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Khan K, Ang JE, Starling N, Sclafani F, Shah K, Judson I, Molife LR, Banerji U, de Bono JS, Cunningham D, Kaye SB. Phase I trials in patients with relapsed, advanced upper gastrointestinal carcinomas: experience in a specialist unit. Gastric Cancer 2014; 17:621-629. [PMID: 24445485 PMCID: PMC4881817 DOI: 10.1007/s10120-013-0328-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conventional therapeutic options for patients with advanced upper gastrointestinal cancers (UGIC) are limited. Following first-line treatments, some patients are offered experimental therapies, including participation in Phase I trials. This study aims to describe the experience of UGIC patients treated in a dedicated Phase I unit. METHODS Patient, tumour and treatment characteristics, and clinical outcomes of UGIC patients treated consecutively at the Drug Development Unit, Royal Marsden Hospital, between 2005 and 2009, were recorded. RESULTS Ninety-six patients who previously received a median of 2 (range 1-4) lines of chemotherapies were treated in 30 Phase I trials. Of 81 evaluable patients, 9 achieved RECIST-objective response (11 %) with a 6-month clinical benefit rate of 14 %. Median progression free and overall survival were 7.7 weeks [95 %CI 7.7 (6.4-9.0)] and 19.1 weeks (95 %CI 17.5-20.8), respectively. Grade 3 or 4 toxicities were observed in 37 patients (39 %) and led to trial discontinuation in 9 (9 %); no toxicity-related death was recorded. In the multivariate analysis, serum albumin (<35 g/dl, HR2.0, p = 0.002) and lactate dehydrogenase (>192 μmol/l, HR1.7, p = 0.016) were prognostic of overall survival. CONCLUSION Phase I clinical trials can be considered a reasonable option in selected patients with relapsed UGIC. The use of objective prognosticators may improve selection and risk/benefit profile of patients.
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Affiliation(s)
- Khurum Khan
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - Joo Ern Ang
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sutton SM2 5NG, UK
- Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - Naureen Starling
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - Francesco Sclafani
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - Krunal Shah
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - Ian Judson
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - L Rhoda Molife
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
- Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - Udai Banerji
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sutton SM2 5NG, UK
- Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - Johann S de Bono
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sutton SM2 5NG, UK
- Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - David Cunningham
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - Stan B Kaye
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
- Division of Cancer Therapeutics, The Institute of Cancer Research, Sutton SM2 5NG, UK
- Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
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Levy A, Hollebecque A, Ferté C, Koscielny S, Fernandez M, Soria JC, Massard C. Tumor Assessment Criteria in Phase I Trials: Beyond RECIST. J Clin Oncol 2013; 31:395. [DOI: 10.1200/jco.2012.46.2184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Antonin Levy
- Service des Innovations Therapeutiques Precoces, Institut Gustave Roussy, Paris XI University, Villejuif, France
| | - Antoine Hollebecque
- Service des Innovations Therapeutiques Precoces, Institut Gustave Roussy, Paris XI University, Villejuif, France
| | - Charles Ferté
- Service des Innovations Therapeutiques Precoces, Institut Gustave Roussy, Paris XI University, Villejuif, France
| | | | - Mariana Fernandez
- Service des Innovations Therapeutiques Precoces, Institut Gustave Roussy, Paris XI University, Villejuif, France
| | - Jean-Charles Soria
- Service des Innovations Therapeutiques Precoces, Institut Gustave Roussy, Paris XI University, Villejuif, France
| | - Christophe Massard
- Service des Innovations Therapeutiques Precoces, Institut Gustave Roussy, Paris XI University, Villejuif, France
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Olmos D, A'hern RP, Marsoni S, Morales R, Gomez-Roca C, Verweij J, Voest EE, Schöffski P, Ang JE, Penel N, Schellens JH, Del Conte G, Brunetto AT, Evans TRJ, Wilson R, Gallerani E, Plummer R, Tabernero J, Soria JC, Kaye SB. Patient selection for oncology phase I trials: a multi-institutional study of prognostic factors. J Clin Oncol 2012; 30:996-1004. [PMID: 22355064 DOI: 10.1200/jco.2010.34.5074] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The appropriate selection of patients for early clinical trials presents a major challenge. Previous analyses focusing on this problem were limited by small size and by interpractice heterogeneity. This study aims to define prognostic factors to guide risk-benefit assessments by using a large patient database from multiple phase I trials. PATIENTS AND METHODS Data were collected from 2,182 eligible patients treated in phase I trials between 2005 and 2007 in 14 European institutions. We derived and validated independent prognostic factors for 90-day mortality by using multivariate logistic regression analysis. RESULTS The 90-day mortality was 16.5% with a drug-related death rate of 0.4%. Trial discontinuation within 3 weeks occurred in 14% of patients primarily because of disease progression. Eight different prognostic variables for 90-day mortality were validated: performance status (PS), albumin, lactate dehydrogenase, alkaline phosphatase, number of metastatic sites, clinical tumor growth rate, lymphocytes, and WBC. Two different models of prognostic scores for 90-day mortality were generated by using these factors, including or excluding PS; both achieved specificities of more than 85% and sensitivities of approximately 50% when using a score cutoff of 5 or higher. These models were not superior to the previously published Royal Marsden Hospital score in their ability to predict 90-day mortality. CONCLUSION Patient selection using any of these prognostic scores will reduce non-drug-related 90-day mortality among patients enrolled in phase I trials by 50%. However, this can be achieved only by an overall reduction in recruitment to phase I studies of 20%, more than half of whom would in fact have survived beyond 90 days.
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Affiliation(s)
- David Olmos
- The Royal Marsden National Health Service Foundation Trust, Sutton, United Kingdom
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