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Karapetis CS, Liu H, Sorich MJ, Pederson LD, Van Cutsem E, Maughan T, Douillard JY, O'Callaghan CJ, Jonker D, Bokemeyer C, Sobrero A, Cremolini C, Chibaudel B, Zalcberg J, Adams R, Buyse M, Peeters M, Yoshino T, de Gramont A, Shi Q. Fluoropyrimidine type, patient age, tumour sidedness and mutation status as determinants of benefit in patients with metastatic colorectal cancer treated with EGFR monoclonal antibodies: individual patient data pooled analysis of randomised trials from the ARCAD database. Br J Cancer 2024; 130:1269-1278. [PMID: 38402342 PMCID: PMC11015038 DOI: 10.1038/s41416-024-02604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND KRAS mutations in metastatic colorectal cancer (mCRC) are used as predictive biomarkers to select therapy with EGFR monoclonal antibodies (mAbs). Other factors may be significant determinants of benefit. METHODS Individual patient data from randomised trials with a head-to-head comparison between EGFR mAb versus no EGFR mAb (chemotherapy alone or best supportive care) in mCRC, across all lines of therapy, were pooled. Overall survival (OS) and progression-free survival (PFS) were compared between groups. Treatment effects within the predefined KRAS biomarker subsets were estimated by adjusted hazard ratio (HRadj) and 95% confidence interval (CI). EGFR mAb efficacy was measured within the KRAS wild-type subgroup according to BRAF and NRAS mutation status. In both KRAS wild-type and mutant subgroups, additional factors that could impact EGFR mAb efficacy were explored including the type of chemotherapy, line of therapy, age, sex, tumour sidedness and site of metastasis. RESULTS 5675 patients from 8 studies were included, all with known mCRC KRAS mutation status. OS (HRadj 0.90, 95% CI 0.84-0.98, p = 0.01) and PFS benefit (HRadj 0.73, 95% CI 0.68-0.79, p < 0.001) from EGFR mAbs was observed in the KRAS wild-type group. PFS benefit was seen in patients treated with fluorouracil (HRadj 0.75, 95% CI 0.68-0.82) but not with capecitabine-containing regimens (HRadj 1.04, 95% CI 0.86-1.26) (pinteraction = 0.002). Sidedness also interacted with EGFR mAb efficacy, with survival benefit restricted to left-sided disease (pinteraction = 0.038). PFS benefits differed according to age, with benefits greater in those under 70 (pinteraction = 0.001). The survival benefit was not demonstrated in those patients with mutations found in the KRAS, NRAS or BRAF genes. The presence of liver metastases interacted with EGFR mAb efficacy in patients with KRAS mutant mCRC (pinteraction = 0.004). CONCLUSION The benefit provided by EGFR mAbs in KRAS WT mCRC is associated with left-sided primary tumour location, younger patient age and absence of NRAS or BRAF mutations. Survival benefit is observed with fluorouracil but not capecitabine. Exploratory results support further research in KRAS mutant mCRC without liver metastases.
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Affiliation(s)
- C S Karapetis
- Flinders Medical Centre, Adelaide, SA, Australia.
- Flinders University, Adelaide, SA, Australia.
| | - H Liu
- Mayo Clinic, Rochester, NY, USA
| | - M J Sorich
- Flinders University, Adelaide, SA, Australia
| | | | - E Van Cutsem
- University Hospitals Gasthuisberg Leuven and University of Leuven, Leuven, Belgium
| | - T Maughan
- University of Liverpool, Liverpool, UK
| | - J Y Douillard
- University of Nantes and Integrated Centers of Oncology ICO Rene Gauducheau Cancer Nantes, Nantes, France
| | | | - D Jonker
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - C Bokemeyer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - B Chibaudel
- Franco-British Institute Levallois-Perre, Levallois-Perre, France
| | - J Zalcberg
- Dept of Medical Oncology, Alfred Health and School of Public Health, Monash University, Melbourne, VIC, Australia
| | - R Adams
- Velindre Cancer Centre Cardiff University, Cardiff, UK
| | - M Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - M Peeters
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - T Yoshino
- National Cancer Centre Hospital East, Kashiwa, Japan
| | - A de Gramont
- Franco-British Institute Levallois-Perre, Levallois-Perre, France
| | - Q Shi
- Mayo Clinic, Rochester, NY, USA
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de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, Louvet C, Hendler D, de Braud F, Wilson C, Morvan F, Bonetti A. Leucovorin and Fluorouracil With or Without Oxaliplatin as First-Line Treatment in Advanced Colorectal Cancer. J Clin Oncol 2023; 41:5080-5089. [PMID: 37967516 DOI: 10.1200/jco.22.02773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
PURPOSE In a previous study of treatment for advanced colorectal cancer, the LV5FU2 regimen, comprising leucovorin (LV) plus bolus and infusional fluorouracil (5FU) every 2 weeks, was superior to the standard North Central Cancer Treatment Group/Mayo Clinic 5-day bolus 5FU/LV regimen. This phase III study investigated the effect of combining oxaliplatin with LV5FU2, with progression-free survival as the primary end point. PATIENTS AND METHODS Four hundred twenty previously untreated patients with measurable disease were randomized to receive a 2-hour infusion of LV (200 mg/m2/d) followed by a 5FU bolus (400 mg/m2/d) and 22-hour infusion (600 mg/m2/d) for 2 consecutive days every 2 weeks, either alone or together with oxaliplatin 85 mg/m2 as a 2-hour infusion on day 1. RESULTS Patients allocated to oxaliplatin plus LV5FU2 had significantly longer progression-free survival (median, 9.0 v 6.2 months; P = .0003) and better response rate (50.7% v 22.3%; P = .0001) when compared with the control arm. The improvement in overall survival did not reach significance (median, 16.2 v 14.7 months; P = .12). LV5FU2 plus oxaliplatin gave higher frequencies of National Cancer Institute common toxicity criteria grade 3/4 neutropenia (41.7% v 5.3% of patients), grade 3/4 diarrhea (11.9% v 5.3%), and grade 3 neurosensory toxicity (18.2% v 0%), but this did not result in impairment of quality of life (QoL). Survival without disease progression or deterioration in global health status was longer in patients allocated to oxaliplatin treatment (P = .004). CONCLUSION The LV5FU2-oxaliplatin combination seems beneficial as first-line therapy in advanced colorectal cancer, demonstrating a prolonged progression-free survival with acceptable tolerability and maintenance of QoL.
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Affiliation(s)
- A de Gramont
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - A Figer
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - M Seymour
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - M Homerin
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - A Hmissi
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - J Cassidy
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - C Boni
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - H Cortes-Funes
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - A Cervantes
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - G Freyer
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - D Papamichael
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - N Le Bail
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - C Louvet
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - D Hendler
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - F de Braud
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - C Wilson
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - F Morvan
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
| | - A Bonetti
- From the Service de Médecine Interne-OncologieHôpital Saint-Antoine, Paris; Debiopharm, Charenton; Service d'Oncologie Médicale, Centre Hospitalier Lyon Sud, Pierre-Benite; and Centre Hospitalier René Dubos, Pontoise, France; Institute of Oncology, Belinson Medical Center, Petach Tikva, Israel; Imperial Cancer Research Fund Cancer Medicine Research Unit, University of Leeds; Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen; Department of Medical Oncology, St Bartholomew's Hospital, London; and Addenbrooke's National Health Service Trust, Cambridge, United Kingdom; Servizio di Oncologia Medica, Arcispedale S. Maria Nuova, Reggio Emilia; Instituto Europeo di Oncologia, Milan; and Clinical Oncology Centre, Service d'Oncologie Médicale, Div Oncologia Medica Azienda, Ospedaliera di Verona, Verona, Italy; Servicio de Oncología, the Hospital 12 de Octubre, Madrid; and Servicio de Onco-Hematologia, Hospital Clinico Universitario, Valencia, Spain
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Tabernero J, Grothey A, Arnold D, de Gramont A, Ducreux M, O'Dwyer P, Tahiri A, Gilberg F, Irahara N, Schmoll HJ, Van Cutsem E. MODUL cohort 2: an adaptable, randomized, signal-seeking trial of fluoropyrimidine plus bevacizumab with or without atezolizumab maintenance therapy for BRAF wt metastatic colorectal cancer. ESMO Open 2022; 7:100559. [PMID: 36029653 PMCID: PMC9588902 DOI: 10.1016/j.esmoop.2022.100559] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background MODUL is an adaptable, signal-seeking trial designed to test novel agents in predefined patient subgroups in first-line metastatic colorectal cancer (mCRC). Patients and methods Patients with measurable, unresectable, previously untreated mCRC received induction with ≤8 cycles of FOLFOX + bevacizumab followed by randomization to maintenance treatment comprising control [fluoropyrimidine (FP)/bevacizumab: 5-fluorouracil 1600-2400 mg/m2 46-h intravenous (i.v.) infusion day 1 q2 weeks plus leucovorin 400 mg/m2 2-h infusion i.v. day 1 q2 weeks or capecitabine 1000 mg/m2 b.i.d. orally days 1-14 every 21 days; bevacizumab 5 mg/kg 15-30-min i.v. infusion q2 weeks] or experimental treatment in one of four biomarker-driven cohorts. In patients with BRAF wild-type (BRAFwt) tumors (cohort 2), experimental treatment was FP/bevacizumab + atezolizumab (800 mg 60-min i.v. infusion q2 weeks). Primary efficacy endpoint was progression-free survival (PFS; intent-to-treat population). Enrollment is complete; efficacy and safety findings from cohort 2 are presented. Results Four hundred and forty-five patients with BRAFwt mCRC were randomized (2 : 1) to maintenance in cohort 2. At a median follow-up of 10.5 months, PFS outcome hypothesis was not met [hazard ratio (HR) 0.92; 95% confidence interval (CI) 0.72-1.17; P = 0.48]; overall survival (OS) was immature. At a median follow-up of 20.3 months (2-year survival follow-up), PFS benefit was also not met (HR 0.95; 95% CI 0.77-1.18; P = 0.666); OS HR with nearly two-thirds of patients with events was 0.83 (95% CI 0.65-1.05; P = 0.117). No new safety signals were identified. The most common grade ≥3 treatment-emergent adverse events (TEAEs) for experimental versus control arms were hypertension (6.1% versus 4.2%), diarrhea (3.1% versus 2.1%), and palmar-plantar erythrodysesthesia syndrome (1.0% versus 2.5%). Four patients experienced TEAEs with fatal outcome, two were study treatment-related: hepatic failure (experimental arm) and large intestine perforation (control arm; bevacizumab-related). Conclusions Adding atezolizumab to FP/bevacizumab as first-line maintenance treatment after FOLFOX + bevacizumab induction for BRAFwt mCRC did not improve efficacy outcomes. MODUL is an adaptable, signal-seeking trial of novel combinations in predefined subgroups of patients with mCRC. In cohort 2 (BRAFwt mCRC), adding atezolizumab to FP/bevacizumab (bev) first-line maintenance therapy did not improve PFS or OS versus FP/bev. ORR and DCR were numerically but not statistically significantly higher with atezolizumab + FP/bev versus FP/bev. The safety profile of atezolizumab + FP/bev was consistent with previous findings with no new safety signals identified. Findings from MODUL cohort 2 indicate that immunotherapy has limited efficacy in patients with microsatellite stable mCRC.
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Affiliation(s)
- J Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain.
| | | | - D Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
| | - A de Gramont
- Franco-British Hospital, Levallois-Perret, France
| | - M Ducreux
- Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - P O'Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - A Tahiri
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - F Gilberg
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - N Irahara
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - E Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
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4
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Margalit O, Harmsen W, Shacham-Shmueli E, Voss M, Boursi B, Cohen R, Olswold C, Saltz L, Hurwitz H, Adams R, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, de Gramont A, Shi Q, Lenz H. P-106 Evaluating sex as a predictive marker for response to bevacizuamb in metastatic colorectal carcinoma: Pooled analysis of 3,369 patients in the ARCAD database. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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André T, Vernerey D, Im SA, Bodoky G, Buzzoni R, Reingold S, Rivera F, McKendrick J, Scheithauer W, Ravit G, Fountzilas G, Yong WP, Isaacs R, Österlund P, Liang JT, Creemers GJ, Rakez M, Van Cutsem E, Cunningham D, Tabernero J, de Gramont A. Bevacizumab as adjuvant treatment of colon cancer: updated results from the S-AVANT phase III study by the GERCOR Group. Ann Oncol 2019; 31:246-256. [PMID: 31959341 DOI: 10.1016/j.annonc.2019.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The bevacizumab-Avastin® adjuVANT (AVANT) study did not meet its primary end point of improving disease-free survival (DFS) with the addition of bevacizumab to oxaliplatin-based chemotherapy in stage III colon cancer (CC). We report here the long-term survival results (S-AVANT). PATIENTS AND METHODS Patients with curatively resected stage III CC were randomly assigned to FOLFOX4, FOLFOX4-bevacizumab, or XELOX-bevacizumab. RESULTS A total of 2867 patients were randomized: FOLFOX4: n = 955, FOLFOX4-bevacizumab: n = 960, XELOX-bevacizumab: n = 952. With a median of 6.73 years follow-up (interquartile range 5.51-10.54), 672 patients died, of whom 198 (20.7%), 250 (26.0%), and 224 (23.5%) were in the FOLFOX4, FOLFOX4-bevacizumab, and XELOX-bevacizumab arms, respectively. The 10-year overall survival (OS) rates were 74.6%, 67.2%, and 69.9%, (P = 0.003) and 5-year disease-free survival (DFS) rates were 73.2%, 68.5%, and 71.0% (P = 0.174), respectively. OS and DFS hazard ratios were 1.29 [95% confidence interval (CI) 1.07-1.55; P = 0.008] and 1.16 (95% CI 0.99-1.37; P = 0.063) for FOLFOX4-bevacizumab versus FOLFOX4 and 1.15 (95% CI 0.95-1.39; P = 0.147) and 1.1 (95% CI 0.93-1.29; P = 0.269) for XELOX-bevacizumab versus FOLFOX4, respectively. CC-related deaths (n = 542) occurred in 157 (79.3%) patients receiving FOLFOX4, 205 (82.0%) receiving FOLFOX4-bevacizumab, and 180 (80.4%) receiving XELOX-bevacizumab (P = 0.764), while non-CC-related deaths occurred in 41 (20.7%), 45 (18.0%), and 44 (19.6%) patients, respectively. Cardiovascular-related and sudden deaths during treatment or follow-up were reported in 13 (6.6%), 17 (6.8%), and 14 (6.3%) patients, in the FOLFOX4, FOLFOX4-bevacizuamb, and XELOX-bevacizumab arms, respectively (P = 0.789). Treatment arm, sex, age, histological differentiation, performance status, T/ N stages, and localization of primary tumor were independent prognostic factors of OS in stage III. CONCLUSIONS S-AVANT confirms the initial AVANT report. No benefit of the bevacizumab addition to FOLFOX4 adjuvant therapy in patients with stage III CC was observed in terms of DFS with a negative effect in OS, without increase in non-CC related deaths. CLINICAL TRIAL IDENTIFICATION NCT00112918.
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Affiliation(s)
- T André
- Sorbonne Université and, Department of Medical Oncology, Saint-Antoine Hospital, Paris, France.
| | - D Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, INSERM UMR 1098, Besançon, France
| | - S A Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - G Bodoky
- Department of Medical Oncology, Combined Szent István and Szent László Hospitals, Budapest, Hungary
| | - R Buzzoni
- Department of Medical Oncology, Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, Milan, Italy
| | - S Reingold
- Department of Medical Oncology, William Osler Health Centre Brampton Civic Hospital, Brampton, Canada
| | - F Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J McKendrick
- Department of Medical Oncology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - W Scheithauer
- Department of Medical Oncology, Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - G Ravit
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - G Fountzilas
- Department of Medical Oncology, Papageorgiou Hospital Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - W P Yong
- Department of Hematology-Oncology, National University of Singapore, Singapore, Singapore
| | - R Isaacs
- Department of Medical Oncology, Palmerston North & Crest Hospitals, Palmerston North, New Zealand
| | - P Österlund
- Department of Oncology, Helsinki and Tampere University Hospitals, University of Helsinki, Helsinki/Tampere, Finland
| | - J T Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - G J Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Rakez
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France
| | - E Van Cutsem
- Department of Internal Medicine, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - D Cunningham
- Department of Medicine, The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic, IOB-Quiron, CIBERONC, TTD Group, Barcelona, Spain
| | - A de Gramont
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France; Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
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Taieb J, Taly V, Vernerey D, Bourreau C, Bennouna J, Faroux R, Desrame J, Bouche O, Borg C, Egreteau J, Mineur L, Lepere C, Deplanque G, Mulot C, Louvet C, Mabro M, Ychou M, de Gramont A, Andre T, Laurent-Puig P. Analysis of circulating tumour DNA (ctDNA) from patients enrolled in the IDEA-FRANCE phase III trial: Prognostic and predictive value for adjuvant treatment duration. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Taieb J, Shi Q, Pederson L, Alberts S, Wolmark N, Van Cutsem E, de Gramont A, Kerr R, Grothey A, Lonardi S, Yoshino T, Yothers G, Sinicrope FA, Zaanan A, André T. Prognosis of microsatellite instability and/or mismatch repair deficiency stage III colon cancer patients after disease recurrence following adjuvant treatment: results of an ACCENT pooled analysis of seven studies. Ann Oncol 2019; 30:1466-1471. [PMID: 31268130 PMCID: PMC7360150 DOI: 10.1093/annonc/mdz208] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Microsatellite instable/deficient mismatch repair (MSI/dMMR) metastatic colorectal cancers have been reported to have a poor prognosis. Frequent co-occurrence of MSI/dMMR and BRAFV600E complicates the association. PATIENTS AND METHODS Patients with resected stage III colon cancer (CC) from seven adjuvant studies with available data for disease recurrence and MMR and BRAFV600E status were analyzed. The primary end point was survival after recurrence (SAR). Associations of markers with SAR were analyzed using Cox proportional hazards models adjusted for age, gender, performance status, T stage, N stage, primary tumor location, grade, KRAS status, and timing of recurrence. RESULTS Among 2630 patients with cancer recurrence (1491 men [56.7%], mean age, 58.5 [19-85] years), multivariable analysis revealed that patients with MSI/dMMR tumors had significantly longer SAR than did patients with microsatellite stable/proficient MMR tumors (MSS/pMMR) (adjusted hazard ratio [aHR], 0.82; 95% CI [confidence interval], 0.69-0.98; P = 0.029). This finding remained when looking at patients treated with standard oxaliplatin-based adjuvant chemotherapy regimens only (aHR, 0.76; 95% CI, 0.58-1.00; P = 0.048). Same trends for SAR were observed when analyzing MSI/dMMR versus MSS/pMMR tumor subgroups lacking BRAFV600E (aHR, 0.84; P = 0.10) or those harboring BRAFV600E (aHR, 0.88; P = 0.43), without reaching statistical significance. Furthermore, SAR was significantly shorter in tumors with BRAFV600E versus those lacking this mutation (aHR, 2.06; 95% CI, 1.73-2.46; P < 0.0001), even in the subgroup of MSI/dMMR tumors (aHR, 2.65; 95% CI, 1.67-4.21; P < 0.0001). Other factors associated with a shorter SAR were as follows: older age, male gender, T4/N2, proximal primary tumor location, poorly differentiated adenocarcinoma, and early recurrence. CONCLUSIONS In stage III CC patients recurring after adjuvant chemotherapy, and before the era of immunotherapy, the MSI/dMMR phenotype was associated with a better SAR compared with MSS/pMMR. BRAFV600E mutation was a poor prognostic factor for both MSI/dMMR and MSS/pMMR patients. TRIAL IDENTIFICATION NUMBERS NCT00079274, NCT00265811, NCT00004931, NCT00004931, NCT00026273, NCT00096278, NCT00112918.
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Affiliation(s)
- J Taieb
- Department of Gastroenterology and GI oncology, Sorbonne Paris Cité, Université Paris Descartes, Hopital Européen Georges Pompidou, Paris, France.
| | - Q Shi
- Department of Health Science Research, Mayo Clinic, Rochester
| | - L Pederson
- Department of Health Science Research, Mayo Clinic, Rochester
| | - S Alberts
- Division of Medical Oncology, Mayo Clinic, Rochester
| | - N Wolmark
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, USA
| | - E Van Cutsem
- Department of Medical Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - A de Gramont
- Department of Medical Oncology, Franco British Institute, Levallois Perret, France
| | - R Kerr
- MRC Clinical Trials Unit at UCL, London, UK
| | - A Grothey
- Department of GI Oncology, West Cancer Center, The University of Tennessee, Memphis, USA
| | - S Lonardi
- Department of Medical Oncology Unit 1, Veneto Oncology Institute-IRCCS, Padua, Italy
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - G Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh
| | - F A Sinicrope
- Department of Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, USA
| | - A Zaanan
- Department of Gastroenterology and GI oncology, Sorbonne Paris Cité, Université Paris Descartes, Hopital Européen Georges Pompidou, Paris, France
| | - T André
- Department of Medical Oncology, Sorbonne Universités and Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris and Groupe Coopérateur Multidisciplinaire en Oncologie (GERCOR), Paris, France
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Larsen A, van Dreden P, Chibaudel B, de Gramont A, Gerotziafas G, Thouroude S. Acquired chemoresistance of colorectal cancer (CRC) cells is accompanied by pro-invasive VEGF-signaling that can be attenuated by aflibercept. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Auclin E, Andre T, Taieb J, Banzi M, van Laethem JL, Tabernero J, Hickish T, de Gramont A, Vernerey D. Postoperative carcinoembryonic antigen (CEA) association with survival and oxaliplatin benefit in stage II colon cancer (CC): Post hoc analysis of the MOSAIC trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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van Rooijen KL, Shi Q, Goey KKH, Meyers J, Heinemann V, Diaz-Rubio E, Aranda E, Falcone A, Green E, de Gramont A, Sargent DJ, Punt CJA, Koopman M. Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: Individual patient data analysis of first-line randomised trials from the ARCAD database. Eur J Cancer 2018; 91:99-106. [PMID: 29353165 DOI: 10.1016/j.ejca.2017.12.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022]
Abstract
Indication for primary tumour resection (PTR) in asymptomatic metastatic colorectal cancer (mCRC) patients is unclear. Previous retrospective analyses suggest a survival benefit for patients who underwent PTR. The aim was to evaluate the prognostic value of PTR in patients with synchronous mCRC by analysis of recent large RCTs including systemic therapy with modern targeted agents. Individual patient data (IPD) of 3423 patients enrolled into 8 randomised controlled trials (RCTs) with first-line systemic therapy in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were analysed. The number of patients with unresected synchronous mCRC, resected synchronous mCRC and metachronous mCRC was 710 (21%), 1705 (50%) and 1008 (29%), respectively. Adjusting for age, gender, performance status (PS) and prior chemotherapy, the unresected group had a significantly worse median overall survival (16.4 m) compared with the synchronous resected (22.2 m; hazard ratio [HR] 1.60, 95% CI 1.43-1.78) and metachronous (22.4 m; HR 1.81, 95% CI 1.58-2.07) groups. Similarly, median progression-free survival was significantly worse for the unresected group compared with the synchronous resected (HR 1.31, 95% CI 1.19-1.44) and metachronous (HR 1.47, 95% CI 1.30-1.66) groups. In a multivariate analysis, the observed associations remained significant. This largest IPD analysis of mCRC trials to date demonstrates an improved survival in synchronous mCRC patients after PTR. These results may be subject to bias since reasons for (non)resection were not available. Until results of ongoing RCTs are available, both upfront PTR followed by systemic treatment and upfront systemic treatment are considered appropriate treatment strategies.
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Affiliation(s)
- K L van Rooijen
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Q Shi
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - K K H Goey
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J Meyers
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | - E Diaz-Rubio
- Cancer Translational Unit, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - E Aranda
- Department of Medical Oncology, UCO, Maimonides Institute of Biomedical Research (IMIBIC), CIBERONC, Instituto de Salud Carlos III, Córdoba, Spain
| | - A Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy
| | - E Green
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - A de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - D J Sargent
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
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Taieb J, Bonnetain F, Mineur L, Bennouna J, Desrame J, Faroux R, Fratte S, Dauba J, Vernerey D, Louvet C, Lepere C, Dupuis O, Becouarn Y, Mabro M, Egreteau J, Bouche O, Deplanque G, Ychou M, de Gramont A, André T. Three versus six months’ adjuvant oxaliplatin-based chemotherapy for patients with stage III colon cancer: Per-protocol, subgroups and long-lasting neuropathy results. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Bonnetain F, Borg C, Adams RR, Ajani JA, Benson A, Bleiberg H, Chibaudel B, Diaz-Rubio E, Douillard JY, Fuchs CS, Giantonio BJ, Goldberg R, Heinemann V, Koopman M, Labianca R, Larsen AK, Maughan T, Mitchell E, Peeters M, Punt CJA, Schmoll HJ, Tournigand C, de Gramont A. How health-related quality of life assessment should be used in advanced colorectal cancer clinical trials. Ann Oncol 2017; 28:2077-2085. [PMID: 28430862 DOI: 10.1093/annonc/mdx191] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Traditionally, the efficacy of cancer treatment in patients with advance or metastatic disease in clinical studies has been studied using overall survival and more recently tumor-based end points such as progression-free survival, measurements of response to treatment. However, these seem not to be the relevant clinical end points in current situation if such end points were no validated as surrogate of overall survival to demonstrate the clinical efficacy. Appropriate, meaningful, primary patient-oriented and patient-reported end points that adequately measure the effects of new therapeutic interventions are then crucial for the advancement of clinical research in metastatic colorectal cancer to complement the results of tumor-based end points. Health-related quality of life (HRQoL) is effectively an evaluation of quality of life and its relationship with health over time. HRQoL includes the patient report at least of the way a disease or its treatment affects its physical, emotional and social well-being. Over the past few years, several phase III trials in a variety of solid cancers have assessed the incremental value of HRQoL in addition to the traditional end points of tumor response and survival results. HRQoL could provide not only complementary clinical data to the primary outcomes, but also more precise predictive and prognostic value. This end point is useful for both clinicians and patients in order to achieve the dogma of precision medicine. The present article examines the use of HRQoL in phase III metastatic colorectal cancer clinical trials, outlines the importance of HRQoL assessment methods, analysis, and results presentation. Moreover, it discusses the relevance of including HRQoL as a primary/co-primary end point to support the progression-free survival results and to assess efficacy of treatment in the advanced disease setting.
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Affiliation(s)
- F Bonnetain
- Methodology and Quality of Life Unit, Oncology Department (INSERM UMR 1098), Quality of Life and Cancer Clinical Research Platform
| | - C Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon
- Centre d'Investigation Clinique en Biothérapie, CIC-1431, Nantes
- 11UMR1098 INSERM/Université de Franche Comté/Etablissement Français du Sang, Besançon
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - R R Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - J A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - A Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - H Bleiberg
- Montagne de Saint Job, Brussels, Belgium
| | - B Chibaudel
- Institut Hospitalier Franco-Britannique, Levallois-Perret, France
| | - E Diaz-Rubio
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J Y Douillard
- Medical Oncology, Institut de Cancérologie de l'Ouest (ICO), Nantes St-Herblain, France
| | - C S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - B J Giantonio
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - R Goldberg
- Department of Medicine, The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, USA
| | - V Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - A K Larsen
- Cancer Biology and Therapeutics, INSERM and Université Pierre et Marie Curie, Hôpital Saint-Antoine, Paris, France
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - E Mitchell
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - M Peeters
- Department of Oncology, Center for Oncological Research Antwerp, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H J Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - C Tournigand
- Department of Oncology, University of Paris Est Creteil; APHP, Henri-Mondor Hospital, Créteil, France
| | - A de Gramont
- Institut Hospitalier Franco-Britannique, Levallois-Perret, France
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Larsen A, Thouroude S, Louadj L, Sabbah M, Dochy E, de Gramont A, Denis J, Bouygues A. Influence of HIF-2alpha deregulation and overexpression of VEGF ligands on the response to aflibercept: Identification of predictive biomarkers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Bleiberg H, Decoster G, de Gramont A, Rougier P, Sobrero A, Benson A, Chibaudel B, Douillard JY, Eng C, Fuchs C, Fujii M, Labianca R, Larsen AK, Mitchell E, Schmoll HJ, Sprumont D, Zalcberg J. A need to simplify informed consent documents in cancer clinical trials. A position paper of the ARCAD Group. Ann Oncol 2017; 28:922-930. [PMID: 28453700 PMCID: PMC5406755 DOI: 10.1093/annonc/mdx050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents. Methods The Aide et Recherche en Cancérologie Digestive (ARCAD) Group, an international scientific committee involving oncologists from all over the world, addressed these issues and developed and uniformly accepted a simplified informed consent documentation for future clinical research. Results A simplified form of informed consent with the leading part of 1200-1800 words containing all of the key information necessary to meet ethical and regulatory requirements and 'relevant supportive information appendix' of 2000-3000 words is provided. Conclusions This position paper, on the basis of the ARCAD Group experts discussions, proposes our informed consent model and the rationale for its content.
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Affiliation(s)
| | | | - A. de Gramont
- Department of Medical Oncology, Institut Hospitalier Franco-Britannique, Levallois Perret
| | - P. Rougier
- Gastroenterology and Digestive Oncology Department, European Hospital, Georges Pompidou, Paris, France
| | - A. Sobrero
- Medical Oncology Unit, Ospedale San Martino, Genova, Italy
| | - A. Benson
- Division of Hematology/Oncology, Robert H. Comprehensive Cancer Center Northwestern University, Chicago, USA
| | - B. Chibaudel
- Department of Medical Oncology, Institut Hospitalier Franco-Britannique, Levallois Perret
| | - J. Y. Douillard
- Department of Medical Oncology, Centre R. Gauducheau Université de Nantes, Saint Herblain, France
| | - C. Eng
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - C. Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M. Fujii
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - R. Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - A. K. Larsen
- Laboratory of Cancer Biology and Therapeutics, INSERM and Université Pierre et Marie Curie, Saint-Antoine Hospital, Paris, France
| | - E. Mitchell
- Kimmel Cancer Center at Jefferson, Jefferson University Hospitals, Philadelphia, USA
| | - H. J. Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - D. Sprumont
- Institute of Health Law, University of Neuchâtel, Neuchâtel, Switzerland
| | - J. Zalcberg
- Faculty of Medicine, Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Szturz P, Raymond E, Abitbol C, Albert S, de Gramont A, Faivre S. Understanding c-MET signalling in squamous cell carcinoma of the head & neck. Crit Rev Oncol Hematol 2017; 111:39-51. [DOI: 10.1016/j.critrevonc.2017.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/28/2016] [Accepted: 01/09/2017] [Indexed: 12/21/2022] Open
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16
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Henriques J, Vernerey D, de Gramont A, Chibaudel B, Van Cutsem E, Falcone A, Goldberg R, Shi Q, Bonnetain F, Shmueli E. O-012 Prognosis of lung metastases in patients with metastatic colorectal cancer: an ARCAD meta analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hickish T, André T, Wyrwicz L, Saunders M, Sarosiek T, Nemecek R, Kocsis J, Stecher M, de Gramont A. O-027 A pivotal phase 3 trial of MABp1 in advanced colorectal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Anota A, Vernerey D, Tournigand C, Chibaudel B, Louvet C, Larsen A, André T, de Gramont A, Bonnetain F. Impact de l’ajout de l’erlotinib à un traitement de maintenance par bévacizumab sur la qualité de vie relative à la santé chez des patients atteints d’un cancer colorectal métastatique : résultats de l’essai de phase III DREAM. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sebbagh S, Roux J, Dreyer C, Neuzillet C, de Gramont A, Orbegoso C, Hentic O, Hammel P, de Gramont A, Raymond E, André T, Chibaudel B, Faivre S. P-139 Efficacy of a Sequential Treatment Strategy with GEMOX Followed by FOLFIRI in Advanced Cholangiocarcinoma. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bouygues A, Mesange P, Ayadi M, Chiron M, Dochy E, Andre T, de Gramont A, Larsen A. P-221 Acquired 5-FU resistance in CRC models is accompanied by upregulation of VEGF-VEGFR1 signaling, increased migration and invasion that can be attenuated by aflibercept. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Mésange P, Bouygues A, Muller D, Savina A, Chibaudel B, Tournigand C, André T, de Gramont A, Larsen A. PD-010 Erlotinib attenuates bevacizumab-mediated activation of EGFR-survival signaling in CRC models independent of KRAS status providing a rational basis for the DREAM phase III clinical trial. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv234.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Arnold D, Schmoll HJ, de Gramont A, Ducreux M, Grothey A, O'Dwyer P, Tabernero J, Hermann F, Bendahmane B, Mancao C, Van Cutsem E. LBA-10 MODUL – A Multicentre Randomised Clinical Trial of Biomarker-Driven Therapy for the 1st-Line Maintenance Treatment of Metastatic Colorectal Cancer (mCRC): A Highly Adaptable Signal-Seeking Approach. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv262.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Hebbar M, Chibaudel B, André T, Mineur L, Smith D, Louvet C, Dutel J, Ychou M, Legoux J, Mabro M, Faroux R, Auby D, Brusquant D, Khalil A, Truant S, Hadengue A, Dalban C, Gayet B, Paye F, Pruvot F, Bonnetain F, de Gramont A. FOLFOX4 versus sequential dose-dense FOLFOX7 followed by FOLFIRI in patients with resectable metastatic colorectal cancer (MIROX): a pragmatic approach to chemotherapy timing with perioperative or postoperative chemotherapy from an open-label, randomized phase III trial. Ann Oncol 2015; 26:1040. [DOI: 10.1093/annonc/mdv141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Santos CD, Tijeras-Raballand A, Serova M, Sebbagh S, Slimane K, Faivre S, de Gramont A, Raymond E. Effects of preset sequential administrations of sunitinib and everolimus on tumour differentiation in Caki-1 renal cell carcinoma. Br J Cancer 2015; 112:86-94. [PMID: 25422908 PMCID: PMC4453618 DOI: 10.1038/bjc.2014.578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Sunitinib (VEGFR/PDGFR inhibitor) and everolimus (mTOR inhibitor) are both approved for advanced renal cell carcinoma (RCC) as first-line and second-line therapy, respectively. In the clinics, sunitinib treatment is limited by the emergence of acquired resistance, leading to a switch to second-line treatment at progression, often based on everolimus. No data have been yet generated on programmed alternating sequential strategies combining alternative use of sunitinib and everolimus before progression. Such strategy is expected to delay the emergence of acquired resistance and improve tumour control. The aim of our study was to assess the changes in tumours induced by three different sequences administration of sunitinib and everolimus. METHODS In human Caki-1 RCC xenograft model, sunitinib was alternated with everolimus every week, every 2 weeks, or every 3 weeks. Effects on necrosis, hypoxia, angiogenesis, and EMT status were assessed by immunohisochemistry and immunofluorescence. RESULTS Sunitinib and everolimus programmed sequential regimens before progression yielded longer median time to tumour progression than sunitinib and everolimus monotherapies. In each group of treatment, tumour growth control was associated with inhibition of mTOR pathway and changes from a mesenchymal towards an epithelial phenotype, with a decrease in vimentin and an increase in E-cadherin expression. The sequential combinations of these two agents in a RCC mouse clinical trial induced antiangiogenic effects, leading to tumour necrosis. CONCLUSIONS In summary, our study showed that alternate sequence of sunitinib and everolimus mitigated the development of mesenchymal phenotype compared with sunitinib as single agent.
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Affiliation(s)
- C D Santos
- AAREC Filia Research, 1 place Paul Verlaine, 92100 Boulogne Billancourt, France
- Inserm U728, Department of Medical Oncology, Beaujon University Hospital, 100 Boulevard du general Leclerc, 92110 Clichy, France
| | - A Tijeras-Raballand
- AAREC Filia Research, 1 place Paul Verlaine, 92100 Boulogne Billancourt, France
- Inserm U728, Department of Medical Oncology, Beaujon University Hospital, 100 Boulevard du general Leclerc, 92110 Clichy, France
| | - M Serova
- AAREC Filia Research, 1 place Paul Verlaine, 92100 Boulogne Billancourt, France
- Inserm U728, Department of Medical Oncology, Beaujon University Hospital, 100 Boulevard du general Leclerc, 92110 Clichy, France
| | - S Sebbagh
- Inserm U728, Department of Medical Oncology, Beaujon University Hospital, 100 Boulevard du general Leclerc, 92110 Clichy, France
| | - K Slimane
- Novartis Pharma SAS, 2 et 4 rue Lionel Terray, 92506 Rueil Malmaison, France
| | - S Faivre
- New drugs Evaluation Laboratory, Center of Experimental Therapeutics and Medical Oncology, Oncology Department, CHUV, Lausanne Switzerland
| | - A de Gramont
- AAREC Filia Research, 1 place Paul Verlaine, 92100 Boulogne Billancourt, France
- New drugs Evaluation Laboratory, Center of Experimental Therapeutics and Medical Oncology, Oncology Department, CHUV, Lausanne Switzerland
| | - E Raymond
- Inserm U728, Department of Medical Oncology, Beaujon University Hospital, 100 Boulevard du general Leclerc, 92110 Clichy, France
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Hebbar M, Chibaudel B, André T, Mineur L, Smith D, Louvet C, Dutel JL, Ychou M, Legoux JL, Mabro M, Faroux R, Auby D, Brusquant D, Khalil A, Truant S, Hadengue A, Dalban C, Gayet B, Paye F, Pruvot FR, Bonnetain F, Taieb J, Brucker P, Landi B, Flesch M, Carola E, Martin P, Vaillant E, de Gramont A. FOLFOX4 versus sequential dose-dense FOLFOX7 followed by FOLFIRI in patients with resectable metastatic colorectal cancer (MIROX): a pragmatic approach to chemotherapy timing with perioperative or postoperative chemotherapy from an open-label, randomized phase III trial. Ann Oncol 2014; 26:340-7. [PMID: 25403578 DOI: 10.1093/annonc/mdu539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Perioperative FOLFOX4 (oxaliplatin plus 5-fluorouracil/leucovorin) chemotherapy is the current standard in patients with resectable metastases from colorectal cancer (CRC). We aimed to determine whether a sequential chemotherapy with dose-dense oxaliplatin (FOLFOX7) and irinotecan (FOLFIRI; irinotecan plus 5-fluorouracil/leucovorin) is superior to FOLFOX4. The chemotherapy timing was not imposed, and was perioperative or postoperative. PATIENTS AND METHODS In this open-label, phase III trial, patients with resectable or resected metastases were randomly assigned either to 12 cycles of FOLFOX4 (oxaliplatin 85 mg/m(2)) or 6 cycles of FOLFOX7 (oxaliplatin 130 mg/m(2)) followed by 6 cycles of FOLFIRI (irinotecan 180 mg/m(2)). Randomization was done centrally, with stratification by chemotherapy timing, type of local treatment (surgery versus radiofrequency ablation with/without surgery), and Fong's prognostic score. The primary end point was 2-year disease-free survival (DFS). RESULTS A total of 284 patients were randomized, 142 in each treatment group. Chemotherapy was perioperative in 168 (59.2%) patients and postoperative in 116 (40.8%) patients. Perioperative chemotherapy was preferentially proposed for synchronous metastases, whereas postoperative chemotherapy was more frequently used for metachronous metastases. Two-year DFS was 48.5% in the FOLFOX4 group and 50.0% in the FOLFOX7-FOLFIRI group. In the multivariable analysis, more than one metastasis [hazard ratio (HR) = 2.15] and synchronous metastases (HR = 1.63) were independent prognostic factors for shorter DFS. Five-year overall survival (OS) rate was 69.5% with FOLFOX4 versus 66.6% with FOLFOX7-FOLFIRI. CONCLUSIONS FOLFOX7-FOLFIRI is not superior to FOLFOX4 in patients with resectable metastatic CRC. Five-year OS rates observed in both groups are the highest ever reported in this setting, possibly reflecting the pragmatic approach to chemotherapy timing. CLINICAL TRIALS NUMBER NCT00268398.
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Affiliation(s)
- M Hebbar
- Department of Medical Oncology, University Hospital, Lille
| | - B Chibaudel
- Department of Medical Oncology, Hospital Saint-Antoine, Paris
| | - T André
- Department of Medical Oncology, Hospital Saint-Antoine, Paris
| | - L Mineur
- Department of Radiotherapy, Institute Sainte-Catherine, Avignon
| | - D Smith
- Department of Medical Oncology and Radiotherapy, Hospital Saint-André, Bordeaux
| | - C Louvet
- Department of Oncology, Institute Mutualiste Montsouris, Paris
| | - J L Dutel
- Department of Medical Oncology, Radiotherapy Service, Hospital Centre Beauvais, Beauvais
| | - M Ychou
- Regional Centre against Cancer, Val d'Aurelle-Paul Lamarque, Montpellier
| | - J L Legoux
- Department of Hepatology and Gastroenterology, Hospital de Haut-Lévêque, Pessac
| | - M Mabro
- Department of Medical Oncology, Hospital Foch, Suresnes
| | - R Faroux
- Department of Gastroenterology, Hospital La Roche-sur-Yon, La Roche-sur-Yon
| | - D Auby
- Department of Medicine, Hospital Libourne, Libourne
| | | | - A Khalil
- Department of Medical Oncology, Hospital Tenon, Paris
| | - S Truant
- Department of Digestive Surgery and Transplantation, University Hospital, Lille
| | | | - C Dalban
- Methodology and Quality of Life in Oncology Department EA 3181, Hospital Besançon, Besançon
| | - B Gayet
- Department of Surgery, Institute Mutualiste Montsouris, Paris
| | - F Paye
- Department of Digestive Surgery, Hospital Saint-Antoine, Paris
| | - F R Pruvot
- Department of Digestive Surgery and Transplantation, University Hospital, Lille
| | - F Bonnetain
- Methodology and Quality of Life in Oncology Department EA 3181, Hospital Besançon, Besançon
| | - J Taieb
- Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris
| | - P Brucker
- Department of Gastroenterology, Centre hospitalier François Maillot, Briey
| | - B Landi
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou Service Hépato-gastroentérologie; Paris
| | - M Flesch
- Department of Medical Oncology, Clinique Clément Drevon, Dijon
| | - E Carola
- Department of Medical Oncology, Centre Hospitalier, Senlis
| | - P Martin
- Department of Cancerology, Centre Bourgogne, Lille
| | - E Vaillant
- Department of Gastroenterology, Clinique Ambroise Paré, Lille, France
| | - A de Gramont
- Department of Medical Oncology, Hospital Saint-Antoine, Paris
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Bouygues A, Mésange P, Ayadi M, Poindessous V, Chiron M, Dochy E, André T, de Gramont A, Larsen A. 406 Aflibercept (Zaltrap) directly attenuates the migration and invasion of colorectal cancer cells. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soveri L, Hermunen K, de Gramont A, Poussa T, Quinaux E, Bono P, André T, Österlund P. Association of adverse events and survival in colorectal cancer patients treated with adjuvant 5-fluorouracil and leucovorin: Is efficacy an impact of toxicity? Eur J Cancer 2014; 50:2966-74. [DOI: 10.1016/j.ejca.2014.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/22/2014] [Accepted: 08/06/2014] [Indexed: 12/27/2022]
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Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, Köhne CH, Rostoft S, Lemmens V, Mitry E, Rutten H, Sargent D, Sastre J, Seymour M, Starling N, Van Cutsem E, Aapro M. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 2014; 26:463-76. [PMID: 25015334 DOI: 10.1093/annonc/mdu253] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Europe and worldwide, with the peak incidence in patients >70 years of age. However, as the treatment algorithms for the treatment of patients with CRC become ever more complex, it is clear that a significant percentage of older CRC patients (>70 years) are being less than optimally treated. This document provides a summary of an International Society of Geriatric Oncology (SIOG) task force meeting convened in Paris in 2013 to update the existing expert recommendations for the treatment of older (geriatric) CRC patients published in 2009 and includes overviews of the recent data on epidemiology, geriatric assessment as it relates to surgery and oncology, and the ability of older CRC patients to tolerate surgery, adjuvant chemotherapy, treatment of their metastatic disease including palliative chemotherapy with and without the use of the biologics, and finally the use of adjuvant and palliative radiotherapy in the treatment of older rectal cancer patients. An overview of each area was presented by one of the task force experts and comments invited from other task force members.
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Affiliation(s)
- D Papamichael
- Department of Medical Oncology, B.O. Cyprus Oncology Centre, Nicosia, Cyprus
| | | | - B Glimelius
- Department of Radiology, Oncology and Radiation Science, University of Uppsala, Uppsala, Sweden
| | | | | | - D Haller
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, USA
| | - C-H Köhne
- Klinikum Oldenburg, Oldenburg, Germany
| | - S Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - V Lemmens
- Erasmus MC University Medical Centre, Rotterdam Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands
| | - E Mitry
- Department of Medical Oncology, Institut Curie, Paris Université Versailles Saint-Quentin, Guyancourt, France
| | - H Rutten
- Catharina Hospital Eindhoven, Eindhoven Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - J Sastre
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, Spain
| | - M Seymour
- Cancer Medicine and Pathology, University of Leeds, Leeds
| | - N Starling
- Gastrointestinal Unit, Royal Marsden Hospital, London, UK
| | - E Van Cutsem
- Digestive Oncology, Leuven Cancer Institute, Leuven, Belgium
| | - M Aapro
- SIOG Office, Clinique de Genolier, Genolier, Switzerland
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29
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Roy AC, Park SR, Cunningham D, Kang YK, Chao Y, Chen LT, Rees C, Lim HY, Tabernero J, Ramos FJ, Kujundzic M, Cardic MB, Yeh CG, de Gramont A. A randomized phase II study of PEP02 (MM-398), irinotecan or docetaxel as a second-line therapy in patients with locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma. Ann Oncol 2013; 24:1567-73. [PMID: 23406728 DOI: 10.1093/annonc/mdt002] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND PEP02 is a novel highly stable liposomal nanocarrier formulation of irinotecan. This randomized phase II study evaluated the efficacy and safety of single agent PEP02 compared with irinotecan or docetaxel in the second-line treatment of advanced oesophago-gastric (OG) cancer. PATIENTS AND METHODS Patients with locally advanced/metastatic disease who had failed one prior chemotherapy regimen were randomly assigned to PEP02 120 mg/m(2), irinotecan 300 mg/m(2) or docetaxel (Taxotere) 75 mg/m(2) every 3 weeks. The primary end point was objective response rate (ORR). Simon's two-stage design was used and the ORR of interest was 20% (α = 0.05, type II error β = 0.10, null hypothesis of ORR was 5%). RESULTS Forty-four patients per arm received treatment, and 124 were assessable for response. The ORR statistical threshold for the first stage was reached in all arms. In the intent-to-treat (ITT) population, ORRs were 13.6% (6/44), 6.8% (3/44) and 15.9% (7/44) in the PEP02, irinotecan and docetaxel arms, respectively. The median progression-free survival (PFS) and overall survival were similar between the trial arms. Commonest grade 3-4 adverse event reported was diarrhoea in the PEP02 and irinotecan groups (27.3% versus 18.2%). CONCLUSION The ORR associated with PEP02 was comparable with docetaxel and numerically greater than that of irinotecan. PEP02 warrants further evaluation in the advanced gastric cancer setting.
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Affiliation(s)
- A C Roy
- Department of Medicine, The Royal Marsden Hospital, Sutton, UK
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30
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André T, Blons H, Mabro M, Chibaudel B, Bachet JB, Tournigand C, Bennamoun M, Artru P, Nguyen S, Ebenezer C, Aissat N, Cayre A, Penault-Llorca F, Laurent-Puig P, de Gramont A. Panitumumab combined with irinotecan for patients with KRAS wild-type metastatic colorectal cancer refractory to standard chemotherapy: a GERCOR efficacy, tolerance, and translational molecular study. Ann Oncol 2013; 24:412-419. [PMID: 23041588 DOI: 10.1093/annonc/mds465] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the combination of panitumumab and irinotecan in patients with KRAS wild-type metastatic colorectal cancer refractory to standard chemotherapy (oxaliplatin, fluoropyrimidines-irinotecan and bevacizumab). PATIENTS AND METHODS KRAS status was first determined locally but subsequent validation of KRAS status and additional screenings (rare KRAS, NRAS, BRAF mutations and EGFR copy number) were centrally assessed. Patients received panitumumab (6 mg/kg) and irinotecan (180 mg/m²) every 2 weeks. RESULTS Sixty-five eligible patients were analyzed. The objective response rate (ORR) was 29.2% [95% confidence interval (95% CI) 18.2-40.3]. Median progression-free and overall survivals were 5.5 and 9.7 months, respectively. Most frequent grade 3/4 toxic effects were skin 32.3%, diarrhea 15.4% and neutropenia 12.3%. Tissue samples were available for 60 patients. For the confirmed KRAS wild-type population codon 12 or 13 mutation (n = 54), ORR was 35.2% (95% CI 22.4.1-47.9). Thirteen patients had a NRAS, a BRAF or a rare KRAS mutation, and no tumor response was observed in this subgroup when compared with 46.3% (95% CI 31.1-61.6) ORR in the subgroup of 41 patients with no identified mutation. CONCLUSION Panitumumab and irinotecan is an active third-line regimen in a well-defined population based on biomarkers. ClinicalTrials.gov Identifier NCT00655499.
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Affiliation(s)
- T André
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris.
| | - H Blons
- Université Paris Sorbonne Cité; Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) - S775 Molecular Basis of Xenobiotics Response; Assistance Publique Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris
| | - M Mabro
- Department of Clinical Research, GERCOR, Paris; Department of medical Oncology,Hôpital Foch, Suresnes, France
| | - B Chibaudel
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris
| | - J-B Bachet
- Department of Clinical Research, GERCOR, Paris; Department of Hepato-Gastro-Enterology, Hôpital La Pitié Salpetrière, Paris
| | - C Tournigand
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris
| | - M Bennamoun
- Department of Clinical Research, GERCOR, Paris; Department of medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | - P Artru
- Department of Clinical Research, GERCOR, Paris; Departement of Hepato-Gastro-Enterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - S Nguyen
- Department of medical Oncology, Centre Hospitalier de Beauvais, Beauvais, France
| | - C Ebenezer
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris
| | - N Aissat
- Department of Clinical Research, GERCOR, Paris
| | - A Cayre
- Biology and Tumor Pathology Department, Centre Jean-Perrin, Université d'Auvergne Equipe Associée EA4233 Centre Hospitalier Universitaire (CHU) Clermont-Ferrand
| | - F Penault-Llorca
- Biology and Tumor Pathology Department, Centre Jean-Perrin, Université d'Auvergne Equipe Associée EA4233 Centre Hospitalier Universitaire (CHU) Clermont-Ferrand
| | - P Laurent-Puig
- Université Paris Sorbonne Cité; Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) - S775 Molecular Basis of Xenobiotics Response; Assistance Publique Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris
| | - A de Gramont
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris
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Neuzillet C, Serova M, Raballand A, Astorgues-Xerri L, Riveiro M, de Gramont A, Ruszniewski P, Hammel P, Faivre S, Raymond E. 398 Benchmarking the Allosteric MEK Inhibitors UO126, AZD6244, AS703026, and GSK1120212 Shows Differences in Potency to Inhibit ERK Phosphorylation, Proliferation, and Invasion in Pancreatic Cancer Models. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Neuzillet C, Serova M, Raballand A, Astorgues-Xerri L, Riveiro M, de Gramont A, Ruszniewski P, Hammel P, Faivre S, Raymond E. 402 Dual Inhibition of the MEK and the PI3K-Akt-mTOR Pathways Using GSK1120212 (or UO126) and Everolimus Overcomes Resistance to MEK Inhibitors Used as Single Agents in Pancreatic Cancer Cells. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- M Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - D J Sargent
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester
| | - R M Goldberg
- Ohio State University Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, Columbus, USA
| | - A de Gramont
- Department of Oncology, Hôpital Saint-Antoine, Paris, France.
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Lledo G, Mammar V, Michel P, Dahan L, Mineur L, Galais MP, Dupuis O, Chibaudel B, Jovenin N, de Gramont A. Chimioradiothérapie concomitante par folfox–cetuximab dans les carcinomes du cardia et de l’œsophage de stade III : résultats définitifs de l’étude de phase II Erafox du groupe Gercor. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andre T, Chibaudel B, Mabro M, Bennamoun M, Artru P, Bachet J, Hadengue A, Blons H, Laurent-Puig P, de Gramont A. 6144 POSTER Phase II Study of Panitumumab With Irinotecan for Patients With KRas Wild-type Metastatic Colorectal Cancer (MCRC) Refractory to Standard Chemotherapy – a GERCor Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rousseau B, Loulergue P, Mir O, Krivine A, Kotti S, Viel E, Simon T, de Gramont A, Goldwasser F, Launay O, Tournigand C. Immunogenicity and safety of the influenza A H1N1v 2009 vaccine in cancer patients treated with cytotoxic chemotherapy and/or targeted therapy: the VACANCE study. Ann Oncol 2011; 23:450-7. [PMID: 21576285 DOI: 10.1093/annonc/mdr141] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza vaccination is recommended to cancer patients undergoing chemotherapy, but vaccine coverage remains low. During the 2009 influenza pandemic, French recommendations were to vaccinate immunocompromised patients with two doses of adjuvanted vaccine. This study aimed to evaluate vaccine immunogenicity in cancer patients receiving chemotherapy. PATIENTS AND METHODS VACANCE is a prospective open-label study that evaluated the immunogenicity and safety of two doses of AS03A-adjuvanted H1N1v vaccine in cancer patients receiving cytotoxic and/or targeted therapies. Serum haemagglutination-inhibited antibody titres against influenza A H1N1v were measured at days 1, 21, and 42, to estimate the proportion of participants with antibody titres ≥ 1 : 40 [seroprotection rate (SPR)], the efficacy of seroconversion, and factors that increased the geometric mean titre. RESULTS Sixty-five patients were included. At baseline, 5% of patients had vaccine strain titres of specific haemagglutination inhibition antibodies that were ≥ 1 : 40. After one and two doses of vaccine, SPRs were 48% and 73%, respectively, and seroconversion rates were 44% and 73%, respectively. Vaccine-related adverse events were mild to moderate. CONCLUSIONS A single dose of AS03-adjuvanted A/H1N1 vaccine triggered a low immune response in cancer patients on chemotherapy depending on their treatment type and frequency. Two doses are needed for these cancer patients.
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Affiliation(s)
- B Rousseau
- Oncology Unit, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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Sargent D, Shi Q, Yothers G, Van Cutsem E, Cassidy J, Saltz L, Wolmark N, Bot B, Grothey A, Buyse M, de Gramont A. Two or three year disease-free survival (DFS) as a primary end-point in stage III adjuvant colon cancer trials with fluoropyrimidines with or without oxaliplatin or irinotecan: data from 12,676 patients from MOSAIC, X-ACT, PETACC-3, C-06, C-07 and C89803. Eur J Cancer 2011; 47:990-6. [PMID: 21257306 DOI: 10.1016/j.ejca.2010.12.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/10/2010] [Accepted: 12/15/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND The ACCENT group previously established disease-free survival (DFS) with 2 or 3 years median follow-up to predict 5 year overall survival (5 year OS) in stage II and III colon cancer. ACCENT further proposed (1) a stronger association between DFS and OS in stage III than II, and (2) 6 or 7 years necessary to demonstrate DFS/OS surrogacy in recent trials. The relationship between end-points in trials with oral fluoropyrimidines, oxaliplatin and irinotecan is unknown. METHODS Associations between the treatment effect hazard ratios (HRs) on 2 and 3 years DFS, and 5 and 6 years OS were examined in 6 phase III trials not included in prior analyses from 1997 to 2002. Individual data for 12,676 patients were analysed; two trials each tested oxaliplatin, irinotecan and oral treatment versus 5-FU/LV. FINDINGS Overall association between 2/3 year DFS and 5/6 year OS HRs was modest to poor (simple R² measures: 0.58-0.76, model-based R²: 0.17-0.49). In stage III patients, the association increased (model-based R² ≥ 0.79). Observed treatment effects on 2 year DFS accurately 5/6 year OS effects overall and in stage III patients. INTERPRETATION In recent trials of cytotoxic chemotherapy, 2 or 3 years DFS HRs are highly predictive of 5 and 6 years OS HRs in stage III but not stage II patients. In all patients the DFS/OS association is stronger for 6 year OS, thus at least 6 year follow-up is recommended to assess OS benefit. These data support DFS as the primary end-point for stage III colon cancer trials testing cytotoxic agents.
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Affiliation(s)
- D Sargent
- NCCTG, Mayo Clinic, Rochester, MN, USA.
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Carola E, Chibaudel B, Mabro M, Kirscher S, Certain-Duclos M, Aparicio T, Mercier-Blas A, Trager-Maury S, Cudennec T, de Gramont A. Geriatric parameters to predict chemotherapy feasibility in elderly patients (≥75 years) with advanced colorectal cancer: Preliminary results of a GERCOR-GEPOG cohort study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chibaudel B, Tournigand C, Bonnetain F, Andre T, Lledo G, Maindrault-Goebel F, Larsen AK, Louvet C, de Gramont A. Handy prognostic model in patients with oxaliplatin-based or irinotecan-based first-line chemotherapy for metastatic colorectal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zaanan A, Cuilliere-Dartigues P, Guilloux A, Parc Y, Louvet C, de Gramont A, Tiret E, Dumont S, Gayet B, Validire P, Fléjou JF, Duval A, Praz F. Impact of p53 expression and microsatellite instability on stage III colon cancer disease-free survival in patients treated by 5-fluorouracil and leucovorin with or without oxaliplatin. Ann Oncol 2010; 21:772-780. [DOI: 10.1093/annonc/mdp383] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ramanathan R, Rothenberg M, de Gramont A, Tournigand C, Goldberg R, Gupta S, André T. Incidence and evolution of oxaliplatin-induced peripheral sensory neuropathy in diabetic patients with colorectal cancer: a pooled analysis of three phase III studies. Ann Oncol 2010; 21:754-758. [DOI: 10.1093/annonc/mdp509] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Tournigand C, Guy-Coichard C, Bengrine-Lefevre L, Garcia ML, Frederic B, de Gramont A. 177 Establishing a program of quality improvement in a medical oncology unit. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041624.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chibaudel B, Tournigand C, Artru P, André T, Cervantes A, Figer A, Lledo G, Flesch M, Buyse M, Mineur L, Carola E, Rivera F, Perez-Staub N, Louvet C, de Gramont A. FOLFOX in patients with metastatic colorectal cancer and high alkaline phosphatase level: an exploratory cohort of the GERCOR OPTIMOX1 study. Ann Oncol 2009; 20:1383-6. [PMID: 19465426 DOI: 10.1093/annonc/mdp012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Alkaline phosphatase (ALP) is a strong prognostic factor in patients with metastatic colorectal cancer (MCRC). Patients with ALP more than three times the upper limit of normal (ULN) were excluded from our previous studies evaluating chemotherapy. An exploratory cohort of patients with ALP >3 ULN was included in the OPTIMOX1 study. PATIENTS AND METHODS Previously untreated patients with MCRC were randomized to FOLFOX4 until progression (arm A) or FOLFOX7 for six cycles, maintenance without oxaliplatin for 12 cycles and reintroduction of FOLFOX7 (arm B). Patients were stratified according to ALP level <or=3 ULN versus 3-5 ULN. RESULTS Among the 620 patients in OPTIMOX1 study, 63 had ALP 3-5 ULN; 33 in arm A and 30 in arm B. The response rate in these patients was 56% versus 59% in patients with ALP <or=3 ULN. Median progression-free survival and overall survival were, respectively, 6.4 and 11.5 months in patients with ALP 3-5 ULN and 9.0 and 21.1 months in patients with ALP <or=3 ULN. Thirty-three percent of the patients in the cohort experienced grade 3/4 toxicity. CONCLUSION Both FOLFOX regimens achieved high tumor response rates and offer good palliation in MCRC patients with a poor prognosis.
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Affiliation(s)
- B Chibaudel
- Department of Medical Oncology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
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Chibaudel B, Tournigand C, Perez-Staub N, Bourges O, Maindrault-Goebel F, André T, Lledo G, Louvet C, Bonnetain F, de Gramont A. Duration of disease control (DDC) or time to failure of strategy (TFS) to evaluate a chemotherapy strategy in advanced colorectal cancer (ACC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4073 Background: Progression-free survival (PFS) is not an optimal endpoint in therapeutic strategies evaluating either stop and go or alternated therapies, or a fixed sequence of two therapies. DDC (Tournigand, JCO 2006) and TFS (Allegra, JCO 2007) composite endpoints have been proposed to evaluate efficacy of these strategies in ACC. This study compared these two alternative endpoints. Methods: DDC is defined as the sum of the PFS of each sequence, except when progressive disease is observed at either reintroduction or second-therapy (DDC=PFS1+PFS2 if treatment 2 achieved stabilization or response). TFS is defined as the total PFS from the initiation of the strategy to disease progression while on all the planned agents, or disease progression during a treatment-free interval and no further therapy received within 1 month, or death (TFS=PFS 1+2). Both DDC and TFS have been calculated in three trials: OPTIMOX1 (oxaliplatin stop and go vs continuous administration, updated database, Tournigand, JCO 2006), OPTIMOX2 (oxaliplatin stop and go vs complete stop and go, updated database, Maindrault-Goebel, ASCO 2007) and C97–3 (FOLFIRI1- FOLFOX6 or reverse sequence, Tournigand 2004). Results: The median potential follow-up time was 39.8 months. There was a moderately shorter DDC than TFS in the two stop and go studies, but a much shorter DDC than TFS in the sequential therapy study. There was a significant correlation between DDC and OS (r=0.96, p=.002) but not between TFS and OS (r=0.71, p=.11) Conclusions: Two bias impacted TFS 1) the results of resuming the planned therapeutic strategy for progression after a chemotherapy-free interval of more than one month was not considered, 2) patients who were not progressive at the end of planned strategy could not be censored at that time. The shorter duration of DDC over TFS may have an advantage in terms of sample size for evaluation of therapeutic strategies. In case of drug registration, DDC does not increase in case of inactive second sequence. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- B. Chibaudel
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - C. Tournigand
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - N. Perez-Staub
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - O. Bourges
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - F. Maindrault-Goebel
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - T. André
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - G. Lledo
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - C. Louvet
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - F. Bonnetain
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - A. de Gramont
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
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Quinaux EM, Baumgaertner I, Khalil A, Louvet C, Buyse ME, de Gramont A, André T. Comparison of l and dl forms of folinic acid in Gercor C96.1 trial (A phase III trial comparing bimonthly LV5FU2 to monthly high-dose 5FU-leucovorin in patients with Dukes’ B2 and C colon cancer). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15004 In C96.1 study (André T et al; J Clin Oncol. 2007 20;25:3732–8), patients were randomized to either monthly 5FU-LV hd (dl LV 200 mg/m2 or l LV 100 mg/m2 15 min iv followed by 5FU 400 mg/m2 15 min iv, d1–5 q4 wk) or LV5FU2 (dl LV 200 mg/m2 or l LV 100 mg/m2 2-hour infusion followed by iv bolus 5FU 400 mg/m2 and 22 hours continuous infusion 600 mg/m2, d1 and d2 q 2 wk). Form l LV was administered to 60% (n=519) of patients and dl LV to 40% (n=357) of patients. It was unknown in 29 patients. No randomization was made between form l or dl (It was the choice of each center). The aim of this analysis was to compare the 2 LV forms in term of safety and efficacy. Important prognostic characteristics were well balanced between the 2 groups. The proportion of any grade III-IV toxicity was 20% in l form and 17% in dl form. There was no difference in term of toxicity between the two groups, except a trend for more diarrhea grade 3–4 in form l (8% in l form vs 4% in dl form, p=0.07). The median follow-up time was 6.2 years in l form and 6.0 years in dl form. There were no statistically significant differences between l and dl forms in term of disease free survival (33.3% vs 32.8% of patients with at least one event in l and dl forms respectively, hazard ratio=1.03, 95% CI=[0.82–1.31], p=0.78). In term of overall survival, there was a trend without statistical significance in favor of l form (21.8% vs 25.5% of patients who died, hazard ratio=1.28, 95% CI=[0.97–1.69], p=0.078). We conclude that the toxicity profile is similar between the two forms (excepted diarrhea). The difference in overall survival should not be attributed to folinic acid form as no difference was observed on DFS. No significant financial relationships to disclose.
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Affiliation(s)
- E. M. Quinaux
- IDDI, Louvain-La- Neuve, Belgium; Gr. Hospitalier Pitié-Salpêtrière, Paris, France; Hôpital Tenon, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - I. Baumgaertner
- IDDI, Louvain-La- Neuve, Belgium; Gr. Hospitalier Pitié-Salpêtrière, Paris, France; Hôpital Tenon, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - A. Khalil
- IDDI, Louvain-La- Neuve, Belgium; Gr. Hospitalier Pitié-Salpêtrière, Paris, France; Hôpital Tenon, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - C. Louvet
- IDDI, Louvain-La- Neuve, Belgium; Gr. Hospitalier Pitié-Salpêtrière, Paris, France; Hôpital Tenon, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - M. E. Buyse
- IDDI, Louvain-La- Neuve, Belgium; Gr. Hospitalier Pitié-Salpêtrière, Paris, France; Hôpital Tenon, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - A. de Gramont
- IDDI, Louvain-La- Neuve, Belgium; Gr. Hospitalier Pitié-Salpêtrière, Paris, France; Hôpital Tenon, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - T. André
- IDDI, Louvain-La- Neuve, Belgium; Gr. Hospitalier Pitié-Salpêtrière, Paris, France; Hôpital Tenon, Paris, France; Hôpital Saint-Antoine, Paris, France
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Sargent DJ, Yothers G, Van Cutsem E, Cassidy J, Saltz L, Wolmark N, Shi Q, Buyse M, de Gramont A. Use of two-year disease-free survival (DFS) as a primary endpoint in stage III adjuvant colon cancer trials with fluoropyrimidines with or without oxaliplatin or irinotecan: New data from 12,676 patients from MOSAIC, X-ACT, PETACC-3, NSAPB C-06 and C-07, and C89803. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4011 Background: The ACCENT group previously validated DFS with 3 years (yr) median follow-up (f-up) based on 20,898 pts from trials testing 5-FU based regimens (rx) (3yr DFS) as an endpoint to predict overall survival with 5 yr median f-up (5yr OS) (Sargent, JCO 2005). ACCENT further proposed (1) 2yr DFS predicts 5yr OS, (2) a stronger relationship between DFS and OS in stage III pts (Sargent JCO 2007) and (3) 6 or 7 yrs are necessary to demonstrate DFS and OS association in future trials due to extended survival following recurrence (de Gramont ASCO 2008). The relationship between endpoints in more recent trials with oral fluoropyrimidines, oxaliplatin, and irinotecan is unknown. Methods: Concordance between 2 and 3yr DFS, and 5 and 6yr OS was examined in 6 randomized phase III trials from 1997–2002. Individual data for 12,676 pts was analyzed; 2 trials tested oxaliplatin, 2 irinotecan, and 2 oral rx vs 5-FU/LV control. Association between DFS and OS hazard ratios (HRs) via weighted least squares (WLS), and concordance between predicted and actual within-trial HRs, were calculated overall and for stage III pts. Results: Overall association between 3 yr DFS and 5 yr OS HRs was reduced compared to the prior ACCENT analysis (Table). In stage III pts, the association between DFS and OS HRs remained strong. Observed 5 and 6yr OS HRs were predicted accurately by 2yr DFS overall and in stage III pts (within 95% prediction limits in all trials). In all pts, DFS HRs were more highly associated with 6 vs 5yr OS HRs. Conclusions: In recent trials in stage III pts, DFS HRs based on 2yr median f-up are highly predictive of 5 and 6yr OS HRs. In all pts the association between DFS and OS HRs is stronger for 6yr OS, but 7yr follow-up may be required. These data support 3yr DFS as a primary endpoint for modern stage III trials, and indicate that 2yr DFS would also be an appropriate primary endpoint. [Table: see text] [Table: see text]
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Affiliation(s)
- D. J. Sargent
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - G. Yothers
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - E. Van Cutsem
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - J. Cassidy
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - L. Saltz
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - N. Wolmark
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - Q. Shi
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - M. Buyse
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
| | - A. de Gramont
- Mayo Clinic, Rochester, MN; NSABP Biostatistical Center, Pittsburgh, PA; University Hospital Gasthuisberg/Leuven, Leuven, Belgium; Cancer Research UK, Glasgow, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Allegheny General Hospital, Pittsburgh, PA; IDDI, Louvian-La-Neuve, Belgium; Hospital Saint Antoine, Paris, France
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Perez-Staub N, Chibaudel B, Paye F, Taieb J, Gayet B, Bourges O, André T, Tournigand C, Louvet C, de Gramont A. Survival after surgery in patients with initially resectable metastasis receiving adjuvant/neoadjuvant FOLFOX therapy and in patients who had surgery after FOLFOX therapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4118 Background: Surgery of metastases can cure approximately 20% of metastatic colorectal cancer (MCRC). About 15% of MCRC pts are resectable at presentation. Among the other pts, 10 to 30% can benefit from a salvage surgery after response to chemotherapy, improving their prognostic. We report here the results in pts resectable at presentation and in pts who underwent surgery after chemotherapy in phase 2 and 3 studies. Methods: We retrospectively analysed 167 pts who underwent R0/R1 surgery, 46 pts at presentation in a phase 2 study testing a combination of FOLFOX followed by FOLFIRI (MIROX, Taieb JCO 2005), and 121 pts who underwent a salvage surgery after FOLFOX treatment in OPTIMOX1 (Tournigand, JCO 2006) and OPTIMOX2 (Maindrault-Goebel, ASCO 2007) after updating the survival. Results: Patients’ baseline characteristics were (MIROX/OPTIMOX %): median age 56/62 yrs, PS 0 50/73, metachronous metastasis 41/21, ≥ 2 met sites 11/18, liver met 78/88, lung met 11/19, other met 17/10, two-stage surgery 9/10, second surgery after relapse 39/22, R0 resection 91/ 85. 114 among 142 evaluable patients had a response to FOLFOX (80%). Median time from randomisation to surgery was 8 mths in the OPTIMOX group. In the MIROX group, 46% had surgery of metastases before chemotherapy. Median disease-free survival from R0/R1 surgery was 18.6 months in MIROX group vs 9.4 months in OPTIMOX group (p=0.006).Median overall survival was 104.8 months in MIROX group vs 42.6 months in OPTIMOX group (p=0.02). Furthermore, initially resectable remained the strongest prognostic factor in this series. Conclusions: MCRC pts initially resectable at presentation have a better prognosis than pts who underwent a salvage surgery after FOLFOX chemotherapy. No significant financial relationships to disclose.
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Affiliation(s)
- N. Perez-Staub
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - B. Chibaudel
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - F. Paye
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - J. Taieb
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - B. Gayet
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - O. Bourges
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - T. André
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - C. Tournigand
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - C. Louvet
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - A. de Gramont
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
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Jackson McCleary NA, Meyerhardt J, Green E, Yothers G, de Gramont A, Van Cutsem E, O’Connell M, Twelves C, Saltz L, Sargent D. Impact of older age on the efficacy of newer adjuvant therapies in >12,500 patients (pts) with stage II/III colon cancer: Findings from the ACCENT Database. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4010 Background: Prior studies suggested that older and younger pts with colon cancer receive similar benefit from IV fluoropyrimidine (FU) adjuvant (adj) therapy (rx). Combination and/or oral FU rx are increasingly given as adj rx. We sought to determine the impact of pts age <70 v ≥70 yrs on colon cancer recurrence and mortality from adj rx with these newer options. Methods: We used data from 10,499 pts <70 yrs and 2,170 pts ≥70 yrs in 6 phase III adj rx trials comparing IV FU to combinations with irinotecan, oxaliplatin or oral FU (capecitabine and UFT/LV) in stage II/III colon cancer from the ACCENT database. Endpoints were overall survival (OS; time to death), disease-free survival (DFS; time to recurrence or death), and time to recurrence (TTR; censoring at last follow-up). Cox models were stratified by age and adjusted for gender and stage; interaction testing was used to explore the differential benefit by age. Results: Approximately 75% of pts had stage III disease (74% age<70, 77% age≥70). OS, DFS, and TTR were statistically significantly improved for those in the experimental v control arms among pts <70 but not those >70 ( table ); the interaction between age and rx was statistically significant for all endpoints (p=0.01 for OS, DFS, and TTR). These results were consistent whether experimental rx was oxaliplatin-based, irinotecan-based or oral FU. Deaths in first 6 month of adj rx were not statistically significantly different between experimental and control arm. Conclusions: Our results show conclusively that pts >70 do not receive the same benefit from combination and/or oral FU as those <70. Any benefit, if present, compared to IV FU/LV would not be clinically meaningful. Outcomes of experimental (combination or oral FU) vs control (IV 5-FU) by treatment and age [Table: see text] [Table: see text]
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Affiliation(s)
- N. A. Jackson McCleary
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - J. Meyerhardt
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - E. Green
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - G. Yothers
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - A. de Gramont
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - E. Van Cutsem
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - M. O’Connell
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - C. Twelves
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - L. Saltz
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
| | - D. Sargent
- Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; University of Pittsburgh, Pittsburgh, PA; Hôpital Saint Antoine, Paris, France; University of Leuven, Leuven, Belgium; Allegheny General Hospital, Allegheny Cancer Center, Pittsburgh, PA; St James's University Hospital, Leeds, United Kingdom; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN
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Tournigand C, Samson B, Scheithauer W, Louvet C, Andre T, Lledo G, Latreille J, Viret F, Chibaudel B, de Gramont A. mFOLFOX-bevacizumab or XELOX-bevacizumab then bevacizumab (B) alone or with erlotinib (E) in first-line treatment of patients with metastatic colorectal cancer (mCRC): Interim safety analysis of DREAM study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4077 Background: Anti-VEGF or EGFR inhibitors demonstrated clinical activity in combination with chemotherapy (CT) in mCRC. The DREAM trial compares, after an induction CT of 6 cy of FOLFOX-B or XELOX-B, a maintenance with B ± E. We report here a pre-planned safety analysis of induction (I) and maintenance (M) phase for the first 200 patients. Methods: Patients (pts) with untreated mCRC were randomly assigned to 2 arms (I): mFOLFOX+B (n=100), or mXELOX+B (n=100). mFOLFOX-B: LV 400 mg/m2, Oxaliplatin (ox) 100 mg/m2, B 5 mg/kg d1, 5FU ci 2.4g/m2 46h, q2w, mXELOX-B: Ox 100 mg/m2 d1, capecitabine 2.5 g/m2 d1–7, B 5mg/kg, q2w. To date, 117 pts with a disease control after 6 cy have had a 2nd randomisation (M): B alone (7.5 mg/kg q3w, n=56) or B+E 150 mg/d (n=61) until PD. Results: Pts characteristics were: sex: 124M/76F, median age: 62.4 years (26–80), primary tumors: colon 152, rectum 53, synchronous metastases: 150 pts, > 1 metastase site: 115, PS 0/1: 134/66, Alk. Ph.>UNL: 87 pts, and LDH>UNL: 88pts. For I, 92 pts in mFOLFOX-B and 93 in XELOX-B were evaluable for toxicity (tox). Tox (%) for mFOLFOX-B/XELOX-B were: any toxicity grade (gr) 3 or 4: 21/30; neutropenia gr 3 6/1, gr 4 0/2; febrile neutropenia gr 3 1/1, gr 4 0/1; thrombopenia gr 3 0/1, gr 4 0/2; anemia gr 2 8/15, gr 3 2/1; nausea gr 2 17/15, gr 3 4/6; vomiting gr 2 10/12, gr 3 2/5; mucositis gr 2 6/6, gr 3 0/4; diarrhea gr 2 8/12, gr 3 5/20, gr 4 0/1; neuropathy gr 2 23/17 gr 3 3/1; HFS gr 2 0/7, gr 3 0/2; hypertension gr 2 2/3, gr 3 1/0; proteinuria gr 2 1/5; SAEs 14/25. For M, 56 pts in B and 61 pts in B+E were evaluable. Tox (% B/B+E) were: neutropenia gr 2 0/3; thrombopenia gr 2 2/0; nausea gr 2 2/2, gr 3 2/0; vomiting gr 3 2/0; mucositis gr 2 2/3; diarrhea gr 2 0/6, gr 3 2/6; skin tox gr 1 9/31, gr 2 0/38, gr 3 0/16, gr 4 0/2; proteinuria gr 2 5/5; hypertension gr 1 9/15, gr 2 3/8, gr 3 3/0. Conclusions: This interim safety analysis demonstrated that induction with mFOLFOX-B or XELOX-B as well as maintenance with B or B + E appears to be well-tolerated, without unexpected side effects. The DREAM study is ongoing, with a prolonged induction phase of 6 months (3 mo with ox then 3 mo with fluoropyrimidines-B) before randomisation for maintenance therapy. [Table: see text]
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Affiliation(s)
- C. Tournigand
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - B. Samson
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - W. Scheithauer
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - C. Louvet
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - T. Andre
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - G. Lledo
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - J. Latreille
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - F. Viret
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - B. Chibaudel
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - A. de Gramont
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
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Bastian G, Chibaudel B, Maindrault-Goebel F, Garcia-Hejl C, Bonnetain F, Rebischung C, Hebbar M, Yataghene Y, de Gramont A. Relation between long-term blood pharmacokinetics (PK), pharmacogenomics (PG), and severe neurotoxicity in patients undergoing an oxaliplatin (O)-based regimen. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15024 The aim of the study was to investigate the residual blood level of O before each cycle of various oxaliplatin (O)-based protocols, and to explore its predictive value for potential occurrence of a severe neurotoxicity. Methods: Between 11/2005 and 06/2008, 220 Pts were included in a prospective cohort, in 7 French centers. Patients received a minimum of 7 cycles of O. Blood samples were taken before each cycle with a maximum of 12 cycles. In parallel neurotoxicity was assessed by the modified Levi score (grade 0 to 3) and by the Von Frey filament exam. Saliva was collected before the first cycle for genomics analysis. The O concentration was obtained by Atomic Absorption Spectrometry assay. Polymorphism of different targets were investigated (carrier proteins: MRP2, OCT1, OCT2, GSTP1, adducts repair system: ERCC1, ERCC2). Time to first severe neurotoxicity occurrence (TTSN Events: Grade 2 or3) was estimated using Kaplan-Meier. Predictive value of severe neurotoxicity was explored using univariate and multivariate logistic or Cox regressions. Harrel C index was produced. Results: 206 pts with gastro-intestinal cancer had, at the time of analysis, completed follow-up and 171 pts were eligible. 84% received FOLFOX regimen (85mg/m2every 2 weeks), the others GEMOX or XELOX (100mg/m2 every 3 weeks). After cycle 1, 2 and 10, median residual level of O was respectively 0.23 mg/L, 0.40 mg/L and 0.58 mg/L. The maximal concentration was obtained between cycle 5 and cycle 9. Respectively 83 Pts (40%) and 15 pts (7%) had a Gr2 and a Gr3 neurotoxicity. Median time TTSN was 141 days (95% CI: 132 - 161). O concentration before 2nd (HR = 1.39, p = 0.34, C =0.53) or 3rd cycle (HR = 1.00, p = 0.99, C =0.54) were not associated with TTSN. Multivariate logistic and Cox analyses confirmed these results. Conclusions: Despite a trend, which needs to be confirmed, the residual blood level of O is not predictive of a Gr 2 or Gr 3 neurotoxicity in patients with an O based-regimen. With updated data, further statistical analyses will be done to be presented at the next ASCO meeting. They will take into account more precise data as the cycle delay or the dose-intensity of O received by the patients. [Table: see text]
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Affiliation(s)
- G. Bastian
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - B. Chibaudel
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - F. Maindrault-Goebel
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - C. Garcia-Hejl
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - F. Bonnetain
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - C. Rebischung
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - M. Hebbar
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - Y. Yataghene
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
| | - A. de Gramont
- Hopital Pitié-Salpétrière, Paris, France; Pavillon Moiana Oncologie Hopital St Antoine, Paris, France; Centre George-François Leclerc, Dijon, France; CHU Grenoble, Grenoble, France; Hopital Huriez, Lille, France; Sanofi-Aventis Laboratory, Paris, France
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