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Klein EA, Richards D, Cohn A, Tummala M, Lapham R, Cosgrove D, Chung G, Clement J, Gao J, Hunkapiller N, Jamshidi A, Kurtzman KN, Seiden MV, Swanton C, Liu MC. Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Ann Oncol 2021; 32:1167-1177. [PMID: 34176681 DOI: 10.1016/j.annonc.2021.05.806] [Citation(s) in RCA: 301] [Impact Index Per Article: 100.3] [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: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A multi-cancer early detection (MCED) test used to complement existing screening could increase the number of cancers detected through population screening, potentially improving clinical outcomes. The Circulating Cell-free Genome Atlas study (CCGA; NCT02889978) was a prospective, case-controlled, observational study and demonstrated that a blood-based MCED test utilizing cell-free DNA (cfDNA) sequencing in combination with machine learning could detect cancer signals across multiple cancer types and predict cancer signal origin (CSO) with high accuracy. The objective of this third and final CCGA substudy was to validate an MCED test version further refined for use as a screening tool. PATIENTS AND METHODS This pre-specified substudy included 4077 participants in an independent validation set (cancer: n = 2823; non-cancer: n = 1254, non-cancer status confirmed at year-one follow-up). Specificity, sensitivity, and CSO prediction accuracy were measured. RESULTS Specificity for cancer signal detection was 99.5% [95% confidence interval (CI): 99.0% to 99.8%]. Overall sensitivity for cancer signal detection was 51.5% (49.6% to 53.3%); sensitivity increased with stage [stage I: 16.8% (14.5% to 19.5%), stage II: 40.4% (36.8% to 44.1%), stage III: 77.0% (73.4% to 80.3%), stage IV: 90.1% (87.5% to 92.2%)]. Stage I-III sensitivity was 67.6% (64.4% to 70.6%) in 12 pre-specified cancers that account for approximately two-thirds of annual USA cancer deaths and was 40.7% (38.7% to 42.9%) in all cancers. Cancer signals were detected across >50 cancer types. Overall accuracy of CSO prediction in true positives was 88.7% (87.0% to 90.2%). CONCLUSION In this pre-specified, large-scale, clinical validation substudy, the MCED test demonstrated high specificity and accuracy of CSO prediction and detected cancer signals across a wide diversity of cancers. These results support the feasibility of this blood-based MCED test as a complement to existing single-cancer screening tests. CLINICAL TRIAL NUMBER NCT02889978.
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Affiliation(s)
- E A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA.
| | | | - A Cohn
- The US Oncology Network, Denver, USA
| | - M Tummala
- Mercy Clinic Cancer Center, Springfield, USA
| | - R Lapham
- Spartanburg Regional Healthcare System, Spartanburg, USA
| | | | - G Chung
- The Christ Hospital Health Network, Cincinnati, USA
| | - J Clement
- Hartford HealthCare Cancer Institute, Hartford, USA
| | - J Gao
- GRAIL, Inc., Menlo Park, USA
| | | | | | | | - M V Seiden
- US Oncology Research, The Woodlands, USA
| | - C Swanton
- The Francis Crick Institute, London, UK; University College London Cancer Institute, London, UK
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Makker V, Rasco D, Vogelzang N, Brose M, Cohn A, Mier J, DiSimone C, Hyman D, Stepan D, Dutcus C, Schmidt E, Guo M, Sachdev P, Shumaker R, Aghajanian C, Taylor M. Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer: Final analysis of a multicentre, open-label, single-arm, phase 2 trial. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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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Abou-Alfa G, Borbath I, Cohn A, Goyal L, Lamarca A, Macarulla T, Oh D, Roychowdhury S, Sadeghi S, Shroff R, Howland M, Li A, Cho T, Pande A, Javle M. P-144 Infigratinib versus gemcitabine plus cisplatin as first-line therapy in patients with advanced cholangiocarcinoma with FGFR2 gene fusions/translocations: phase 3 PROOF trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.226] [Citation(s) in RCA: 2] [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: 11/26/2022] Open
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Grant LK, Cohn A, Abramson M, Russell JA, Wiley A, Coborn JE, Nathan MD, Scheer FA, Klerman EB, Kaiser UB, Rahman SA, Joffe H. 0190 Impact of Menopause-Related Sleep Fragmentation on Daytime Sleepiness and Neurobehavioral Performance: Results of an Experimental Model. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.188] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Cognitive performance may be adversely affected during the menopause transition from hot flash-induced sleep fragmentation even without changes in sleep duration. We examined the effects of experimentally-induced sleep fragmentation without shortened sleep duration on daytime sleepiness and neurobehavioral performance in women in a high and low estradiol (E2) state.
Methods
Seven pre-menopausal women (29.4 ± 3.8 years) participated in two 6-day inpatient studies repeated in a high-E2 (mid-to-late follicular phase) then low-E2 state (gonadotropin-releasing hormone agonist-induced E2 suppression - similar to levels during menopause) ~6 weeks apart. Sleep was uninterrupted on nights 1–2 [8-h time-in-bed (TIB)] and fragmented on nights 3–5 (9-h TIB) using an auditory stimulus delivered every 15 min that sustained wake for 2 minutes, producing 1-h total wake after sleep onset. Wakefulness was confirmed by event-markers during polysomnographically-recorded sleep episodes. Daytime subjective sleepiness (Karolinska Sleepiness Scale; KSS) and neurobehavioral performance (Psychomotor Vigilance Task; PVT) were assessed every 2–3 hours on study days 2–5. The effects of study day and E2 state on KSS scores and PVT measured reaction time (RT) and attentional failures (RT>500ms) were examined using linear mixed models.
Results
Participants reported feeling sleepier (+10%), had longer RTs (+22ms), and more attentional failures (+53%) after sleep fragmentation than after uninterrupted sleep (all p<0.001). While there was no main effect of E2 state, there was a differential effect of sleep fragmentation by E2 state on PVT, but not sleepiness, such that the increase in RT and attentional failures in response to sleep fragmentation was only observed in the high-E2 state (p<0.001).
Conclusion
Eight hours of total sleep time may not be sufficient to maintain subjective sleepiness and PVT performance levels when sleep is not consolidated. These findings have important implications for understanding the role of sleep and E2-modulated cognitive impairment during the menopause transition.
Support
This work was supported by the NIH: 5R01 AG053838-02 (HJ) and K24-HL105664 (EBK).
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Affiliation(s)
- L K Grant
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
| | - A Cohn
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - M Abramson
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - J A Russell
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - A Wiley
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - J E Coborn
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - M D Nathan
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - F A Scheer
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
| | - E B Klerman
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - U B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - S A Rahman
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
| | - H Joffe
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Hingray C, Donné C, Martini H, Cohn A, El Hage W, Schwan R, Paille F. Description of type of trauma in alcohol-dependent women. European Journal of Trauma & Dissociation 2018. [DOI: 10.1016/j.ejtd.2018.01.001] [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: 10/18/2022]
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Daien V, Nguyen V, Essex RW, Morlet N, Barthelmes D, Gillies MC, Gillies M, Hunt A, Essex R, Dayajeewa C, Hunyor A, Fraser-Bell S, Younan C, Fung A, Guymer R, Louis D, Arnold J, Chan D, Cass H, Harper A, O’Day J, Daniell M, Field A, Chow L, Barthelmes D, Cohn A, Young S, Lal S, Ferrier R, Barnes R, Thompson A, Vincent A, Manning L, Lake S, Phillips R, Perks M, Chen J, Landers J, Niladri, Banerjee G, Swamy B, Windle P, Dunlop A, Tang K, McLean I, Amini A, Hunt A, Clark G, McAllister I, Chen F, Squirrell D, Ng C, Hinchcliffe P, Barry R, Ah-Chan J, Steiner H, Morgan M, Thompson C, Game J, Murray N. Incidence and Outcomes of Infectious and Noninfectious Endophthalmitis after Intravitreal Injections for Age-Related Macular Degeneration. Ophthalmology 2018; 125:66-74. [DOI: 10.1016/j.ophtha.2017.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
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Voss MH, Hussain A, Vogelzang N, Lee JL, Keam B, Rha SY, Vaishampayan U, Harris WB, Richey S, Randall JM, Shaffer D, Cohn A, Crowell T, Li J, Senderowicz A, Stone E, Figlin R, Motzer RJ, Haas NB, Hutson T. A randomized phase II trial of CRLX101 in combination with bevacizumab versus standard of care in patients with advanced renal cell carcinoma. Ann Oncol 2017; 28:2754-2760. [PMID: 28950297 DOI: 10.1093/annonc/mdx493] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 01/07/2023] Open
Abstract
BACKGROUND Nanoparticle-drug conjugates enhance drug delivery to tumors. Gradual payload release inside cancer cells augments antitumor activity while reducing toxicity. CRLX101 is a novel nanoparticle-drug conjugate containing camptothecin, a potent inhibitor of topoisomerase I and the hypoxia-inducible factors 1α and 2α. In a phase Ib/2 trial, CRLX101 + bevacizumab was well tolerated with encouraging activity in metastatic renal cell carcinoma (mRCC). We conducted a randomized phase II trial comparing CRLX101 + bevacizumab versus standard of care (SOC) in refractory mRCC. PATIENTS AND METHODS Patients with mRCC and 2-3 prior lines of therapy were randomized 1 : 1 to CRLX101 + bevacizumab versus SOC, defined as investigator's choice of any approved regimen not previously received. The primary end point was progression-free survival (PFS) by blinded independent radiological review in patients with clear cell mRCC. Secondary end points included overall survival, objective response rate and safety. RESULTS In total, 111 patients were randomized and received ≥1 dose of drug (CRLX101 + bevacizumab, 55; SOC, 56). Within the SOC arm, patients received single-agent bevacizumab (19), axitinib (18), everolimus (7), pazopanib (4), sorafenib (4), sunitinib (2), or temsirolimus (2). In the clear cell population, the median PFS on the CRLX101 + bevacizumab and SOC arms was 3.7 months (95% confidence interval, 2.0-4.3) and 3.9 months (95% confidence interval 2.2-5.4), respectively (stratified log-rank P = 0.831). The objective response rate by IRR was 5% with CRLX101 + bevacizumab versus 14% with SOC (Mantel-Haenszel test, P = 0.836). Consistent with previous studies, the CRLX101 + bevacizumab combination was generally well tolerated, and no new safety signal was identified. CONCLUSIONS Despite promising efficacy data on the earlier phase Ib/2 trial of mRCC, this randomized trial did not demonstrate improvement in PFS for the CRLX101 + bevacizumab combination when compared with approved agents in patients with heavily pretreated clear cell mRCC. Further development in this disease is not planned. CLINICAL TRIAL IDENTIFICATION NCT02187302 (NIH).
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Affiliation(s)
- M H Voss
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York. mailto:
| | - A Hussain
- Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore
| | - N Vogelzang
- Department of Hematology/Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas; US Oncology Research, USA
| | - J L Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - B Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - S Y Rha
- Department of Medicine, Severance Hospital, Seoul, Korea
| | - U Vaishampayan
- Department of Oncology, Karmanos Cancer Institute, Detroit
| | - W B Harris
- Department of Hematology/Oncology, Emory University Winship Cancer Institute, Atlanta
| | - S Richey
- US Oncology Research, USA; Department of Medicine, Texas Oncology, Fort Worth
| | - J M Randall
- Department of Medicine, University of California, San Diego, La Jolla
| | - D Shaffer
- US Oncology Research, USA; Department of Medicine, Albany Medical Center, NYOH, Albany
| | - A Cohn
- US Oncology Research, USA; Department of Clinical Research, Rocky Mountain Cancer Centers, Denver
| | - T Crowell
- Department of Medicine, Cerulean Pharma Inc., Waltham
| | - J Li
- Department of Medicine, Cerulean Pharma Inc., Waltham
| | - A Senderowicz
- Department of Medicine, Cerulean Pharma Inc., Waltham
| | - E Stone
- Department of Medicine, Cerulean Pharma Inc., Waltham
| | - R Figlin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles
| | - R J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - N B Haas
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - T Hutson
- US Oncology Research, USA; Department of Medicine, Texas Oncology, Dallas, USA
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Hingray C, Donne C, Cohn A, Maillard L, Schwan R, Montel S, El-Hage W. Link between psychogenic nonepileptic seizures and complex PTSD: A pilot study. European Journal of Trauma & Dissociation 2017. [DOI: 10.1016/j.ejtd.2017.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Obermannová R, Van Cutsem E, Yoshino T, Bodoky G, Prausová J, Garcia-Carbonero R, Ciuleanu T, Garcia Alfonso P, Portnoy D, Cohn A, Yamazaki K, Clingan P, Lonardi S, Kim TW, Yang L, Nasroulah F, Tabernero J. Subgroup analysis in RAISE: a randomized, double-blind phase III study of irinotecan, folinic acid, and 5-fluorouracil (FOLFIRI) plus ramucirumab or placebo in patients with metastatic colorectal carcinoma progression. Ann Oncol 2016; 27:2082-2090. [PMID: 27573561 PMCID: PMC5091322 DOI: 10.1093/annonc/mdw402] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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] [Received: 05/13/2016] [Revised: 07/27/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The RAISE phase III clinical trial demonstrated that ramucirumab + FOLFIRI improved overall survival (OS) [hazard ratio (HR) = 0.844, P = 0.0219] and progression-free survival (PFS) (HR = 0.793, P < 0.0005) compared with placebo + FOLFIRI for second-line metastatic colorectal carcinoma (mCRC) patients previously treated with first-line bevacizumab, oxaliplatin, and a fluoropyrimidine. Since some patient or disease characteristics could be associated with differential efficacy or safety, prespecified subgroup analyses were undertaken. This report focuses on three of the most relevant ones: KRAS status (wild-type versus mutant), age (<65 versus ≥65 years), and time to progression (TTP) on first-line therapy (<6 versus ≥6 months). PATIENTS AND METHODS OS and PFS were evaluated by the Kaplan-Meier analysis, with HR determined by the Cox proportional hazards model. Treatment-by-subgroup interaction was tested to determine whether treatment effect was consistent between subgroup pairs. RESULTS Patients with both wild-type and mutant KRAS benefited from ramucirumab + FOLFIRI treatment over placebo + FOLFIRI (interaction P = 0.526); although numerically, wild-type KRAS patients benefited more (wild-type KRAS: median OS = 14.4 versus 11.9 months, HR = 0.82, P = 0.049; mutant KRAS: median OS = 12.7 versus 11.3 months, HR = 0.89, P = 0.263). Patients with both longer and shorter first-line TTP benefited from ramucirumab (interaction P = 0.9434), although TTP <6 months was associated with poorer OS (TTP ≥6 months: median OS = 14.3 versus 12.5 months, HR = 0.86, P = 0.061; TTP <6 months: median OS = 10.4 versus 8.0 months, HR = 0.86, P = 0.276). The subgroups of patients ≥65 versus <65 years also derived a similar ramucirumab survival benefit (interaction P = 0.9521) (≥65 years: median OS = 13.8 versus 11.7 months, HR = 0.85, P = 0.156; <65 years: median OS = 13.1 versus 11.9 months, HR = 0.86, P = 0.098). The safety profile of ramucirumab + FOLFIRI was similar across subgroups. CONCLUSIONS These analyses revealed similar efficacy and safety among patient subgroups with differing KRAS mutation status, longer or shorter first-line TTP, and age. Ramucirumab is a beneficial addition to second-line FOLFIRI treatment for a wide range of patients with mCRC. TRIAL REGISTRATION ClinicalTrials.gov, NCT01183780.
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Affiliation(s)
- R Obermannová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - E Van Cutsem
- University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - G Bodoky
- Department of Oncology, St László Hospital, Budapest, Hungary
| | - J Prausová
- Onocology Clinic, Charles University, Prague, Czech Republic
| | - R Garcia-Carbonero
- Department of Oncology, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - T Ciuleanu
- Institutul Oncologic Ion Chiricuta and UMF, Cluj-Napoca, Romania
| | - P Garcia Alfonso
- Department of Oncology, Hospital General Universitario Gregorio Maraňón, Madrid, Spain
| | - D Portnoy
- The West Clinic-University of Tennessee Health Sciences Center, Memphis
| | - A Cohn
- Rocky Mountain Cancer Center, Denver, USA
| | - K Yamazaki
- Department of Gastrointestinal Oncology, Shizouka Cancer Center, Shizouka, Japan
| | - P Clingan
- Southern Medical Day Care Centre, Wollongong, NSW, Australia
| | - S Lonardi
- Department of Medical Oncology, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - T W Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - L Yang
- Eli Lilly and Company, Bridgewater, USA
| | - F Nasroulah
- Eli Lilly and Company, Buenos Aires, Argentine Republic
| | - J Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
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O'Neil B, O'Reilly S, Kasbari S, Kim R, McDermott R, Moore D, Grogan W, Cohn A, Bekaii-Saab T, Ivanova A, Olowokure O, Fernando N, McCaffrey J, El-Rayes B, Horgan A, Ryan T, Sherrill G, Yacoub G, Goldberg R, Sanoff H. A multi-center, randomized, double-blind phase II trial of FOLFIRI + regorafenib or placebo for patients with metastatic colorectal cancer who failed one prior line of oxaliplatin-containing therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.13] [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: 11/14/2022] Open
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Kisro J, Cohn A, Yoshino T, Van Cutsem E, Hegewisch-Becker S, Kullmann F, Brück P, Liepa A, Yang L, Nasroulah F, Tabernero J. PD-008 Adding ramucirumab to second-line irinotecan, 5-fluorouracil and folinic acid (FOLFIRI) treatment for metastatic colorectal carcinoma (mCRC): resource utilization data from RAISE, a global, randomized, double-blind, multicenter phase 3 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.08] [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: 11/13/2022] Open
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Van Cutsem E, Obermannova R, Bodoky G, Prausová J, García-Carbonero R, Ciuleanu T, Alfonso PG, Portnoy D, Cohn A, Yamazaki K, Clingan P, Yoshino T, Polikoff J, Lonardi S, Macarulla T, Yang L, Nasroulah F. 2108 Subgroup analysis by KRAS status in RAISE: A randomized, double-blind phase III study of irinotecan, folinic acid, and 5-fluorouracil (FOLFIRI) plus ramucirumab or placebo in patients with metastatic colorectal carcinoma progression during or following first-line combination therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31030-9] [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: 10/22/2022]
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Garcia-Carbonero R, Obermannova R, Bodoky G, Prausova J, Ciuleanu TE, Garcia Alfonso P, Portnoy D, Cohn A, Van Cutsem E, Yamazaki K, Al-Batran SE, Rougier P, Liepa A, Yang L, Zhang Y, Nasroulah F, Chang SC, Tabernero J. O-020 Quality-of-life results from RAISE: randomized, double-blind phase III study of FOLFIRI plus ramucirumab or placebo in patients with metastatic colorectal carcinoma after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv235.19] [Citation(s) in RCA: 4] [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: 11/14/2022] Open
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Van Cutsem E, Boni C, Tabernero J, Massuti B, Middleton G, Dane F, Reichardt P, Pimentel FL, Cohn A, Follana P, Clemens M, Zaniboni A, Moiseyenko V, Harrison M, Richards DA, Prenen H, Pernot S, Ecstein-Fraisse E, Hitier S, Rougier P. Docetaxel plus oxaliplatin with or without fluorouracil or capecitabine in metastatic or locally recurrent gastric cancer: a randomized phase II study. Ann Oncol 2015; 26:149-156. [PMID: 25416687 DOI: 10.1093/annonc/mdu496] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [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: 12/13/2022] Open
Abstract
BACKGROUND Docetaxel/cisplatin/infusional 5-fluorouracil (5-FU; DCF) is a standard chemotherapy regimen for patients with advanced gastric cancer (GC). This phase II study evaluated docetaxel/oxaliplatin (TE), docetaxel/oxaliplatin/5-FU (TEF), and docetaxel/oxaliplatin/capecitabine (TEX) in patients with advanced GC. PATIENTS AND METHODS Patients with metastatic or locally recurrent gastric adenocarcinoma (including carcinoma of the gastro-oesophageal junction) were randomly assigned (1 : 1 : 1) to TE, TEF, or TEX. Each regimen was tested at two doses before full evaluation at optimized dose levels. The primary end point was progression-free survival (PFS). Overall survival (OS), tumour response, and safety were also assessed. A therapeutic index (median PFS relative to the incidence of febrile neutropenia) was calculated for each regimen and compared with DCF (historical data). RESULTS Overall, 248 patients were randomly assigned to receive optimized dose treatment. Median PFS was longer with TEF (7.66 [95% confidence interval (CI): 6.97-9.40] months) versus TE (4.50 [3.68-5.32] months) and TEX (5.55 [4.30-6.37] months). Median OS was 14.59 (95% CI: 11.70-21.78) months for TEF versus 8.97 (7.79-10.87) months for TE and 11.30 (8.08-14.03) months for TEX. The rate of tumour response (complete or partial) was 46.6% (95% CI 35.9-57.5) for TEF versus 23.1% (14.3-34.0) for TE and 25.6% (16.6-36.4) for TEX. The frequency and type of adverse events (AEs) were similar across the three arms. Common grade 3/4 AEs were fatigue (21%), sensory neuropathy (14%), and diarrhoea (13%). Febrile neutropenia was reported in 2% (TEF), 14% (TE), and 9% (TEX) of patients. The therapeutic index was improved with TEF versus TEX, TE, or DCF. CONCLUSION These results suggest that TEF is worthy of evaluation as an arm in a phase III trial or as a backbone regimen for new targeted agents in advanced GC. CLINICALTRIALS.GOV: Identifier Trial registration number: NCT00382720.
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Affiliation(s)
- E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
| | - C Boni
- Department of Oncology, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona
| | - B Massuti
- Medical Oncology Service, Alicante University Hospital, Alicante, Spain
| | - G Middleton
- Department of Medical Oncology, University of Birmingham, Birmingham, UK
| | - F Dane
- Department of Medical Oncology, Marmara University Medical Faculty, Istanbul, Turkey
| | - P Reichardt
- Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - F L Pimentel
- Oncology, Hospital de São Sebastião, Santa Maria da Feira, Portugal
| | - A Cohn
- US Oncology Research, Rocky Mountain Cancer Centers, Denver, USA
| | - P Follana
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - M Clemens
- Department of Internal Medicine I, Klinikum Mutterhaus der Borromaeerinnen, Trier, Germany
| | - A Zaniboni
- Medical Oncology, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - V Moiseyenko
- Medical Oncology, N.N. Petrov Oncology SRI, St Petersburg, Russia
| | - M Harrison
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - D A Richards
- US Oncology Research, Texas Oncology-Tyler, Tyler, USA
| | - H Prenen
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - S Pernot
- Digestive Oncology, Universite Paris-V European Hospital Georges Pompidou, APHP, Paris, France
| | | | - S Hitier
- Statistics, Sanofi, Chilly-Mazarin, France
| | - P Rougier
- Digestive Oncology, Universite Paris-V European Hospital Georges Pompidou, APHP, Paris, France
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Kapoun A, O'Reilly E, Cohn A, Bendell J, Smith L, Strickler J, Gluck W, Liu Y, Wallace B, Tam R, Cancilla B, Brunner A, Hill D, Zhou L, Dupont J, Zhang C, Wang M. 465 Biomarker analysis in Phase 1b study of anti-cancer stem cell antibody Tarextumab (TAR) in combination with nab-paclitaxel and gemcitabine (Nab-P+Gem) demonstrates pharmacodynamic (PD) modulation of the Notch pathway in patients (pts) with untreated metastatic pancreatic cancer (mPC). Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70591-x] [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: 11/17/2022]
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Bendell J, Cohn A, Mun Y, Fish S, Sommer N, Grothey A. Clinical Outcomes with First-Line Bevacizumab and Chemotherapy for Patients with Metastatic Colorectal Cancer and a History of Diabetes: Results From the Aries Observational Cohort Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu164.10] [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: 11/12/2022] Open
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D'Angelo SP, Park BJ, Krug LM, Crevar C, Medina CE, Sumner DK, Richman J, Coeshott C, Apelian D, Cohn A, Kris MG, Azzoli CG. Immunogenicity of GI-4000 vaccine in adjuvant consolidation therapy following definitive treatment in patients with stage I-III adenocarcinoma of the lung with G12C, G12D, or G12V KRAS mutations. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Madan RA, Bilusic M, Hodge JW, Tsang KY, Arlen PM, Heery CR, Rauckhorst M, McMahon S, Intrivici C, Ferrara TA, Cohn A, Apelian D, Franzusoff A, Guo Z, Schlom J, Gulley JL. A phase I trial of a yeast-based therapeutic cancer vaccine targeting CEA. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2604] [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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Whiting SH, Muscarella P, Rosemurgy A, Fisher WE, Richards DA, Harrell FE, Ferraro J, Speyer S, Cohn A. A randomized, placebo-controlled, multicenter phase II adjuvant trial of the efficacy, immunogenicity, and safety of GI-4000 plus gemcitabine versus gemcitabine alone in patients with resected pancreatic cancer with activating ras mutations. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps226] [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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Cohn A, Smith D, Neubauer M, Richards D, Watkins D, Zhang K, Yassine M. 6083 Final results from PRECEPT: efficacy and safety of second-line treatment with panitumumab and FOLFIRI in patients with metastatic colorectal cancer (mCRC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71178-4] [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: 11/16/2022] Open
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Price TJ, Peeters M, Douillard J, Mitchell E, Cohn A, Strickland AH, Rivera F, Xu F, Gansert J, Siena S. Safety summary of panitumumab (pmab) in combination with chemotherapy (ctx) from four clinical trials in patients (pts) with metastatic colorectal cancer (mCRC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
e15005 Background: Pmab is a fully human anti-epidermal growth factor receptor (EGFR) monoclonal antibody approved in the US and EU (wild-type KRAS) as monotherapy for pts with mCRC. Safety data from 4 studies (Siena et al ASCO 2008; Peeters et al ASCO 2008; Cohn et al ASCO 2008; Mitchell et al WORLD GI 2008) of pmab in combination with ctx are summarized. Methods: Two studies are single-arm, phase II trials and two are randomized, phase III trials with pooled, blinded safety data that include ctx-controls. All studies were multicenter. Common pt eligibility criteria included: diagnosis of mCRC with measurable disease per modified RECIST criteria, age ≥ 18 years, and adequate hematologic, renal, hepatic, and metabolic function. All studies required pts to receive FOLFOX, FOLFIRI, or irinotecan ctx in combination with pmab. Pts received pmab 6.0 mg/kg Q2W with FOLFOX Q2W or FOLFIRI Q2W, or pmab 9.0 mg/kg Q3W with irinotecan Q3W. Results from planned interim analyses are available for 3 studies, and results from the final analysis are available for one study. Results: Among the 4-study safety data, 1213 pts received pmab + ctx; 703 pts received pmab + FOLFIRI, 455 pts received pmab + FOLFOX, and 55 pts received pmab + irinotecan. Approximately 1,200 pts were enrolled in each phase III study, and data are available from 1,003 pts who received pmab + ctx and 997 pts who received ctx alone. All pts in the phase III studies, regardless of treatment group, were included in the pooled, blinded interim analysis sets monitored by the data monitoring committee for each study. Safety results for the two phase II studies of pmab + ctx and two phase III studies of pmab ± ctx are summarized (Table). Conclusions: Phase II data are consistent with expectations, and phase III trials are ongoing. A consistent safety profile was observed across studies. [Table: see text] [Table: see text]
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Affiliation(s)
- T. J. Price
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - M. Peeters
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - J. Douillard
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - E. Mitchell
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - A. Cohn
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - A. H. Strickland
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - F. Rivera
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - F. Xu
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - J. Gansert
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - S. Siena
- Queen Elizabeth Hosp, South Australia, Australia; University Hospital Ghent, Ghent, Belgium; Centre René Gauducheau, Saint-Herblain, France; Thomas Jefferson University, Philadelphia, PA; Rocky Mountain Cancer Centers, Denver, CO; Monash Medical Center, East Bentleigh, Australia; Hospital Marques de Valdecilla, Santander, Spain; Amgen, Inc., Thousand Oaks, CA; Ospedale Niguarda Ca’ Granda, Milan, Italy
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Kozloff M, Hainsworth J, Badarinath S, Cohn A, Flynn P, Dong W, Purdie D, Yi J, Sugrue M, Grothey A. 3049 POSTER Management of hypertension (HTN) in patients (pts) with metastatic colorectal cancer (mCRC) treated with bevacizumab (BV) plus chemotherapy (CT). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70977-1] [Citation(s) in RCA: 7] [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: 10/22/2022] Open
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Modiano M, Plezia P, Baram J, Catane R, Cohn A, Basche M, Kurman M, Tapolsky G, Yancik S. A phase I study of TPI 287, a third generation taxane, administered every 21 days in patients with advanced cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.2569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
2569 Background: TPI 287 is a third generation taxane engineered to overcome multi-drug resistance and to bind to mutant tubulin. In preclinical studies, TPI 287 suppressed the growth of multiple human tumor xenografts in nude mice, including xenografts that expressed mdr- 1 and that were resistant to other taxanes. The safety and tolerability of TPI 287 when administered every 21 days was examined in this Phase 1 dose escalation study in patients (pts) with advanced neoplasms. Methods: TPI 287 was administered over 1 hour every 21 days in ascending doses to groups of 3 pts. Treatment cohorts were expanded to 6 pts in the face of dose-limiting toxicity (DLT); pts could remain on study until the development of progressive disease or an intolerable adverse event. DLT was defined as Gr 4 heme toxicity lasting 7 days; febrile neutropenia, Gr 3 thrombocytopenia with bleeding, Gr 3 elevation of transaminases lasting 7 days or any other Gr 3/4 toxicity other than nausea or vomiting. Results: 14 pts (M:F 5:9, median age 58.5, range 49 - 77) were enrolled in 5 dose levels ranging from 56 - 185 mg/m2. Pts’ cancers included colorectal (5 pts), esophageal (2), pancreatic (2), NSCLC (2), breast (2) and ovarian (1). All patients had received prior chemotherapy (median no. prior treatments: 3 (range, 2 - 10). Drug related adverse events included mucositis, vomiting, diarrhea, neutropenia, thrombocytopenia, myalgias and peripheral neuropathy. Only 1 pt. experienced Gr 4 neutropenia. DLT of Gr 3 peripheral sensory neuropathy was observed at a dose of 185 mg/m2. At a dose of 160 mg/m2 no DLT was observed. 1 pt with pancreatic cancer had a confirmed response to TPI 287 that has persisted for 2.5 months and continues as of this writing. PK data reveal that AUC is generally dose linear. At a dose of 126 mg/m2, clearance was 24.7 + 12.2 L/hr/m2 and t1/2 was 10.6 + 7.1 hrs. Conclusions: TPI 287 can be safely administered in a dose of 160 mg/m2 every 21 days. The dose limiting toxicity was Gr 3 peripheral neuropathy. Anti-neoplastic activity was seen in a patient with pancreatic cancer. PK is dose linear and predictable. Several Phase 2 studies of TPI 287 are being planned. No significant financial relationships to disclose.
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Affiliation(s)
- M. Modiano
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - P. Plezia
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - J. Baram
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - R. Catane
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - A. Cohn
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - M. Basche
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - M. Kurman
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - G. Tapolsky
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
| | - S. Yancik
- Arizona Clinical Research Center, Tucson, AZ; Sheba Medical Center, Tel Hashomer, Israel; Rocky Mountain Cancer Centers of Denver, Denver, CO; Tapestry Pharmaceuticals, Inc., Boulder, CO
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Cartwright TH, Kuefler P, Cohn A, Hyman W, Yoffe M, Boehm KA, Ilegbodu D, Asmar L. Results of a phase II trial of cetuximab + XELIRI as first-line therapy of patients with advanced and/or metastatic colorectal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4094] [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
4094 Background: We have previously shown that capecitabine/irinotecan (XELIRI) is effective and well-tolerated in metastatic colorectal cancer (mCRC). Cetuximab, a monoclonal IgG1 antibody that binds to the extracellular domain of EGFR, is active in mCRC alone or in combination with chemotherapy. This study was designed to evaluate if cetuximab (Erbitux®) added to XELIRI improves outcome in first-line treatment of mCRC. Methods: Subjects had histologically confirmed colorectal adenocarcinoma with T4 lesions that were unresectable after preoperative chemoradiation therapy and/or metastases. The study regimen was capecitabine 1700 mg/m2 (850 mg/m2 PO BID Days 1–14), irinotecan 200 mg/m2 IV Day 1 every 3 weeks, and weekly cetuximab (initial dose 400 mg/m2 IV over 120 minutes, subsequent doses 250 mg/m2 over 30 minutes). Results: Between February and October 2005, 70 subjects enrolled. Baseline characteristics: 43 males (61%), median age 61.5 years, and ECOG PS 0/1= 66%/34%; 94% of subjects had adenocarcinoma. Prior therapy; surgery (91%), chemotherapy (20%), or radiotherapy (7%). Responses (pts >2 cycles) were; CR (4%), PR (36%), SD (40%) and PD (20%); 15 patients failed treatment; (n=4 allergic reaction, n=2 MD request, n=2 withdrew consent, n=2 Grade 4 neutropenia, and n=5 other AEs). The overall response rate was 40% and the disease control rate was 80%. Median duration of response was 8.8 months (range, 2.6–15.1) and median time to response was 2.0 months (range, 1.2–8.3). 64% of patients remain alive; of the 25 deaths, 84% were due to PD. No death was drug related. The most frequent Grade 3 and 4 treatment-related adverse events (AEs) included: diarrhea (25%), neutropenia (18%), nausea/vomiting (12%), rash and dehydration (9%, each), HFS and fatigue (7%), and allergic reaction (6%). 54% of patients required dose reductions. To date, 64 patients (91%) have gone off study, primarily due to PD (39%) or AE (33%); 3 patients remain on treatment. Conclusions: The combination of cetuximab and XELIRI is feasible and tolerable in first line mCRC. Toxicities are expected and manageable with dose reductions/delay. Funded in part by Bristol-Myers Squibb, Plainsboro, NJ. No significant financial relationships to disclose.
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Affiliation(s)
- T. H. Cartwright
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
| | - P. Kuefler
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
| | - A. Cohn
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
| | - W. Hyman
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
| | - M. Yoffe
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
| | - K. A. Boehm
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
| | - D. Ilegbodu
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
| | - L. Asmar
- US Oncology Research, Houston, TX; Ocala Oncology, Ocala, FL; Northern Arizona Hematology Oncology, Flagstaff, AZ; Rocky Mountain Cancer Centers, Denver, CO; Tyler Cancer Center, Tyler, TX; Cancer Centers of North Carolina, Raleigh, NC
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Hwang JJ, Marshall JL, Ahmed T, Chun H, Basche M, Cohn A, Kurman M, Tapolsky G, Tapolsky G, Allen E. A phase I study of TPI287: A third generation taxane administered weekly in patients with advanced cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.2575] [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
2575 Background: TPI 287 is an investigational taxane designed to not be a substrate for mdr-1 and to bind to mutant tubulin. In preclinical studies, TPI 287 demonstrated activity against multiple human tumor xenografts in nude mice, including xenografts that expressed mdr-1 and that were resistant to other taxanes. The safety and tolerability of TPI 287 when administered weekly for 3 weeks followed by a 1 week rest (4 week cycle) was examined in this Phase 1 dose escalation study in patients (pts) with advanced neoplasms. Materials and Methods: TPI 287 was administered over 1 hour weekly for 3 weeks followed by 1 week of no treatment. Treatment cohorts consisted of 3 pts and were expanded to 6 pts in the face of dose-limiting toxicity (DLT); pts could remain on study until the development of progressive disease or an intolerable adverse event. DLT was defined as Gr 4 heme toxicity lasting 7 days; febrile neutropenia, Gr 3 thrombocytopenia with bleeding, Gr 3 elevation of transaminases lasting 7 days or any other Gr 3/4 toxicity other than nausea or vomiting. Results: 25 pts (M:F 16:9, median age 60, range 24 - 86) were enrolled in 7 dose levels ranging from 7–185 mg/m2. Pts’ cancers included colorectal (6 pts); NSCLC (2); prostate (2); squamous cell carcinoma (2) and 1 pt each with cervical, breast, ovarian, gastric, pancreatic, bladder endometrial, NSCLC, SCLC, glioblastoma, melanoma, renal cell and hepatocellular carcinoma. All pts but 1 had received prior chemotherapy (median no. prior treatments: 3 (range, 1–7). Drug related adverse events included nausea, vomiting, diarrhea, fatigue, anorexia, rash, anemia and peripheral neuropathy. 1 pt., who was inadvertently treated with inadequate marrow reserve, experienced Gr 4 neutropenia and died of sepsis. DLT of Grade 3 peripheral neuropathy has been observed. PK data to date reveal that AUC is generally dose linear. At a dose of 127.5 mg/m2, clearance was 30.2 + 11.9 L/hr/m2 and t1/2 8.6 + 1.3 hrs. Results are similar with non-compartmental methods and 2-compartment modeling. Conclusions: TPI 287 can be safely administered in doses of up to 127.5 mg/m2 weekly x 3. No significant financial relationships to disclose.
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Affiliation(s)
- J. J. Hwang
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - J. L. Marshall
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - T. Ahmed
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - H. Chun
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - M. Basche
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - A. Cohn
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - M. Kurman
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - G. Tapolsky
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - G. Tapolsky
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
| | - E. Allen
- Georgetown University Medical Center, Washington, DC; Georgetown University, Washington, DC; New York Medical College, Valhalla, NY; Rocky Mountain Cancer Centers, Denver, CO; Tapestry Pharmaceuticals, Boulder, CO
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Cohn A, Myers JW, Mamus S, Deur C, Nicol S, Hood KE, Khan MM, Ilegbodu D, Asmar L. Single-agent pemetrexed in patients with advanced and metastatic hepatoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14064] [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
14064 Background: The incidence of hepatoma is rising in the United States, primarily due to the increase in the prevalence of hepatitis C. Surgical treatments are rarely an option for patients with advanced hepatoma, and while chemotherapy, particularly with doxorubicin-based regimens, has marginally prolonged survival, response rates have been poor with the burden of high toxicity. Pemetrexed, a folate antimetabolite, has demonstrated activity in hepatoma cell lines with a manageable toxicity profile, making it a potentially useful agent in hepatocellular carcinoma. Methods: A multicenter, Phase II study was conducted to assess the response rate and evaluate the toxicity profile of single-agent pemetrexed (ALIMTA) in first-line patients with advanced or metastatic hepatoma. Pemetrexed 600 mg/m2 IV was administered on Day 1 of each 21-day cycle until disease progression (PD). Patients were premedicated with dexamethasone 4 mg PO BID and received daily folic acid 350–1000 μg PO and Vitamin B12 1000 μg IM every 9 weeks. Results: This nonrandomized study employed Simon’s 2-stage design. There were 21 eligible patients enrolled in the first stage, and all 21 patients were enrolled within 4 months of trial opening. Median age was 72 years (range, 44–88), and most patients were white (62%) and male (81%). Ten percent (10%) had an ECOG PS of 2, 48% Stage IV disease, 52% prior surgery, and 33% tumors of unknown histological grade. The plan was to stop accrual if ≤2 responders were observed among the 21 patients. Of the 21 patients, 3 had SD, 2 had early toxicities (renal/liver failure, sepsis), 15 progressed, and 1 was noncompliant. The trial was closed due to lack of response. The most common Grade 3 hematological toxicities were neutropenia 6/21 (28.6%) and thrombocytopenia 3/21 (14.3%). One patient experienced both Grade 3 nausea and vomiting. There were no Grade 4 toxicities. There were 10 on-study deaths: 9 PD and 1 liver failure. None of the deaths were drug-related. The median actual survival was 2.5 months (range, <1–8). Conclusions: While pemetrexed was well tolerated in this patient population, it was not active. Most adverse events were related to disease state, not study treatment. Supported by Eli Lilly and Company, Indianapolis, IN [Table: see text]
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Affiliation(s)
- A. Cohn
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - J. W. Myers
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - S. Mamus
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - C. Deur
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - S. Nicol
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - K. E. Hood
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - M. M. Khan
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - D. Ilegbodu
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
| | - L. Asmar
- US Oncology Research, Inc., Denver, CO; Texas Oncology PA, Austin, TX; Cancer Centers of Florida, Orlando, FL; Texas Oncology PA, Arlington, TX; Eli Lilly and Company, Indianapolis, IN; US Oncology Research, Inc., Houston, TX
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Hedrick E, Kozloff M, Hainsworth J, Badarinath S, Cohn A, Flynn P, Dong W, Suzuki S, Sugrue M, Grothey A. Safety of bevacizumab plus chemotherapy as first-line treatment of patients with metastatic colorectal cancer: Updated results from a large observational registry in the US (BRiTE). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3536] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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
3536 Background: Bevacizumab (BV) prolongs overall survival and progression-free survival when added to standard chemotherapy for patients with metastatic colorectal cancer (mCRC). BRiTE is a large, community-based observational registry of patients with mCRC receiving BV plus first-line chemotherapy. Safety and efficacy information in unselected patients with mCRC are collected. Chemotherapy regimen choice is at the physician’s discretion. Methods: To facilitate and evaluate enrollment of a typical community-based mCRC population, eligibility criteria were minimized. Cohort demographics were consistent with the NCI Surveillance, Epidemiology, and End Results (SEER) database for mCRC. Patients are followed for up to 3 years, and safety data including targeted BV-associated serious adverse events (SAEs) are updated every 3 months (mo). Results are based on descriptive analyses and are not adjusted for propensity of treatment, baseline characteristics, and treatment effects. Results: 1968 patients were enrolled between Feb 2004 and Jun 2005. Median study follow-up was 10 mo by Nov 4, 2005. SAEs were reported in 12.0% of patients including gastrointestinal perforation (GIP) (1.7%), postoperative bleeding/wound healing complications (1.2%), arterial thromboembolic events (ATE) (2.1%), and grade 3–4 bleeding (1.9%). 3.2% of patients discontinued BV due to a BV-related toxicity, most commonly bleeding. For patients with the respective event(s), median time to first event was 2.1 mo for GIP, 3.5 mo for ATE and 4.0 mo for grade 3–4 bleeding. 8.9% of patients with no history of hypertension (HTN) developed HTN requiring medication and 6.2% of patients who had HTN requiring medication at baseline experienced worsening of their HTN while on study treatment. Conclusions: In this unselected population of patients with mCRC, the safety profile of BV plus various chemotherapy regimens appears consistent with that observed in the pivotal BV trial. Overall discontinuation of BV due to a BV-related toxicity was uncommon. In this large community-based observational registry, no new BV associated safety issues have been identified. [Table: see text]
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Affiliation(s)
- E. Hedrick
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - M. Kozloff
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - J. Hainsworth
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - S. Badarinath
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - A. Cohn
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - P. Flynn
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - W. Dong
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - S. Suzuki
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - M. Sugrue
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
| | - A. Grothey
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Mayo Clinic, Rochester, MN
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Sugrue M, Kozloff M, Hainsworth J, Badarinath S, Cohn A, Flynn P, Steis R, Dong W, Sarkar S, Grothey A. Risk factors for gastrointestinal perforations in patients with metastatic colorectal cancer receiving bevacizumab plus chemotherapy. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3535] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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
3535 Background: Bevacizumab (BV) prolongs overall survival and progression-free survival when added to standard chemotherapy in patients (pts) with metastatic colorectal cancer (mCRC). BRiTE is a large, community-based observational registry of pts with mCRC receiving BV plus first-line chemotherapy (CT). Incidence rate, temporal pattern, and potential risk factors associated with gastrointestinal perforation (GIP) were explored. Methods: Baseline patient characteristics (BC), including prospectively identified potential risk factors for GIP, were collected at study entry. Safety data were collected every 3 months (mo). Logistic regression models, adjusted and unadjusted for treatment assignment, were used to identify BC potentially associated with GIP. Results: 1968 pts were enrolled between Feb 2004 and Jun 2005. Median study follow-up was 10 mo as of Nov 4, 2005. GIPs were observed in 34 pts (1.7%). For pts with GIP, median time to first event was 2.1 mo; the majority of events were non-fatal and occurred within the first 3 mo after starting BV. BC including GI medical history (chronic aspirin or NSAID use, peptic ulcer disease, diverticulosis) were similar in pts with or without GIP and with earlier or later GIP onset (≤ or >3 mo from start of BV). Although adjusted models did not show any significant BC, GIP rates were numerically higher in pts with primary tumor intact (2.6%) vs. resected (1.6%). Furthermore, univariate analyses revealed a significant difference between intact (2.3%) and resected (0.8%) primary tumor for earlier GIP (≤3 mo from start of BV). The majority of pts with GIP had at least one of the following: acute diverticulitis, intra-abdominal abscess, gastrointestinal obstruction, tumor at GIP site, abdominal carcinomatosis, prior abdominal or pelvic radiation therapy. Conclusions: Preliminary analyses indicate the incidence of GIP in this large, community-based observational registry is similar to that previously reported in phase III mCRC trials with BV. No associations between specific BCs and an increased risk of GIP were identified. Patients with primary tumor intact were more likely to incur a GIP within the first 3 mo of starting BV and CT. [Table: see text]
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Affiliation(s)
- M. Sugrue
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - M. Kozloff
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - J. Hainsworth
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - S. Badarinath
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - A. Cohn
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - P. Flynn
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - R. Steis
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - W. Dong
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - S. Sarkar
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
| | - A. Grothey
- Genentech, Inc., South San Francisco, CA; University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Mayo Clinic, Rochester, MN
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Cartwright TH, Kuefler P, Cohn A, Hyman W, Boehm KA, Ilegbodu D, Asmar L. Results of a phase II trial of cetuximab+XELIRI as first-line therapy of patients with advanced and/or metastatic colorectal cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
13502 Background: We have previously shown that capecitabine/irinotecan (XELIRI) is effective and well-tolerated in metastatic colorectal cancer (mCRC). Cetuximab targets EGFR and is active in mCRC either alone or combined with chemotherapy. This study evaluated potential improved outcomes with cetuximab+XELIRI in first-line treatment of mCRC. Subjects and Methods: Subjects had histologically confirmed colorectal adenocarcinoma with T4 lesions that were deemed unresectable after preoperative chemoradiation and/or metastatic disease. Treatment: capecitabine 1700 mg/m2 (850 mg/m2 PO BID Days 1–14), irinotecan 200 mg/m2 IV Day 1 every 3 weeks, and weekly cetuximab (initial dose 400 mg/m2 IV over 120 minutes, subsequent doses 250 mg/m2 over 30 minutes). Toxicity was assessed at each visit. Results: Between February and October 2005, 70 subjects enrolled. Baseline characteristics: 43 males (61%), 79% White, median age 61.5 years (range, 32.2 - 85.4), and ECOG PS 0/1= 66%/34%. 63% of subjects had Stage IV disease at diagnosis; 87% of subjects had adenocarcinoma. Prior therapy: surgery (n=60, 86%), chemotherapy (n=14, 20%), and radiotherapy (n=5, 7%). Grade 3–4 treatment-related toxicities in >1 subject included diarrhea (17%); neutropenia and rash (8.5% each); dehydration (7%); nausea/vomiting (5%); and anorexia, dyspepsia, and hypokalemia (3% each). 30 subjects discontinued due to progressive disease (PD) (n=9), toxicity (n=12), MD decision (n=2), patient request/withdrew consent (n=3), death (n=1) and other (n=3; doses delayed >3 weeks). To date 5 subjects have died; no death was treatment-related. Evaluation of tumor responses is ongoing. Conclusions: The combination of cetuximab+XELIRI is feasible and well-tolerated in first-line mCRC. Updated safety and efficacy data will be presented. Funded in part by Bristol-Myers Squibb, Plainsboro, NJ. [Table: see text]
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Affiliation(s)
- T. H. Cartwright
- US Oncology Research, Inc., Ocala, FL; Northern Arizona Hematology Oncology Associates, Flagstaff, AZ; Rocky Mountain Cancer Centers, Aurora, CO; Tyler Cancer Center, Tyler, TX; US Oncology Research, Inc., Houston, TX
| | - P. Kuefler
- US Oncology Research, Inc., Ocala, FL; Northern Arizona Hematology Oncology Associates, Flagstaff, AZ; Rocky Mountain Cancer Centers, Aurora, CO; Tyler Cancer Center, Tyler, TX; US Oncology Research, Inc., Houston, TX
| | - A. Cohn
- US Oncology Research, Inc., Ocala, FL; Northern Arizona Hematology Oncology Associates, Flagstaff, AZ; Rocky Mountain Cancer Centers, Aurora, CO; Tyler Cancer Center, Tyler, TX; US Oncology Research, Inc., Houston, TX
| | - W. Hyman
- US Oncology Research, Inc., Ocala, FL; Northern Arizona Hematology Oncology Associates, Flagstaff, AZ; Rocky Mountain Cancer Centers, Aurora, CO; Tyler Cancer Center, Tyler, TX; US Oncology Research, Inc., Houston, TX
| | - K. A. Boehm
- US Oncology Research, Inc., Ocala, FL; Northern Arizona Hematology Oncology Associates, Flagstaff, AZ; Rocky Mountain Cancer Centers, Aurora, CO; Tyler Cancer Center, Tyler, TX; US Oncology Research, Inc., Houston, TX
| | - D. Ilegbodu
- US Oncology Research, Inc., Ocala, FL; Northern Arizona Hematology Oncology Associates, Flagstaff, AZ; Rocky Mountain Cancer Centers, Aurora, CO; Tyler Cancer Center, Tyler, TX; US Oncology Research, Inc., Houston, TX
| | - L. Asmar
- US Oncology Research, Inc., Ocala, FL; Northern Arizona Hematology Oncology Associates, Flagstaff, AZ; Rocky Mountain Cancer Centers, Aurora, CO; Tyler Cancer Center, Tyler, TX; US Oncology Research, Inc., Houston, TX
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Kozloff M, Hainsworth J, Badarinath S, Cohn A, Flynn P, Steis R, Dong W, Suzuki S, Sugrue M, Grothey A. Efficacy of bevacizumab plus chemotherapy as first-line treatment of patients with metastatic colorectal cancer: Updated results from a large observational registry in the US (BRiTE). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3537] [Citation(s) in RCA: 17] [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: 11/20/2022] Open
Abstract
3537 Background: Bevacizumab (BV) prolongs overall survival and progression-free survival (PFS) when added to standard chemotherapy (CT) in patients with metastatic colorectal cancer (mCRC). BRiTE is a large, community-based observational registry of patients with mCRC receiving BV plus first-line CT. Safety and efficacy information in unselected patients with mCRC are collected. Chemotherapy regimen choice is at the physician’s discretion. Methods: 1968 patients receiving BV plus first-line CT were enrolled at 248 sites in 49 states between Feb 2004 and Jun 2005. Patients are followed for up to 3 years, with data reporting every 3 months (mo) including disease status as assessed by investigator using his/her method of choice. Patients were grouped twice by CT. Cox regression models, adjusted and unadjusted for treatment assignment, were used to identify baseline characteristics (BC) and differential chemotherapy effects on PFS. Results: Cohort demographics were consistent with the NCI Surveillance, Epidemiology, and End Results (SEER) database for mCRC. Median study follow-up was 10 months by Nov 4, 2005. CT regimens included FOLFOX (55.8%), FOLFIRI (14.1%), and IFL (9.7%). Based on observed progression events (n=800) or deaths (n=123), projected median PFS is 11.3 mo (95% CI: 10.4–11.7). Median PFS was comparable in patients treated with CT regimen based on irinotecan (11.3 mo), oxaliplatin (11.4 mo), or neither (10.2 mo) (CT Grouping 1); or 5FU infusion (11.5 mo), 5-FU bolus (9.7 mo), or capecitabine (11.6 mo) (CT Grouping 2). Significant BC in adjusted and unadjusted models are ECOG performance status (PS), primary disease site, and albumin, with no significant difference among CT regimens. Conclusions: This large, community-based registry included a patient population with demographics consistent with the SEER database for mCRC. Preliminary median PFS of 11.3 mo compares favorably to that reported in the pivotal trial. Median PFS appears to be comparable for all CTs when combined with BV. Higher baseline albumin, PS of 0, and primary disease site of rectum were associated with improved outcome. [Table: see text]
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Affiliation(s)
- M. Kozloff
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - J. Hainsworth
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - S. Badarinath
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - A. Cohn
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - P. Flynn
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - R. Steis
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - W. Dong
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - S. Suzuki
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - M. Sugrue
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
| | - A. Grothey
- University of Chicago, Chicago, IL; Sarah Cannon Research Institute, Nashville, TN; Florida Oncology Associates, Jacksonville, FL; Rocky Mountain Cancer Center, Denver, CO; Abbott Northwestern Hospital, Minneapolis, MN; Atlanta Cancer Care, Roswell, GA; Genentech, Inc., South San Francisco, CA; Mayo Clinic, Rochester, MN
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Cohn A, Morse MA, O’Neil B, Bellgrau D, Duke RC, Franzusoff AJ, Munson S, Ferraro J, Rodell TC. Treatment of Ras mutation-bearing solid tumors using whole recombinant S. cerevisiae yeast expressing mutated Ras: Preliminary safety and immunogenicity results from a phase 1 trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2571] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Cohn
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - M. A. Morse
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - B. O’Neil
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - D. Bellgrau
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - R. C. Duke
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - A. J. Franzusoff
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - S. Munson
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - J. Ferraro
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
| | - T. C. Rodell
- Rocky Mount Cancer Ctr, Denver, CO; Duke Univ Medcl Ctr, Durham, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Univ of Colorado, Aurora, CO; GlobeImmune, Inc, Aurora, CO
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Kozloff M, Cohn A, Christiansen N, Flynn P, Kabbinavar F, Robles R, Ulcickas Yood M, Sarkar S, Hambleton J, Grothey A. Safety of bevacizumab (BV) among patients (pts) receiving first-line chemotherapy (CT) for metastatic colorectal cancer (mCRC): Preliminary results from a larger registry in the U.S. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3566] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Kozloff
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - A. Cohn
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - N. Christiansen
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - P. Flynn
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - F. Kabbinavar
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - R. Robles
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - M. Ulcickas Yood
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - S. Sarkar
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - J. Hambleton
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
| | - A. Grothey
- Univ of Chicago, Chicago, IL; Rocky Mount Cancer Ctr, Denver, CO; South Carolina Oncology Assoc, Columbia, SC; Abbott North Western Hosp, Minneapolis, MN; Univ of CA Los Angeles, Los Angeles, CA; John Muir Hosp, Walnut Creek, CA; Josephine Ford Cancer Ctr, Detroit, MI; Genentech, Inc, San Francisco, CA; Mayo Clinic, Rochester, MN
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Affiliation(s)
- A Cohn
- Department of Paediatrics, Watford General Hospital, Vicarage Road, Watford WD18 OHB, UK.
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Van Cutsem E, Mayer R, Gold P, Stella P, Cohn A, Pippas A, Windt P, Molloy P, Lenz H. 279 Correlation of acne rash and tumor response with cetuximab monotherapy in patients with colorectal cancer refractory to both irinotecan and oxaliplatin. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80287-8] [Citation(s) in RCA: 10] [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: 10/26/2022] Open
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Falcon-Lizaraso S, Leon Chong J, Perazzo F, Goldwasser F, Cohn A, Kahatt C, Weems G, Eckhardt SG. Phase II trial of every 2 weeks dosing of irofulven (IROF) in patients (pts) with unresectable hepatocellular carcinoma (HCC): preliminary results. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Falcon-Lizaraso
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
| | - J. Leon Chong
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
| | - F. Perazzo
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
| | - F. Goldwasser
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
| | - A. Cohn
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
| | - C. Kahatt
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
| | - G. Weems
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
| | - S. G. Eckhardt
- Es Salud, Lima, Peru; INEN, Lima, Peru; CEMIC, Buenos Aires, Argentina; Hôpital Cochin, Paris, France; US Oncology, Denver, CO; CAC, Le Kremlin-Bicêtre, France; MGI PHARMA Inc, Bloomington, MN; University of Colorado, Denver, CO
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Jaeckle KA, Phuphanich S, Bent MJ, Aiken R, Batchelor T, Campbell T, Fulton D, Gilbert M, Heros D, Rogers L, O'Day SJ, Akerley W, Allen J, Baidas S, Gertler SZ, Greenberg HS, LaFollette S, Lesser G, Mason W, Recht L, Wong E, Chamberlain MC, Cohn A, Glantz MJ, Gutheil JC, Maria B, Moots P, New P, Russell C, Shapiro W, Swinnen L, Howell SB. Intrathecal treatment of neoplastic meningitis due to breast cancer with a slow-release formulation of cytarabine. Br J Cancer 2001; 84:157-63. [PMID: 11161370 PMCID: PMC2363714 DOI: 10.1054/bjoc.2000.1574] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [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: 11/25/2022] Open
Abstract
DepoCyte is a slow-release formulation of cytarabine designed for intrathecal administration. The goal of this multi-centre cohort study was to determine the safety and efficacy of DepoCyte for the intrathecal treatment of neoplastic meningitis due to breast cancer. DepoCyte 50 mg was injected once every 2 weeks for one month of induction therapy; responding patients were treated with an additional 3 months of consolidation therapy. All patients had metastatic breast cancer and a positive CSF cytology or neurologic findings characteristic of neoplastic meningitis. The median number of DepoCyte doses was 3, and 85% of patients completed the planned 1 month induction. Median follow up is currently 19 months. The primary endpoint was response, defined as conversion of the CSF cytology from positive to negative at all sites known to be positive, and the absence of neurologic progression at the time the cytologic conversion was documented. The response rate among the 43 evaluable patients was 28% (CI 95%: 14-41%); the intent-to-treat response rate was 21% (CI 95%: 12-34%). Median time to neurologic progression was 49 days (range 1-515(+)); median survival was 88 days (range 1-515(+)), and 1 year survival is projected to be 19%. The major adverse events were headache and arachnoiditis. When drug-related, these were largely of low grade, transient and reversible. Headache occurred on 11% of cycles; 90% were grade 1 or 2. Arachnoiditis occurred on 19% of cycles; 88% were grade 1 or 2. DepoCyte demonstrated activity in neoplastic meningitis due to breast cancer that is comparable to results reported with conventional intrathecal agents. However, this activity was achieved with one fourth as many intrathecal injections as typically required in conventional therapy. The every 2 week dose schedule is a major advantage for both patients and physicians.
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Affiliation(s)
- K A Jaeckle
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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Castilho EA, Cohn A. [On the Brazilian National Medical Educational Examination]. CAD SAUDE PUBLICA 2000; 16:1133-6. [PMID: 11175537 DOI: 10.1590/s0102-311x2000000400032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/22/2022] Open
Abstract
In Brazil, implementation of the so-called "Provão", or National Medical Course Examination, has raised numerous levels of discussion. This article aims to identify patterns in some of the more controversial issues: whether the Exam is really an instrument for evaluation of medical courses themselves, or that of future physicians; adequacy of assumptions underlying the questions as formulated; and lack of precision in the questions.
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Affiliation(s)
- E A Castilho
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 01246-903, Brasil.
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Melville C, Atherton D, Burch M, Cohn A, Sullivan I. Fatal cardiomyopathy in dystrophic epidermolysis bullosa. Br J Dermatol 1996; 135:603-6. [PMID: 8915155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two unrelated children with autosomal recessive dystrophic epidermolysis bullosa (RDEB) developed fatal dilated cardiomyopathy. Both were malnourished and had severe growth problems. We believe that the most likely cause for the cardiomyopathy is a micronutrient deficiency, most probably selenium deficiency, since the serum selenium level was found to be reduced in the case in whom we measured this, and in 14 of 25 other children with dystrophic epidermolysis bullosa. Echocardiographic screening of 18 other patients revealed no evidence of cardiomyopathy. We recommend careful attention to nutrition, with prospective monitoring of vitamins and micronutrients including selenium and carnitine, and regular echocardiographic screening of patients with severe RDEB.
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Affiliation(s)
- C Melville
- Department of Dermatology, Great Ormond Street Hospital for Children, London, U.K
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41
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Robinson JF, Robinson WA, Cohn A, Garg K, Armstrong JD. Perforation of the great vessels during central venous line placement. Arch Intern Med 1995; 155:1225-8. [PMID: 7763129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Placement of central venous lines for the administration of a variety of therapies has become common practice. The most severe complication of this procedure is perforation of a large vessel, with bleeding, infusion of fluids into an extravascular site, and death. It is not clear from currently available data how often this occurs, what risk factors are associated, and how this complication can be avoided. METHODS We reviewed the records of all patients who were identified as having perforation of a major vessel during central venous line placement occurring between 1986 and 1993 at the University Hospital, the major teaching facility of the University of Colorado Health Sciences Center, Denver. Data collected included the age and sex of the patient, diagnosis, type of catheter and site of placement, operator means and time to the diagnosis of perforation, and outcome. RESULTS Eleven such complications were identified and 10 of them are reviewed in detail. The overall incidence was less than 1%. Most complications occurred when the right subclavian vein approach was attempted, and they were thought to result from guidewire kinking during advancement of a vessel dilator. All medical specialties and levels of training were involved. Four of 10 patients died of immediate or subsequent complications of the perforation. CONCLUSIONS Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.
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Affiliation(s)
- J F Robinson
- Department of Medicine, University of Colorado Health Sciences Center, Denver, USA
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42
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Cohn A. A Cúpula para o Desenvolvimento Social, saúde e a América Latina. CAD SAUDE PUBLICA 1995; 11:175-6. [PMID: 14528324 DOI: 10.1590/s0102-311x1995000200001] [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: 11/22/2022] Open
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43
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Xu L, Lai FA, Cohn A, Etter E, Guerrero A, Fay FS, Meissner G. Evidence for a Ca(2+)-gated ryanodine-sensitive Ca2+ release channel in visceral smooth muscle. Proc Natl Acad Sci U S A 1994; 91:3294-8. [PMID: 8159742 PMCID: PMC43563 DOI: 10.1073/pnas.91.8.3294] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Although a role for the ryanodine receptor (RyR) in Ca2+ signaling in smooth muscle has been inferred, direct information on the biochemical and functional properties of the receptor has been largely lacking. Studies were thus carried out to purify and characterize the RyR in stomach smooth muscle cells from the toad Bufo marinus. Intracellular Ca2+ measurements with the Ca(2+)-sensitive fluorescent indicator fura-2 under voltage clamp indicated the presence of a caffeine- and ryanodine-sensitive internal store for Ca2+ in these cells. The (CHAPS)-solubilized, [3H]ryanodine-labeled RyR of toad smooth muscle was partially purified from microsomal membranes by rate density centrifugation as a 30-S protein complex. SDS/PAGE indicated the comigration of a high molecular weight polypeptide with the peak attributed to 30-S RyR, which had a mobility similar to the cardiac RyR and on immunoblots cross-reacted with a monoclonal antibody to the canine cardiac RyR. Following planar lipid bilayer reconstitution of 30-S stomach muscle RyR fractions, single-channel currents (830 pS with 250 mM K+ as the permeant ion) were observed that were activated by Ca2+ and modified by ryanodine. In vesicle-45Ca2+ efflux measurements, the toad channel was activated to a greater extent at 100-1000 microM than 1-10 microM Ca2+. These results suggest that toad stomach muscle contains a ryanodine-sensitive Ca2+ release channel with properties similar but not identical to those of the mammalian skeletal and cardiac Ca(2+)-release channels.
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Affiliation(s)
- L Xu
- Department of Biochemistry and Biophysics, School of Medicine, University of North Carolina, Chapel Hill 27599-7260
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Abstract
Metastatic cancer to the thyroid gland is uncommon. In this report we describe a patient with a malignant fibrous histiocytoma that metastasized to the thyroid, possibly to a preexisting thyroid nodule. A review of the literature reveals that breast and lung carcinoma are the most frequently identified sources of secondary thyroid carcinoma found at autopsy, while renal carcinoma comprises over 50% of secondary thyroid malignancies discovered clinically. A number of authors suggest that preexisting thyroid disease (i.e., multinodular goiter and thyroid nodules) may provide a nidus for metastases to the thyroid gland.
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Affiliation(s)
- B R Haugen
- Division of Endocrinology, University of Colorado Health Sciences Center, Denver 80262
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Cohn A. From a policy of inequality to a proposal of equity: political processes and health care in the municipality of São Paulo. Int J Health Serv 1992; 22:767-81. [PMID: 1399181 DOI: 10.2190/0f70-598r-gmum-40yf] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A tentative analysis is made of the recent São Paulo experience in health care management, in which the chief guideline has been to create institutional space for grass-roots and health worker participation within the State apparatus. The analysis takes Brazil's recent health policies and the so-called Sanitary Reform movement as reference points. The issue is approached from the angle of democracy and democracy's possibilities in the context of a society characterized by tremendous social inequalities, and in the context of the current international and national neoliberal offensive.
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Affiliation(s)
- A Cohn
- Centro de Estudos de Cultura Contemporânea-CEDEC, São Paulo, Brazil
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Abstract
We treated 29 patients with chronic-phase and accelerated chronic myeloid leukemia (CML) with alpha-interferon in a dose of 2 mU/m2 given subcutaneously daily for 30 days and then three times per week. Most had received prior treatment. Three patients have had sustained hematologic and karyotypic remissions after a median of 22 months of treatment. Three further patients have had complete hematologic and partial karyotypic remissions. At a median follow-up of 48 months, the median survival has not been reached. This dose of alpha-interferon may induce sustained remissions even in pretreated patients and may prolong survival in CML.
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MESH Headings
- Adult
- Aged
- Dose-Response Relationship, Drug
- Female
- Follow-Up Studies
- Humans
- Injections, Subcutaneous
- Interferon-alpha/administration & dosage
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Male
- Middle Aged
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Affiliation(s)
- A Sanchez
- Leukemia Research Clinic, University of Colorado Health Sciences Center, Denver 80262
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Abstract
We undertook a study to investigate the therapeutic potential of orally administered melatonin in patients with advanced melanoma. Forty-two patients received melatonin in doses ranging from 5 mg/m2/day to 700 mg/m2/day in four divided doses. Two were excluded from analysis. After a median follow-up of 5 weeks, six patients had partial responses, six additional patients had stable disease. Sites of response included the central nervous system, subcutaneous tissue and lung. The median response duration was 33 weeks for the partial responders. There was a suggestion of a dose-response relationship. The toxicity encountered was minimal and consisted primarily of fatigue in 17 of 40 patients. Melatonin also appeared to reduce basal levels of follicle-stimulating hormone (FSH). No significant changes were encountered in serum levels of luteinizing hormone (LH) or thyroid stimulating hormone (TSH). We conclude that further study of melatonin as a potentially useful agent in metastatic melanoma is warranted.
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Affiliation(s)
- R Gonzalez
- Division of Medical Oncology, University of Colorado Cancer Center, Denver 80262
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Gottschalck E, Alexandersen S, Cohn A, Poulsen LA, Bloom ME, Aasted B. Nucleotide sequence analysis of Aleutian mink disease parvovirus shows that multiple virus types are present in infected mink. J Virol 1991; 65:4378-86. [PMID: 1649336 PMCID: PMC248877 DOI: 10.1128/jvi.65.8.4378-4386.1991] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [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: 12/28/2022] Open
Abstract
Different isolates of Aleutian mink disease parvovirus (ADV) were cloned and nucleotide sequenced. Analysis of individual clones from two in vivo-derived isolates of high virulence indicated that more than one type of ADV DNA were present in each of these isolates. Analysis of several clones from two preparations of a cell culture-adapted isolate of low virulence showed the presence of only one type of ADV DNA. We also describe the nucleotide sequence from map units 44 to 88 of a new type of ADV DNA. The new type of ADV DNA is compared with the previously published ADV sequences, to which it shows 95% homology. These findings indicate that ADV, a single-stranded DNA virus, has a considerable degree of variability and that several virus types can be present simultaneously in an infected animal.
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Affiliation(s)
- E Gottschalck
- Department of Veterinary Microbiology, Royal Veterinary and Agricultural University of Copenhagen, Frederiksberg C, Denmark
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49
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White AC, An-Foraker SH, Cohn A, Sicilian L. Solitary cavitating pulmonary metastasis from prostatic carcinoma. Am J Med 1990; 88:193-5. [PMID: 2301446 DOI: 10.1016/0002-9343(90)90474-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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50
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Alexandersen S, Larsen S, Cohn A, Uttenthal A, Race RE, Aasted B, Hansen M, Bloom ME. Passive transfer of antiviral antibodies restricts replication of Aleutian mink disease parvovirus in vivo. J Virol 1989; 63:9-17. [PMID: 2535756 PMCID: PMC247651 DOI: 10.1128/jvi.63.1.9-17.1989] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [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: 01/01/2023] Open
Abstract
When mink kits were infected neonatally with a highly virulent strain of Aleutian disease virus (ADV), 100% of both Aleutian and non-Aleutian genotype mink died of interstitial pneumonia characterized by permissive ADV infection of alveolar type II cells. Treatment of infected kits with either mink anti-ADV gamma globulin or mouse monoclonal antibodies against ADV structural proteins reduced mortality by 50 to 75% and drastically reduced the severity of clinical signs. Interestingly, mink kits that survived the acute pulmonary disease all developed the chronic form of immune complex-mediated Aleutian disease. Thus, the antibodies directed against ADV structural proteins were capable of modulating the in vivo pathogenicity from an acute fulminant disease to a chronic immune complex-mediated disorder. The mechanism of this modulation was examined by strand-specific in situ hybridization. We found that the number of ADV-infected type II cells was the same in both untreated and antibody-treated kits. However, in the treated kits, viral replication and transcription were restricted at the cellular level. These data suggested that antibodies prevented acute viral pneumonia by restricting the intracellular level of viral replication and that the relevant antigenic determinants were contained within the viral structural proteins. The restricted levels of viral replication and transcription seen in antibody-treated mink kits resembled the levels observed in infected adult mink and suggested a role of antiviral antibodies in development of persistent infection and chronic immune complex disease.
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Affiliation(s)
- S Alexandersen
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, Hamilton, Montana 59840
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