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Basso M, Dadduzio V, Rossi S, D'Argento E, Strippoli A, Di Salvatore M, Orlandi A, Zurlo V, Di Noia V, Barone C. The interference between oxaliplatin & anti-EGFR therapies: a different hypothesis to explain the 'unexplainable'. Per Med 2018; 15:319-327. [PMID: 29927360 DOI: 10.2217/pme-2017-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper has been written because we have a differing idea concerning the suspected negative interference between oxaliplatin and anti-EGFR therapies in cancer patients. Several multicenter, randomized, controlled clinical trials investigated whether the efficacy of oxaliplatin-based chemotherapy is improved by the addition of anti-EGFR therapies in patients affected by KRAS wild-type advanced colorectal cancer. Results of these trials have produced puzzling findings, with some studies demonstrating improved survival and other studies showing no differences in overall survival between experimental and control arms. Moreover, a detrimental effect has been demonstrated in some settings. Nevertheless, the extent of this interaction remains uncertain. Some physicians proposed personal interpretations. This paper describes our hypothesis.
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Affiliation(s)
- Michele Basso
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Dadduzio
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.,Unit of Oncology 1, Department of Clinical & Experimental Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Sabrina Rossi
- Department of Medical Oncology, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | - Ettore D'Argento
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonia Strippoli
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariantonietta Di Salvatore
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Armando Orlandi
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Zurlo
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Di Noia
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Barone
- Department of Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Poston G, Adam R, Xu J, Byrne B, Esser R, Malik H, Wasan H, Xu J. The role of cetuximab in converting initially unresectable colorectal cancer liver metastases for resection. Eur J Surg Oncol 2017; 43:2001-2011. [DOI: 10.1016/j.ejso.2017.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 12/15/2022] Open
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Pugh SA, Bowers M, Ball A, Falk S, Finch-Jones M, Valle JW, O'Reilly DA, Siriwardena AK, Hornbuckle J, Rees M, Rees C, Iveson T, Hickish T, Maishman T, Stanton L, Dixon E, Corkhill A, Radford M, Garden OJ, Cunningham D, Maughan TS, Bridgewater JA, Primrose JN. Patterns of progression, treatment of progressive disease and post-progression survival in the New EPOC study. Br J Cancer 2016; 115:420-4. [PMID: 27434036 PMCID: PMC4985352 DOI: 10.1038/bjc.2016.208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/02/2016] [Accepted: 06/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The addition of cetuximab (CTX) to perioperative chemotherapy (CT) for operable colorectal liver metastases resulted in a shorter progression-free survival. Details of disease progression are described to further inform the primary study outcome. METHODS A total of 257 KRAS wild-type patients were randomised to CT alone or CT with CTX. Data regarding sites and treatment of progressive disease were obtained for the 109 (CT n=48, CT and CTX n=61) patients with progressive disease at the cut-off date for analysis of November 2012. RESULTS The liver was the most frequent site of progression (CT 67% (32/48); CT and CTX 66% (40/61)). A higher proportion of patients in the CT and group had multiple sites of progressive disease (CT 8%, 4/48; CT and CTX 23%, 14/61 P=0.04). Further treatment for progressive disease is known for 84 patients of whom 69 received further CT, most frequently irinotecan based. Twenty-two patients, 11 in each arm, received CTX as a further line agent. CONCLUSIONS Both the distribution of progressive disease and further treatment are as expected for such a cohort. The pattern of disease progression seen is consistent with failure of systemic micrometastatic disease control rather than failure of local disease control following liver surgery.
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Affiliation(s)
- Siân A Pugh
- University Surgery and Cancer Sciences Division, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Megan Bowers
- Southampton Clinical Trials Unit, Southampton, UK
| | | | - Stephen Falk
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Meg Finch-Jones
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Department of Upper Gastrointestinal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Juan W Valle
- University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - Derek A O'Reilly
- Department of Hepatopancreatobiliary Surgery, Central Manchester NHS Foundation Trust, Manchester, UK
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | | | - Joanne Hornbuckle
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Myrddin Rees
- Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Charlotte Rees
- Department of Medical Oncology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Tim Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tamas Hickish
- Bournemouth University, Bournemouth, UK
- Poole Hospital, Poole, UK
| | - Tom Maishman
- Southampton Clinical Trials Unit, Southampton, UK
| | | | | | | | - Mike Radford
- Southampton Clinical Trials Unit, Southampton, UK
| | - O James Garden
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - David Cunningham
- Department of Medicine, Gastrointestinal and Lymphoma Units, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Tim S Maughan
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - John N Primrose
- University Surgery and Cancer Sciences Division, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
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Khoo E, O'Neill S, Brown E, Wigmore SJ, Harrison EM. Systematic review of systemic adjuvant, neoadjuvant and perioperative chemotherapy for resectable colorectal-liver metastases. HPB (Oxford) 2016; 18:485-93. [PMID: 27317952 PMCID: PMC4913134 DOI: 10.1016/j.hpb.2016.03.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/02/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The role of systemic chemotherapy in patients with resectable colorectal liver metastases (CRLM) is ambiguous. The aim of this review was to compare the outcomes of regimens using systemic neoadjuvant, adjuvant or perioperative (combination of pre and postoperative) chemotherapy, for the treatment of resectable CRLM. METHODS MEDLINE was searched for articles investigating the use of chemotherapy for adults with resectable CRLM. Randomized controlled trials reporting overall survival (OS), disease-free survival (DFS) and grade 3-4 adverse events (AEs) were screened for inclusion. PROSPERO record: CRD42015020609. RESULTS Four trials met the inclusion criteria (1098 patients). No significant improvement in median OS was achieved with chemotherapy/surgery compared with surgery-alone. Two trials demonstrated a significant improvement in DFS with chemotherapy/surgery compared to surgery-alone (Hazard ratio 0.78 (0.61-0.99) p = 0.04 and HR 0.66 (0.46-0.96) p = 0.03). Fluorouracil/folinic acid alone had a lower incidence of AEs than combination therapies, and the addition of cetuximab shortened DFS in one trial (HR 1.48 (1.04-2.12) p = 0.03). CONCLUSION There is a lack of adequately powered trials of chemotherapy in combination with liver resection for CRLM, partly due to difficulties in recruitment. In an unselected patient group, FOLFOX in combination with liver resection appears to improve DFS compared to surgery-alone, but trials are underpowered for OS. Future trials will require prospective stratification of patients based on biomarkers predictive of response.
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Affiliation(s)
- Emily Khoo
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Stephen O'Neill
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Ewan Brown
- Edinburgh Cancer Centre, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Stephen J. Wigmore
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Ewen M. Harrison
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK,Correspondence: Ewen M. Harrison, Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK. Tel.: +44 7974420495.Department of Clinical SurgeryUniversity of EdinburghRoyal Infirmary of Edinburgh51 Little France CrescentEdinburghEH16 4SAUK
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Schanzer JM, Wartha K, Moessner E, Hosse RJ, Moser S, Croasdale R, Trochanowska H, Shao C, Wang P, Shi L, Weinzierl T, Rieder N, Bacac M, Ries CH, Kettenberger H, Schlothauer T, Friess T, Umana P, Klein C. XGFR*, a novel affinity-matured bispecific antibody targeting IGF-1R and EGFR with combined signaling inhibition and enhanced immune activation for the treatment of pancreatic cancer. MAbs 2016; 8:811-27. [PMID: 26984378 PMCID: PMC4966845 DOI: 10.1080/19420862.2016.1160989] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) and the insulin-like growth factor-1 receptor (IGF-1R) play critical roles in tumor growth, providing a strong rationale for the combined inhibition of IGF-1R and EGFR signaling in cancer therapy. We describe the design, affinity maturation, in vitro and in vivo characterization of the bispecific anti-IGF-1R/EGFR antibody XGFR*. XGFR* is based on the bispecific IgG antibody XGFR, which enabled heterodimerization of an IGF-1R binding scFab heavy chain with an EGFR-binding light and heavy chain by the "knobs-into-holes" technology. XGFR* is optimized for monovalent binding of human EGFR and IGF-1R with increased binding affinity for IGF-1R due to affinity maturation and highly improved protein stability to oxidative and thermal stress. It bears an afucosylated Fc-portion for optimal induction of antibody-dependent cell-mediated cytotoxicity (ADCC). Stable Chinese hamster ovary cell clones with production yields of 2-3 g/L were generated, allowing for large scale production of the bispecific antibody. XGFR* potently inhibits EGFR- and IGF-1R-dependent receptor phosphorylation, reduces tumor cell proliferation in cells with heterogeneous levels of IGF-1R and EGFR receptor expression and induces strong ADCC in vitro. A comparison of pancreatic and colorectal cancer lines demonstrated superior responsiveness to XGFR*-mediated signaling and tumor growth inhibition in pancreatic cancers that frequently show a high degree of IGF-1R/EGFR co-expression. XGFR* showed potent anti-tumoral efficacy in the orthotopic MiaPaCa-2 pancreatic xenograft model, resulting in nearly complete tumor growth inhibition with significant number of tumor remissions. In summary, the bispecific anti-IGF-1R/EGFR antibody XGFR* combines potent signaling and tumor growth inhibition with enhanced ADCC induction and represents a clinical development candidate for the treatment of pancreatic cancer.
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Affiliation(s)
- Juergen M Schanzer
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Katharina Wartha
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Ekkehard Moessner
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Ralf J Hosse
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Samuel Moser
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Rebecca Croasdale
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Halina Trochanowska
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Cuiying Shao
- c Pharma Research and Early Development, Roche Innovation Center Shanghai , Cai Lun Road, Shanghai , China
| | - Peng Wang
- c Pharma Research and Early Development, Roche Innovation Center Shanghai , Cai Lun Road, Shanghai , China
| | - Lei Shi
- c Pharma Research and Early Development, Roche Innovation Center Shanghai , Cai Lun Road, Shanghai , China
| | - Tina Weinzierl
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Natascha Rieder
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Marina Bacac
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Carola H Ries
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Hubert Kettenberger
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Tilman Schlothauer
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Thomas Friess
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Pablo Umana
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Christian Klein
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
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Nordlinger BM, Poston GJ, Goldberg RM. Reply to J.N. Primrose et al and C.-H. Köhne. J Clin Oncol 2015; 33:2408-9. [PMID: 26033799 DOI: 10.1200/jco.2014.60.4751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bernard M Nordlinger
- Hôpital Ambroise Paré, Boulogne; and Assistance Publique Hôpitaux de Paris, Université de Versailles, Versailles, France
| | - Graeme J Poston
- Aintree University Hospital; and Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Richard M Goldberg
- The James Cancer Hospital and Solove Research Institute, The Ohio State University James Comprehensive Cancer Center, Columbus, OH
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