solid tumor indications. In the ongoing, first-in-human TROPION-PanTumor01 phase I study (ClinicalTrials.gov: NCT03401385), encouraging and durable antitumor activity and a manageable safety profile was demonstrated in patients with advanced/metastatic hormone receptor-positive/human epidermal growth factor receptor2-negative breast cancer (HR+/HER2- BC), triple-negative breast cancer (TNBC), and non-small cell lung cancer (NSCLC). Improved understanding of the adverse events (AEs) that are associated with Dato-DXd and their optimal management is essential to ensure safe and successful administration. Interstitial lung disease/pneumonitis, infusion-related reactions, oral mucositis/stomatitis, and ocular surface events have been identified as AEs of special interest (AESIs) for which appropriate prevention, monitoring, and management is essential. This article summarizes the incidence of AESIs among patients with HR+/HER2- BC, TNBC, and NSCLC reported in TROPION-PanTumor01. We report our recommendations for AESI prophylaxis, early detection, and management, using experience gained from treating AESIs that occur with Dato-DXd in clinical trials.
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Affiliation(s)
- Rebecca S Heist
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Jacob Sands
- Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Aditya Bardia
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Toshio Shimizu
- Department of Pulmonary Medicine and Medical Oncology, Wakayama Medical University Hospital, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| | - Aaron Lisberg
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ian Krop
- Yale Cancer Center, New Haven, CT, USA
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Kogawa
- Department of Advanced Medical Development, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Saba Al-Hashimi
- Department of Ophthalmology, UCLA Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Simon S M Fung
- Department of Ophthalmology, UCLA Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, FL, USA; Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Francesca Pisetzky
- Clinical Safety and Pharmacovigilence, Daiichi Sankyo, Inc., Schiphol-Rijk, The Netherlands
| | - Priyanka Basak
- Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | - Cindy Lau
- Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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8
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Teppala S, Scuffham PA, Tuffaha H. The cost-effectiveness of germline BRCA testing-guided olaparib treatment in metastatic castration resistant prostate cancer. Int J Technol Assess Health Care 2024; 40:e14. [PMID: 38439629 DOI: 10.1017/s0266462324000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Olaparib targets the DNA repair pathways and has revolutionized the management of metastatic castration resistant prostate cancer (mCRPC). Treatment with the drug should be guided by genetic testing; however, published economic evaluations did not consider olaparib and genetic testing as codependent technologies. This study aims to assess the cost-effectiveness of BRCA germline testing to inform olaparib treatment in mCRPC. METHODS We conducted a cost-utility analysis of germline BRCA testing-guided olaparib treatment compared to standard care without testing from an Australian health payer perspective. The analysis applied a decision tree to indicate the germline testing or no testing strategy. A Markov multi-state transition approach was used for patients within each strategy. The model had a time horizon of 5 years. Costs and outcomes were discounted at an annual rate of 5 percent. Decision uncertainty was characterized using probabilistic and scenario analyses. RESULTS Compared to standard care, BRCA testing-guided olaparib treatment was associated with an incremental cost of AU$7,841 and a gain of 0.06 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was AU$143,613 per QALY. The probability of BRCA testing-guided treatment being cost effective at a willingness-to-pay threshold of AU$100,000 per QALY was around 2 percent; however, the likelihood for cost-effectiveness increased to 66 percent if the price of olaparib was reduced by 30 percent. CONCLUSION This is the first study to evaluate germline genetic testing and olaparib treatment as codependent technologies in mCRPC. Genetic testing-guided olaparib treatment may be cost-effective with significant discounts on olaparib pricing.
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Affiliation(s)
- Srinivas Teppala
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Haitham Tuffaha
- Centre for the Business and Economics of Health, The University of Queensland, St. Lucia, QLD, Australia
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9
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Aşır S, Uğur B, Jalilzadeh M, Göktürk I, Türkmen D. Development of a Plasmonic Sensor for a Chemotherapeutic Agent Cabazitaxel. ACS OMEGA 2023; 8:492-501. [PMID: 36643531 PMCID: PMC9835620 DOI: 10.1021/acsomega.2c05327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Drug dosage is a crucial subject in both human and animal treatment. Administering less drug dosage may prevent treatment or make it less effective, and high drug dosage may cause a heightened risk of adverse effects, or in some cases, cost a patient's life. Also, even when the dosage is administered carefully, metabolic differences may cause different effects on different patients. Because of these considerations, monitoring drug dosage in the body is a critical and significant requirement in the health industry. Within the scope of this study, a reusable surface plasmon resonance (SPR) chip with fast response, high selectivity, and no pretreatment is produced for the chemotherapeutic agent cabazitaxel. A cabazitaxel-imprinted nanofilm was synthesized on the sensor chip surface and characterized by atomic force microscopy, ellipsometry, and contact angle measurements. Standard cabazitaxel solution and an artificial plasma sample were used for the kinetic analysis. Docetaxel, methylprednisolone, and dexamethasone were analyzed for their selectivity experiment. In addition, the repeatability and storage durability of the sensor were also evaluated. As a result of the adsorption studies, the limit of detection and limit of quantitation values were found to be 0.012 and 0.036 μg/mL, respectively. High-performance liquid chromatography analysis was used to validate the response of the cabazitaxel-imprinted sensor.
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Affiliation(s)
- Süleyman Aşır
- Department
of Materials Science and Nanotechnology Engineering, Near East University, Mersin 10, Nicosia99138, North Cyprus, Turkey
| | - Buse Uğur
- Department
of Biomedical Engineering, Near East University, Mersin 10, Nicosia99138, North
Cyprus, Turkey
| | - Mitra Jalilzadeh
- Department
of Chemistry, Faculty of Science, Hacettepe
University, Beytepe, Ankara06800, Turkey
| | - Ilgım Göktürk
- Department
of Chemistry, Faculty of Science, Hacettepe
University, Beytepe, Ankara06800, Turkey
| | - Deniz Türkmen
- Department
of Chemistry, Faculty of Science, Hacettepe
University, Beytepe, Ankara06800, Turkey
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10
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Chen W, Zhao Y, Dai Y, Nie K. Gastrointestinal inflammation plays a critical role in chemotherapy-induced nausea and vomiting. Eur J Pharmacol 2022; 936:175379. [DOI: 10.1016/j.ejphar.2022.175379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
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11
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Yanagisawa T, Kimura T, Hata K, Narita S, Hatakeyama S, Enei Y, Atsuta M, Mori K, Obayashi K, Yoshihara K, Kondo Y, Oguchi T, Sadakane I, Habuchi T, Ohyama C, Shariat SF, Egawa S. Does castration status affect docetaxel-related adverse events? :Identification of risk factors for docetaxel-related adverse events in metastatic prostate cancer. Prostate 2022; 82:1322-1330. [PMID: 35767376 DOI: 10.1002/pros.24406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Docetaxel-related adverse events (AEs) such as neutropenia and febrile neutropenia (FN) can be life-threatening. A previous in vivo study raised the hypothesis that the castration status affects the rate of hematologic AEs. We aimed to investigate the impact of castration status on the incidence of docetaxel-related AE in metastatic prostate cancer (mPCa) patients. METHODS We retrospectively analyzed the records of 265 mPCa patients treated with docetaxel, comprising 92 patients with metastatic hormone-sensitive prostate cancer (mHSPC) and 173 patients with metastatic castration-resistant prostate cancer (mCRPC) between January 2015 and December 2021. Common terminology Criteria for Adverse Events (CTCAE) was applied to evaluate AEs. We analyzed the differential incidences between mHSPC and mCRPC, and risk factors of hematologic and nonhematologic AEs using a logistic regression model. RESULTS The rate of patients who received primary prophylaxis against neutropenia was higher in those with the mHSPC compared with those with the mCRPC (7.5% vs. 33%, p < 0.001). Among the patients without primary prophylaxis, incidence rates of severe neutropenia (CTCAE ≥ Grade3) and FN were 89% and 16% in patients with mCRPC compared to 81% and 18% in those with mHSPC. Logistic regression analysis revealed that age ≥ 75 years and failure to provide primary prophylaxis were independent risk factors of severe neutropenia (odds ratio [OR]: 2.39, 95% confidential interval [CI]: 1.10-5.18 and OR: 15.8, 95% CI: 7.23-34.6, respectively). Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ≧ 1 was an independent risk factor of FN (OR: 2.26, 95% CI: 1.13-4.54). Castration status (mHSPC vs. mCRPC) was not associated with the risks of severe neutropenia and FN. CONCLUSIONS Castration status did not affect the risk of severe neutropenia or FN in mPCa patients treated with docetaxel regardless of the disease state. Failure to provide primary prophylaxis and advanced patient age are independent risk factors of severe neutropenia; while patients with poor PS are more likely to develop FN. These findings may help guide the clinical decision-making for proper candidate selection of docetaxel treatment.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Hata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Atsugi City Hospital, Kanagawa, Japan
| | - Shintaro Narita
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Shingo Hatakeyama
- Division of Advanced Blood Purification Therapy, Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yuki Enei
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mahito Atsuta
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koki Obayashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Yoshihara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yosuke Kondo
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Oguchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ibuki Sadakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Chikara Ohyama
- Division of Advanced Blood Purification Therapy, Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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12
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Lehtonen M, Sormunen J, Luukkaala T, Marttila T, McDermott R, Joensuu T, Lehtinen I, Ginman C, Kellokumpu-Lehtinen PL. 2-weekly versus 3-weekly docetaxel for metastatic castration-resistant prostate cancer: complete quality of life results from the randomised, phase-III PROSTY trial. Acta Oncol 2022; 61:963-971. [PMID: 35847998 DOI: 10.1080/0284186x.2022.2098680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Treatment with 2-weekly docetaxel 50 mg/m2 was shown to improve overall survival and was better tolerated than the standard 75 mg/m2 3-weekly regimen in men with metastatic castration-resistant prostate cancer (mCRPC) in the original randomised PROSTY trial. The aim of this study was to investigate, whether quality of life (QoL) effects would differ between the 2-weekly docetaxel 50 mg/m2 regimen from the standard 3-weekly 75 mg/m2 treatment. MATERIALS AND METHODS QoL data were collected with the Functional Assessment of Cancer Therapy - Prostate (FACT-P) and Functional Assessment of Cancer Therapy Advanced Prostate Symptom Index - 8 Item version (FAPSI-8). Pain was measured using the Visual Analogue Scale (VAS). A total of 743 forms from 163 patients were analysed in Arm A (2-weekly docetaxel), and 704 forms from 173 patients were analysed in Arm B (3-weekly docetaxel). The data were analysed using both the Wilcoxon signed rank test (with Holm-Bonferroni adjustment) and Mann-Whitney U models. RESULTS No major differences were found in total QoL. Total QoL was higher at month 8 in Arm B (p = .020), but this was reversed in the following month (p = .043), and no statistically significant differences were found during other months. Compared to Arm A, participants in Arm B had longer-lasting deterioration in FAPSI-8 scores and emotional well-being subdomain at the beginning of treatment (p < .05). Various one-month differences were found in FACT-P subdomains (except for functional well-being), and these favoured participants in Arm A, except for the prostate-cancer subdomain. There were no differences in pain. CONCLUSION Based on our results, 2-weekly docetaxel was not inferior to 3-weekly docetaxel in terms of total health-related QoL and seemed to be superior at least in terms of the FAPSI-8 and emotional well-being subdomain in the first three to four months of treatment. More research on the topic is suggested to confirm the results.
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Affiliation(s)
- Miikka Lehtonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Katriina Hospital, Vantaa, Finland
| | - Jorma Sormunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Docrates Cancer Center, Helsinki, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Ray McDermott
- St Vincent's University Hospital and Cancer Trials, Dublin, Ireland
| | | | - Ilari Lehtinen
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | | | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere University Hospital Cancer Center, Tampere, Finland
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13
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George DJ, Agarwal N, Sartor O, Sternberg CN, Tombal B, Saad F, Miller K, Constantinovici N, Guo H, Reeves J, Jiao X, Sandström P, Verholen F, Higano CS, Shore N. Real-world patient characteristics associated with survival of 2 years or more after radium-223 treatment for metastatic castration-resistant prostate cancer (EPIX study). Prostate Cancer Prostatic Dis 2022; 25:306-313. [PMID: 35190653 PMCID: PMC9184267 DOI: 10.1038/s41391-021-00488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022]
Abstract
Background The real-world EPIX study was conducted to gather information about the characteristics of patients with metastatic castration-resistant prostate cancer (mCRPC) who survived ≥2 years after treatment with the alpha-emitter radium-223. Methods This retrospective study of electronic health records in the US Flatiron database (NCT04516161) included patients with mCRPC treated with radium-223 between January 2013 and June 2019. Median overall survival (OS) and prostate-specific antigen (PSA) response (≥50% reduction) from start of radium-223 treatment were the primary and secondary endpoints, respectively. Patient characteristics were compared between those who survived ≥2 years versus <2 years, including a subgroup who survived <6 months. Results In the 1180 patients identified, median OS was 12.9 months (95% CI: 12.1–13.7), and 13% of patients with data at 6 months had a PSA response. The survival groups included 775 patients (65.7%) who survived <2 years (including 264 (22.4%) who survived <6 months) and 185 patients (15.7%) who survived ≥2 years; 220 patients (18.6%) had incomplete follow-up data and were censored. On multivariate analysis, age >75 years, Eastern Cooperative Oncology Group performance status (ECOG PS) 2–4, visceral metastases, prior symptomatic skeletal events (SSEs), and prior chemotherapy were independently prognostic of reduced OS. For patients with survival ≥2 years versus <2 years, median age was 71 versus 75 years, 4% versus 14% had ECOG PS 2–4, 4% versus 10% had visceral metastases, 38% versus 44% had prior SSEs, and 16% versus 32% had prior chemotherapy. Conclusions In this study of men with mCRPC treated in real-world clinical practice, median OS was consistent with that seen in the phase 3 ALSYMPCA trial. Patients who survived ≥2 years after the start of radium-223 were younger and had better ECOG PS, lower disease burden, and less use of prior chemotherapy than those who survived <2 years.
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Affiliation(s)
- Daniel J George
- Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Oliver Sartor
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Department of Medicine, Meyer Cancer Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Bertrand Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint-Luc, UC Louvain, Brussels, Belgium
| | - Fred Saad
- University of Montreal Hospital Center, Montreal, QC, Canada
| | - Kurt Miller
- Charité - Universitätsmedizin Berlin, Urologische Klinik und Hochschulambulanz, Berlin, Germany
| | | | - Helen Guo
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - John Reeves
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | | | | | | | - Celestia S Higano
- Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
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14
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Chen MK, Liang ZJ, Luo DS, Xue KY, Liao DY, Li Z, Yu Y, Chen ZS, Zhao SC. Abiraterone, Orteronel, Enzalutamide and Docetaxel: Sequential or Combined Therapy? Front Pharmacol 2022; 13:843110. [PMID: 35250590 PMCID: PMC8891580 DOI: 10.3389/fphar.2022.843110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/12/2022] [Indexed: 12/19/2022] Open
Abstract
Objective: To summarize the current therapeutic status using chemotherapeutic agent docetaxel and endocrine therapeutic agents (ARAT, abiraterone, orteronel or enzalutamide) for the treatment of metastatic castration-resistant prostate cancer (mCRPC), including sequential therapy and combined therapy, to promote the consensus on the optimal regimen for achieving superior treatment efficacy.Methods: Through literature search in PubMed, articles with the following relevant keywords were collected and anlyzed: CRPC, abiraterone, orteronel and enzalutamide, median survival, overall survival, prostate specific antigen (PSA), PSA response rate and median radiologic progression-free survival.Results: Fifty-eight articles were obtained and analyzed in this review. These articles included androgen axis-targeting agents after docetaxel, docetaxel after androgen axis-targeting agents, Triple sequential and combination therapy, covering four current drugs for mCRPC treatment: docetaxel, abiraterone, orteronel, and enzalutamide. It was found that there may be some cross-resistance between androgen axis-targeting agents, which will reduce the efficacy of subsequent drug treatment. Although neither of the studies of using combination therapy showed serious drug toxicity, the efficacy of sequential therapy was not as good as expected. Most adverse reactions after treatment were reported to be level 1–2.Conclusion: Based on the results of the current studies, abiraterone followed by enzalutamide treatment is the best sequential treatment for most docetaxel-naïve patients. This treatment achieves not only good OS, but also PFS and PSA response rates. In addition, for patients who have previously failed docetaxel treatment, enzalutamide is the best choice as the subsequent treatment.
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Affiliation(s)
- Ming-kun Chen
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
- Department of Urology, The Third Clinical College of Southern Medical University, Guangzhou, China
| | - Zhi-jian Liang
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
- Department of Urology, The Third Clinical College of Southern Medical University, Guangzhou, China
| | - Dao-Sheng Luo
- Dongguan Hospital, Southern Medical University, Dongguan, China
| | - Kang-yi Xue
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
- Department of Urology, The Third Clinical College of Southern Medical University, Guangzhou, China
| | - De-ying Liao
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
- Department of Urology, The Third Clinical College of Southern Medical University, Guangzhou, China
| | - Zheshen Li
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, United States
| | - Yuzhong Yu
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, United States
- *Correspondence: Zhe-Sheng Chen, ; Shan-Chao Zhao,
| | - Shan-Chao Zhao
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
- Department of Urology, The Third Clinical College of Southern Medical University, Guangzhou, China
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Zhe-Sheng Chen, ; Shan-Chao Zhao,
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15
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Small changes in the length of diselenide bond-containing linkages exert great influences on the antitumor activity of docetaxel homodimeric prodrug nanoassemblies. Asian J Pharm Sci 2021; 16:337-349. [PMID: 34276822 PMCID: PMC8261084 DOI: 10.1016/j.ajps.2021.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 12/27/2022] Open
Abstract
Homodimeric prodrug-based self-assembled nanoparticles, with carrier-free structure and ultrahigh drug loading, is drawing more and more attentions. Homodimeric prodrugs are composed of two drug molecules and a pivotal linkage. The influence of the linkages on the self-assembly, in vivo fate and antitumor activity of homodimeric prodrugs is the focus of research. Herein, three docetaxel (DTX) homodimeric prodrugs are developed using different lengths of diselenide bond-containing linkages. Interestingly, compared with the other two linkages, the longest diselenide bond-containing linkage could facilitate the self-delivery of DTX prodrugs, thus improving the stability, circulation time and tumor targeting of prodrug nanoassemblies. Besides, the extension of linkages reduces the redox-triggered drug release and cytotoxicity of prodrug nanoassemblies in tumor cells. Although the longest diselenide bond-containing prodrug nanoassemblies possessed the lowest cytotoxicity to 4T1 cells, their stable nanostructure maintained intact during circulation and achieve the maximum accumulation of DTX in tumor cells, which finally “turned the table”. Our study illustrates the crucial role of linkages in homodimeric prodrugs, and gives valuable proposal for the development of advanced nano-DDS for cancer treatment.
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Gadisa DA, Wang SH, Yimer G. The Impact of AC and AC-T Chemotherapy's Toxicities on Quality of Life Among Women with Breast Cancer in Ethiopia: A Prospective Patient-Reported Outcomes Study. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:107-132. [PMID: 33658844 PMCID: PMC7917350 DOI: 10.2147/bctt.s289014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE The study aimed to evaluate the quality of life patterns and the effects of AC and AC-T chemotherapy's toxicities on QoL among Ethiopian women with breast cancer. METHODS QoL was measured at baseline and at every end of two cycles, for the median of 8 cycles among 146 breast cancer women on AC and AC-T chemotherapy, using EORTC QLQ-C30 and BR23 instruments. The effect of QoL score, socio-demographic, and clinical variables at baseline were adjusted for the effect of chemotherapy's toxicities on QoL. RESULTS Overall QoL, all functional scales (except cognitive functioning, body image, future perspectives, and sexual functioning) and symptom scales (except dyspnea, insomnia, pain score, arm, and breast symptoms) of EORTC QLQ-C30 and BR23 deteriorated significantly both clinically and statistically, in particular, during the first two cycles of chemotherapy. After the end of cycle 2 or 4, except for cognitive, social functioning, and financial difficulties of the patients, almost all other QoL dimensions were improved towards pretreatment score by the end of cycle 8. In addition to age, educational status, and tumor stage, the Global Health Status (-10.55≤B≤-7.71, P≤0.013), and the functional scales (-25.320≤B≤-6.351, P≤0.033) of EORTC QLQ-C30 and BR23 were significantly affected at least by one of the AC and AC-T chemotherapy's toxicity such as grade≥2 fatigue, dysgeusia, constipation, dry mouth, vomiting, oral mucositis, skin hyperpigmentation and/or peripheral neuropathy than their lower grade. Grade≥2 fatigue, dysgeusia, oral mucositis, constipation, peripheral neuropathy, anemia arthralgia/myalgia, dry mouth, diarrhea, constipation, and/or skin hyperpigmentation were positively predicted for the deterioration of symptoms scale of EORTC QLQ-C30 and BR23 (4.819≤B≤26.451, P≤0.043). CONCLUSION Quality of life among Ethiopian breast cancer patients on AC and AC-T regimens significantly deteriorated particularly during the first two cycles of chemotherapy. In addition to the age, tumor stage and educational status of the patients, grade≥2 fatigue, dysgeusia, constipation, oral mucositis, dry mouth, peripheral neuropathy, and skin hyperpigmentation due to AC and AC-T chemotherapy were frequently associated with deterioration of different scales/items QoL. Hence, devising different strategies to improve the deteriorated QoL due to chemotherapy's toxicities particularly during the first two cycles has paramount importance.
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Affiliation(s)
- Diriba Alemayehu Gadisa
- Pharmacy Department, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Shu-Hua Wang
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
- Ben Franklin TB Control Program, Columbus, OH, USA
| | - Getnet Yimer
- Ohio State Global One Health Initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
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17
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Ben Nasr S, Zribi A, Ben Hassen M, Doghri Y, Ben Abdallah I, Trigui E, Fendri S, Ayari J, Balti M, Haddaoui A. Toxicity profile of taxanes in Tunisian cancer patients: A retrospective study of 90 cases. Bull Cancer 2021; 108:266-271. [PMID: 33423777 DOI: 10.1016/j.bulcan.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/26/2020] [Accepted: 10/08/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Taxanes are widely used in medical oncology. The aim of our study was to report and analyze the toxicity features of these drugs in Tunisian patients and to determine their impact on treatment response. METHODS Our retrospective study concerned 90 patients treated by taxanes in a medical oncology unit, from January 2014 to January 2017. We collected their epidemiologic and anatomo-clinical data and we detailed toxicity features including types grades and impact on tumor response. RESULTS Median age was 46 years. 80% of patients had breast cancer. Tumors were metastatic in 23.3% of cases. Nail toxicity was observed in 100% of patients. Grade I-II digestive toxicity was observed in 54.4% of cases. Hematological toxicity was noted in 42.2% of patients and it reached grade III-IV in five patients. Neurological toxicity occurred in 31% of patients and was grade III-IV in 6 cases. Alopecia was observed in 60% of patients. Fatigue was noted in 57.8% of patients. Myalgia was observed in 42.2% of patients. Toxicity did not affect the response to treatment. CONCLUSION The taxanes' toxicity profile in Tunisian patients is characterized by more frequent digestive and nail toxicities and less frequent hematological toxicities, dose reduction and treatment delays than other populations.
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Affiliation(s)
- Sonia Ben Nasr
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia.
| | - Aref Zribi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Mouna Ben Hassen
- Université de Tunis El Manar, Faculté des sciences de Tunis, 2092 Tunis, Tunisia
| | - Yosr Doghri
- Université de Tunis El Manar, Faculté des sciences de Tunis, 2092 Tunis, Tunisia
| | - Ichrak Ben Abdallah
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Emna Trigui
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Sana Fendri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Jihen Ayari
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Mehdi Balti
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Abderrazek Haddaoui
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia; The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
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18
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Liang C, Bai X, Qi C, Sun Q, Han X, Lan T, Zhang H, Zheng X, Liang R, Jiao J, Zheng Z, Fang J, Lei P, Wang Y, Möckel D, Metselaar JM, Storm G, Hennink WE, Kiessling F, Wei H, Lammers T, Shi Y, Wei B. Π electron-stabilized polymeric micelles potentiate docetaxel therapy in advanced-stage gastrointestinal cancer. Biomaterials 2020; 266:120432. [PMID: 33069116 DOI: 10.1016/j.biomaterials.2020.120432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/10/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022]
Abstract
Gastrointestinal (GI) cancers are among the most lethal malignancies. The treatment of advanced-stage GI cancer involves standard chemotherapeutic drugs, such as docetaxel, as well as targeted therapeutics and immunomodulatory agents, all of which are only moderately effective. We here show that Π electron-stabilized polymeric micelles based on PEG-b-p(HPMAm-Bz) can be loaded highly efficiently with docetaxel (loading capacity up to 23 wt%) and potentiate chemotherapy responses in multiple advanced-stage GI cancer mouse models. Complete cures and full tumor regression were achieved upon intravenously administering micellar docetaxel in subcutaneous gastric cancer cell line-derived xenografts (CDX), as well as in CDX models with intraperitoneal and lung metastases. Nanoformulated docetaxel also outperformed conventional docetaxel in a patient-derived xenograft (PDX) model, doubling the extent of tumor growth inhibition. Furthermore, micellar docetaxel modulated the tumor immune microenvironment in CDX and PDX tumors, increasing the ratio between M1-and M2-like macrophages, and toxicologically, it was found to be very well-tolerated. These findings demonstrate that Π electron-stabilized polymeric micelles loaded with docetaxel hold significant potential for the treatment of advanced-stage GI cancers.
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Affiliation(s)
- Chenghua Liang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Xiangyang Bai
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Cuiling Qi
- Vascular Biology Research Institute, School of Basic Course, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Qingxue Sun
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Xiaoyan Han
- Central Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Tianyun Lan
- Central Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Haibo Zhang
- Central Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Xiaoming Zheng
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Rongpu Liang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Ju Jiao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Zongheng Zheng
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Jiafeng Fang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Purun Lei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Yan Wang
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands
| | - Diana Möckel
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Josbert M Metselaar
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands; Department of Biomaterials Science & Technology (BST), University of Twente, 7500 AE, Enschede, the Netherlands
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany; Fraunhofer MEVIS, Institute for Medical Image Computing, 52074, Aachen, Germany
| | - Hongbo Wei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, the Netherlands; Department of Biomaterials Science & Technology (BST), University of Twente, 7500 AE, Enschede, the Netherlands.
| | - Yang Shi
- Institute for Experimental Molecular Imaging, Uniklinik RWTH Aachen and Helmholtz Institute for Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany.
| | - Bo Wei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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Odeo S, Degu A. Factors affecting health-related quality of life among prostate cancer patients: A systematic review. J Oncol Pharm Pract 2020; 26:1997-2010. [PMID: 32972301 DOI: 10.1177/1078155220959414] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prostate cancer is recognized as the leading cause of malignancy-related incidence and mortality in the male population. The treatment regimens have long-term effects detrimental to the patient's quality of life. Hence, this review was aimed to determine the overall HRQOL and its associated among prostate cancer patients. METHODS The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases searched were PubMed, Embase, Google Scholar and Cumulative Index to the Nursing and Allied Literature (CINAHL), which provided articles that were critically examined, yielding 52 studies that met the inclusion criteria for the systematic review. RESULTS Out of 52 studies, 30 studies reported poor overall HRQOL in various domains after prostate cancer treatment. Contrastingly, 15 studies reported good overall quality of life after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer. Nonetheless, seven studies showed that the absence of a significant change in the overall quality of life after treatment. According to the studies, older age, comorbidities, higher clinical stage, higher Gleason score, greater cancer severity, African American race, impaired mental health, neoadjuvant hormonal therapy and lower level of education were the major poor predictors of HRQOL among prostate cancer patients. CONCLUSION The overall HRQOL in prostate cancer patients was generally poor in various functional domains after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer.
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Affiliation(s)
- Sharon Odeo
- School of Pharmacy and Health Sciences, United States International University-Africa, Nairobi, Kenya
| | - Amsalu Degu
- School of Pharmacy and Health Sciences, United States International University-Africa, Nairobi, Kenya
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de Mol M, Visser S, Aerts J, Lodder P, van Walree N, Belderbos H, den Oudsten B. The association of depressive symptoms, personality traits, and sociodemographic factors with health-related quality of life and quality of life in patients with advanced-stage lung cancer: an observational multi-center cohort study. BMC Cancer 2020; 20:431. [PMID: 32423432 PMCID: PMC7236491 DOI: 10.1186/s12885-020-06823-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 04/02/2020] [Indexed: 01/11/2023] Open
Abstract
Background Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy. Methods Patients (n = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses (P ≤ 0.05). Results In the multiple regression analyses, CES-D score (β = − 0.63 to − 0.53; P-values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (β = − 0.67 to − 0.40; P-values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (β = − 0.30 to − 0.30; P-values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: β = 0.30; P = 0.02, Environment: β = − 0.39; P = 0.007) and conscientiousness (Physical health: β = 0.20; P-value < 0.04). Conclusions Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.
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Affiliation(s)
- Mark de Mol
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Sabine Visser
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Joachim Aerts
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands.,Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Huub Belderbos
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800, RK, Breda, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000, LE, Tilburg, The Netherlands.
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21
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Peritoneal metastasis in gastric cancer: results from the German database. Gastric Cancer 2020; 23:11-22. [PMID: 31228044 DOI: 10.1007/s10120-019-00978-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with peritoneal metastases of gastric cancer have a poor prognosis with a median survival of 7 months. A benefit of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) could be shown in several selected patient cohorts but remains controversial. The aim of this study was, to reflect the results of a national German HIPEC registry initiated by the German Society of General and Visceral Surgery (DGAV). METHODS The DGAV HIPEC registry StuDoQ|Peritoneum documents patients with peritoneal malignancy contributed from 52 hospitals. All consecutive documented patients from 2011 until 2016 (n = 3078) were treated with CRS and HIPEC and were analysed. A total of 315 (10%) suffered from gastric cancer and were analysed. RESULTS A complete data set of 235 patients was available for this study, including 113 male (48.1%) and 122 female (51.9%) patients with a median age of 53.4 years (SD ± 11.9). The median PCI was 8.0 (range 1-30). A complete cytoreduction was achieved in 121 patients (71.6%). Postoperative complications (Clavien-Dindo grades 3-4) occurred in 40 patients (17%). The median overall survival (OS) time was 13 months. The 5-year survival rate was 6%. According to the PCI from 0-6 (n = 74); 7-15 (n = 70) and 16-39 (n = 24) the median OS differs significantly (18 months vs. 12 months vs. 5 months; p = 0.002). CONCLUSIONS CRS and HIPEC in selected patients with gastric cancer and peritoneal spread can improve survival when they are treated in centers. An accurate staging and patient selection are of major importance to achieve long-term survival.
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Chung DY, Kang DH, Kim JW, Kim DK, Lee JY, Hong CH, Cho KS. Comparison of Oncologic Outcomes Between Two Alternative Sequences with Abiraterone Acetate and Enzalutamide in Patients with Metastatic Castration-Resistant Prostate Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2019; 12:cancers12010008. [PMID: 31861415 PMCID: PMC7017207 DOI: 10.3390/cancers12010008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/15/2019] [Indexed: 01/03/2023] Open
Abstract
Sequential treatment of androgen receptor axis targeted agents (ARAT), abiraterone acetate (ABI) and enzalutamide (ENZA), in metastatic castration-resistant prostate cancer (mCRPC) demonstrated some positive effects, but cross-resistances between ABI and ENZA that reduce activity have been suggested. Therefore, we conducted a meta-analysis to compare oncologic outcomes between the treatment sequences of ABI-ENZA and ENZA-ABI in patients with mCRPC. The primary endpoint was a combined progression-free survival (PFS), and the secondary endpoint was overall survival (OS). A total of five trials on 553 patients were included in this study. Each of the included studies was retrospective. In two studies including both chemo-naïve and post-chemotherapy mCRPC patients, for ABI-ENZA compared with ENZA-ABI, pooled hazard ratios (HRs) for PFS and OS were 0.37 (p < 0.0001; 95% confidence intervals (CIs), 0.23–0.60) and 0.64 (p = 0.10; 95% CIs, 0.37–1.10), respectively. In three studies with chemo-naïve mCRPC patients only, for ABI-ENZA compared with ENZA-ABI, pooled HRs for PFS and OS were 0.57 (p = 0.02; 95% CIs, 0.35–0.92) and 0.86 (p = 0.39; 95% CIs, 0.61–1.21), respectively. The current meta-analysis revealed that ABI-ENZA had a significantly more favorable oncological outcome, but the level of evidence was low. Therefore, large-scale randomized trials may be needed.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea; (D.Y.C.); (D.H.K.)
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea; (D.Y.C.); (D.H.K.)
| | - Jong Won Kim
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (J.W.K.); (C.H.H.)
| | - Do Kyung Kim
- Department of Urology, Soonchunhyang University Medical College, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Chang Hee Hong
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (J.W.K.); (C.H.H.)
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (J.W.K.); (C.H.H.)
- Correspondence: ; Tel.: +82-2-2019-3471
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23
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Preventing chemotherapy-induced alopecia: a prospective clinical trial on the efficacy and safety of a scalp-cooling system in early breast cancer patients treated with anthracyclines. Br J Cancer 2019; 121:325-331. [PMID: 31303642 PMCID: PMC6738323 DOI: 10.1038/s41416-019-0520-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Chemotherapy-induced alopecia (CIA) is a distressing side effect of cancer therapy. The trial aimed to assess feasibility and effectiveness of scalp-cooling system DigniCap® to prevent CIA in primary breast cancer patients receiving an anthracycline containing adjuvant chemotherapy (CT). Methods Hair loss (HL) was evaluated by patient self-assessment and by the physician according to the Dean’s scale at baseline and after each cycle of CT. The primary efficacy endpoint was the patient self-assessment HL score evaluated at least 3 weeks after completing CT. A Dean's scale score of 0–2 (i.e. HL ≤50%) was considered a success. Results From July 2014 to November 2016, 139 consecutive breast cancer patients were enrolled and received at least one treatment with scalp cooling. Fifty-six out of 131 evaluated patients successfully prevented HL (43%, 95% CI: 34–51%). Twenty-four patients (32%) discontinued the scalp cooling because of alopecia or scalp-cooling related AE, three patients had missing information on CIA, and 48 patients (64%) had a HL greater than 50% after CT. No serious AEs were reported. Conclusions DigniCap® System resulted as a promising medical device to be safely integrated in supportive care of early breast cancer patients. Longer follow-up is needed to assess long-term safety and feasibility. Clinical trial registration number NCT03712696.
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Leufgens F, Berneking V, Vögeli TA, Kirschner-Hermanns R, Eble MJ, Pinkawa M. Quality of Life Changes >10 Years After Postoperative Radiation Therapy After Radical Prostatectomy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2019; 105:382-388. [PMID: 31201895 DOI: 10.1016/j.ijrobp.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/20/2019] [Accepted: 06/01/2019] [Indexed: 02/09/2023]
Abstract
PURPOSE To analyze long-term quality-of-life (QoL) changes related to postoperative radiation therapy (RT) after radical prostatectomy. METHODS AND MATERIALS Patients who received postoperative 3-dimensional conformal RT in the years 2003 to 2008 with 1.8 to 2.0 Gy fractions up to 66.0 to 66.6 Gy (n = 181) were surveyed using the Expanded Prostate Cancer Index Composite questionnaire before the beginning of RT (A); on the last day (B); and 2 months (C), 1 to 3 years (D), 6 to 9 years (E), and 10 to 13 years (F) after RT. RESULTS Mean urinary bother, urinary incontinence bother, and bowel bother score changes (in relation to baseline at time A) of 13, 14, and 7 and 14, 15, and 7 were found at times E and F, respectively (P < .01 for all comparisons). Sexual function scores decreased 6 and 8 points on average (P < .01). Patient age at the time of RT had a considerable impact on urinary bother and urinary incontinence bother, with increasing differences over time when comparing patients aged <68 versus ≥68 years: 0 versus 7 and 0 versus 7 points at time D and 8 versus 23 and 6 versus 35 points at time F, respectively. Patients who did not respond to RT with a decreasing prostate-specific antigen level had greater urinary and urinary incontinence bother and bowel bother score changes >10 years after treatment (25 vs 12; P = .04, 36 vs 10; P = .03, and 20 vs 5; P = .07, respectively). A higher rectal dose was associated with greater acute and long-term bowel bother score decrease. No correlation was found between the dose to the bladder and QoL changes. CONCLUSIONS In contrast to early evaluations in the first years, significantly decreasing QoL in the urinary, bowel, and sexual domains was found >5 years after RT. Aging is likely to be a major factor. Younger patients who responded to the treatment had the most favorable long-term QoL results. As 3-dimensional conformal RT was used in this study, intensity modulated concepts could result in improved outcomes.
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Affiliation(s)
| | - Vanessa Berneking
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | | | | | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany.
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Ou H, Chung W, Su P, Lin T, Lin J, Wen Y, Fang W. Health‐related quality of life associated with different cancer treatments in Chinese breast cancer survivors in Taiwan. Eur J Cancer Care (Engl) 2019; 28:e13069. [DOI: 10.1111/ecc.13069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/26/2019] [Accepted: 03/25/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Huang‐Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine National Cheng Kung University Tainan Taiwan
- Department of Pharmacy, College of Medicine National Cheng Kung University Tainan Taiwan
- Department of Pharmacy National Cheng Kung University Hospital Tainan Taiwan
| | - Wei‐Pang Chung
- Division of Hemato‐Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Pei‐Fang Su
- Department of Statistics National Cheng Kung University Tainan Taiwan
| | - Tzu‐Hsuan Lin
- Department of Statistics National Cheng Kung University Tainan Taiwan
| | - Ji‐Ying Lin
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine National Cheng Kung University Tainan Taiwan
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Mortimer J, Di Palma J, Schmid K, Ye Y, Jahanzeb M. Patterns of occurrence and implications of neratinib-associated diarrhea in patients with HER2-positive breast cancer: analyses from the randomized phase III ExteNET trial. Breast Cancer Res 2019; 21:32. [PMID: 30813966 PMCID: PMC6391844 DOI: 10.1186/s13058-019-1112-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background We characterized patterns of occurrence and the impact of neratinib-associated diarrhea in the absence of protocol-directed antidiarrheal prophylaxis or a formal diarrhea management plan using data from Extended Adjuvant Treatment of Breast Cancer with Neratinib (ExteNET). Methods ExteNET is a multicenter, double-blind, placebo-controlled, randomized phase III trial involving community-based and academic institutions in 40 countries. Women with HER2-positive early-stage breast cancer with prior standard primary therapy and trastuzumab-based (neo)adjuvant therapy were randomized to neratinib 240 mg/day or placebo for 12 months. Safety, a secondary outcome, was assessed using the National Cancer Institute Common Terminology Criteria version 3.0. Health-related quality of life by diarrhea grade was assessed using Functional Assessment of Cancer Therapy-Breast (FACT-B). Results Two thousand eight hundred sixteen women (1408 per group) were safety-evaluable. Grade 3 and 4 diarrhea occurred in 561 (39.8%) and 1 (0.1%) patients with neratinib versus 23 (1.6%) and 0 patients with placebo, respectively. In the neratinib group, 28.6% of patients had grade 3 events during month 1 decreasing to ≤ 6% after month 3. The median cumulative duration of grade 3/4 diarrhea with neratinib was 5 days (interquartile range, 2–9). Serious diarrheal events (n = 22, 1.6%) and diarrheal events requiring hospitalization (n = 20, 1.4%) were rare with neratinib. Changes in FACT-B total score by diarrhea grade in the neratinib group did not meet the threshold for clinically important differences. Conclusions In the absence of antidiarrheal prophylaxis, neratinib-related diarrhea is short-lived and not associated with complications or long-term sequelae. This suggests that targeted preventive management with antidiarrheal prophylaxis early during neratinib treatment is appropriate. Trial registration ClinicalTrials.gov NCT00878709. Registered 9 April 2009. Electronic supplementary material The online version of this article (10.1186/s13058-019-1112-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanne Mortimer
- City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA.
| | - Jack Di Palma
- University of South Alabama College of Medicine, Mobile, AL, USA
| | - Kendra Schmid
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yining Ye
- Puma Biotechnology Inc., South San Francisco, CA, USA.,Present address: QED Therapeutics, San Francisco, CA, USA
| | - Mohammad Jahanzeb
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Deerfield Beach, FL, USA
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27
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de Mol M, Visser S, den Oudsten BL, Lodder P, van Walree N, Belderbos H, Aerts JG. Frequency of low-grade adverse events and quality of life during chemotherapy determine patients' judgement about treatment in advanced-stage thoracic cancer. Support Care Cancer 2019; 27:3563-3572. [PMID: 30690684 PMCID: PMC6660482 DOI: 10.1007/s00520-019-4659-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE In lung cancer, the preservation of well-being is warranted given the limited prognosis. Chemotherapy may negatively influence health-related quality of life (HRQoL) due to adverse events. However, patients' judgement about this negative impact is not well understood. We examined the relationship between expectations, feelings about side effects, and satisfaction with therapy and (HR)QoL in advanced-stage thoracic cancer and investigated which of these factors has the highest impact on (HR)QoL. METHODS Sixty-nine patients completed the Cancer Therapy Satisfaction Questionnaire (CTSQ), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Multiple regression analyses were performed to investigate the relation of the CTSQ domains (i.e., expectations of therapy, feelings about side effects, satisfaction with therapy) with (HR)QoL and simple regression analyses to identify the factors of the CTSQ domain that was most often associated with (HR)QoL. RESULTS Feelings about side effects were associated with the (HR)QoL domain/scale scores (i.e., WHOQOL-BREF domains: β = 0.36 to 0.58; EORTC QLQ-C30 scales: β = 0.33 to 0.61) except social relationships of the WHOQOL-BREF. Low-grade adverse events were related to feelings about side effects (β = - 0.326; P = 0.007). CONCLUSIONS Patients experiencing negative feelings about side effects have worse (HR)QoL. Additional care should be provided to prevent low-grade adverse events.
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Affiliation(s)
- Mark de Mol
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sabine Visser
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000 LE, Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000 LE, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, P.O. Box 90151, 5000 LE, Tilburg, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
| | - Huub Belderbos
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
| | - Joachim G Aerts
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Spaich S, Kinder J, Hetjens S, Fuxius S, Gerhardt A, Sütterlin M. Patient Preferences Regarding Chemotherapy in Metastatic Breast Cancer-A Conjoint Analysis for Common Taxanes. Front Oncol 2018; 8:535. [PMID: 30519542 PMCID: PMC6260130 DOI: 10.3389/fonc.2018.00535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/31/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The purpose of this investigation was to explore patient perception regarding the importance of efficacy, toxicity, and logistics in the choice of regimen of taxane-based chemotherapy (CHT) for patients with metastatic breast cancer (MBC). Methods: This dual-center study analyzed data of 100 women diagnosed with MBC, who were asked for their preferences regarding chemotherapy by means of conjoint analysis. Included attributes were progression free survival (PFS), application form, time and frequency, need of premedication, risk of alopecia, fatigue, febrile neutropenia, and neuropathy. Furthermore, participants completed a questionnaire about their personal and medical history. Regression analyses were performed to identify factors that influence patient preference in terms of specific treatment choice. Results: Of 8 attributes, severe neutropenia was top priority for the majority of patients, followed by alopecia, neuropathy and PFS. When combining these patient preferences and the results of the questionnaire, patients' age as, well as, relationship status had significant impact on the importance of PFS. Moreover, longer travel time to the treatment center was significantly associated with preferences regarding PFS. Ranking by combination of respective part-worth values demonstrated nab-paclitaxel to be favored over paclitaxel and docetaxel. Conclusion: Side effects of CHT and PFS prove to be critical factors for patients affecting choice of treatment in MBC with severe neutropenia being top priority, followed by alopecia, neuropathy, and PFS. Age, commute time, and relationship status were identified as significant determinants of patient preference. Total utility calculation by combination of part-worth values ranked nab-paclitaxel as the most preferable taxane.
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Affiliation(s)
- Saskia Spaich
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Johanna Kinder
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Fuxius
- Private Oncology Center Fuxius/Karcher, Heidelberg, Germany
| | - Axel Gerhardt
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.,Department of Gynaecology and Obstetrics, St. Hedwig-Klinik, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
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29
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Kristensen A, Solheim TS, Fløtten Ø, Grønberg BH. Associations between hematologic toxicity and health-related quality of life during first-line chemotherapy in advanced non-small-cell lung cancer: a pooled analysis of two randomized trials. Acta Oncol 2018; 57:1574-1579. [PMID: 30074418 DOI: 10.1080/0284186x.2018.1492151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Many patients experience toxicity from chemotherapy that may negatively impact their health-related quality of life (HRQoL), but side effects often go undetected by health care personnel. Our aim was to investigate whether hematologic toxicity (HT) was associated with HRQoL impairment, and, consequently, if blood counts could be used to identify patients with the highest need for supportive care during chemotherapy. MATERIAL AND METHODS Data from two phase III trials of first-line chemotherapy in advanced non-small-cell lung cancer (NSCLC) were analyzed (n = 873). Blood counts were measured weekly in the treatment period. We categorized patients as having severe (CTCAE grade 3-4) or non-severe (grade 0-2) HT during the first chemotherapy cycle. HRQoL was reported on the EORTC QLQ-C30 and LC13 before and at the end of the cycle. The primary endpoints were changes in global quality of life, fatigue, nausea/vomiting and dyspnea (LC13). RESULTS Of the 766 patients with complete data set, 177 (23%) developed severe HT during the first chemotherapy cycle. Changes in fatigue and nausea/vomiting were significantly worse for patients experiencing severe compared to patients with non-severe HT (difference in mean change of 4.9 points; p = .01, and 6.4 points; p = .01, respectively), but this association was limited to neutropenia, not thrombocytopenia or anemia. There were no significant associations between HT and global quality of life or dyspnea (difference in mean change of 2.1 points; p = .28, and 3.3 points; p = .053, respectively). CONCLUSIONS Patients developing severe HT had worse changes in two out of four of the primary HRQoL endpoints, but the association was not strong enough to use blood counts to identify patients who need more clinical attention and supportive care during chemotherapy.
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Affiliation(s)
- Are Kristensen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øystein Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Henning Grønberg
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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30
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Song P, Huang C, Wang Y. The efficacy and safety comparison of docetaxel, cabazitaxel, estramustine, and mitoxantrone for castration-resistant prostate cancer: A network meta-analysis. Int J Surg 2018; 56:133-140. [PMID: 29906643 DOI: 10.1016/j.ijsu.2018.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/26/2018] [Accepted: 06/07/2018] [Indexed: 01/05/2023]
Abstract
AIMS The aim of this study was to compare the efficacy and safety of docetaxel, cabazitaxel, docetaxel + estramustine, mitoxantrone in the management of castration-resistant prostate cancer (CRPC). METHODS Electronic databases including PubMed, Cochrance Library and Embase were searched for studies published from when the databases were established to January 1st, 2018. Randomized controlled trials (RCTs) that compared docetaxel + prednisone (DP), cabazitaxel + prednisone (CP), docetaxel + estramustine + prednisone (DEP), and mitoxantrone + cabazitaxel + prednisone (MP) for CRPC treatment were identified. The network meta-analysis was conducted with software R 3.3.2. We analyzed the main outcomes, including the overall survival (OS), progression-free survival (PFS), prostate-specific antigen (PSA) response, tumor response and severe adverse events (AEs). Ranking of the chemotherapeutic agents was based on probabilities of interventions for each of the outcomes that were performed. The consistency of direct and indirect evidence was assessed by node splitting. RESULTS 10 RCTs, with 3590 patients, were analyzed. The network meta-analysis results revealed that CP significantly increased OS, PFS, PSA response, tumor response, and severe AEs compared to MP. DP showed similar results with CP except for tumor response, where it showed slight inferiority in effectiveness. DEP was associated with clearly improved outcomes in PFS, PSA response and tumor response compared to those of MP, but this was not the case for OS benefit and severe AEs. No significant difference was detected in DP, CP and DEP except for the outcomes of severe AEs. MP was less effective in survival and clinical benefit, but much safer in safety outcomes than other chemotherapy agents. The probabilities of rank plots showed that CP ranked first in OS and tumor response; DEP ranked first in PFS time and PSA response; MP was the best treatment mode for safety. CONCLUSIONS DP and CP survival benefit (OS, PFS) and clinical benefit (PSA response and tumor response) were comparable, as well as their associated AEs. DEP was associated with less survival benefit, similar clinical improvement and more AEs than DP or CP. MP had the lowest survival and clinical benefit but excellent safety than other agents. Based on evidences of current results, we recommended CP as the most suitable chemotherapy agent for CRPC patients, followed by DP, MP as third, and DEP as the last choice. However, considering limitations of our network meta-analysis, additional high-quality studies are needed for further evaluation.
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Affiliation(s)
- Pan Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
| | - Chuiguo Huang
- Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan Province, China.
| | - Yan Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
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31
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Kulkarni HR, Singh A, Langbein T, Schuchardt C, Mueller D, Zhang J, Lehmann C, Baum RP. Theranostics of prostate cancer: from molecular imaging to precision molecular radiotherapy targeting the prostate specific membrane antigen. Br J Radiol 2018; 91:20180308. [PMID: 29762048 DOI: 10.1259/bjr.20180308] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Alterations at the molecular level are a hallmark of cancer. Prostate cancer is associated with the overexpression of prostate-specific membrane antigen (PSMA) in a majority of cases, predominantly in advanced tumors, increasing with the grade or Gleason's score. PSMA can be selectively targeted using radiolabeled PSMA ligands. These small molecules binding the PSMA can be radiolabeled with γ-emitters like 99mTc and 111In or positron emitters like 68Ga and 18F for diagnosis as well as with their theranostic pairs such as 177Lu (β-emitter) or 225Ac (α-emitter) for therapy. This review summarizes the theranostic role of PSMA ligands for molecular imaging and targeted molecular radiotherapy, moving towards precision oncology.
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Affiliation(s)
- Harshad R Kulkarni
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
| | - Aviral Singh
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
| | - Thomas Langbein
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
| | - Christiane Schuchardt
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
| | - Dirk Mueller
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
| | - Jingjing Zhang
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
| | - Coline Lehmann
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
| | - Richard P Baum
- 1 Theranostics Center for Molecular Radiotherapy and Molecular Imaging, Zentralklinik Bad Berka , Bad Berka , Germany
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Berger K, Schopohl D, Bollig A, Strobach D, Rieger C, Rublee D, Ostermann H. Burden of Oral Mucositis: A Systematic Review and Implications for Future Research. Oncol Res Treat 2018; 41:399-405. [PMID: 29734184 DOI: 10.1159/000487085] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/22/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surprisingly little is known about the burden of oral mucositis (OM). We provide a systematic review of studies on the burden of OM (incidence, economic impact, health-related quality of life (HRQoL)). METHODS Systematic literature searches were made in BIOSIS, EMBASE, and MEDLINE. Inclusion criteria were studies on OM in hematology/oncology patients of ≥ 18 years, journal articles, English language, and published between 2000 and 2016; OM treatment studies were excluded. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS We screened 4,996 hits, and identified 68 studies of which 13 were without transparency on OM grading. The evidence level of 65 studies was rated 'low' or 'very low' in 58.5%, 'moderate' in 20% and 'high' in 21.5%. Mean value of incidence (7 studies) was 83.5% for all grades of OM with hematopoietic stem cell transplantation. OM incidence for all grades in head and neck cancer patients was 59.4-100%. Considering the economic impact, 16 studies showed highly variable numbers. HRQoL was measured in 16 studies using 13 different instruments. Statistically significant changes in HRQoL scores were demonstrated. CONCLUSION OM is common, burdensome, costly and imposes major reductions in HRQoL. However, from a quality standpoint, the level of current evidence in OM is disappointing. The field needs continued attention to address methodological challenges.
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Chaillou T, McPeek A, Lanner JT. Docetaxel does not impair skeletal muscle force production in a murine model of cancer chemotherapy. Physiol Rep 2018; 5:5/11/e13261. [PMID: 28583990 PMCID: PMC5471428 DOI: 10.14814/phy2.13261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 01/07/2023] Open
Abstract
Chemotherapy drugs such as docetaxel are commonly used to treat cancer. Cancer patients treated with chemotherapy experience decreased physical fitness, muscle weakness and fatigue. To date, it is unclear whether these symptoms result only from cancer‐derived factors or from the combination of cancer disease and cancer treatments, such as chemotherapy. In this study, we aimed at determining the impact of chemotherapy per se on force production of hind limb muscles from healthy mice treated with docetaxel. We hypothesized that docetaxel will decrease maximal force, exacerbate the force decline during repeated contractions and impair recovery after fatiguing stimulations. We examined the function of soleus and extensor digitorum longus (EDL) muscles 24 h and 72 h after a single injection of docetaxel (acute treatment), and 7 days after the third weekly injection of docetaxel (repeated treatment). Docetaxel was administrated by intravenous injection (20 mg/kg) in female FVB/NRj mice and control mice were injected with saline solution. Our results show that neither acute nor repeated docetaxel treatment significantly alters force production during maximal contractions, repeated contractions or recovery. Only a tendency to decreased peak specific force was observed in soleus muscles 24 h after a single injection of docetaxel (−17%, P = 0.13). In conclusion, docetaxel administered intravenously does not impair force production in hind limb muscles from healthy mice. It remains to be clarified whether docetaxel, or other chemotherapy drugs, affect muscle function in subjects with cancer and whether the side effects associated with chemotherapy (neurotoxicity, central fatigue, decreased physical activity, etc.) are responsible for the experienced muscle weakness and fatigue.
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Affiliation(s)
- Thomas Chaillou
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ashley McPeek
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Johanna T Lanner
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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34
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Miles D, Im YH, Fung A, Yoo B, Knott A, Heeson S, Beattie MS, Swain SM. Effect of docetaxel duration on clinical outcomes: exploratory analysis of CLEOPATRA, a phase III randomized controlled trial. Ann Oncol 2017; 28:2761-2767. [PMID: 29112701 DOI: 10.1093/annonc/mdx406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Combination pertuzumab, trastuzumab, and docetaxel (D) is considered standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. This post hoc, exploratory analysis of CLEOPATRA study data evaluated the clinical effects of D treatment duration within this regimen. The clinical benefits of pertuzumab and trastuzumab by different durations of D treatment were also evaluated. Patients and methods Patients with HER2-positive metastatic breast cancer received trastuzumab and D plus pertuzumab or placebo. Clinical outcomes were analyzed by the number of D cycles that patients received (<6D, 6D, or >6D). Progression-free survival (PFS) and overall survival (OS) for each treatment arm within each D cycle group were estimated using the Kaplan-Meier approach. Time-dependent, multivariate Cox regression was applied to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for HER2-targeted therapy and D cycle groups. Results Overall, 804 patients received <6D (n = 119), 6D (n = 210), or >6D (n = 475) cycles. After adjusting for pertuzumab benefits versus placebo (PFS HR = 0.61, 95% CI 0.51-0.74, P < 0.0001; OS HR = 0.60, 95% CI, 0.49-0.74, P < 0.0001), >6D versus 6D cycles was not associated with statistically significant improvements in PFS (HR = 0.80, 95% CI 0.63-1.01, P = 0.0640) or OS (HR = 0.88, 95% CI 0.69-1.12, P = 0.3073). Consistent improvements in PFS and OS were observed with pertuzumab versus placebo, irrespective of D duration. The HRs for PFS were 0.395, 0.615, and 0.633 for <6D, 6D, and >6D cycles, respectively (P < 0.05 for all D cycle groups). Corresponding HRs for OS were 0.577, 0.700, and 0.612, respectively (P < 0.05 for <6D and >6D). Conclusions After accounting for pertuzumab benefits, more than six cycles of D treatment was not associated with significant improvements in either PFS or OS compared with six cycles. The addition of pertuzumab to trastuzumab improved clinical outcomes versus trastuzumab plus placebo, regardless of D treatment duration. ClinicalTrials.gov identifier NCT00567190.
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Affiliation(s)
- D Miles
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK;.
| | - Y-H Im
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - B Yoo
- Biostatistics, Genentech Inc., South San Francisco, USA
| | - A Knott
- Clinical Development, Roche Products Ltd, Welwyn Garden City, UK
| | - S Heeson
- Clinical Development, Roche Products Ltd, Welwyn Garden City, UK
| | | | - S M Swain
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, USA
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35
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Tonyali S, Haberal HB, Sogutdelen E. Toxicity, Adverse Events, and Quality of Life Associated with the Treatment of Metastatic Castration-Resistant Prostate Cancer. Curr Urol 2017; 10:169-173. [PMID: 29234258 DOI: 10.1159/000447176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/08/2016] [Indexed: 12/19/2022] Open
Abstract
Objectives Among males, prostate cancer (PCa) is the most common cancer in Europe and the second most common cancer worldwide, especially in those aged > 70 years. With the advent of novel alternative treatments, survival in patients with advanced PCa has increased. PCa is now considered a chronic disease. Survival is an important endpoint in advanced PCa, as is quality of life (QoL). The effects of the disease and its treatment on patient health-related QoL must be taken into account when selecting the most appropriate treatment options. The present literature review aimed to provide an overview of metastatic castration-resistant prostate cancer treatment modalities, with an emphasis on side effect profiles and general health-related QoL. Methods PubMed was searched using the keywords metastatic castration-resistant prostate cancer, docetaxel, cabazitaxel, enzalutamide, abiraterone acetate, and QoL. Conclusion Based on the studies reviewed herein, abiraterone acetate and enzalutamide provide favorable outcomes, in terms of hematological adverse events. As enzalutamide and abiraterone acetate can be taken orally, they might have a positive effect on patient QoL.
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Affiliation(s)
- Senol Tonyali
- Department of Urology, Turkiye Yuksek Ihtisas Training and Research Hospital, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Emrullah Sogutdelen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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36
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Abstract
BACKGROUND The diagnosis and treatment of breast cancer may negatively affect the quality of life (QOL) of women. OBJECTIVES The aim of this study is to assess QOL in women with breast cancer who were treated with or without chemotherapy and to identify factors associated with improved or worsening QOL in these women. METHODS This cross-sectional study enrolled 112 women who were treated with chemotherapy (CTX group, with 85 [75.9%] women) or without chemotherapy (non-CTX group, with 27 [24.1%] women) for breast cancer. The Short-Form Health Survey (SF-36) assessed QOL and the Hospital Anxiety and Depression scale assessed anxiety and depression. RESULTS The overall mean SF-36 score was below 50 in all domains. Relative to CTX women, non-CTX women were significantly older (P = .001) and more likely to engage in physical exercise (P = .002). The non-CTX group had higher scores in the Physical Functioning (P = .001) and Role-Physical (P = .0009) domains of the SF-36 relative to the CTX group, and the fluoruracil + epirubicin + cyclophosphamide group had significantly lower scores in the SF-36 domains Physical Functioning (P = .009) and Role-Physical (P = .02). CONCLUSION Chemotherapy treatment for breast cancer worsens QOL in the Physical Functioning and the Role-Physical domains of the SF-36 relative to women treated without chemotherapy. IMPLICATIONS FOR PRACTICE Nurses should assess Physical Functioning and the Role-Physical before treatment, as a woman who was not physically active before breast cancer is not likely to become physically active after treatment. Establishing support groups and providing educational sessions about the disease and its management, supportive care can improve the QOL of this population.
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37
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Prostate-Specific Membrane Antigen-Directed Therapy for Metastatic Castration-Resistant Prostate Cancer. Cancer J 2017; 22:347-352. [PMID: 27749329 DOI: 10.1097/ppo.0000000000000221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prostate-specific membrane antigen (PSMA) is highly expressed on both benign and malignant prostatic tissue. Prostate-specific membrane antigen-directed therapy is conceptually promising, with a potential to additionally serve as a theranostic model in management of advanced prostate cancer. To date, various approaches have been devised and tested, including radiolabeled PSMA antibodies and inhibitor and antibody-drug conjugates. However, development and progress have faced challenges in determining the optimal combination of payload, PSMA-binding moiety, and linker technology. We review the available clinical data to date in PSMA-directed therapies and discuss the challenges faced.
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38
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Bergin ART, Hovey E, Lloyd A, Marx G, Parente P, Rapke T, de Souza P. Docetaxel-related fatigue in men with metastatic prostate cancer: a descriptive analysis. Support Care Cancer 2017; 25:2871-2879. [PMID: 28429147 DOI: 10.1007/s00520-017-3706-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 04/10/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Fatigue is a prevalent and debilitating side effect of docetaxel chemotherapy in metastatic prostate cancer. A better understanding of the kinetics and nature of docetaxel-related fatigue may provide a framework for intervention. METHODS This secondary analysis was performed using the MOTIF database, from a phase III, randomised, double-blind, placebo-controlled study of modafinil (200 mg/day for 15 days) for docetaxel-related fatigue in men with metastatic prostate cancer [1]. The pattern of fatigue was analysed using the MDASI (MD Anderson Symptom Inventory) score. The impact of modafinil, cumulative docetaxel exposure, age and smoking status on fatigue kinetics were explored. Fatigue-related symptoms were assessed using the SOMA6 (fatigue and related symptoms) subset of the SPHERE (Somatic and Psychological Health Report). Mood was tracked using the short form 36 health survey questionnaire (SF-36). RESULTS Across four docetaxel cycles, fatigue scores were higher in the first week and decreased over weeks two and three. Whilst men randomised to modafinil had reduced fatigue scores, cumulative docetaxel had little impact. Younger men (55-68 years) had significantly reduced fatigue scores, whereas current and ex-smokers had higher scores. There was no significant change in mood status or haemoglobin across treatment cycles. Men described both 'somnolence' and 'muscle fatigue' contributing significantly to their symptom complex. CONCLUSIONS Assessment and management of docetaxel-related fatigue remains an important challenge. Given the complex, multifactorial nature of fatigue, identification through structured interview and interventions targeted to specific 'at risk' groups may be the most beneficial. Understanding the temporal pattern (kinetics) and nature of fatigue is critical to guide this process.
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Affiliation(s)
- A R T Bergin
- Eastern Health, Box Hill Hospital, 8 Arnold St, Box Hill, Victoria, Australia.
| | - E Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Barker St, Randwick, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia
| | - A Lloyd
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Barker St, Randwick, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia.,Inflammation and Infection Research Centre (IIRC), School of Medical Sciences and National Centre for Cancer Survivorship (NCCS), Randwick, New South Wales, Australia
| | - G Marx
- Sydney Adventist Hospital Clinical Trials Unit & Integrated Cancer Centre, 185 Fox Valley Rd, Wahroonga, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - P Parente
- Eastern Health, Box Hill Hospital, 8 Arnold St, Box Hill, Victoria, Australia.,Eastern Health, Monash University Clinical School, 5 Arnold St, Box Hill, Victoria, Australia
| | - T Rapke
- Sanofi Aventis, Sydney, New South Wales, Australia
| | - P de Souza
- Liverpool Hospital, Goulburn Street, Liverpool, New South Wales, Australia.,Western Sydney University, Penrith, New South Wales, Australia
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Jang J, Kim HK, Cho BC, Lee KH, Yun HJ, Woo IS, Song HS, Ryoo HM, Kim CH, Sun DS, Shin JW. Randomized phase II study comparing weekly docetaxel-cisplatin vs. gemcitabine-cisplatin in elderly or poor performance status patients with advanced non-small cell lung cancer. Cancer Chemother Pharmacol 2017; 79:873-880. [PMID: 28341958 DOI: 10.1007/s00280-017-3289-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Docetaxel/cisplatin (DP) and gemcitabine/cisplatin (GP) are standard treatment regimens for advanced non-small cell lung cancer (NSCLC). In spite of potent efficacy, the conventional 1-day DP is regarded as having more toxicity as compared with GP. There is increasing interest in a biweekly split administration of DP to reduce its toxicity. Hypothesis was that first-line biweekly DP is as safe as GP in the elderly or poor performance status (PS) patients. METHODS Chemotherapy-naïve patients with advanced NSCLC (IIIB/IV) who were elderly (65<) or PS (ECOG 2) were randomized to DP or GP arm by balancing for ECOG (0-1 vs. 2) and stage (IIIB vs. IV). DP comprised docetaxel (35 mg/m2)/cisplatin (30 mg/m2) iv on days 1 and 8, every 3 weeks. GP comprised gemcitabine (1000 mg/m2)/cisplatin (30 mg/m2) iv on days 1 and 8, every 3 weeks. Chemotherapy lasted up to 4-6 cycles or until progression. Primary endpoint was safety (proportion of grade 3/4 toxicities). Planned sample size was 49 patients in each arm. RESULTS From November 2009 to August 2012, a total of 99 patients were randomized (DP 50/GP 49) from nine institutions. Adenocarcinoma and squamous cell carcinoma were observed in 62% and 33% of patients, respectively. Toxicity profiles were comparable for both arms and the differences were not statistically significant except for anemia and leucocytopenia. Any grade of anemia (86 vs. 98%) and of leucocytopenia (18 vs. 43%) was more common in the GP arm with statistical significance. Oral mucositis tended to be predominant in the DP arm. Patients in the DP arm (51%) suffered grade 3 or higher toxicities as did 47% in the GP arm (47%). The most common grade 3 or higher toxicities were as follows: In the DP arm, neutropenia (8%), leucopenia (8%), anemia (4%), pneumonia with normal ANC (4%) and febrile neutropenia (2%) were observed. In the GP arm, anemia (15%), neutropenia (15%), pneumonia with normal ANC (4%), thrombocytopenia (4%) and leucopenia (2%) were observed. The best overall response rates (CR + PR) for the DP and GP arms were 20.0 and 21% with no CR, respectively, and disease control rates (CR + PR + SD) were 70.0 and 76%, respectively. Median progression-free survival and median overall survival were 3.7 and 14.9 months in the DP arm and 5.6 and 20.8 months in the GP arm, respectively. CONCLUSION This study showed that DP is similar to GP in terms of efficacy and toxicity in treatment of elderly or poor performance patients. Both regimens showed similar grade 3/4 toxicities with different profiles.
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Affiliation(s)
- JoungSoon Jang
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Kyo Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea.
| | - Byoung Chul Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hee Lee
- Department of Internal Medicine, College of Medicine Yeungnam University, Daegu, Republic of Korea
| | - Hwan-Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - In Sook Woo
- Department of Internal Medicine, Catholic University Yeouido St. Mary Hospital, Seoul, Republic of Korea
| | - Hong Suk Song
- Department of Internal Medicine, Dongsan Medical center, Keimyung University, Daegu, Republic of Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Daegu Catholic University Medical Centre, Daegu, Republic of Korea
| | - Chi-Hong Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea
| | - Der-Sheng Sun
- Department of Internal Medicine, Uijungbu St. Mary's Hospital, The Catholic Unviersity of Korea, Uijungbu, Republic of Korea
| | - Jong Wook Shin
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Tsao CK, Galsky MD, Oh WK. Docetaxel for Metastatic Hormone-sensitive Prostate Cancer: Urgent Need to Minimize the Risk of Neutropenic Fever. Eur Urol 2016; 70:707-708. [DOI: 10.1016/j.eururo.2016.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
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Schwentner L, Harbeck N, Singer S, Eichler M, Rack B, Forstbauer H, Wischnik A, Scholz C, Huober J, Friedl TWP, Weissenbacher T, Härtl K, Kiechle M, Janni W, Fink V. Short term quality of life with epirubicin-fluorouracil-cyclophosphamid (FEC) and sequential epirubicin/cyclophosphamid-docetaxel (EC-DOC) chemotherapy in patients with primary breast cancer - Results from the prospective multi-center randomized ADEBAR trial. Breast 2016; 27:69-77. [PMID: 27054751 DOI: 10.1016/j.breast.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 03/05/2016] [Accepted: 03/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The recommendation for adjuvant dose-dense chemotherapy in high risk primary breast cancer is heterogeneous among guidelines. Understanding the impact on QoL is thereby a crucial factor, especially if the benefit is potentially low. This study aims to assess QoL as a secondary outcome in the prospective randomized multi-center ADEBAR trial. METHODS QoL was assessed at baseline (t1), before cycle 4 FEC and cycle 5 EC-DOC (t2), 4 weeks after chemotherapy (t3) and 6 weeks after radiation (t4) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer-Specific Module (QLQ-BR23). RESULTS 1306 patients were enrolled into the ADEBAR trial. 675 were assigned to the FEC and 688 to the EC-DOC arm. After the beginning of treatment, global QoL dropped in both arm by 3-4 points. In the EC-DOC arm, QoL dropped further at t3 by 7 points and stayed stable in the FEC arm. 6 weeks after radiation, QoL exceeded baseline in both arms by 6-8 points. The differences between treatment arms were strongest at t3 (53.0 vs. 49.5) but did not reach clinical relevance at any point in time. Physical functioning, nausea and vomiting, fatigue and systemic therapy side effects followed with some minor exceptions similar patterns but showed higher amplitudes. CONCLUSION In conclusion, we could not detect a clinically relevant difference between the two treatment arms in global QoL, although the results consistently show that patients on EC-DOC report worse scores during the treatment.
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Affiliation(s)
- Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Nadia Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
| | - Susanne Singer
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Martin Eichler
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | | | - Christoph Scholz
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Tobias Weissenbacher
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Marion Kiechle
- Department of Obstetrics and Gynecology, Technical University Clinics Rechts der Isar Munich, Munich, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Al-Batran SE, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Sugimoto N, Lipatov ON, Kim TY, Cunningham D, Rougier P, Muro K, Liepa AM, Chandrawansa K, Emig M, Ohtsu A, Wilke H. Quality-of-life and performance status results from the phase III RAINBOW study of ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated gastric or gastroesophageal junction adenocarcinoma. Ann Oncol 2016; 27:673-9. [PMID: 26747859 PMCID: PMC4803452 DOI: 10.1093/annonc/mdv625] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/17/2015] [Accepted: 12/18/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The phase III RAINBOW trial demonstrated that the addition of ramucirumab to paclitaxel improved overall survival, progression-free survival, and tumor response rate in fluoropyrimidine-platinum previously treated patients with advanced gastric/gastroesophageal junction (GEJ) adenocarcinoma. Here, we present results from quality-of-life (QoL) and performance status (PS) analyses. PATIENTS AND METHODS Patients with Eastern Cooperative Oncology Group PS of 0/1 were randomized to receive ramucirumab (8 mg/kg i.v.) or placebo on days 1 and 15 of a 4-week cycle, with both arms receiving paclitaxel (80 mg/m(2)) on days 1, 8, and 15. Patient-reported outcomes were assessed with the QoL/health status questionnaires EORTC QLQ-C30 and EQ-5D at baseline and 6-week intervals. PS was assessed at baseline and day 1 of every cycle. Time to deterioration (TtD) in each QLQ-C30 scale was defined as randomization to first worsening of ≥10 points (on 100-point scale) and TtD in PS was defined as first worsening to ≥2. Hazard ratios (HRs) for treatment effect were estimated using stratified Cox proportional hazards models. RESULTS Of the 665 patients randomized, 650 (98%) provided baseline QLQ-C30 and EQ-5D data, and 560 (84%) also provided data from ≥1 postbaseline time point. Baseline scores for both instruments were similar between arms. Of the 15 QLQ-C30 scales, 14 had HR < 1, indicating similar or longer TtD in QoL for ramucirumab + paclitaxel. Treatment with ramucirumab + paclitaxel was also associated with a delay in TtD in PS to ≥2 (HR = 0.798, P = 0.0941). Alternate definitions of PS deterioration yielded similar results: PS ≥ 3 (HR = 0.656, P = 0.0508), deterioration by ≥1 PS level (HR = 0.802, P = 0.0444), and deterioration by ≥2 PS levels (HR = 0.608, P = 0.0063). EQ-5D scores were comparable between treatment arms, stable during treatment, and worsened at discontinuation. CONCLUSION In patients with previously treated advanced gastric/GEJ adenocarcinoma, addition of ramucirumab to paclitaxel prolonged overall survival while maintaining patient QoL with delayed symptom worsening and functional status deterioration. CLINICALTRIALSGOV NCT01170663.
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Affiliation(s)
- S-E Al-Batran
- Institute of Clinical Cancer Research (IKF), UCT-University Cancer Center, Frankfurt, Germany
| | - E Van Cutsem
- University Hospitals Gasthuisberg, Leuven, Belgium
| | - S C Oh
- Korea University Guro Hospital, Seoul, South Korea
| | - G Bodoky
- Szent László Hospital, Budapest, Hungary
| | - Y Shimada
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - S Hironaka
- Department of Clinical Trial Promotion, Chiba Cancer Center, Chiba, Japan
| | - N Sugimoto
- Department of Clinical Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - O N Lipatov
- Bashkortostan Clinical Oncology Center, Ufa, Russia
| | - T-Y Kim
- Department of Internal Medicine and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | | | - P Rougier
- Hôpital Européen Georges Pompidou, Université Paris V, Paris, France
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - A M Liepa
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - M Emig
- Eli Lilly and Company, Bad Homburg, Germany
| | - A Ohtsu
- Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - H Wilke
- Department of Oncology, Kliniken Essen Mitte Center of Pallative Care, Muenster University Clinic, Essen, Germany
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Young K, Smyth E, Chau I. Ramucirumab for advanced gastric cancer or gastro-oesophageal junction adenocarcinoma. Therap Adv Gastroenterol 2015; 8:373-83. [PMID: 26557893 PMCID: PMC4622287 DOI: 10.1177/1756283x15592586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Ramucirumab, a fully humanized monoclonal antibody directed against vascular endothelial growth factor receptor 2, is the first targeted agent to have demonstrated an improvement in survival, as a single agent or in combination, in a molecularly unselected population in gastro-oesophageal cancer. Now that second-line treatment is routinely considered for patients with advanced gastro-oesophageal cancer, ramucirumab, with its favourable toxicity profile compared with cytotoxic treatment, provides a valuable additional treatment option.
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Affiliation(s)
- Kate Young
- Royal Marsden Hospital, Gastrointestinal Oncology Unit, Sutton, Surrey, UK
| | - Elizabeth Smyth
- Royal Marsden Hospital, Gastrointestinal Oncology Unit, Sutton, Surrey, UK
| | - Ian Chau
- Royal Marsden Hospital, Gastrointestinal Oncology Unit, Down’s Road, Sutton, Surrey SM2 5PT, UK
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Lin PL, Hao Y, Xie J, Li N, Ohashi E, Koo V, Wu EQ. Real-world effectiveness of everolimus-based therapy versus endocrine monotherapy and chemotherapy in patients of HR+/HER2- breast cancer with liver metastasis in the USA. Expert Opin Pharmacother 2015; 16:2101-11. [PMID: 26290278 DOI: 10.1517/14656566.2015.1074182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study investigated the comparative effectiveness of everolimus-based therapy (EVE) versus endocrine monotherapy (ET) and chemotherapy (CT) in the treatment of hormone-receptor-positive human-epidermal-growth-factor-receptor-2-negative (HR+/HER2-) metastatic breast cancer (mBC) patients with liver metastasis. METHODS Medical charts of patients treated by community oncologists were examined. Eligible patients included postmenopausal women with HR+/HER2- mBC with liver metastasis who received EVE, ET or CT between 1 July 2012 and 15 April 2013 after non-steroidal aromatase inhibitor use. Time on treatment (TOT) and progression-free survival (PFS) were compared between EVE and ET or CT using Kaplan-Meier analyses and Cox proportional hazards models. RESULTS Among the 202 patients in the study, 82 received EVE, 49 ET, and 71 CT. After adjusting for baseline characteristics, EVE was associated with significantly longer TOT than ET (hazard ratio [HR]: 0.49; 95% CI: 0.28 - 0.86) or CT (HR: 0.35; 95% CI: 0.22 - 0.55), and significantly longer PFS than ET (HR: 0.48; 95% CI: 0.27 - 0.87). PFS was not significantly different with EVE versus CT (HR: 0.76; 95% CI: 0.44 - 1.32). CONCLUSIONS EVE had significantly longer TOT and PFS than ET and longer TOT than CT among postmenopausal HR+/HER2- mBC patients with liver metastasis.
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Affiliation(s)
- Peggy L Lin
- a 1 Analysis Group, Inc. , 111 Huntington Ave, 10th Floor, Boston, MA 02199, USA +1 617 425 8475 ; +1 617 425 8001 ;
| | - Yanni Hao
- b 2 Novartis Pharmaceuticals Corporation , East Hanover, NJ, USA
| | - Jipan Xie
- c 3 Analysis Group, Inc. , New York, NY, USA
| | - Nanxin Li
- a 1 Analysis Group, Inc. , 111 Huntington Ave, 10th Floor, Boston, MA 02199, USA +1 617 425 8475 ; +1 617 425 8001 ;
| | - Erika Ohashi
- a 1 Analysis Group, Inc. , 111 Huntington Ave, 10th Floor, Boston, MA 02199, USA +1 617 425 8475 ; +1 617 425 8001 ;
| | - Valerie Koo
- a 1 Analysis Group, Inc. , 111 Huntington Ave, 10th Floor, Boston, MA 02199, USA +1 617 425 8475 ; +1 617 425 8001 ;
| | - Eric Q Wu
- a 1 Analysis Group, Inc. , 111 Huntington Ave, 10th Floor, Boston, MA 02199, USA +1 617 425 8475 ; +1 617 425 8001 ;
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