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Carboplatin (every 21 days) and divided-dose paclitaxel (days 1, 11): rationale and tolerance in chemotherapy naïve women with high-grade epithelial cancers of Mullerian origin. Cancer Chemother Pharmacol 2018. [PMID: 29516152 DOI: 10.1007/s00280-018-3559-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We report here on the tolerance of a carboplatin-'divided dose' paclitaxel (given on days 1 and 11) regimen in chemotherapy-naïve patients with resected and staged endometrial epithelial neoplasms deemed at high-risk of recurrence or early stage epithelial high-grade serous tubo-ovarian adenocarcinomas after risk-reducing surgery. More recently, we applied this regimen as neoadjuvant chemotherapy for advanced ovarian cancer presentations. METHODS A retrospective chart review of patients receiving this day 1, 11 paclitaxel regimens in combination with carboplatin at AUC 6 every 3 weeks since 2004 was carried out by the second author with subsequent updates by the first and third authors. Tolerance over the first three cycles was analyzed. RESULTS A total of 27 women were treated with at least three cycles of this paclitaxel 'divided dose' schedule combined with carboplatin: 6 had endometrial adenocarcinoma, 9 had early stage ovarian cancer, and 12 received it as part of neoadjuvant therapy prior to undergoing cytoreductive surgery. Only 14 of 27 patients required dose reductions to complete the first three cycles of treatment. CONCLUSIONS A median of three cycles of divided dose paclitaxel (D1, D11) concurrent with carboplatin dosed every 3 weeks was found to be safe and feasible as adjuvant to surgery in early endometrial and ovarian cancers or as neoadjuvant treatment in chemotherapy-naive women with ovarian cancer.
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2
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Cho H, Gao J, Kwon GS. PEG-b-PLA micelles and PLGA-b-PEG-b-PLGA sol-gels for drug delivery. J Control Release 2016; 240:191-201. [PMID: 26699425 PMCID: PMC4909590 DOI: 10.1016/j.jconrel.2015.12.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 02/07/2023]
Abstract
Poly(ethylene glycol)-block-poly(D,L-lactic acid) (PEG-b-PLA) micelles and poly(D,L-lactic-co-glycolic acid)-block-polyethylene glycol)-block-poly(D,L-lactic-co-glycolic acid) (PLGA-b-PEG-b-PLGA) sol-gels have been extensively researched for systemic and localized drug delivery applications, respectively, and they have both progressed into humans for paclitaxel, an important yet poorly water-soluble chemotherapeutic agent. In this review article, preclinical and clinical research on PEG-b-PLA micelles and PLGA-b-PEG-b-PLGA sol-gels that has focused on paclitaxel will be updated, and recent research on other poorly water-soluble anticancer agents and delivery of drug combinations (i.e. multi-drug delivery) that seeks synergistic anticancer efficacy will be summarized. PEG-b-PLA micelles are a first-generation platform for the systemic multi-delivery of poorly water soluble anticancer agents. PLGA-b-PEG-b-PLGA sol-gels are a first-generation platform for the localized multi-drug delivery of water-soluble and/or poorly water-soluble anticancer agents. In summary, PEG-b-PLA micelles and PLGA-b-PEG-b-PLGA sol-gels may safely enable pre-clinical evaluation and clinical translation of poorly water-soluble anticancer agents, especially for promising, rapidly emerging anticancer combinations.
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Affiliation(s)
- Hyunah Cho
- Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States
| | - Jieming Gao
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison, WI 53705, United States
| | - Glen S Kwon
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison, WI 53705, United States; Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Hwarangno 14-gil 5, Seongbuk-gu, Seoul 136-791, Republic of Korea.
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3
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Liu R, Colby AH, Gilmore D, Schulz M, Zeng J, Padera RF, Shirihai O, Grinstaff MW, Colson YL. Nanoparticle tumor localization, disruption of autophagosomal trafficking, and prolonged drug delivery improve survival in peritoneal mesothelioma. Biomaterials 2016; 102:175-86. [PMID: 27343465 DOI: 10.1016/j.biomaterials.2016.06.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 02/07/2023]
Abstract
The treatment outcomes for malignant peritoneal mesothelioma are poor and associated with high co-morbidities due to suboptimal drug delivery. Thus, there is an unmet need for new approaches that concentrate drug at the tumor for a prolonged period of time yielding enhanced antitumor efficacy and improved metrics of treatment success. A paclitaxel-loaded pH-responsive expansile nanoparticle (PTX-eNP) system is described that addresses two unique challenges to improve the outcomes for peritoneal mesothelioma. First, following intraperitoneal administration, eNPs rapidly and specifically localize to tumors. The rate of eNP uptake by tumors is an order of magnitude faster than the rate of uptake in non-malignant cells; and, subsequent accumulation in autophagosomes and disruption of autophagosomal trafficking leads to prolonged intracellular retention of eNPs. The net effect of these combined mechanisms manifests as rapid localization to intraperitoneal tumors within 4 h of injection and persistent intratumoral retention for >14 days. Second, the high tumor-specificity of PTX-eNPs leads to delivery of greater than 100 times higher concentrations of drug in tumors compared to PTX alone and this is maintained for at least seven days following administration. As a result, overall survival of animals with established mesothelioma more than doubled when animals were treated with multiple doses of PTX-eNPs compared to equivalent dosing with PTX or non-responsive PTX-loaded nanoparticles.
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Affiliation(s)
- Rong Liu
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron H Colby
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Departments of Biomedical Engineering and Chemistry, Boston University, Boston, MA, USA
| | - Denis Gilmore
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Morgan Schulz
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jialiu Zeng
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston, MA, USA
| | - Robert F Padera
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Orian Shirihai
- Department of Medicine, Obesity and Nutrition Section, Evans Biomedical Research Center, Boston University School of Medicine, Boston, MA, USA; Department of Clinical Biochemistry, School of Medicine, Ben Gurion University, Beer-Sheva, Israel
| | - Mark W Grinstaff
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston, MA, USA.
| | - Yolonda L Colson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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4
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Mustacchi G, De Laurentiis M. The role of taxanes in triple-negative breast cancer: literature review. Drug Des Devel Ther 2015; 9:4303-18. [PMID: 26273192 PMCID: PMC4532347 DOI: 10.2147/dddt.s86105] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Breast cancer (BC) is the most frequent tumor worldwide. Triple-negative BCs are characterized by the negative estrogen and progesterone receptors and negative HER2, and represent 15% of all BCs. In this review, data on the use of taxanes in triple-negative BCs are analyzed, concluding they are effective in any clinical setting (neoadjuvant, adjuvant, and metastatic). Further, the role of nab-paclitaxel (formulation of albumin-bound paclitaxel) in these tumors is also evaluated. The available data show the clinical potential of nab-paclitaxel based combinations in terms of long-duration response, increased survival, and better quality of life of patients with triple-negative metastatic BC. The ongoing trials will give further information on the better management of this type of tumor.
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Affiliation(s)
| | - Michelino De Laurentiis
- Breast Medical Oncology Unit, National Cancer Institute, Fondazione G. Pascale, Napoli, Italy
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5
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Kourlaba G, Rapti V, Alexopoulos A, Relakis J, Koumakis G, Chatzikou M, Maniadakis N, Georgoulias V. Everolimus plus exemestane versus bevacizumab-based chemotherapy for second-line treatment of hormone receptor-positive metastatic breast cancer in Greece: An economic evaluation study. BMC Health Serv Res 2015; 15:307. [PMID: 26239115 PMCID: PMC4524048 DOI: 10.1186/s12913-015-0971-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022] Open
Abstract
Background The objective of our study was to conduct a cost-effectiveness (CE) study of combined everolimus (EVE) and exemestane (EXE) versus the common clinical practice in Greece for the treatment of postmenopausal women with HR+/HER2- advanced breast cancer (BC) progressing on nonsteroidal aromatase inhibitors (NSAI). The combinations of bevacizumab (BEV) plus paclitaxel (PACL) and BEV plus capecitabine (CAPE) were selected as comparators. Method A Markov model, consisting of three health states, was used to describe disease progression and evaluate the CE of the comparators from a third-party payer perspective over a lifetime horizon. Efficacy and safety data as well as utility values considered in the model were extracted from the relevant randomized Phase III clinical trials and other published studies. Direct medical costs referring to the year 2014 were incorporated in the model. A probabilistic sensitivity analysis was conducted to account for uncertainty and variation in the parameters of the model. Primary outcomes were patient survival (life-years), quality-adjusted life years (QALYs), total direct costs and incremental cost-effectiveness ratios (ICER). Results The discounted quality-adjusted survival of patients treated with EVE plus EXE was greater by 0.035 and 0.004 QALYs, compared to BEV plus PACL and BEV plus CAPE, respectively. EVE plus EXE was the least costly treatment in terms of drug acquisition, administration, and concomitant medications. The total lifetime cost per patient was estimated at €55,022, €67,980, and €62,822 for EVE plus EXE, BEV plus PACL, and BEV plus CAPE, respectively. The probabilistic analysis confirmed the deterministic results. Conclusion Our results suggest that EVE plus EXE may be a dominant alternative relative to BEV plus PACL and BEV plus CAPE for the treatment of HR+/HER2- advanced BC patients failing initial therapy with NSAIs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0971-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgia Kourlaba
- The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | | | | | - John Relakis
- Department of Health Services Organization & Management, National School of Public Health, Athens, Greece.
| | - Georgios Koumakis
- 2nd Department of Pathology-Oncology, St. Savvas Hospital, Athens, Greece.
| | | | - Nikos Maniadakis
- Department of Health Services Organization & Management, National School of Public Health, Athens, Greece.
| | - Vassilis Georgoulias
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece.
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6
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Zhang F, Zhang S, Pollack SF, Li R, Gonzalez AM, Fan J, Zou J, Leininger SE, Pavía-Sanders A, Johnson R, Nelson LD, Raymond JE, Elsabahy M, Hughes DMP, Lenox MW, Gustafson TP, Wooley KL. Improving Paclitaxel Delivery: In Vitro and In Vivo Characterization of PEGylated Polyphosphoester-Based Nanocarriers. J Am Chem Soc 2015; 137:2056-66. [DOI: 10.1021/ja512616s] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Laura D. Nelson
- Department
of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
| | | | - Mahmoud Elsabahy
- Department
of Pharmaceutics, and Assiut International Center of Nanomedicine,
Al-Rajhy Liver Hospital, Assiut University, 71515 Assiut, Egypt
| | - Dennis M. P. Hughes
- Department
of Pediatric Research, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
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7
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Huck JJ, Zhang M, Mettetal J, Chakravarty A, Venkatakrishnan K, Zhou X, Kleinfield R, Hyer ML, Kannan K, Shinde V, Dorner A, Manfredi MG, Shyu WC, Ecsedy JA. Translational exposure-efficacy modeling to optimize the dose and schedule of taxanes combined with the investigational Aurora A kinase inhibitor MLN8237 (alisertib). Mol Cancer Ther 2014; 13:2170-83. [PMID: 24980948 DOI: 10.1158/1535-7163.mct-14-0027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aurora A kinase orchestrates multiple key activities, allowing cells to transit successfully into and through mitosis. MLN8237 (alisertib) is a selective Aurora A inhibitor that is being evaluated as an anticancer agent in multiple solid tumors and heme-lymphatic malignancies. The antitumor activity of MLN8237 when combined with docetaxel or paclitaxel was evaluated in in vivo models of triple-negative breast cancer grown in immunocompromised mice. Additive and synergistic antitumor activity occurred at multiple doses of MLN8237 and taxanes. Moreover, significant tumor growth delay relative to the single agents was achieved after discontinuing treatment; notably, durable complete responses were observed in some mice. The tumor growth inhibition data generated with multiple dose levels of MLN8237 and paclitaxel were used to generate an exposure-efficacy model. Exposures of MLN8237 and paclitaxel achieved in patients were mapped onto the model after correcting for mouse-to-human variation in plasma protein binding and maximum tolerated exposures. This allowed rank ordering of various combination doses of MLN8237 and paclitaxel to predict which pair would lead to the greatest antitumor activity in clinical studies. The model predicted that 60 and 80 mg/m(2) of paclitaxel (every week) in patients lead to similar levels of efficacy, consistent with clinical observations in some cancer indications. The model also supported using the highest dose of MLN8237 that can be achieved, regardless of whether it is combined with 60 or 80 mg/m(2) of paciltaxel. The modeling approaches applied in these studies can be used to guide dose-schedule optimization for combination therapies using other therapeutic agents.
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Affiliation(s)
- Jessica J Huck
- Department of Cancer Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Mengkun Zhang
- Department of Cancer Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Jerome Mettetal
- Department of DMPK, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Arijit Chakravarty
- Department of DMPK, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Karthik Venkatakrishnan
- Department of Clinical Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Xiaofei Zhou
- Department of Clinical Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Rob Kleinfield
- Department of Drug Development Management, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Marc L Hyer
- Department of Cancer Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Karuppiah Kannan
- Department of Cancer Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Vaishali Shinde
- Department of Molecular Pathology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Andy Dorner
- Department of Translational Medicine, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Mark G Manfredi
- Department of Cancer Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Wen Chyi Shyu
- Department of DMPK, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts
| | - Jeffrey A Ecsedy
- Department of Translational Medicine, Takeda Pharmaceuticals International Co., Cambridge, Massacheusetts.
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8
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Model-based meta-analysis for quantifying Paclitaxel dose response in cancer patients. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2014; 3:e115. [PMID: 24850445 PMCID: PMC4055787 DOI: 10.1038/psp.2014.14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/26/2014] [Indexed: 12/24/2022]
Abstract
Model-based meta-analysis of dose response is a sophisticated method to guide dose and regimen selection. In this report, the effects of paclitaxel dose and regimen (weekly or every 3 weeks) on the efficacy and safety in cancer patients were quantified by model-based meta-analysis of 29 monotherapy trials. Logistic regression models were developed to assess the relationship between dose and objective response rate or neutropenia rate. Survival models were developed to assess the relationship between dose and overall survival or progression-free survival. Paclitaxel efficacy (e.g., objective response rate, median overall survival, and progression-free survival) is correlated with average dose per week (mg/m2/week), whereas safety (e.g., neutropenia rate) is correlated with dose per administration (mg/m2). Weekly paclitaxel regimen at 65–80 mg/m2 is supported to have comparable to better efficacy and lower neutropenia incidence than an every-3-week regimen at 175 mg/m2.
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9
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Evaluation of a Pharmacology-Driven Dosing Algorithm of 3-Weekly Paclitaxel Using Therapeutic Drug Monitoring. Clin Pharmacokinet 2012; 51:607-17. [DOI: 10.1007/bf03261934] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Gonzalez-Angulo AM, Hortobagyi GN, Ellis LM. Targeted therapies: peaking beneath the surface of recent bevacizumab trials. Nat Rev Clin Oncol 2011; 8:319-20. [PMID: 21556024 DOI: 10.1038/nrclinonc.2011.66] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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11
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Lee SJ, Kang HY, Kim SY, Chung JH, Oh SJ, Ryu JS, Kim SB, Kang JS, Park SK, Kim HM, Kim MH, Moon DH. Early assessment of tumor response to JAC106, an anti-tubulin agent, by 3′-deoxy-3′-[18F]fluorothymidine in preclinical tumor models. Eur J Nucl Med Mol Imaging 2011; 38:1436-48. [DOI: 10.1007/s00259-011-1802-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
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12
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Treatment of metastatic breast cancer: state-of-the-art, subtypes and perspectives. Crit Rev Oncol Hematol 2011; 80:433-49. [PMID: 21330148 DOI: 10.1016/j.critrevonc.2011.01.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 12/16/2010] [Accepted: 01/18/2011] [Indexed: 01/01/2023] Open
Abstract
Current treatment of metastatic breast cancer (MBC) aims at achieving meaningful clinical responses, improved quality of life, long-term remissions, prolonged survival, and dares to hope for a cure in a small percentage of cases. This article will discuss both consensus and controversies in the management of MBC in the context of the new evolving breast cancer molecular classification. Hormonal therapy remains the mainstay of management of MBC Luminal A and B. Data is emerging on management of ErbB2-positive HR-positive MBC by combining hormonal manipulation and targeted anti-ErbB2 therapy and has recently received regulatory approval in Europe and USA. The optimal use and duration of single agent or combination chemotherapy is discussed. Data and controversies surrounding the use of newer agents such as nab-paclitaxel, ixabepilone, eribulin, and PARP inhibitors as well as trastuzumab is reviewed. Better understanding of pathophysiology has paved the way for the introduction of newer anti-ErbB2 agents such as lapatinib, pertuzumab, T-DM1 and neratinib. Controversies regarding bevacizumab and anti-angiogenesis are discussed. Bisphosphonates have significantly reduced skeletal related events and made significant improvements in the quality of life of patients with MBC. Newer anti-RANK Ligand antibodies show promising results. Significant advances in the understanding of molecular biology of breast cancer have been made and should lead to an improvement in the outcome of MBC. More possibilities of cure can become an attainable goal in the near future.
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13
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Gerritsen-van Schieveen P, Royer B. Level of evidence for therapeutic drug monitoring of taxanes. Fundam Clin Pharmacol 2010; 25:414-24. [DOI: 10.1111/j.1472-8206.2010.00874.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Phase I trial of weekly irinotecan and paclitaxel combined with carboplatin in patients with advanced cancer: a Hellenic Cooperative Oncology Group Study. Anticancer Drugs 2010; 21:785-9. [DOI: 10.1097/cad.0b013e32833d5ec0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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15
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Schieveen PGV, Royer B. Niveau de preuve du suivi thérapeutique pharmacologique du paclitaxel. Therapie 2010; 65:195-200. [DOI: 10.2515/therapie/2010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 03/03/2010] [Indexed: 11/20/2022]
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16
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Chiorean EG, Malireddy S, Younger AE, Jones DR, Waddell MJ, Sloop MI, Yu M, Hall SD, Schneider B, Sweeney CJ. A phase I dose escalation and pharmacokinetic study of vatalanib (PTK787/ZK 222584) in combination with paclitaxel in patients with advanced solid tumors. Cancer Chemother Pharmacol 2009; 66:441-8. [PMID: 20091169 DOI: 10.1007/s00280-009-1179-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 11/04/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE To define the maximum-tolerated dose (MTD) for weekly paclitaxel administered in combination with daily vatalanib (PTK787/ZK 222584, PTK/ZK) and assess for a drug-drug interaction. METHODS Patients were treated with escalating doses of weekly paclitaxel (75-85 mg/m(2)), and daily PTK/ZK (250-1,000 mg). During the first cycle only, paclitaxel was given on days 1 and 15, and PTK/ZK on days 3-28. Pharmacokinetic studies were conducted on cycle 1 days 1 and 15 for paclitaxel, and on cycle 1 day 15 for PTK/ZK. Therapy was given until disease progression. RESULTS Twenty-seven patients were accrued to four dose levels. Two of five patients treated with paclitaxel 85 mg/m(2) and PTK/ZK 1,000 mg had Grade 3 transaminase elevation as dose-limiting toxicity. Paired PK analyses demonstrated a significant increase in paclitaxel clearance on day 15 (p = 0.006). Activity included one partial response and 11 patients with stable disease > or =4 months, including patients previously treated with paclitaxel. CONCLUSIONS The MTD for weekly paclitaxel plus daily PTK/ZK is 75 mg/m(2) and 750 mg. PK analysis revealed a significant drug-drug interaction, with an increase in paclitaxel clearance. This combination was well tolerated with evidence of anti-cancer activity and provides guidance for phase 2 planning.
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Affiliation(s)
- E Gabriela Chiorean
- Department of Medicine, Indiana University Simon Cancer Center, Indianapolis, IN, USA
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17
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Sakamoto J, Matsui T, Kodera Y. Paclitaxel chemotherapy for the treatment of gastric cancer. Gastric Cancer 2009; 12:69-78. [PMID: 19562460 DOI: 10.1007/s10120-009-0505-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 03/21/2009] [Indexed: 02/07/2023]
Abstract
A comprehensive review of phase I and phase II clinical trials of paclitaxel and paclitaxel-containing chemotherapy regimens for advanced gastric cancer was performed. Response rates, median progression-free survivals, and median overall survivals were examined, together with the treatment regimens and the numbers of patients registered in each trial. Although paclitaxel monotherapy produced considerable improvement in tumor response and prognosis, combination doublet or triplet chemotherapy with fluoropyrimidines and/or platinum compounds showed better results than the paclitaxel monotherapy. With regard to the schedule of paclitaxel administration, weekly injection seemed to show less toxicity and better results than administration every 3 weeks. Adjuvant therapies, chemoradiation therapies, and paclitaxel treatment for gastric ascites were also investigated and are discussed.
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Affiliation(s)
- Junichi Sakamoto
- Department of Young Leaders' Program in Medical Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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18
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Advanced Breast Cancer: Diagnosis and Treatment. National Institute for Health and Clinical Excellence Guideline 2009 — a Solid Basis for Good Clinical Practice. Clin Oncol (R Coll Radiol) 2009; 21:368-70. [DOI: 10.1016/j.clon.2009.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 04/15/2009] [Indexed: 11/23/2022]
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19
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Trastuzumab plus weekly epirubicin and paclitaxel for locally advanced and metastatic breast cancer: preliminary results of a feasibility-phase II study aimed at cardiotoxicity. Anticancer Drugs 2009; 20:109-14. [PMID: 19209027 DOI: 10.1097/cad.0b013e32831bc09b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A feasibility-phase II study was conducted to assess the cardiotoxicity of weekly trastuzumab, epirubicin, and paclitaxel in patients with human epidermal growth factor receptor-2-positive metastatic breast cancer. Untreated patients with human epidermal growth factor receptor-2-positive advanced breast cancer received trastuzumab (day 1), and epirubicin (25 mg/m2) and paclitaxel (80 mg/m2) (day 2) on a weekly basis. The rate of patients with left-ventricular ejection fraction (L-VEF) reduction greater than 10% after 12 weeks was the primary end point. According to a two-stage model, an initial step with 15 patients was required; after 11 patients without toxicity, a second step with 21 patients was planned. After 255 courses in 15 patients (median treatment weeks: 18), the relative dose intensity was 94.7%. At 12 weeks, three patients (20%) displayed a L-VEF reduction greater than 10%, six and six (40%) patients showed a L-VEF reduction < or =10% or no change, respectively. Baseline, -12 weeks, and -24 weeks median L-VEF was 69% (range 61-77), 65% (range 60-76), and 65% (range 55-73), respectively. No EKG/cardiac signs were present. Thirteen patients had grade 3 alopecia and two patients had grade 3 asthenia, in the absence of severe hematological toxicity. Objective responses were observed in 11 patients (73.3%, 95% confidence interval 51.0-95.7), with 10 partial. The weekly administration of trastuzumab-epirubicin-paclitaxel is extremely tolerable, also with regard to L-VEF reduction. These results allowed entrance to the second step of the study.
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20
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Haines IE. Dose selection in phase I studies: why we should always go for the most effective. J Clin Oncol 2008; 26:3650-2; author reply 3652-3. [PMID: 18640947 DOI: 10.1200/jco.2008.17.6719] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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