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Cohen SJ, Konski AA, Putnam S, Ball DS, Meyer JE, Yu JQ, Astsaturov I, Marlow C, Dickens A, Cade DN, Meropol NJ. Phase I study of capecitabine combined with radioembolization using yttrium-90 resin microspheres (SIR-Spheres) in patients with advanced cancer. Br J Cancer 2014; 111:265-71. [PMID: 24983373 PMCID: PMC4102951 DOI: 10.1038/bjc.2014.344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/16/2014] [Accepted: 05/27/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This was a prospective single-centre, phase I study to document the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and the recommended phase II dose for future study of capecitabine in combination with radioembolization. METHODS Patients with advanced unresectable liver-dominant cancer were enrolled in a 3+3 design with escalating doses of capecitabine (375-1000 mg/m(2) b.i.d.) for 14 days every 21 days. Radioembolization with (90)Y-resin microspheres was administered using a sequential lobar approach with two cycles of capecitabine. RESULTS Twenty-four patients (17 colorectal) were enrolled. The MTD was not reached. Haematologic events were generally mild. Common grade 1/2 non-haematologic toxicities included transient transaminitis/alkaline phosphatase elevation (9 (37.5%) patients), nausea (9 (37.5%)), abdominal pain (7 (29.0%)), fatigue (7 (29.0%)), and hand-foot syndrome or rash/desquamation (7 (29.0%)). One patient experienced a partial gastric antral perforation with a capecitabine dose of 750 mg/m(2). The best response was partial response in four (16.7%) patients, stable disease in 17 (70.8%) and progression in three (12.5%). Median time to progression and overall survival of the metastatic colorectal cancer cohort was 6.4 and 8.1 months, respectively. CONCLUSIONS This combined modality treatment was generally well tolerated with encouraging clinical activity. Capecitabine 1000 mg/m(2) b.i.d. is recommended for phase II study with sequential lobar radioembolization.
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Affiliation(s)
- S J Cohen
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A A Konski
- Department of Radiation Oncology, Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - S Putnam
- Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - D S Ball
- Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - J E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - J Q Yu
- Department of Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - I Astsaturov
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - C Marlow
- Clinical Trials Office, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A Dickens
- Clinical Trials Office, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - D N Cade
- Sirtex Medical Ltd, Sydney, New South Wales, Australia
| | - N J Meropol
- Division of Hematology and Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
OBJECTIVE The purpose of our study was to evaluate the effects of the addition of melatonin and capecitabine on experimental pancreatic cancer. METHODS Fifty Syrian hamsters were randomized in 5 groups: group 1: no tumor induction (control group); group 2: tumor induction with BOP [N-nitrosobis(2-oxopropyl) amine]; group 3: tumor induction with BOP and melatonin administration; group 4: tumor induction with BOP and capecitabine administration; and group 5: tumor induction with BOP and administration of combined capecitabine and melatonin therapy. The evaluation of pathological tumor evolution and oxidative stress markers in pancreatic tissue was carried out. RESULTS All animals under BOP exposure presented poorly or moderately differentiated pancreatic adenocarcinoma associated with increased lipoperoxide levels and decreased antioxidant activity in pancreatic tissue. Pancreatic cancer was shown in only 66% of the capecitabine-treated group and 33% of melatonin-treated group (P < 0.05), most of them moderately differentiated adenocarcinoma. When capecitabine and melatonin were combined, a well-differentiated pancreatic adenocarcinoma was observed in 10% of animals. The beneficial effect was associated with a decrease in lipoperoxide levels and increased antioxidant activity in pancreatic tissue. CONCLUSIONS The combined administration of capecitabine and melatonin provided an improvement in antioxidant status as well as a synergistic antitumoral effect in experimental pancreatic cancer.
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Arjona-Sánchez A, Ruiz-Rabelo J, Perea MD, Vázquez R, Cruz A, Muñoz MDC, Túnez I, Muntané J, Padillo FJ. Effects of capecitabine and celecoxib in experimental pancreatic cancer. Pancreatology 2010; 10:641-7. [PMID: 21051919 DOI: 10.1159/000288708] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 02/05/2010] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pancreatic cancer is a major health problem because of its aggressiveness and the lack of effective systemic therapies. The aim of the study was the identification of beneficial properties of combined celecoxib and capecitabine treatment during an experimental pancreatic cancer model. METHODS N-nitrosobis (2-oxopropyl)amine (BOP) was used as a tumoral agent for 12 weeks. Celecoxib and capecitabine were administered either as monotherapy or combined 12 weeks after cancer induction for a period of 24 weeks. The presence of well-developed or moderate adenocarcinoma was evaluated in the pancreas. Several markers of stress, such as lipoperoxides, reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GHS-Px) were determined. RESULTS BOP induced the presence of pancreatic tumors associated with a rise in lipoperoxides and the reduction of the antioxidant status in the pancreas. The administration of celecoxib and capecitabine reduced the number of animals with tumors (33 and 66%, respectively). This antitumoral effect was associated with a recovery of GSH, SOD and CAT activity in the pancreas of BOP-treated animals. The combined treatment exerted a synergic antitumoral effect and reduced pancreatic oxidative stress. CONCLUSION The combined administration of celecoxib and capecitabine exerted a synergistic antitumoral effect and increased the antioxidant status restoration in pancreatic cancer.
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Middleton G, Ghaneh P, Costello E, Greenhalf W, Neoptolemos JP. New treatment options for advanced pancreatic cancer. Expert Rev Gastroenterol Hepatol 2008; 2:673-96. [PMID: 19072345 DOI: 10.1586/17474124.2.5.673] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pancreatic cancer has a very high mortality rate and affects approximately 230,000 individuals worldwide. Gemcitabine has become established as the standard therapy for advanced pancreatic cancer; however, the survival advantage is small. Adjuvant chemotherapy using either 5-fluorouracil or gemcitabine is now established in pancreatic cancer as an alternative therapy. Combinations of gemcitabine with either platin agents or capecitabine may be advantageous. Anti-EGFR and anti-VEGF agents have been unsuccessful but multiple tyrosine kinase inhibitors are under investigation. Of the increasing number of immunological agents, the GV1001 antitelomerase vaccine holds some interest. Targeted agents against important mitogenic pathways, including MEK/ERK, Src, PI3K/Akt, mTOR, Hedgehog and NF-kappaB, as well as agents targeting histone deacetylase, poly(ADP-ribose) polymerase, heat shock protein 90 and other agents such as beta-lapachone, hold considerable interest for further development. However, the probability of individual success is low.
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Affiliation(s)
- Gary Middleton
- Royal Surrey County Hospital NHS Trust, Egerton Road, Guildford, GU2 7XX, UK.
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Sultana A, Ghaneh P, Cunningham D, Starling N, Neoptolemos JP, Smith CT. Gemcitabine based combination chemotherapy in advanced pancreatic cancer-indirect comparison. BMC Cancer 2008; 8:192. [PMID: 18611273 PMCID: PMC2474853 DOI: 10.1186/1471-2407-8-192] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Accepted: 07/08/2008] [Indexed: 11/30/2022] Open
Abstract
Background Recent meta-analyses have found a survival advantage with gemcitabine based combinations over single agent gemcitabine in patients with advanced pancreatic cancer. There is paucity of evidence in the form of direct head-to-head randomised controlled trials to determine which combinations are to be preferred. Method Using the adjusted indirect comparison method proposed by Bucher et al, we have assessed randomised controlled trials of four gemcitabine based combinations namely gemcitabine plus a platinum compound or 5-fluorouracil or irinotecan or capecitabine. Results No particular combination was significantly superior to another, but the indirect evidence suggests some important trends. Conclusion The strongest trends on indirect comparison are towards favouring gemcitabine plus capecitabine or gemcitabine plus a platinum compound over gemcitabine plus irinotecan, and to a lesser degree, over gemcitabine plus 5-fluorouracil.
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Affiliation(s)
- Asma Sultana
- CRUK Liverpool Cancer Trials Unit, Cancer Research Centre, 200 London Road, Liverpool L3 9TA, UK.
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Tripathy D. Capecitabine in Combination with Novel Targeted Agents in the Management of Metastatic Breast Cancer: Underlying Rationale and Results of Clinical Trials. Oncologist 2007; 12:375-89. [PMID: 17470680 DOI: 10.1634/theoncologist.12-4-375] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
At present there is no established standard of care for metastatic breast cancer and prognosis remains poor, although the use of newer chemotherapeutic regimens has led to modest improvements in survival. Capecitabine, an oral prodrug of 5-fluorouracil, is a promising addition to these approaches, having already shown single-agent activity against metastatic breast cancer. Following a pivotal trial demonstrating that capecitabine confers increased survival when used in combination with docetaxel, it is being investigated intensively in combined regimens using other standard chemotherapeutic agents, as well as with novel molecularly targeted therapies. Among the novel agents, the most intensively studied in combination with capecitabine is trastuzumab. Despite preclinical data suggesting that these two agents might not show additive effects, clinical trials have been very encouraging for both heavily pretreated patients and for patients receiving first-line therapy in the metastatic setting. This work is being further extended in an ongoing trial in the neoadjuvant setting. An initial trial in combination with bevacizumab, enrolling heavily pretreated patients, was less successful, but following the example of the E2100 trial, this combination is being re-examined in less heavily treated patients. In addition, this review discusses ongoing trials with an array of newer molecularly targeted agents. Significant improvement in time to progression has already been demonstrated in the combination of lapatinib and capecitabine compared with capecitabine monotherapy; for the most part, however, these trials are still in early stages.
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Affiliation(s)
- Debu Tripathy
- Komen/University of Texas Southwestern Breast Cancer Research Program, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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