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Dzienis M, Cundom J, Fuentes CS, Spreafico A, Nordlinger M, Pastor AV, Alesi E, Neki A, Fung AS, Figueiredo Lima IP, Oppelt P, da Cunha Junior GF, Burtness B, Franke FA, Tseng JE, Joshi A, McCarthy J, Swaby R, Sidi Y, Gumuscu B, Naicker N, de Castro G. Pembrolizumab Plus Carboplatin and Paclitaxel as First-Line Therapy for Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-B10): A Single-Arm Phase IV Trial. J Clin Oncol 2024; 42:2989-2999. [PMID: 39038265 PMCID: PMC11361359 DOI: 10.1200/jco.23.02625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 04/23/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Standard-of-care first-line treatment for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) is pembrolizumab plus platinum and fluorouracil (FU). However, FU is associated with potential challenges (continuous 4-day infusion, high administration costs, and cardiovascular and gastrointestinal toxicities), creating a clinical need for alternative chemotherapy combinations. We evaluated the efficacy and safety of first-line pembrolizumab plus carboplatin and paclitaxel for R/M HNSCC in the open-label, single-arm, phase IV KEYNOTE-B10 study (ClinicalTrials.gov identifier: NCT04489888). METHODS Eligible adults had previously untreated, histologically or cytologically confirmed R/M HNSCC regardless of PD-L1 status, measurable disease per RECIST v1.1 by blinded independent central review (BICR), and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients received pembrolizumab 200 mg intravenously once every 3 weeks for ≤35 cycles and carboplatin AUC 5 mg/mL/min intravenously once every 3 weeks for ≤6 cycles and investigator's choice of paclitaxel 100 mg/m2 on days 1 and 8 or 175 mg/m2 on day 1, intravenously once every 3 weeks. The primary end point was objective response rate per RECIST v1.1 by BICR. RESULTS Between October 27, 2020, and April 29, 2022, 149 patients were screened and 101 received treatment. As of February 20, 2023, the median follow-up was 18.9 months (range, 9.1-27.0). At this final analysis, 49 (49%) of 101 patients had an objective response (95% CI, 38.4 to 58.7), including seven patients (7%) with a confirmed complete response. Of the 101 treated patients, grade 3-5 and serious treatment-related adverse events occurred in 76 (75%) and 27 (27%), respectively. There were no new safety signals. CONCLUSION Pembrolizumab plus carboplatin and paclitaxel showed promising antitumor activity and a manageable safety profile in first-line R/M HNSCC, suggesting this combination may be an alternative option for this patient population.
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Affiliation(s)
- Marcin Dzienis
- Cancer Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Juan Cundom
- Department of Oncology, IDIM Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina
| | | | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Melanie Nordlinger
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson-Abington Hospital, Philadelphia, PA
| | | | - Erin Alesi
- Department of Hematology/Oncology and Palliative Medicine, VCU Massey Cancer Center, Richmond, VA
| | - Anterpreet Neki
- Department of Hematology/Oncology, UC Davis Medical Center, Sacramento, CA
| | - Andrea S. Fung
- Department of Oncology, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
| | | | - Peter Oppelt
- Department of Oncology, Washington University School of Medicine, St Louis, MO
| | | | - Barbara Burtness
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - Fabio Andre Franke
- Department of Oncology, Oncosite Centro de Pesquisa Clínica em Oncologia, Ijuí, Brazil
| | - Jennifer E. Tseng
- Department of Hematology and Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - Abhishek Joshi
- Department of Medical Oncology, The Townsville University Hospital, Douglas, QLD, Australia
| | - Joy McCarthy
- Dr. H. Bliss Murphy Cancer Centre, St John's, NL, Canada
| | | | | | | | - Niroshini Naicker
- Oncology European Clinical Development, MSD (UK) Limited, London, United Kingdom
| | - Gilberto de Castro
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo—ICESP, São Paulo, Brazil
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Taliento C, Restaino S, Scutiero G, Arcieri M, Bernardi G, Martinello R, Driul L, Perrone AM, Fagotti A, Scambia G, Greco P, Vizzielli G. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in patients with ovarian cancer: A systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107250. [PMID: 37951158 DOI: 10.1016/j.ejso.2023.107250] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/10/2023] [Accepted: 10/27/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND PIPAC consists in delivering normothermic chemotherapy solution directly into the peritoneal cavity as an aerosol under pressure. Currently PIPAC is considered as a palliative treatment for patients suffering from non-resectable peritoneal carcinomatosis. We performed a SR to assess tolerance and response of this novel method among patient with OC. METHODS We searched electronic database PubMed, Embase, Web of Science, Clinical Trials.gov. We only included clinical studies reporting PIPAC with cisplatin and doxorubicin in patients with ovarian cancer. RESULTS This systematic review included 4 studies. In 3 studies all patients were pretreated with cytoreductive surgery, in 1 study surgery was performed in 8/34 (23 %) patients. Mean PCI at first PIPAC procedure ranged from 16.3 to 19.6. All studies reported the proportion of patients with ascites at the first PIPAC with a pooled rate of 48,3 %. Pooled rate of CTCAE Grade 3 toxicity calculated on the total number of PIPAC was 6 % and Grade 4 was 0.9 %. One study reported two cases of small bowel perforation related or potentially related to PIPAC. On study reported a cumulative survival after 400 days of 62 % and a mean actuarial survival time of all patients who underwent PIPAC of 442 days. In another study the mean time to progression was 144 days (95 % CI 122-168 days). CONCLUSION This systematic review demonstrated that PIPAC with cisplatin and doxorubicin appear to have a good safety profile with low toxicity and encouraging trend in terms of overall survival.
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Affiliation(s)
- Cristina Taliento
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Gennaro Scutiero
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Human Pathology of Adult and Childhood "G. Barresi", Unit of Gynecology and Obstetrics, University of Messina, Italy
| | - Giulia Bernardi
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Ruby Martinello
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, Department of Medical and Surgical Sciences (DIMEC), Sant'Orsola-Malpighi Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy.
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da Costa Junior LC, de Castro CL, Freitas-Alves DR, Vianna-Jorge R, Santos PCJL. ABCB1 and ERCC1 gene polymorphisms are associated with nephro- and hepatotoxicity to carboplatin/paclitaxel-based chemotherapy in patients with gynecologic cancers. Eur J Clin Pharmacol 2020; 76:1401-1408. [PMID: 32564116 DOI: 10.1007/s00228-020-02934-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Paclitaxel/carboplatin combination is the standard chemotherapeutic protocol for gynecologic cancers, but severe toxicities may compromise treatment. There is great inter-individual variability regarding the incidence and severity of toxicities, which may be due to single-nucleotide polymorphisms (SNPs) affecting drug disposition or cellular sensitivity. Here we investigate the impact of selected SNPs in ERCC1, ABCB1, CYP2C8, and CYP3A5 genes on the incidence of severe toxicities, including nephro- and hepatotoxicity. METHODS A cohort of 507 gynecological cancer patients receiving paclitaxel/carboplatin was recruited at the Brazilian National Cancer Institute (INCA-Brazil). Clinical data were obtained during routine consultations or from electronic medical records. Toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). Genotyping was performed using real-time PCR. RESULTS ABCB1 c.1236C>T was associated with moderate-to-severe (grades 2-4) nephrotoxicity (ORadjusted 2.40; 95% CI 1.39-4.15), even after adjustment for age (≥ 65) and diabetes. The risk association between ABCB1 c.1236C>T and moderate-to-severe nephrotoxicity following paclitaxel/carboplatin chemotherapy was also present among non-diabetic patients (ORadjusted 2.16; 95% CI 1.22-3.82). ERCC1 c.118C>T was the only individual variable associated with an increased risk for moderate-to-severe (grades 2-4) hepatotoxicity (OR 3.71; 95% CI 1.08-12.77), severe nausea (OR 4.18; 95% CI 1.59-10.95), and severe myalgia (OR 1.95; 95% CI 1.12-3.40). CONCLUSIONS ABCB1 c.1236C>T and ERCC1 c.118C>T might serve as potential biomarkers for the risk of moderate-to-severe toxicities to carboplatin/paclitaxel chemotherapy of gynecological cancers.
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Affiliation(s)
- Luiz Carlos da Costa Junior
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), Rua Três de Maio, nº 100, 4° andar, Infar, Vila Clementino, São Paulo, SP, 04044-020, Brazil
| | - Clarissa Lourenço de Castro
- Hospital do Câncer II (HCII), Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Escola Nacional de Saúde Pública (ENSP), Fundação Osvaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Daniely Regina Freitas-Alves
- Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Escola Nacional de Saúde Pública (ENSP), Fundação Osvaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas, nº 373, Bl.J, 1° andar, sala 27, Centro de Ciências da Saúde, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Rosane Vianna-Jorge
- Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Escola Nacional de Saúde Pública (ENSP), Fundação Osvaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil. .,Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro (UFRJ), Av. Carlos Chagas, nº 373, Bl.J, 1° andar, sala 27, Centro de Ciências da Saúde, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil. .,Coordenação de Pesquisa (CPQ), Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil.
| | - Paulo Caleb Júnior Lima Santos
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), Rua Três de Maio, nº 100, 4° andar, Infar, Vila Clementino, São Paulo, SP, 04044-020, Brazil.
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Impact of gene polymorphisms on the systemic toxicity to paclitaxel/carboplatin chemotherapy for treatment of gynecologic cancers. Arch Gynecol Obstet 2019; 300:395-407. [PMID: 31123858 DOI: 10.1007/s00404-019-05197-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/15/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Gynecologic malignancies are often detected in advanced stages, requiring chemotherapy with taxane/platinum combinations, which may cause severe toxicities, such as neutropenia and peripheral neuropathy. Gene polymorphisms are suspected as possible causes for the interindividual variability on chemotherapy toxicities. OBJECTIVE To evaluate the role of ABCB1 1236C>T, 3435C>T; CYP2C8*3; CYP3A5*3C variants on paclitaxel/carboplatin toxicities. METHODS A cohort of 503 gynecologic cancer patients treated with paclitaxel/carboplatin at the Brazilian National Cancer Institute (INCA-Brazil) was recruited (2013-2017). Polymorphisms were genotyped by real-time PCR, and toxicities were evaluated by patients' interviews at each chemotherapy cycle and by data collection from electronic records. The association of clinical features and genotypes with severe toxicities was estimated using Pearson's Chi square tests and multiple regression analyses, with calculation of adjusted odds ratios (ORadjusted), and respective 95% confidence intervals (95% CI). RESULTS CYP2C8*3 was significantly associated with increased risks of severe (grades 3-4) neutropenia (ORadjusted 2.11; 95% CI 1.24-3.6; dominant model) and severe thrombocytopenia (ORadjusted 4.93; 95% CI 1.69-14.35; recessive model), whereas ABCB1 variant genotypes (ORadjusted 2.13; 95% CI 1.32-3.42), in association with CYP2C8*3 wild type (GG) (ORadjusted 1.93; 95% CI 1.17-3.19), were predictive of severe fatigue. CONCLUSIONS The present study suggests that CYP2C8*3 is a potential predictor of hematological toxicities related to paclitaxel/carboplatin treatment. Since hematological toxicities, especially neutropenia, may lead to dose delay or treatment interruption, such prognostic evaluation may contribute to clinical management of selected patients with paclitaxel-based chemotherapy.
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Risk factors for septic adverse events and their impact on survival in advanced ovarian cancer patients treated with neoadjuvant chemotherapy and interval debulking surgery. Gynecol Oncol 2018; 151:32-38. [DOI: 10.1016/j.ygyno.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 01/13/2023]
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