1
|
Heidari F, Madadi S, Alizadeh N, Alimardani MH, Safari A, Armand MH, Pishgahzadeh E, Soleimani M. The potential of monoclonal antibodies for colorectal cancer therapy. Med Oncol 2023; 40:273. [PMID: 37603117 DOI: 10.1007/s12032-023-02151-1] [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: 05/13/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
Conventional chemotherapy has significant limitations for colorectal cancer (CRC) treatment, especially those who have developed metastatic recurrence CRC. A growing number of studies have investigated the potential use of monoclonal antibodies (mAbs) for CRC therapy. mAbs showing clinical benefits for CRC, making the treatment more selective with lower side effects without significant immunogenicity. In addition, recent advancements in antibody engineering strategies and the development of bifunctional or even trifunctional drugs have helped to overcome heterogeneity as the main challenge in cancer treatment. The current review discusses advances in applying mAbs for CRC therapy alone, combined, or with small molecules.
Collapse
Affiliation(s)
- Fatemeh Heidari
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Shahid Fahmide Blvd, 6517838678, Hamadan, Iran
| | - Soheil Madadi
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Shahid Fahmide Blvd, 6517838678, Hamadan, Iran
| | - Neda Alizadeh
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Hossein Alimardani
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Shahid Fahmide Blvd, 6517838678, Hamadan, Iran
| | - Armin Safari
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Shahid Fahmide Blvd, 6517838678, Hamadan, Iran
| | - Mohammad Hossein Armand
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Shahid Fahmide Blvd, 6517838678, Hamadan, Iran
| | - Elahe Pishgahzadeh
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Shahid Fahmide Blvd, 6517838678, Hamadan, Iran
| | - Meysam Soleimani
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Shahid Fahmide Blvd, 6517838678, Hamadan, Iran.
| |
Collapse
|
2
|
Wagman LD, Geller DA, Jacobs SA, Petrelli NJ, Allegra CJ, Lipchik C, Pogue‐Geile KL, Srinivasan A, Wang Y, O'Connell MJ. NSABP FC‐6: Surgical conversion rate in colorectal cancer patients with unresectable, KRAS wild‐type liver metastases receiving mFOLFOX7 plus cetuximab. J Surg Oncol 2022; 126:1494-1503. [DOI: 10.1002/jso.27078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/13/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Lawrence D. Wagman
- Department of Medicine NSABP Foundation Pittsburgh PA
- Department of Surgery/Oncology City of Hope Orange CA
| | - David A. Geller
- Department of Medicine NSABP Foundation Pittsburgh PA
- Department of Surgery/Oncology, UPMC Hillman Cancer Center University of Pittsburgh Pittsburgh PA
| | - Samuel A. Jacobs
- Department of Oncology/Hematology NSABP Foundation Pittsburgh PA
| | - Nicholas J. Petrelli
- Department of Medicine NSABP Foundation Pittsburgh PA
- Department of Surgery/Oncology Christiana Care Health Service/Helen F Graham Cancer Center; Newark DE
| | - Carmen J. Allegra
- Department of Medicine NSABP Foundation Pittsburgh PA
- Department of Medicine, Hematology/Oncology University of Florida Gainesville FL
| | - Corey Lipchik
- Department of Pathology NSABP Foundation Pittsburgh PA
| | | | | | - Ying Wang
- Department of Pathology NSABP Foundation Pittsburgh PA
| | | | | |
Collapse
|
3
|
RAS Mutations Beyond KRAS Exon 2: A Review and Discussion of Clinical Trial Data. Curr Treat Options Oncol 2015; 16:33. [DOI: 10.1007/s11864-015-0350-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
4
|
Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, Humblet Y, Bodoky G, Cunningham D, Jassem J, Rivera F, Kocákova I, Ruff P, Błasińska-Morawiec M, Šmakal M, Canon JL, Rother M, Oliner KS, Tian Y, Xu F, Sidhu R. Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol 2014; 25:1346-1355. [PMID: 24718886 DOI: 10.1093/annonc/mdu141] [Citation(s) in RCA: 391] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Panitumumab Randomized trial In combination with chemotherapy for Metastatic colorectal cancer to determine Efficacy (PRIME) demonstrated that panitumumab-FOLFOX4 significantly improved progression-free survival (PFS) versus FOLFOX4 as first-line treatment of wild-type (WT) KRAS metastatic colorectal cancer (mCRC), the primary end point of the study. PATIENTS AND METHODS Patients were randomized 1:1 to panitumumab 6.0 mg/kg every 2 weeks + FOLFOX4 (arm 1) or FOLFOX4 (arm 2). This prespecified final descriptive analysis of efficacy and safety was planned for 30 months after the last patient was enrolled. RESULTS A total of 1183 patients were randomized. Median PFS for WT KRAS mCRC was 10.0 months [95% confidence interval (CI) 9.3-11.4 months] for arm 1 and 8.6 months (95% CI 7.5-9.5 months) for arm 2; hazard ratio (HR) = 0.80; 95% CI 0.67-0.95; P = 0.01. Median overall survival (OS) for WT KRAS mCRC was 23.9 months (95% CI 20.3-27.7 months) for arm 1 and 19.7 months (95% CI 17.6-22.7 months) for arm 2; HR = 0.88; 95% CI 0.73-1.06; P = 0.17 (68% OS events). An exploratory analysis of updated survival (>80% OS events) was carried out which demonstrated improvement in OS; HR = 0.83; 95% CI 0.70-0.98; P = 0.03 for WT KRAS mCRC. The adverse event profile was consistent with the primary analysis. CONCLUSIONS In WT KRAS mCRC, PFS was improved, objective response was higher, and there was a trend toward improved OS with panitumumab-FOLFOX4, with significant improvement in OS observed in an updated analysis of survival in patients with WT KRAS mCRC treated with panitumumab + FOLFOX4 versus FOLFOX4 alone (P = 0.03). These data support a positive benefit-risk profile for panitumumab-FOLFOX4 for patients with previously untreated WT KRAS mCRC. KRAS testing is critical to select appropriate patients for treatment with panitumumab.
Collapse
Affiliation(s)
- J Y Douillard
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France.
| | - S Siena
- Division of Medical Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - J Cassidy
- Division of Cancer Sciences and Molecular Pathology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - R Burkes
- Department of Medicine, Division of Hematology/Oncology, Mount Sinai Hospital, Toronto, Canada
| | - M Barugel
- Department of Medical Oncology, Hospital de Gastroenterología, Buenos Aires, Argentina
| | - Y Humblet
- Department of Medical Oncology, Université Catholique de Louvain, Brussels, Belgium
| | - G Bodoky
- Department of Oncology, Szent Laszlo Hospital, Budapest, Hungary
| | - D Cunningham
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - F Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Kocákova
- Oncology Department, Masarykuv Onkologicky Ustav, Brno, Czech Republic
| | - P Ruff
- Department of Medical Oncology, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | | | - M Šmakal
- Department of Oncology, Institut Onkologie a Rehabilitace na Plesi s.r.o., Nová Ves pod Pleší, Czech Republic
| | - J L Canon
- Department of Oncology and Hematology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - M Rother
- Department of Oncology, The Credit Valley Hospital, Mississauga,Canada
| | - K S Oliner
- Department of Medical Sciences, Amgen, Inc., Thousand Oaks
| | - Y Tian
- Department of Biostatistics, Amgen, Inc., Thousand Oaks
| | - F Xu
- Department of Biostatistics, Amgen, Inc., Thousand Oaks
| | - R Sidhu
- Department of Global Development, Amgen, Inc., Thousand Oaks, USA
| |
Collapse
|
5
|
Is Codon 13 KRAS Mutation Biologically Different from Codon 12 Mutation? CURRENT COLORECTAL CANCER REPORTS 2012. [DOI: 10.1007/s11888-012-0140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
6
|
Broadbridge VT, Karapetis CS, Price TJ. Cetuximab in metastatic colorectal cancer. Expert Rev Anticancer Ther 2012; 12:555-65. [PMID: 22594891 DOI: 10.1586/era.12.25] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Management of metastatic colorectal cancer has evolved in the last 10 years, with the availability of targeted therapies resulting in improvement in quality of life and overall survival. Cetuximab is a chimeric monoclonal antibody that binds to the EGF receptor, and the net effects are inhibition of tumor growth, invasion, angiogenesis and metastasis. Cetuximab binding to the EGF receptor is also known to augment the effects of chemotherapy and radiotherapy. Only tumors expressing wild-type KRAS respond to cetuximab and improvements in progression-free survival and overall survival are seen, whereas patients with mutant KRAS are considered to be resistant. Cetuximab is currently available worldwide for use as monotherapy or in combination with chemotherapy in first-, second- or third-line settings in metastatic colorectal cancer patients with wild-type KRAS.
Collapse
Affiliation(s)
- Vy Tuong Broadbridge
- The Queen Elizabeth Hospital and Discipline of Medicine University of Adelaide, 28 Woodville Road, Woodville South, SA 5011, Australia
| | | | | |
Collapse
|
7
|
Aissi S, Ben Mrad M, Zarraa S, Bounedjar A, Laabidi S, Boussen H. [Targeted therapies: towards a new toxicology?]. PATHOLOGIE-BIOLOGIE 2012; 60:234-238. [PMID: 22743098 DOI: 10.1016/j.patbio.2012.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
Targeted therapies (TT) represent since 10 years, an interesting progress in oncology for many cancers in adjuvant, neoadjuvant or palliative situation. The development of this new class of drugs, with an original mechanism of action, their easy administration, mainly per os, and a particular toxicity profile different from "classical" chemotherapy (CT) leads them entering in the therapeutic arsenal of breast, digestive tract, lung and hematologic cancers, in association with CT. Medical oncologists took rapidly the train of TT, managing a new and original skin, digestive, cardiovascular, endocrine and pulmonary toxicity profile, that remains relatively less important than "classical" CT.
Collapse
Affiliation(s)
- S Aissi
- Service de carcinologie médicale, hôpital Abderrahman-Mami, rue Abderrahmen-Mami, 2080 Ariana-Tunis, Tunisie
| | | | | | | | | | | |
Collapse
|
8
|
Venook AP, Bendell JC, Warren RS. Is there currently an established role for the use of predictive or prognostic molecular markers in the management of colorectal cancer? A point/counterpoint. Am Soc Clin Oncol Educ Book 2012:193-200. [PMID: 24451733 DOI: 10.14694/edbook_am.2012.32.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The term "personalized oncology" means different things to the oncologist than to the patient. But fundamentally, the phrase creates the expectation that decisions can be informed by the unique features of the patient and patient's cancer. Much like determining antibiotic sensitivities in urinary tract infections, the oncologist is expected to choose the right treatment(s), for each individual patient. Numerous methods can be used to "personalize" management decisions, although truly useful biomarkers continue to escape our grasp. Positron Emission Tomography in patients with GI stromal tumors or genotyping of c-kit in chronic myelogenous leukemia cells can guide the use of imatinib, these scenarios represent a minority of patients. The promise of individualized therapy, however, has led to the commercialization of numerous assays to probe patient's genetic make-up and that of the tumor. Breast cancer management has benefitted from the analysis of gene recurrence scores. More recently the analysis of germline or tumor-associated mutations in non-small cell lung cancer and melanoma has led to clinically meaningful molecular subsets of these diseases, guiding the successful targeting of such cancers with small-molecule inhibitors. Despite the high incidence of colorectal cancer and our relatively long-standing grasp of the molecular pathways in colorectal carcinogenesis, the management of these patients remains mostly empiric and movement toward "personalization" has been slow and incremental. Now, however, molecular imaging and commercial assays for genetic makeup of tumor specimens has put the oncologist and oncologic surgeon in the crossfire with patients and families who believe the era of "personalization" is here.
Collapse
Affiliation(s)
- Alan P Venook
- From the Department of Medicine (Hematology/Oncology); Department of Surgical Oncology, University of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Gastrointestinal Oncology Research, Sarah Cannon Research Institute, Nashville, TN
| | - Johanna C Bendell
- From the Department of Medicine (Hematology/Oncology); Department of Surgical Oncology, University of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Gastrointestinal Oncology Research, Sarah Cannon Research Institute, Nashville, TN
| | - Robert S Warren
- From the Department of Medicine (Hematology/Oncology); Department of Surgical Oncology, University of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Gastrointestinal Oncology Research, Sarah Cannon Research Institute, Nashville, TN
| |
Collapse
|
9
|
Tomková H, Pospíšková M, Zábojníková M, Kohoutek M, Šerclová M, Gharibyar M, Šternberský J. Phytomenadione pre-treatment in EGFR inhibitor-induced folliculitis. J Eur Acad Dermatol Venereol 2011; 27:514-9. [DOI: 10.1111/j.1468-3083.2011.04324.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Fruehauf J, Lutzky J, McDermott D, Brown CK, Meric JB, Rosbrook B, Shalinsky DR, Liau KF, Niethammer AG, Kim S, Rixe O. Multicenter, phase II study of axitinib, a selective second-generation inhibitor of vascular endothelial growth factor receptors 1, 2, and 3, in patients with metastatic melanoma. Clin Cancer Res 2011; 17:7462-9. [PMID: 21976544 DOI: 10.1158/1078-0432.ccr-11-0534] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE This multicenter, open-label, phase II study evaluated the safety and clinical activity of axitinib, a potent and selective second-generation inhibitor of vascular endothelial growth factor receptors (VEGFR)-1, 2, and 3, in patients with metastatic melanoma. EXPERIMENTAL DESIGN Thirty-two patients with a maximum of one prior systemic therapy received axitinib at a starting dose of 5 mg twice daily. The primary endpoint was objective response rate. RESULTS Objective response rate was 18.8% [95% confidence interval (CI), 7.2-36.4], comprising one complete and five partial responses with a median response duration of 5.9 months (95% CI, 5.0-17.0). Stable disease at 16 weeks was noted in six patients (18.8%), with an overall clinical benefit rate of 37.5%. Six-month progression-free survival rate was 33.9%, 1-year overall survival rate was 28.1%, and median overall survival was 6.6 months (95% CI, 5.2-9.0). The most frequently (>15%) reported nonhematologic, treatment-related adverse events were fatigue, hypertension, hoarseness, and diarrhea. Treatment-related fatal bowel perforation, a known class effect, occurred in one patient. Axitinib selectively decreased plasma concentrations of soluble VEGFR (sVEGFR)-2 and sVEGFR-3 compared with soluble stem cell factor receptor (sKIT). No significant association was noted between plasma levels of axitinib and response. However, post hoc analyses indicated potential relationships between efficacy endpoints and diastolic blood pressure of 90 mm Hg or higher as well as baseline serum lactate dehydrogenase levels. CONCLUSIONS Axitinib was well tolerated, showed a selective VEGFR-inhibitory profile, and showed single-agent activity in metastatic melanoma. Further evaluations of axitinib, alone and combined with chemotherapy, are ongoing.
Collapse
Affiliation(s)
- John Fruehauf
- University of California, Irvine, Orange, 92868, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Balagula Y, Garbe C, Myskowski PL, Hauschild A, Rapoport BL, Boers-Doets CB, Lacouture ME. Clinical presentation and management of dermatological toxicities of epidermal growth factor receptor inhibitors. Int J Dermatol 2011; 50:129-46. [PMID: 21244375 DOI: 10.1111/j.1365-4632.2010.04791.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The last decade in oncology has been highlighted by the emergence of novel, highly specific anti-cancer agents, targeting a variety of molecular structures and able to inhibit aberrantly activated oncogenic pathways. Epidermal growth factor receptor inhibitors (EGFRIs) represent one type of such "targeted" agents. Their use made treatment more tolerable and resulted in significant reduction of systemic adverse effects. However, EGFRIs are associated with toxicities affecting the skin and adnexal structures, and mucosal surfaces that affect the majority of treated patients. Significant dermatologic toxicities have changed the role and involvement of dermatologists in their care. It is essential to be familiar with these adverse effects, potential complications, long-term sequelae, and available effective treatment strategies in order to appropriately manage these patients. This review will describe the clinical presentation, histopathology, underlying mechanisms, and management options, emphasizing evidence-based approaches.
Collapse
|
12
|
Lemech C, Arkenau HT. Biomarkers in advanced colorectal cancer: challenges in translating clinical research into practice. Cancers (Basel) 2011; 3:1844-60. [PMID: 24212785 PMCID: PMC3757393 DOI: 10.3390/cancers3021844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 03/25/2011] [Indexed: 01/04/2023] Open
Abstract
The growing number of therapeutic agents and known molecular targets in oncology makes the study and clinical use of biomarkers imperative for improving response and survival, reducing toxicity and ensuring economic sustainability. Colorectal cancer, among others, is at the forefront of development of predictive and prognostic biomarkers; however, the difficulty lies in translating potential biomarkers garnered from retrospective analyses in small numbers of patients to generalizable and affordable biomarkers used worldwide. This review outlines the progress made in prognostic and predictive biomarkers in advanced colorectal cancer (ACRC) from the early use of carcinoembryonic antigen (CEA) to the KRAS mutation and beyond. Future challenges are to incorporate standardized and validated methods preferentially during early phases of drug development linked with sophisticated biostatistical support. New trial designs focusing on biomarkers will be essential not only for better understanding of mechanisms of action, but also to make confident 'go or no-go' decisions.
Collapse
Affiliation(s)
- Charlotte Lemech
- Sarah Cannon Research Institute, 93 Harley Street, W1G 6AD, London, UK; E-Mail: (C.L.)
| | | |
Collapse
|
13
|
Machiels JP, Subramanian S, Ruzsa A, Repassy G, Lifirenko I, Flygare A, Sørensen P, Nielsen T, Lisby S, Clement PMJ. Zalutumumab plus best supportive care versus best supportive care alone in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck after failure of platinum-based chemotherapy: an open-label, randomised phase 3 trial. Lancet Oncol 2011; 12:333-43. [DOI: 10.1016/s1470-2045(11)70034-1] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
14
|
Deschoolmeester V, Baay M, Specenier P, Lardon F, Vermorken JB. A review of the most promising biomarkers in colorectal cancer: one step closer to targeted therapy. Oncologist 2010; 15:699-731. [PMID: 20584808 PMCID: PMC3228001 DOI: 10.1634/theoncologist.2010-0025] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 05/01/2010] [Indexed: 02/06/2023] Open
Abstract
Rapidly growing insights into the molecular biology of colorectal cancer (CRC) and recent developments in gene sequencing and molecular diagnostics have led to high expectations for the identification of molecular markers to be used in optimized and tailored treatment regimens. However, many of the published data on molecular biomarkers are contradictory in their findings and the current reality is that no molecular marker, other than the KRAS gene in the case of epidermal growth factor receptor (EGFR)- targeted therapy for metastatic disease, has made it into clinical practice. Many markers investigated suffer from technical shortcomings, resulting from lack of quantitative techniques to capture the impact of the molecular alteration. This understanding has recently led to the more comprehensive approaches of global gene expression profiling or genome-wide analysis to determine prognostic and predictive signatures in tumors. In this review, an update of the most recent data on promising biological prognostic and/or predictive markers, including microsatellite instability, epidermal growth factor receptor, KRAS, BRAF, CpG island methylator phenotype, cytotoxic T lymphocytes, forkhead box P3-positive T cells, receptor for hyaluronic acid-mediated motility, phosphatase and tensin homolog, and T-cell originated protein kinase, in patients with CRC is provided.
Collapse
Affiliation(s)
- Vanessa Deschoolmeester
- Laboratory of Cancer Research and Clinical Oncology, Department of Medical Oncology, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | | | | | | | | |
Collapse
|
15
|
Markman B, Rodríguez-Freixinos V, Tabernero J. Biomarkers in colorectal cancer. Clin Transl Oncol 2010; 12:261-70. [DOI: 10.1007/s12094-010-0502-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
16
|
Abstract
IMPORTANCE OF THE FIELD The overexpression of EGFR has been documented in 30-90% of cases of advanced colorectal cancer (CRC). An increased understanding of the EGFR pathway in CRC has paved the way for the development of other targeted agents to augment therapeutic efficacy as well as for efforts to circumvent tumor resistance to therapy. AREAS COVERED IN THIS REVIEW Our aim is to discuss the recent progress in the role of the EGFR pathway, the status of anti-EGFR therapeutic agents currently in use and the rationale for the development of novel agents that work along the pathway for the treatment of CRC. WHAT THE READER WILL GAIN The readers will learn about the development and evolution of mAbs directed against EGFR as well as tyrosine kinase inhibitors in the management of CRC patients. In the same vein, determination of optimal dosing and better methods of defining those subsets of patients most likely to benefit will be discussed. TAKE HOME MESSAGE All these data must encourage clinicians and basic researches to continue in their efforts to untangle the network behind EGFR and try to focus all that effort towards improving patient's quality of life as well as survival.
Collapse
Affiliation(s)
- Muhammad W Saif
- Yale University School of Medicine, Section of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520, USA.
| |
Collapse
|
17
|
Lévi F, Karaboué A, Gorden L, Innominato PF, Saffroy R, Giacchetti S, Hauteville D, Guettier C, Adam R, Bouchahda M. Cetuximab and circadian chronomodulated chemotherapy as salvage treatment for metastatic colorectal cancer (mCRC): safety, efficacy and improved secondary surgical resectability. Cancer Chemother Pharmacol 2010; 67:339-48. [PMID: 20401611 DOI: 10.1007/s00280-010-1327-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Circadian rhythm disruption was linked to high serum levels of Transforming Growth Factor Receptor α, an Epidermal Growth Factor Receptor (EGFR) ligand and poor survival in patients with metastatic colorectal cancer (mCRC). We hypothesized that EGFR blockade with cetuximab would enhance the activity of chronotherapy as a result of improved circadian coordination. METHODS All the patients with mCRC referred to our unit for progression on prior chemotherapy over a 30-month-period received weekly cetuximab and fortnightly chronotherapy. RESULTS Fifty-six patients were treated with a median of six courses of fluoropyrimidine-based chemotherapy and irinotecan (61%), oxaliplatin (25%) or both (14%) after a median of three prior regimens. We found no EFGR amplification by FISH in the tumor of 27 consecutive patients. Acneiform rash and diarrhea were the most common toxicities. Objective response rate was 32.1% and positively correlated with rash grade (p = 0.025). None of the responders had K-Ras mutation in their tumor. Median progression-free and overall survival were 4.6 and 13.7 months, respectively. Complete macroscopic resections of metastases in liver, lung or other abdominopelvic sites were performed following tumor downstaging by the treatment regimen in 11 patients (21%), 8 of whom being alive at 3 years. These figures are twice as high as those reported for first-line combination of cetuximab with conventional chemotherapy or for third line chronotherapy. CONCLUSIONS The addition of cetuximab to chronotherapy allowed safe and effective therapeutic control of metastases, including their complete resection, despite previous failure of several treatment regimens.
Collapse
Affiliation(s)
- Francis Lévi
- INSERM, U776 Rythmes biologiques et cancers, Hôpital Paul Brousse, 14 avenue Paul-Vaillant-Couturier, 94807 Villejuif Cedex, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Erlotinib 150 mg daily plus chemotherapy in advanced pancreatic cancer: an interim safety analysis of a multicenter, randomized, cross-over phase III trial of the 'Arbeitsgemeinschaft Internistische Onkologie'. Anticancer Drugs 2010; 21:94-100. [PMID: 19770635 DOI: 10.1097/cad.0b013e32833123ed] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To date, only limited toxicity data are available for the combination of erlotinib with either capecitabine or gemcitabine as front-line therapy for advanced pancreatic cancer. Within a randomized phase III trial, 281 treatment-naive patients were randomly assigned between capecitabine (2000 mg/m/day, for 14 days, once every 3 weeks) plus erlotinib (150 mg/day, arm A) and gemcitabine (1000 mg/m as a 30-min infusion) plus erlotinib (150 mg/day, arm B). In case of treatment failure, patients were crossed over to a second-line treatment with the comparator cytostatic drug without erlotinib. The primary study endpoint was the time to treatment failure of second-line therapy (TTF2). This interim analysis of toxicity contains safety data from the first 127 randomized patients. During first-line therapy, patients received a median number of three treatment cycles (range 0-13) in both the arms. Regarding chemotherapy, a treatment delay was observed in 12% of the cycles in arm A and in 22% of the cycles in arm B. Dose reductions of the cytostatic drug were performed in 18 and 27% of treatment cycles, respectively. Erlotinib dose reductions were performed in 6 and 11% of all cycles. Grade 3/4 hematological toxicity was <10% in both the arms; major grade 3/4 toxicities in arms A and B were diarrhea (9 vs. 7%), skin rash (4 vs. 12%), and hand-foot syndrome (7 vs. 0%). No treatment-related death was observed. In conclusion, this interim safety analysis suggests that treatment with erlotinib 150 mg/day is feasible in combination with capecitabine or gemcitabine.
Collapse
|
19
|
Markman B, Javier Ramos F, Capdevila J, Tabernero J. EGFR and KRAS in Colorectal Cancer. Adv Clin Chem 2010; 51:71-119. [DOI: 10.1016/s0065-2423(10)51004-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
20
|
García-Sáenz JA, Sastre J, Díaz-Rubio García E. Biomarkers and anti-EGFR therapies for KRAS wild-type metastatic colorectal cancer. Clin Transl Oncol 2009. [DOI: 10.1007/s12094-009-0436-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
21
|
Siena S, Sartore-Bianchi A, Di Nicolantonio F, Balfour J, Bardelli A. Biomarkers predicting clinical outcome of epidermal growth factor receptor-targeted therapy in metastatic colorectal cancer. J Natl Cancer Inst 2009; 101:1308-24. [PMID: 19738166 PMCID: PMC2758310 DOI: 10.1093/jnci/djp280] [Citation(s) in RCA: 417] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 07/17/2009] [Accepted: 07/24/2009] [Indexed: 12/13/2022] Open
Abstract
The monoclonal antibodies panitumumab and cetuximab that target the epidermal growth factor receptor (EGFR) have expanded the range of treatment options for metastatic colorectal cancer. Initial evaluation of these agents as monotherapy in patients with EGFR-expressing chemotherapy-refractory tumors yielded response rates of approximately 10%. The realization that detection of positive EGFR expression by immunostaining does not reliably predict clinical outcome of EGFR-targeted treatment has led to an intense search for alternative predictive biomarkers. Oncogenic activation of signaling pathways downstream of the EGFR, such as mutation of KRAS, BRAF, or PIK3CA oncogenes, or inactivation of the PTEN tumor suppressor gene is central to the progression of colorectal cancer. Tumor KRAS mutations, which may be present in 35%-45% of patients with colorectal cancer, have emerged as an important predictive marker of resistance to panitumumab or cetuximab treatment. In addition, among colorectal tumors carrying wild-type KRAS, mutation of BRAF or PIK3CA or loss of PTEN expression may be associated with resistance to EGFR-targeted monoclonal antibody treatment, although these additional biomarkers require further validation before incorporation into clinical practice. Additional knowledge of the molecular basis for sensitivity or resistance to EGFR-targeted monoclonal antibodies will allow the development of new treatment algorithms to identify patients who are most likely to respond to treatment and could also provide rationale for combining therapies to overcome primary resistance. The use of KRAS mutations as a selection biomarker for anti-EGFR monoclonal antibody (eg, panitumumab or cetuximab) treatment is the first major step toward individualized treatment for patients with metastatic colorectal cancer.
Collapse
Affiliation(s)
- Salvatore Siena
- The Falck Division of Medical Oncology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | | | | | | | | |
Collapse
|
22
|
Abstract
Despite recent advances in treatment options, advanced colorectal cancer (ACC) remains a leading cause of cancer death worldwide, and new therapies are needed to improve the grim prognosis of this disease. Drug development in ACC faces the challenges of a constrained pipeline, a paucity of patients enrolled in clinical trials, and an outdated "one drug fits all" model of clinical research. This article discusses potential innovations in clinical trial design--including enrichment strategies, novel patient populations, and the use of randomization in the phase 2 setting--to optimize the testing of new therapies. It concludes with a selection of promising agents and pathways under investigation in ACC.
Collapse
|
23
|
Kim ES, Mauer AM, William WN, Tran HT, Liu D, Lee JJ, Windt P, Hong WK, Vokes EE, Herbst RS. A phase 2 study of cetuximab in combination with docetaxel in chemotherapy-refractory/resistant patients with advanced nonsmall cell lung cancer. Cancer 2009; 115:1713-22. [PMID: 19208430 DOI: 10.1002/cncr.24148] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cetuximab in combination with docetaxel was examined in chemotherapy-refractory/resistant patients with advanced nonsmall-cell lung cancer (NSCLC) to determine response rate, survival, safety, and pharmacokinetics (PK). METHODS Patients had evidence of epidermal growth factor receptor (EGFR) expression (> or =1 +) and tumor progression during or disease recurrence within 3 months after chemotherapy. Cetuximab was administered weekly (400 mg/m(2) initial; 250 mg/m(2) thereafter). Docetaxel was administered every 3 weeks (75 mg/m(2)). A response in 3 of the first 21 patients was required to continue accrual to the target sample size of 50 patients. RESULTS Confirmed responses included 1 complete response (1.8%), 10 partial responses (18.2%), and 20 with stable disease (36.4%). The response rate was 20% (95% confidence interval [CI], 10.4% to 33.0%) and median time to disease progression was 104 days. There were no differences in PK parameters of docetaxel alone or with cetuximab. The most common grade 3 of 4 adverse events were leukopenia (27.3%) and acne (21.8%). Four patients (7.3%) discontinued due to allergic reaction. The median overall survival (OS) was 7.5 months with a 1-year survival of 35%. CONCLUSIONS Cetuximab in combination with docetaxel was well tolerated. The response rate supports more definitive evaluation of this combination in the second-line setting.
Collapse
Affiliation(s)
- Edward S Kim
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Treatment of advanced colorectal cancer (CRC) increasingly requires a multidisciplinary approach and multiple treatment options add to the complexity of clinical decision-making. Recently novel targeted therapy against angiogenesis and epidermal growth factor receptor completed a plethora of phase III studies. The addition of bevacizumab to chemotherapy improved the efficacy over chemotherapy alone in both first and second line settings, although the magnitude of benefit may not be as great when a more optimal chemotherapy platform is used. Studies performed thus far did not address conclusively whether bevacizumab should be continued in subsequent lines of treatment. Anti-angiogenesis tyrosine kinase inhibitors have not shown any additional benefit over chemotherapy alone so far. Although some benefits were seen with cetuximab in all settings of treating advanced CRC, K-ras mutation status provides an important determinant of who would not benefit from such a treatment. Caution should be exercised in combining anti-angiogenesis with anti-EGFR strategy until further randomised data become available. In this review, we have focused on the implications of these trial results on the everyday management decisions of treating advanced CRC.
Collapse
|
25
|
Capdevila J, Elez E, Macarulla T, Ramos FJ, Ruiz-Echarri M, Tabernero J. Anti-epidermal growth factor receptor monoclonal antibodies in cancer treatment. Cancer Treat Rev 2009; 35:354-63. [PMID: 19269105 DOI: 10.1016/j.ctrv.2009.02.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 01/31/2009] [Accepted: 02/04/2009] [Indexed: 12/30/2022]
Abstract
Although the prognosis of cancer remains poor recent advances in the diagnostic methods, new approaches in surgical procedures and the development of new therapeutic agents have had a significant impact in the outcome of cancer patients. A better understanding of the molecular pathways that characterize cell growth, apoptosis, angiogenesis and invasion has provided novel targets in cancer therapy. The epidermal growth factor receptor (EGFR) mediated signal transduction has been one of the most studied pathways in carcinogenesis. The phosphorylation of EGFR activates multiple biological processes including apoptosis, differentiation, cellular proliferation, motility, invasion, adhesion, DNA repair and survival. Several therapies have been developed to inactivate the EGFR pathway including monoclonal antibodies against the extracellular domain of EGFR. In this review, the authors examine the development of monoclonal antibodies against EGFR and the effects of this blockage in cell cycle, as well as the most important trials with these monoclonal antibodies in several tumor types.
Collapse
Affiliation(s)
- Jaume Capdevila
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
26
|
Javle M, Hsueh CT. Updates in Gastrointestinal Oncology - insights from the 2008 44th annual meeting of the American Society of Clinical Oncology. J Hematol Oncol 2009; 2:9. [PMID: 19236713 PMCID: PMC2654905 DOI: 10.1186/1756-8722-2-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 02/23/2009] [Indexed: 01/08/2023] Open
Abstract
We have reviewed the pivotal presentations rcelated to colorectal cancer (CRC) and other gastrointestinal malignancies from 2008 annual meeting of the American Society of Clinical Oncology (ASCO). We have discussed the scientific findings and the impact on practice guidelines and ongoing clinical trials. The report on KRAS status in patients with metastatic CRC receiving epidermal growth factor receptor (EGFR) targeted antibody treatment has led to a change in National Comprehensive Cancer Network guideline that recommends only patients with wild-type KRAS tumor should receive this treatment. The results of double biologics (bevacizumab and anti-EGFR antibody) plus chemotherapy as first-line treatment in patients with metastatic CRC has shown a worse outcome than bevacizumab-based regimen. Microsatellite Instability has again been confirmed to be an important predictor in patients with stage II colon cancer receiving adjuvant treatment. Adjuvant gemcitabine therapy for pancreatic cancer was investigated by the CONKO-001 study; this resulted in superior survival as compared with observation and can be regarded as an acceptable option, without the addition of radiotherapy. The addition of bevacizumab to gemcitabine and erlotinib was not supior to gemcitabine and erlotinib for advanced disease. Second-line therapy for advanced pancreatic cancer with 5-fluorouracil and oxaliplatin resulted in a survival benefit. Irinotecan plus cisplatin and paclitaxel plus cisplatin result in similar survival when combined with radiotherapy for esophageal cancer. The novel fluoropyrimidine S1 appears to be active in gastric cancer, as a single agent or as combination therapy. Adjuvant intraperitoneal mitomycin-C may decrease the incidence of peritoneal recurrence of gastric cancer. Sorafenib is an effective agent in Asian patients with hepatocellular carcinoma secondary to hepatitis B; its utility in child's B cirrhosis remains to be proven. Sunitinib is also an active agent in hepatocellular carcinoma, and may represent an alterative to sorafenib for advanced disease. These and other important presentations from the 2008 ASCO annual meeting are discussed in this article.
Collapse
Affiliation(s)
- Milind Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chung-Tsen Hsueh
- Division of Medical Oncology and Hematology, Loma Linda University, Loma Linda, CA 92354, USA
| |
Collapse
|
27
|
Patel DK. Clinical use of anti-epidermal growth factor receptor monoclonal antibodies in metastatic colorectal cancer. Pharmacotherapy 2009; 28:31S-41S. [PMID: 18980550 DOI: 10.1592/phco.28.11-supp.31s] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract Cetuximab and panitumumab, monoclonal antibodies used to target the epidermal growth factor receptor (EGFR), were recently approved by the United States Food and Drug Administration for use as single agents or in combination with other chemotherapy drugs in the treatment of metastatic colorectal cancer. The anti-EGFR monoclonal antibodies, either as single agents or in combination with chemotherapy, have demonstrated clinical activity in this setting. When combined with standard cytotoxic chemotherapy or other targeted agents (e.g., bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody), anti-EGFR monoclonal antibodies have been well tolerated and produced minimal toxicities. However, cetuximab and panitumumab appear to benefit only select patients. Predictive markers of efficacy, including EGFR overexpression, development of skin rash, and the absence of a K-ras mutation, have been evaluated in clinical studies to identify patients likely to respond to anti-EGFR monoclonal antibody therapy. This review discusses recent clinical studies of anti-EGFR monoclonal antibodies in the treatment of metastatic colorectal cancer, predictive markers of their efficacy, and common toxicities associated with their use.
Collapse
Affiliation(s)
- Dina K Patel
- Division of Pharmacy, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-40009, USA.
| |
Collapse
|
28
|
AZAD A, TEBBUTT NC. Predicting the response to targeted therapy in metastatic colorectal cancer. Asia Pac J Clin Oncol 2008. [DOI: 10.1111/j.1743-7563.2008.00215.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
Kim GP. Predictive Markers in Colorectal Cancer. SEMINARS IN COLON AND RECTAL SURGERY 2008. [DOI: 10.1053/j.scrs.2008.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Wong R, Cunningham D. Using predictive biomarkers to select patients with advanced colorectal cancer for treatment with epidermal growth factor receptor antibodies. J Clin Oncol 2008; 26:5668-70. [PMID: 19001346 DOI: 10.1200/jco.2008.19.5024] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
31
|
Personeni N, Fieuws S, Piessevaux H, De Hertogh G, De Schutter J, Biesmans B, De Roock W, Capoen A, Debiec-Rychter M, Van Laethem JL, Peeters M, Humblet Y, Van Cutsem E, Tejpar S. Clinical usefulness of EGFR gene copy number as a predictive marker in colorectal cancer patients treated with cetuximab: a fluorescent in situ hybridization study. Clin Cancer Res 2008; 14:5869-76. [PMID: 18794099 DOI: 10.1158/1078-0432.ccr-08-0449] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the usefulness and the pitfalls inherent to the assessment of the epidermal growth factor receptor (EGFR) gene copy number (GCN) by fluorescence in situ hybridization (FISH) for outcome prediction to cetuximab in metastatic colorectal cancer. The value of testing KRAS mutation status, in addition to EGFR GCN, was also explored. EXPERIMENTAL DESIGN FISH analysis of 87 metastatic colorectal cancer patients treated with cetuximab was done, recording individual GCN per cell and using different samples per tumor. Performances of published cutoff points and different summaries of EGFR GCN distribution were assessed for response prediction. RESULTS In our data set, two published cutoff points performed less well than in their training set, yielding positive predictive values and negative predictive values between 40.0% and 48.3% and between 81.0% and 86.5%, respectively. Among summaries of GCN distribution explored, mean and right-tailed distribution of GCN yielded the highest performances. A mean EGFR GCN > or = 2.83 provided an area under the curve of 0.71. Important heterogeneity of repeated measures of mean EGFR GCN was observed within tumors (intraclass correlation, 0.61; within-class SD, 0.40), leading to potential misclassifications of FISH status in 7 of 18 (38.8%) patients if a cutoff point were used. In multivariable analysis, EGFR GCN testing provided significant information independent of the KRAS status to predict response (P = 0.016) and overall survival (P = 0.005). CONCLUSIONS We confirm the association between increased EGFR GCN and outcome after cetuximab. However, because of reproducibility concerns, any decision making based on published cutoff points is not warranted.
Collapse
Affiliation(s)
- Nicola Personeni
- Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Saif MW. Erlotinib: the first biologic in the management of pancreatic cancer. Expert Opin Pharmacother 2008; 9:1595-607. [PMID: 18518788 DOI: 10.1517/14656566.9.9.1595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pancreatic cancer remains a major therapeutic challenge largely characterized by chemotherapy-refractory disease and poor responses to currently available treatments. Pivotal studies of combination chemotherapeutic agents with gemcitabine showed that responses may exceed single-agent gemcitabine, but with added toxicities. The EGFR is known to be overexpressed in pancreatic cancer and data suggest that the presence of EGFR is associated with a poor prognosis. OBJECTIVE To analyze the current data on erlotinib and compare against other agents targeting against the EGFR pathway in pancreatic cancer. METHODS PubMed, Ovid, Cochran and the American Society of Clinical Oncology abstract database were searched using the terms 'erlotinib', 'EGFR', 'cetuximab', 'gemcitabine', 'fluorouracil', 'capecitabine' and 'pancreatic cancer' to identify relevant studies. Only studies using erlotinib in pancreatic cancer patients were reviewed and analyzed. CONCLUSIONS The combination of gemcitabine and erlotinib is the first combination therapy to demonstrate survival benefits in pancreatic cancer in a Phase III study albeit a modest one. Increased understanding of the EGFR pathway may permit the use of other targeted agents to either augment therapeutic efficacy or circumvent resistance. It is warranted to develop strategies to truly target our therapy with the EGFR agents by identifying those patients who are most likely to derive benefit and achieve meaningful responses.
Collapse
Affiliation(s)
- M Wasif Saif
- Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
33
|
Zuckerman DS, Clark JW. Systemic therapy for metastatic colorectal cancer: current questions. Cancer 2008; 112:1879-91. [PMID: 18338815 DOI: 10.1002/cncr.23409] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A proliferation of new cytotoxic and biologic agents has led to improved survival in patients with metastatic colorectal cancer (mCRC). The ability of surgery to increase long-term survival in patients with liver and/or lung metastases also has been firmly established. It has become increasingly difficult as the numbers and types of treatment options have expanded to identify optimal drug combinations, sequences, and duration and the best way to integrate systemic chemotherapy with potentially curative surgery for metastatic lesions. For this review, the authors examined how recent clinical trials have addressed some pertinent questions regarding the use of systemic chemotherapy and biologic agents in patients with mCRC.
Collapse
Affiliation(s)
- Dan S Zuckerman
- Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | | |
Collapse
|
34
|
Arnold D, Höhler T, Dittrich C, Lordick F, Seufferlein T, Riemann J, Wöll E, Herrmann T, Zubel A, Schmoll HJ. Cetuximab in combination with weekly 5-fluorouracil/folinic acid and oxaliplatin (FUFOX) in untreated patients with advanced colorectal cancer: a phase Ib/II study of the AIO GI Group. Ann Oncol 2008; 19:1442-1449. [PMID: 18441330 DOI: 10.1093/annonc/mdn150] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This two-part phase Ib/II study investigated the feasibility of administering cetuximab in combination with oxaliplatin and infusional 5-fluorouracil (5-FU)/folinic acid (FA) in a weekly schedule (AIO FUFOX protocol) as first-line treatment in patients with epidermal growth factor receptor-detectable advanced colorectal cancer. PATIENTS AND METHODS Cetuximab was administered weekly: 400 mg/m(2) initial dose, then 250 mg/m(2) and FUFOX: oxaliplatin 50 mg/m(2), FA 500 mg/m(2) and 5-FU as a 24-h infusion at either 1500 or 2000 mg/m(2) administered for 4 weeks followed by a 1-week rest (one cycle). RESULTS Dose-limiting toxicity (grade 3 diarrhea) occurred in 3 of 14 assessable patients receiving 5-FU at standard 2000 mg/m(2). This dose was administered to a further 25 patients. Cetuximab combined with FUFOX was generally well tolerated with the most common grade 3/4 adverse events being diarrhea (27%) and paresthesia (16%). The confirmed response rate for patients receiving 5-FU at standard 2000 mg/m(2) (N = 41) was 56%, with a median duration of 9.3 months. Median progression-free and overall survival times including all 49 patients were 8.1 (95% confidence interval 6.0-9.7) and 28.2 months, respectively. Cetuximab pharmacokinetics seemed not to be different for combination with FUFOX compared with cetuximab/irinotecan combinations. CONCLUSION This protocol is well tolerated and shows promising efficacy supporting further investigation.
Collapse
Affiliation(s)
- D Arnold
- Department of Oncology and Hematology, Martin-Luther-University Halle-Wittenberg, Halle
| | - T Höhler
- Johannes-Gutenberg University Hospital, Mainz, Germany
| | - C Dittrich
- ACR-ITR VIEnna and LBI-ACR VIEnna, Kaiser Franz Josef-Spital, Vienna, Austria
| | - F Lordick
- Klinikum rechts der Isar, Technische Universitaet, Muenchen
| | | | - J Riemann
- Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - E Wöll
- University Hospital Innsbruck, Innsbruck, Austria
| | - T Herrmann
- Department of Internal Medicine IV and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg
| | - A Zubel
- Clinical Research and Development, Merck KGaA, Darmstadt, Germany
| | - H-J Schmoll
- Department of Oncology and Hematology, Martin-Luther-University Halle-Wittenberg, Halle.
| |
Collapse
|
35
|
Mahtani RL, Macdonald JS. Synergy between cetuximab and chemotherapy in tumors of the gastrointestinal tract. Oncologist 2008; 13:39-50. [PMID: 18245011 DOI: 10.1634/theoncologist.2006-0049] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cetuximab is a recently approved monoclonal antibody that targets the epidermal growth factor receptor, a receptor tyrosine kinase involved in the development and progression of colorectal cancer (CRC) and other solid tumors. Cetuximab, as a single agent or in combination with chemotherapy, has demonstrated significant clinical efficacy against CRC. Combinations of cetuximab with chemotherapy have proven to be well tolerated, with minimal overlap of toxicities between agents; and the anticancer synergy between cetuximab and traditional chemotherapy agents has made cetuximab a vital treatment for patients who are no longer responsive to chemotherapy alone. The U.S. Food and Drug Administration approved cetuximab in combination with irinotecan for the treatment of irinotecan-refractory metastatic CRC or as monotherapy for treating patients intolerant to irinotecan. Combination chemotherapies involving cetuximab as well as combinations involving cetuximab and other targeted agents, such as bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody, constitute powerful new treatment options for the management of CRC. This review discusses recent clinical studies that have further defined this synergy, focusing primarily on tumors of the gastrointestinal tract.
Collapse
Affiliation(s)
- Reshma L Mahtani
- St. Voncent's Comprehensive Cancer Cernter, New York, New York , USA.
| | | |
Collapse
|
36
|
Manegold PC, Lurje G, Pohl A, Ning Y, Zhang W, Lenz HJ. Can we predict the response to epidermal growth factor receptor targeted therapy? Target Oncol 2008. [DOI: 10.1007/s11523-008-0077-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
37
|
Graziano F, Ruzzo A, Loupakis F, Canestrari E, Santini D, Catalano V, Bisonni R, Torresi U, Floriani I, Schiavon G, Andreoni F, Maltese P, Rulli E, Humar B, Falcone A, Giustini L, Tonini G, Fontana A, Masi G, Magnani M. Pharmacogenetic profiling for cetuximab plus irinotecan therapy in patients with refractory advanced colorectal cancer. J Clin Oncol 2008; 26:1427-34. [PMID: 18349392 DOI: 10.1200/jco.2007.12.4602] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Regulation of epidermal growth factor receptor (EGFR) signaling pathways may play a relevant role in determining the activity of cetuximab therapy in patients with metastatic colorectal cancer (MCRC). We investigated possible associations between genetic variants and clinical outcomes of MCRC patients treated with cetuximab-irinotecan salvage therapy. PATIENTS AND METHODS Patients who underwent cetuximab-irinotecan salvage therapy after disease progression during or after first-line bolus/infusional fluorouracil, leucovorin, and oxaliplatin chemotherapy and a second-line irinotecan-based regimen were considered eligible for analysis of polymorphisms with putative influence on cetuximab-related pathways. Epidermal growth factor (EGF) 61A>G, EGF receptor (EGFR) 216G>T, EGFR 497G>A, EGFR intron-1 (CA)(n) dinucleotide short (S)/long (L) variant, cyclin-D1 870A>G, immunoglobulin-G fragment-C receptors RIIIa 158G>T, and RIIa 131G>A were studied for a possible association with overall survival (OS) as the primary end point. Additional analyses were addressed at possible associations among polymorphisms and EGFR expression, toxicity, and response. RESULTS In 110 assessable patients, significant association with favorable OS was observed for EGFR intron-1 S/S and EGF 61 G/G genotypes. In the multivariate model, EGFR intron-1 S/S and EGF 61 G/G genotypes showed a hazard ratio of 0.41 (95% CI, 0.21 to 0.78; P = .006) and 0.44 (95% CI, 0.23 to 0.84; P = .01), respectively. EGFR intron-1 S/S carriers showed more frequent G2-G3 skin toxicity (chi(2) test = 12.7; P = .001) and treatment response (chi(2) test = 9.45; P = .008) than EGFR intron-1 L/L carriers. CONCLUSION Although additional studies are required for confirmation, our findings could optimize the use of cetuximab in MCRC patients.
Collapse
|
38
|
Wong R, Cunningham D. What is the impact of biologicals in colorectal cancer? Target Oncol 2008. [DOI: 10.1007/s11523-008-0074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
|
40
|
Abstract
Colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer-related death in the USA. Prognosis is best when the disease is detected early; however, nearly two-thirds of newly diagnosed cases of CRC have lymph node involvement or metastatic disease. For years, 5-fluorouracil (FU)-based regimens represented the only viable treatment option for patients with metastatic CRC. However, in recent years several newer agents have been added to the treatment arsenal for this disease. These agents include oxaliplatin, irinotecan and newer monoclonal antibodies targeting the epidermal growth factor receptor (cetuximab and panitumumab) and VEGF (bevacizumab). This review aims to discuss current systemic and targeted therapies for metastatic colon cancer with a focus on mechanism of action, indications, toxicity and efficacy.
Collapse
Affiliation(s)
- Sanjay R Hegde
- University of Pennsylvania School of Medicine, Division of Gastroenterology, 650 Clinical Research Building, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | | | | |
Collapse
|
41
|
Lièvre A, Bachet JB, Boige V, Cayre A, Le Corre D, Buc E, Ychou M, Bouché O, Landi B, Louvet C, André T, Bibeau F, Diebold MD, Rougier P, Ducreux M, Tomasic G, Emile JF, Penault-Llorca F, Laurent-Puig P. KRASMutations As an Independent Prognostic Factor in Patients With Advanced Colorectal Cancer Treated With Cetuximab. J Clin Oncol 2008; 26:374-9. [PMID: 18202412 DOI: 10.1200/jco.2007.12.5906] [Citation(s) in RCA: 1109] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeCetuximab is efficient in advanced colorectal cancer (CRC). We previously showed that KRAS mutations were associated with resistance to cetuximab in 30 CRC patients. The aim of this study was to validate, in an independent larger series of 89 patients, the prognostic value of KRAS mutations on response to cetuximab and survival.Patients and MethodsEighty-nine metastatic CRC patients treated with cetuximab after treatment failure with irinotecan-based chemotherapy were analyzed for KRAS mutation by allelic discrimination on tumor DNA. The association between KRAS mutations and tumor response, skin toxicity, progression-free survival (PFS) and overall survival (OS) was analyzed.ResultsA KRAS mutation was present in 27% of the patients and was associated with resistance to cetuximab (0% v 40% of responders among the 24 mutated and 65 nonmutated patients, respectively; P < .001) and a poorer survival (median PFS: 10.1 v 31.4 weeks in patients without mutation; P = .0001; median OS: 10.1 v 14.3 months in patients without mutation; P = .026). When we pooled these 89 patients with patients from our previous study, the multivariate analysis showed that KRAS status was an independent prognostic factor associated with OS and PFS, whereas skin toxicity was only associated with OS. In a combined analysis, median OS times of patients with two, one, or no favorable prognostic factors (severe skin toxicity and no KRAS mutation) was of 15.6, 10.7, and 5.6 months, respectively.ConclusionThese results confirm the high prognostic value of KRAS mutations on response to cetuximab and survival in metastatic CRC patients treated with cetuximab.
Collapse
Affiliation(s)
- Astrid Lièvre
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Jean-Baptiste Bachet
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Valérie Boige
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Anne Cayre
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Delphine Le Corre
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Emmanuel Buc
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Marc Ychou
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Olivier Bouché
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Bruno Landi
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Christophe Louvet
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Thierry André
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Fréderic Bibeau
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Marie-Danièle Diebold
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Philippe Rougier
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Michel Ducreux
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Gorana Tomasic
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Jean-François Emile
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Frédérique Penault-Llorca
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| | - Pierre Laurent-Puig
- From the L'Institut National de la Santé et de la Recherche Médicale; Université Paris-Descartes; Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges Pompidou; Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique–Hôpitaux de Paris, Hôpital Tenon, Paris; Assistance Publique–Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt; Université de Versailles Saint-Quentin-en-Yvelines, Versailles; Institut Gustave Roussy, Villejuif; Centre Jean Perrin; Université
| |
Collapse
|