1
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Kiesewetter B, Dafni U, de Vries EGE, Barriuso J, Curigliano G, González-Calle V, Galotti M, Gyawali B, Huntly BJP, Jäger U, Latino NJ, Malcovati L, Oosting SF, Ossenkoppele G, Piccart M, Raderer M, Scarfò L, Trapani D, Zielinski CC, Wester R, Zygoura P, Macintyre E, Cherny NI. ESMO-Magnitude of Clinical Benefit Scale for haematological malignancies (ESMO-MCBS:H) version 1.0. Ann Oncol 2023; 34:734-771. [PMID: 37343663 DOI: 10.1016/j.annonc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The European Society for Medical Oncology (ESMO)-Magnitude of Clinical Benefit Scale (MCBS) has been accepted as a robust tool to evaluate the magnitude of clinical benefit reported in trials for oncological therapies. However, the ESMO-MCBS hitherto has only been validated for solid tumours. With the rapid development of novel therapies for haematological malignancies, we aimed to develop an ESMO-MCBS version that is specifically designed and validated for haematological malignancies. METHODS ESMO and the European Hematology Association (EHA) initiated a collaboration to develop a version for haematological malignancies (ESMO-MCBS:H). The process incorporated five landmarks: field testing of the ESMO-MCBS version 1.1 (v1.1) to identify shortcomings specific to haematological diseases, drafting of the ESMO-MCBS:H forms, peer review and revision of the draft based on re-scoring (resulting in a second draft), assessment of reasonableness of the scores generated, final review and approval by ESMO and EHA including executive boards. RESULTS Based on the field testing results of 80 haematological trials and extensive review for feasibility and reasonableness, five amendments to ESMO-MCBS were incorporated in the ESMO-MCBS:H addressing the identified shortcomings. These concerned mainly clinical trial endpoints that differ in haematology versus solid oncology and the very indolent nature of nevertheless incurable diseases such as follicular lymphoma, which hampers presentation of mature data. In addition, general changes incorporated in the draft version of the ESMO-MCBS v2 were included, and specific forms for haematological malignancies generated. Here we present the final approved forms of the ESMO-MCBS:H, including instructions. CONCLUSION The haematology-specific version ESMO-MCBS:H allows now full applicability of the scale for evaluating the magnitude of clinical benefit derived from clinical studies in haematological malignancies.
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Affiliation(s)
- B Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens; Frontier Science Foundation-Hellas, Athens, Greece
| | - E G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Barriuso
- The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - G Curigliano
- European Institute of Oncology, IRCCS, Division of Early Drug Development, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - V González-Calle
- Servicio de Hematología, Hospital Universitario de Salamanca-IBSAL, CIBERONC and Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - M Galotti
- ESMO Head Office, Lugano, Switzerland
| | - B Gyawali
- Departments of Oncology, Oncology; Public Health Sciences, Queen's University, Kingston; Division of Cancer Care and Epidemiology, Queen's University, Kingston, Canada
| | - B J P Huntly
- Cambridge Stem Cell Institute, Department of Haematology, University of Cambridge & Cambridge University Hospitals, Cambridge, UK
| | - U Jäger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - L Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia; Department of Hematology Oncology, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - S F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Ossenkoppele
- Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands
| | - M Piccart
- Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - L Scarfò
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - D Trapani
- European Institute of Oncology, IRCCS, Division of Early Drug Development, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - C C Zielinski
- Wiener Privatklinik, Central European Academy Cancer Center, Vienna, Austria
| | - R Wester
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P Zygoura
- Frontier Science Foundation-Hellas, Athens, Greece
| | - E Macintyre
- Onco-hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris; Université Paris Cité, INSERM, CNRS, INEM F-75015, Paris, France
| | - N I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
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2
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Subbiah V, Kreitman RJ, Wainberg ZA, Cho JY, Schellens JHM, Soria JC, Wen PY, Zielinski CC, Cabanillas ME, Boran A, Ilankumaran P, Burgess P, Romero Salas T, Keam B. Dabrafenib plus trametinib in patients with BRAF V600E–mutant anaplastic thyroid cancer: updated analysis from the phase II ROAR basket study. Ann Oncol 2022; 33:406-415. [PMID: 35026411 PMCID: PMC9338780 DOI: 10.1016/j.annonc.2021.12.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Combined therapy with dabrafenib plus trametinib was approved in several countries for treatment of BRAF V600E-mutant anaplastic thyroid cancer (ATC) based on an earlier interim analysis of 23 response-assessable patients in the ATC cohort of the phase II Rare Oncology Agnostic Research (ROAR) basket study. We report an updated analysis describing the efficacy and safety of dabrafenib plus trametinib in the full ROAR ATC cohort of 36 patients with ~4 years of additional study follow-up. Patients and methods: ROAR (NCT02034110) is an open-label, nonrandomized, phase II basket study evaluating dabrafenib plus trametinib in BRAF V600E-mutant rare cancers. The ATC cohort comprised 36 patients with unresectable or metastatic ATC who received dabrafenib 150 mg twice daily plus trametinib 2 mg once daily orally until disease progression, unacceptable toxicity, or death. The primary endpoint was investigator-assessed overall response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints were duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. Results: At data cutoff (14 September 2020), median follow-up was 11.1 months (range, 0.9–76.6 months). The investigator-assessed ORR was 56% (95% confidence interval, 38.1% to 72.1%), including three complete responses; the 12-month DOR rate was 50%. Median PFS and OS were 6.7 and 14.5 months, respectively. The respective 12-month PFS and OS rates were 43.2% and 51.7%, and the 24-month OS rate was 31.5%. No new safety signals were identified with additional follow-up, and adverse events were consistent with the established tolerability of dabrafenib plus trametinib. Conclusions: These updated results confirm the substantial clinical benefit and manageable toxicity of dabrafenib plus trametinib in BRAF V600E-mutant ATC. Dabrafenib plus trametinib notably improved long-term survival and represents a meaningful treatment option for this rare, aggressive cancer.
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Affiliation(s)
- V Subbiah
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - J Y Cho
- Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | | | - J C Soria
- Institut Gustave Roussy, University of Paris-Sud, and University of Paris-Saclay, Villejuif, France
| | - P Y Wen
- Dana-Farber Cancer Institute, Boston, USA
| | | | - M E Cabanillas
- The University of Texas MD Anderson Cancer Center, Houston
| | - A Boran
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - P Ilankumaran
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - P Burgess
- Novartis Pharma AG, Basel, Switzerland
| | | | - B Keam
- Seoul National University Hospital, Seoul, Republic of Korea.
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3
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Füreder LM, Widhalm G, Gatterbauer B, Dieckmann K, Hainfellner JA, Bartsch R, Zielinski CC, Preusser M, Berghoff AS. Brain metastases as first manifestation of advanced cancer: exploratory analysis of 459 patients at a tertiary care center. Clin Exp Metastasis 2018; 35:727-738. [PMID: 30421093 PMCID: PMC6267666 DOI: 10.1007/s10585-018-9947-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/25/2018] [Accepted: 10/30/2018] [Indexed: 01/14/2023]
Abstract
Symptomatic brain metastases (BM) are a frequent and late complication in cancer patients. However, a subgroup of cancer patients presents with BM as the first symptom of metastatic cancer. Here we aimed to analyze the clinical course and prognostic factors of this particular BM patient population. Patients presenting with newly diagnosed BM without a history of metastatic cancer were identified from the Vienna Brain Metastasis Registry. Clinical characteristics and overall survival were retrieved by chart review. 459/2419 (19.0%) BM patients presented with BM as first symptom of advanced cancer. In 374/459 (81.5%) patients, an extracranial primary tumor, most commonly lung cancer, could be identified within 3 months after BM diagnosis. In 85/459 (18.5%) patients no extracranial primary tumor could be identified despite comprehensive diagnostic workup within the first 3 months after diagnosis of BM. Survival of patients with identified extracranial tumor differed only numerically from patients with cancer of unknown primary (CUP), however patients receiving targeted therapy after molecular workup showed significantly enhanced survival (20 months vs. 7 months; p = 0.003; log rank test). The GPA score showed a statistically significant association with median overall survival times in the CUP BM patients (class I: 46 months; class II: 7 months; class III: 4 months; class IV: 2 months; p < 0.001; log rank test). The GPA score has a strong prognostic value in patients with CUP BM and may be useful for patient stratification in the clinical setting. Comprehensive diagnostic workup including advanced imaging techniques and molecular tissue analyses appears to benefit patients by directing specific molecular targeted therapies.
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Affiliation(s)
- L M Füreder
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - B Gatterbauer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - J A Hainfellner
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Clinical Division of Oncology, Comprehensive Cancer Center CNS Tumors Unit, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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4
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Masel EK, Berghoff AS, Füreder LM, Heicappell P, Schlieter F, Widhalm G, Gatterbauer B, Dieckmann U, Birner P, Bartsch R, Schur S, Watzke HH, Zielinski CC, Preusser M. Decreased body mass index is associated with impaired survival in lung cancer patients with brain metastases: A retrospective analysis of 624 patients. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28488812 DOI: 10.1111/ecc.12707] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/30/2022]
Abstract
Body mass index (BMI) is a prognostic factor in several cancer types. We investigated the prognostic role of BMI in a large patient cohort with newly diagnosed lung cancer brain metastases (BM) between 1990 and 2013. BMI at diagnosis of BM and graded prognostic assessment (GPA) were calculated. Definitions were underweight (BMI <18.50), weight within normal range (BMI 18.50-24.99) and overweight (BMI ≥ 25.00). A total of 624 patients (men 401/624 [64.3%]; women 223/624 [35.7%]; median age of 61 [range 33-88]) were analysed. Histology was non-small cell lung cancer in 417/622 (66.8%), small cell lung cancer (SCLC) in 205/624 (32.9%) and not otherwise specified in 2/624 (0.3%) patients. About 313/624 (50.2%) had normal BMI, 272/624 (43.5%) were overweight and 39/624 (6.3%) were underweight. Underweight patients had shorter median overall survival (3 months) compared to patients with normal BMI (7 months) and overweight (8 months; p < .001; log rank test). At multivariate analysis, higher GPA class (HR 1.430; 95% cumulative incidence, CI 1.279-1.598; p < .001; Cox regression model), SCLC histology (HR 1.310; 95% CI 1.101-1.558) and presence of underweight (HR 1.845; 95% CI 1.317-2.585; p = .014; Cox regression model) were independent prognostic factors. Underweight at diagnosis of BM in lung cancer is associated with an unfavourable prognosis.
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Affiliation(s)
- E K Masel
- Department of Medicine I, Clinical Division of Palliative Care, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - L M Füreder
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - P Heicappell
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - F Schlieter
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - G Widhalm
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - B Gatterbauer
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - U Dieckmann
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - P Birner
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - S Schur
- Department of Medicine I, Clinical Division of Palliative Care, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - H H Watzke
- Department of Medicine I, Clinical Division of Palliative Care, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
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5
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Füreder LM, Berghoff AS, Gatterbauer B, Dieckmann K, Widhalm G, Hainfellner JA, Birner P, Bartsch R, Zielinski CC, Preusser M. OS7.4 Outcome of patients presenting with brain metastasis as first manifestation of cancer. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.054] [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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6
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Berghoff AS, Kresl P, Rajky O, Widhalm G, Ricken G, Hainfellner J, Marosi C, Zielinski CC, Birner P, Preusser M. P04.03 Analysis of the inflammatory tumor microenvironment in meningeal malignancies. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7
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Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Exner R, Gnant M, Zielinski CC, Steger GG, Preusser M, Bartsch R. Prognostic impact of breast cancer subtypes in elderly patients. Breast Cancer Res Treat 2016; 157:91-9. [PMID: 27107570 PMCID: PMC4866984 DOI: 10.1007/s10549-016-3787-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/05/2016] [Indexed: 01/29/2023]
Abstract
We aimed to analyse the impact of breast cancer (BC) subtypes on the clinical course of disease with special emphasis on the occurrence of brain metastases (BM) and outcome in an elderly BC population. A total number of 706 patients ≥65 years receiving treatment for BC from 2007 to 2011 were identified from a BC database. 62 patients diagnosed with DCIS and 73 patients with incomplete datasets were excluded, leaving 571 patients for this analysis. Patient characteristics, biological tumour subtypes, and clinical outcome including overall survival (OS) were obtained by retrospective chart review. 380/571 (66, 5 %) patients aged 65–74 years were grouped among the young-old, 182/571 (31.9 %) patients aged 75–84 years among the old–old, and 29/571 (5.1 %) patients aged ≥85 years among the oldest-old. 392/571 (68.8 %) patients presented with luminal BC, 119/571 (20.8 %) with HER2-positive, and 59/571 (10.3 %) with triple-negative BC (TNBC). At 38 months median follow-up, 115/571 (20.1 %) patients presented with distant recurrence. A higher recurrence rate was observed in the HER2-positive subtype (43/119 (36.1 %)), as compared to TNBC (15/59 (25.4 %)) and luminal BC (57/392 (14.5 %); p < 0.001). BM were detected at a significantly higher rate in HER2-positive BC patients (9/119 (7.6 %)), as compared to TNBC (2/59 (3.4 %)) and luminal BC patients (6/392 (1.5 %); p = 0.003). Diagnosis of metastatic disease (HR 7.7; 95 % CI 5.2–11.4; p < 0.001) as well as development of BM (HR 3.5; 95 % CI 1.9–6.4; p < 0.001) had a significantly negative impact on OS in a time-dependent covariate cox regression model. In contrast to younger BC patients, outcome in this large cohort of elderly patients suggests that HER2-positive disease—not TNBC—featured the most aggressive clinical course with the highest rates of metastatic spread and BM. In-depth analysis regarding a potentially distinct biology of TNBC in elderly is therefore warranted.
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Affiliation(s)
- E S Bergen
- Comprehensive Cancer Center, Vienna, Austria. .,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
| | - C Tichy
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - A S Berghoff
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Z Bago-Horvath
- Comprehensive Cancer Center, Vienna, Austria.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - R M Mader
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - R Exner
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center, Vienna, Austria.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - G G Steger
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center, Vienna, Austria.,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center, Vienna, Austria. .,Clinical Division of Oncology, Department of Medicine 1, Medical University of Vienna, Vienna, Austria.
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8
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Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Gnant M, Dieckmann K, Zielinski CC, Steger GG, Preusser M, Bartsch R. Abstract P2-08-17: Prognostic impact of breast cancer subtypes in elderly patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-17] [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: 11/16/2022]
Abstract
Abstract
Background
We aimed to analyze the impact of BC subtypes on the clinical course with special emphasis on the occurrence of brain metastases (BM) and outcome in an elderly breast cancer population.
Patients and Methods
571 patients ≥65 years receiving treatment for BC from 2007-2011 were identified from a BC database. BC subtypes and clinical characteristics including overall survival (OS) were obtained by chart review. Statistical analysis was performed using the Chi Square test, the log rank test and time depended covariate cox regression model as appropriate.
Results
Three-hundred-eighty/571 (63%) were grouped among the young-old (65-74 years), 182/571 (31.9%) among the old-old (75-84 years), and 29/571 (5,1%) among the oldest-old (≥85 years). 392/571 (68.8%) patients presented with luminal BC, 119/571 (20.8%) with HER2 positive and 59/571 (10.3%) with triple negative BC. After a median follow up of 38 months (range 0-204), 115/571 (20.1%) patients presented with metastatic recurrence. Highest recurrence rate was observed in HER2 positive BC patients (43/119 (36.1%)), followed by triple negative (15/59 (25.4%) and luminal BC (57/392 (14.5%); p<0.001; Chi Square test). BM occurred significantly more frequently in HER2 positive BC patients (9/119 (7.6%) compared to triple negative (2/59 (3.4%) and luminal BC patients (6/392 (1.5%); p=0.003; Chi Square test). Occurrence of metastases (HR 7.7; 95% CI 5.2-11.4; p<0.001) as well as development of BM (HR 3.5; 95% CI 1.9-6.4; p<0.001) had a significant impact on OS prognosis as entered in a time depended covariate cox regression model.
Conclusions
In contrast to younger BC patients, HER2 positive BC subtype and not triple negative BC subtype was linked to the most aggressive clinical course including the development of metastatic disease and BM in our elderly cohort.
Citation Format: Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Gnant M, Dieckmann K, Zielinski CC, Steger GG, Preusser M, Bartsch R. Prognostic impact of breast cancer subtypes in elderly patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-17.
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Affiliation(s)
- ES Bergen
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - C Tichy
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - AS Berghoff
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - M Rudas
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - P Dubsky
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - Z Bago-Horvath
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - RM Mader
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - K Dieckmann
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - CC Zielinski
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - GG Steger
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center Vienna, Austria; Medical University of Vienna, Austria
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9
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Zielinski CC, Weissel M, Müller C, Till P, Höfer R. Long-term follow-up of patients with Graves' orbitopathy treated by plasmapheresis and immunosuppression. Dev Ophthalmol 2015; 20:130-8. [PMID: 2574116 DOI: 10.1159/000417929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- C C Zielinski
- Department for Nuclear Medicine, Ludwig Boltzmann Institute for Nuclear Medicine, University Eye Clinic II, Vienna, Austria
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Berghoff AS, Bartsch R, Bergen E, Rudas M, Gnant M, Dieckmann K, Pinker K, Zielinski CC, Steger GG, Preusser M. P08.01 * RESPONSE TO T-DM1 IN HER2-POSITIVE BREAST CANCER BRAIN METASTASES (BM). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Bartsch R, Frings S, Marty M, Awada A, Berghoff AS, Conte P, Dickin S, Enzmann H, Gnant M, Hasmann M, Hendriks HR, Llombart A, Massacesi C, von Minckwitz G, Penault-Llorca F, Scaltriti M, Yarden Y, Zwierzina H, Zielinski CC. Present and future breast cancer management--bench to bedside and back: a positioning paper of academia, regulatory authorities and pharmaceutical industry. Ann Oncol 2014; 25:773-780. [PMID: 24351401 DOI: 10.1093/annonc/mdt531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Insights into tumour biology of breast cancer have led the path towards the introduction of targeted treatment approaches; still, breast cancer-related mortality remains relatively high. Efforts in the field of basic research revealed new druggable targets which now await validation within the context of clinical trials. Therefore, questions concerning the optimal design of future studies are becoming even more pertinent. Aspects such as the ideal end point, availability of predictive markers to identify the optimal cohort for drug testing, or potential mechanisms of resistance need to be resolved. An expert panel representing the academic community, the pharmaceutical industry, as well as European Regulatory Authorities met in Vienna, Austria, in November 2012, in order to discuss breast cancer biology, identification of novel biological targets and optimal drug development with the aim of treatment individualization. This article summarizes statements and perspectives provided by the meeting participants.
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Affiliation(s)
- R Bartsch
- Clinical Division of Oncology/Department of Medicine I; Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - S Frings
- Hoffmann-La Roche, Basel, Switzerland
| | - M Marty
- Centre for Therapeutic Innovations in Oncology and Haematology, Saint Louis University Hospital, Paris, France
| | - A Awada
- Institut Jules Bordet/Medical Oncology Clinic, Université Libre de Bruxelles, Brussels, Belgium
| | - A S Berghoff
- Clinical Division of Oncology/Department of Medicine I; Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - P Conte
- Department of Surgery/Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - S Dickin
- Eli-Lilly and Company, Basingstoke, UK
| | - H Enzmann
- BfArM - Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
| | - M Gnant
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria; Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - M Hasmann
- Roche Diagnostics GmbH, pRED Penzberg, Penzberg, Germany
| | - H R Hendriks
- Hendriks Pharmaceutical Consulting, Purmerend, The Netherlands
| | - A Llombart
- Medical Oncology Department, Arnau Vilanova Hospital, Valencia, Spain
| | | | - G von Minckwitz
- German Breast Group, Neu-Isenburg; University Women's Hospital Frankfurt, Frankfurt, Germany
| | - F Penault-Llorca
- Department of Pathology, Centre Jean-Perrin, Clermont-Ferrand; Department of Pathology, University of Auvergne, Clermont-Ferrand, France
| | - M Scaltriti
- Human Oncology & Pathogenesis Program (HOPP) and Memorial Sloan Kettering Cancer Center, New York, USA
| | - Y Yarden
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - H Zwierzina
- Medical University of Innsbruck, Innsbruck, Austria
| | - C C Zielinski
- Clinical Division of Oncology/Department of Medicine I; Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
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12
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Abstract
BACKGROUND In the United States, there will be a shortage of medical oncologists (MO) by 2020. However, this information is not available for Europe. The aim of this study was to assess the current number of MO in the 27 European Union (27-EU) countries and to predict their availability by 2020. MATERIAL AND METHODS Between June 2012 and January 2013, a survey was submitted to health authorities, medical oncology societies, and personal contacts in all 27-EU countries in order to gather annual data on the number of practicing MO. Data were collected by e-mail, telephone contact, or through research on official websites. Data regarding cancer incidence in 2008 and projections for 2015 and 2020 were obtained through Globocan. The mean annual increase in the number of MO was calculated for each country. The total number of MO by 2015 and 2020 was estimated, and the ratio of new cancer cases versus number of MO was calculated for 2008, 2015, and 2020. RESULTS Twelve countries provided sufficient data. The average mean annual increase in the total number of MO was 5.3% (range 1.8%-8.7%), with Belgium being the lowest and UK the highest. The 2008 ratio of cancer cases versus MO was lowest in Hungary (113) and highest in UK (1067). A favorable decrease in this ratio was estimated in most countries. CONCLUSION Our estimates, based on incidence and not on prevalence, indicate that MO availability will probably meet the projected need in most of the 12 countries analyzed, provided that: (i) these countries maintain their rate of annual increase in MO; and (ii) no unforeseen changes occur in cancer incidence. Unfortunately, minimal information is available for Eastern Europe. Our data call for the prospective surveillance of the cancer burden and MO availability to ensure adequate and equal care for cancer patients throughout Europe.
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Affiliation(s)
- E de Azambuja
- Medical Oncology Clinic and BrEAST Data Center, Jules Bordet Institute, Brussels
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13
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Steger GG, Greil R, Lang A, Rudas M, Fitzal F, Mlineritsch B, Hartmann BL, Bartsch R, Melbinger E, Hubalek M, Stoeger H, Dubsky P, Ressler S, Petzer AL, Singer CF, Muss C, Jakesz R, Gampenrieder SP, Zielinski CC, Fesl C, Gnant M. Epirubicin and docetaxel with or without capecitabine as neoadjuvant treatment for early breast cancer: final results of a randomized phase III study (ABCSG-24). Ann Oncol 2013; 25:366-71. [PMID: 24347519 DOI: 10.1093/annonc/mdt508] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This randomized phase III trial compared pathologic complete response (pCR) rates of early breast cancer (EBC) following neoadjuvant epirubicin-docetaxel (ED)±capecitabine (C), and evaluated the addition of trastuzumab in HER2-positive tumors. PATIENTS AND METHODS Patients with invasive breast cancer (except T4d) were randomly assigned to receive six 3-weekly cycles of ED (both 75 mg/m2)±C (1000 mg/m2, twice daily, days 1-14). Patients with HER2-positive disease were further randomized to receive trastuzumab (8 mg/kg, then 6 mg/kg every 3 weeks) or not. Primary end point: pCR rate at the time of surgery. RESULTS Five hundred thirty-six patients were randomized to ED (n=266) or EDC (n=270); 93 patients were further randomized to trastuzumab (n=44) or not (n=49). pCR rate was significantly increased with EDC (23.0% versus 15.4% ED, P=0.027), and nonsignificantly further increased with trastuzumab (38.6% EDC versus 26.5% ED, P=0.212). Rates of axillary node involvement at surgery and breast conservation were improved with EDC versus ED, but not significantly; the addition of trastuzumab had no further impact. Hormone receptor status, tumor size, grade, and C (all P≤0.035) were independent prognostic factors for pCR. Trastuzumab added to ED±C significantly increased the number of serious adverse events (35 versus 18; P=0.020), mainly due to infusion-related reactions. CONCLUSION These findings show that the integration of C into a neoadjuvant taxane-/anthracycline-based regimen is a feasible, safe, and effective treatment option, with incorporation of trastuzumab in HER2-positive disease. CLINICAL TRIAL NUMBER NCT00309556, www.clinicaltrials.gov.
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Affiliation(s)
- G G Steger
- Department of Internal Medicine I, Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna
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14
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Foedermayr M, Sebesta M, Rudas M, Berghoff AS, Promberger R, Preusser M, Dubsky P, Fitzal F, Gnant M, Steger GG, Weltermann A, Zielinski CC, Zach O, Bartsch R. Abstract P1-08-40: BRCA-1 promotor methylation and p53 mutation in triple-negative breast cancer patients refrectory to taxane-based neoadjuvant chemotherapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-40] [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: 11/16/2022]
Abstract
Abstract
Introduction
Triple-negative breast cancer (TNBC) without pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) is associated with high risk of disease recurrence. In ABCSG trials 14 and 24, concomitant epirubicin plus docetaxel (+/- capecitabine) was used as NAC regimen; patients (pts) without pCR routinely received another 4-8 cycles of adjuvant CMF.
Tumours harbouring BRCA-1 germline mutations are apparently less responsive to taxane-based chemotherapy, while sensitivity to DNA-damaging agents is retained. In sporadic TNBC, BRCA-1 promotor methylation is frequently observed; this may also result in an impaired activity of genetic repair mechanisms. Therefore, we investigated the effect of adjuvant CMF as salvage therapy in pts with or without BRCA-1 promotor methylation who did not achieve pCR to taxane-based (cyclophosphamide-free) NAC. Moreover, the predictive role of TP53 mutations was investigated in these tumours.
Methods
All pts with TNBC refractory to taxane-based NAC who received adjuvant CMF were included.
DNA was extracted from formalin-fixed paraffin-embedded tissue samples with the Qiagen DNA FFPE Tissue Kit® and purified. For determining BRCA1 promoter methylation status, DNA was bisulfite-treated; the TaqMan® assay was used in order to perform a quantitative methylation-specific PCR. DNA quantity was normalized using Actin-b.
For the investigation of TP53 mutations in exons 4-9, purified DNA was PCR amplified, sequenced by Sanger sequencing and results were analyzed with SeqScape® software version 2.7. Mutations were validated using the IARC p53 database.
Results
Twenty-four pts, median age 47 years, were available for this analysis. In 10/24 pts (41.7%), a BRCA-1 promotor methylation was detected; TP53 mutations were observed in 16/24 pts (66.7%). At a median follow-up of 27.5 months, 2/10 pts (20%) with BRCA-1 promotor metyhlation had a disease-free survival (DFS) event, as compared to 9/14 (64.3%) in the non-methylated group (p = 0.0472; Fisher's exact test). Kaplan Meier estimation of disease-free survival (DFS) in the non-methylated group was 16 months (95% CI 0.0-41.73) and was not reached in the methylated group (n.s.). TP53 mutation was neither associated with increased risk of disease recurrence nor with DFS. No correlation was observed between BRCA-1 promotor methylation and TP53 mutation; still, all methylated samples were exclusively affected be missense and nonsense mutations.
Conclusions
Adjuvant CMF is of limited activity in TNBC refractory to taxane-based NAC. Still, in breast cancer harbouring BRCA-1 promotor methylation, a significant decrease of DFS events was observed. TP53 mutation status on the other hand, was not associated with outcome; while no correlation was found between BRCA-1 promotor methylation and TP53 mutation status, we only observed missense and non-sense mutations in methylated samples.
In conclusion, tumours harbouring BRCA-1 promotor methylation are apparently sensitive to DNA damage caused by cyclophosphamide. Further clinical validation of this concept is warranted.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-40.
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Affiliation(s)
- M Foedermayr
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Sebesta
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - AS Berghoff
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - R Promberger
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - F Fitzal
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - GG Steger
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - A Weltermann
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - CC Zielinski
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - O Zach
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
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15
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Brodowicz T, Ciuleanu TE, Radosavljevic D, Shacham-Shmueli E, Vrbanec D, Plate S, Mrsic-Krmpotic Z, Dank M, Purkalne G, Messinger D, Zielinski CC. FOLFOX4 plus cetuximab administered weekly or every second week in the first-line treatment of patients with KRAS wild-type metastatic colorectal cancer: a randomized phase II CECOG study. Ann Oncol 2013; 24:1769-1777. [PMID: 23559149 DOI: 10.1093/annonc/mdt116] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND This randomized phase II study investigated first-line chemotherapy plus cetuximab administered every second week in KRAS wild-type metastatic colorectal cancer. PATIENTS AND METHODS Patients received FOLFOX4 plus either standard weekly cetuximab (arm 1) or cetuximab (500 mg/m(2)) every second week (arm 2), until disease progression or unacceptable toxicity. Primary end point was the objective response rate (ORR). Progression-free survival (PFS), overall survival (OS), disease control rate (DCR) and safety were also investigated. The study was not powered to establish non-inferiority, but aimed at the estimation of treatment differences. RESULTS Of 152 randomized eligible patients, 75 were treated in arm 1 and 77 in arm 2; ORRs [53% versus 62%, odds ratio 1.40, 95% confidence interval (CI) 0.74-2.66], PFS [median 9.5 versus 9.2 months, hazard ratio (HR) 0.92, 95% CI 0.63-1.34], OS (median 25.8 versus 23.0 months, HR 0.86, 95% CI 0.56-1.30) and DCR (87%) were comparable. HRs adjusted for baseline factors were 1.01 and 0.99 for PFS and OS, respectively. Frequencies of grade 3/4 adverse events in arms 1 versus 2 were similar: most common were neutropenia (28% versus 34%) and rash (15% versus 17%). CONCLUSIONS Activity and safety of FOLFOX4 plus either cetuximab administered weekly or every second week were similar.
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Affiliation(s)
- T Brodowicz
- Department of Medicine I, Medical University of Vienna, Vienna; Comprehensive Cancer Centre, Vienna, Austria
| | | | | | - E Shacham-Shmueli
- Division of Oncology, Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - D Vrbanec
- Department of Oncology, University Hospital Zagreb/Rebro, Zagreb, Croatia
| | - S Plate
- The Latvian Center of Oncology, Riga, Latvia
| | - Z Mrsic-Krmpotic
- Department of Medical Oncology, University Hospital for Tumors, Zagreb, Croatia
| | - M Dank
- Radiology Clinic, Semmelweis University, Budapest, Hungary
| | - G Purkalne
- P Stradins University Hospital, Riga, Latvia
| | | | - C C Zielinski
- Department of Medicine I, Medical University of Vienna, Vienna; Comprehensive Cancer Centre, Vienna, Austria.
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16
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André F, Zielinski CC. Optimal strategies for the treatment of metastatic triple-negative breast cancer with currently approved agents. Ann Oncol 2013; 23 Suppl 6:vi46-51. [PMID: 23012302 DOI: 10.1093/annonc/mds195] [Citation(s) in RCA: 205] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive histological subtype with limited treatment options and very poor prognosis following progression after standard chemotherapeutic regimens. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Duration of response is usually short, with rapid relapse very common and median survival of just 13 months. The newly approved agent eribulin has shown a survival benefit in patients who had previously been treated with anthracycline- or taxane-containing regimens, including in patients with TNBC. Platinum-based regimens are an emerging option for patients with BRCA1 mutation, and newer targeted agents such as anti-angiogenic treatment with bevacizumab or anti-epidermal growth factor receptor treatment with cetuximab, have shown some benefit in combination therapy. However, there remains an urgent unmet need for improved targeted agents for this patient population. Improved treatment may be facilitated by biomarker-led understanding of subgroup molecular targets, which may predict benefit from currently approved agents, as well as newer targeted drugs.
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Affiliation(s)
- F André
- Department of Medical Oncology and INSERM U981, Institut Gustave Roussy, Villejuif, France.
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17
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Berghoff AS, Bago-Horvath Z, Ilhan-Mutlu A, Magerle M, Dieckmann K, Marosi C, Birner P, Widhalm G, Steger GG, Zielinski CC, Bartsch R, Preusser M. Brain-only metastatic breast cancer is a distinct clinical entity characterised by favourable median overall survival time and a high rate of long-term survivors. Br J Cancer 2012; 107:1454-8. [PMID: 23047551 PMCID: PMC3493775 DOI: 10.1038/bjc.2012.440] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The clinical course of breast cancer patients with brain metastases (BM) as only metastatic site (brain-only metastatic breast cancer (BO-MBC)) has been insufficiently explored. METHODS All breast cancer patients with BM treated at our institution between 1990 and 2011 were identified. For each patient, full information on follow-up and administered therapies was mandatory for inclusion. Oestrogen receptor, progesterone receptor and Her2 status were determined according to standard protocols. Statistical analyses including computation of survival probabilities was performed. RESULTS In total, 222 female patients (26% luminal; 47% Her2; 27% triple negative) with BM of MBC were included in this study. In all, 38/222 (17%) BM patients did not develop extracranial metastases (ECM) during their disease course and were classified as BO-MBC. Brain-only-MBC was not associated with breast cancer subtype or number of BM. The median overall survival of BO-MBC patients was 11 months (range 0-69) and was significantly longer than in patients with BM and ECM (6 months, range 0-104; P=0.007). In all, 7/38 (18%) BO-MBC patients had long-term survival of >3 years after diagnosis of BM and long-term survival was significantly more common in BO-MBC patients as compared with BM patients with ECM (P<0.001). CONCLUSIONS Brain-only metastatic behaviour occurs in around 17% of breast cancer with BM and is not associated with breast cancer subtype. Exploitation of all multimodal treatment options is warranted in BO-MBC patients, as these patients have favourable prognosis and long-term survival is not uncommon.
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Affiliation(s)
- A S Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
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18
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Brodowicz T, Ciuleanu T, Crawford J, Filipits M, Fischer JR, Georgoulias V, Gridelli C, Hirsch FR, Jassem J, Kosmidis P, Krzakowski M, Manegold C, Pujol JL, Stahel R, Thatcher N, Vansteenkiste J, Minichsdorfer C, Zöchbauer-Müller S, Pirker R, Zielinski CC. Third CECOG consensus on the systemic treatment of non-small-cell lung cancer. Ann Oncol 2012; 23:1223-1229. [PMID: 21940784 DOI: 10.1093/annonc/mdr381] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 01/21/2023] Open
Abstract
The current third consensus on the systemic treatment of non-small-cell lung cancer (NSCLC) builds upon and updates similar publications on the subject by the Central European Cooperative Oncology Group (CECOG), which has published such consensus statements in the years 2002 and 2005 (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137). The principle of all CECOG consensus is such that evidence-based recommendations for state-of-the-art treatment are given upon which all participants and authors of the manuscript have to agree (Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). This is of particular importance in diseases in which treatment options depend on very particular clinical and biologic variables (Zielinski CC, Beinert T, Crawford J et al. Consensus on medical treatment of non-small-cell lung cancer--update 2004. Lung Cancer 2005; 50: 129-137; Beslija S, Bonneterre J, Burstein HJ et al. Third consensus on medical treatment of metastatic breast cancer. Ann Oncol 2009; 20 (11): 1771-1785). Since the publication of the last CECOG consensus on the medical treatment of NSCLC, a series of diagnostic tools for the characterization of biomarkers for personalized therapy for NSCLC as well as therapeutic options including adjuvant treatment, targeted therapy, and maintenance treatment have emerged and strongly influenced the field. Thus, the present third consensus was generated that not only readdresses previous disease-related issues but also expands toward recent developments in the management of NSCLC. It is the aim of the present consensus to summarize minimal quality-oriented requirements for individual patients with NSCLC in its various stages based upon levels of evidence in the light of a rapidly expanding array of individual therapeutic options.
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Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria; Central European Cooperative Oncology Group
| | - T Ciuleanu
- Medical Oncology Department, Institute of Oncology, Cluj-Napoca, Romania
| | - J Crawford
- Department of Medicine, Duke Medical Center, Durham, USA
| | - M Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - J R Fischer
- Department of Medicine II, Onkology, Klinik Löwenstein, Löwenstein, Germany
| | - V Georgoulias
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - C Gridelli
- Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta, Italy
| | - F R Hirsch
- Department of Pathology, University of Colorado, Aurora, USA
| | - J Jassem
- Central European Cooperative Oncology Group; Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - P Kosmidis
- Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - M Krzakowski
- Central European Cooperative Oncology Group; Department of Lung and Thoracic Tumours, Maria Sklodowska Curie Memorial Cancer Center, Warsaw, Poland
| | - Ch Manegold
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J L Pujol
- Department of Oncology Lung, Hopital Arnaud de Villeneuve, Montpellier, France
| | - R Stahel
- Laboratory for Molecular Oncology, Department of Thoracic Oncology, Clinic and Policlinic for Oncology, University Hospital Zurich, Zurich, Switzerland
| | - N Thatcher
- Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK
| | - J Vansteenkiste
- Respiratory Oncology Unit (Pulmonology), University Hospital Gasthuisberg, Leuven, Belgium
| | - C Minichsdorfer
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - S Zöchbauer-Müller
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - R Pirker
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria
| | - C C Zielinski
- Clinical Division of Oncology, Comprehensive Cancer Center, Medical University Vienna-General Hospital, Vienna, Austria; Central European Cooperative Oncology Group.
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19
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Berghoff A, Bago-Horvath Z, De Vries C, Dubsky P, Pluschnig U, Rudas M, Rottenfusser A, Knauer M, Eiter H, Fitzal F, Dieckmann K, Mader RM, Gnant M, Zielinski CC, Steger GG, Preusser M, Bartsch R. Brain metastases free survival differs between breast cancer subtypes. Br J Cancer 2012; 106:440-6. [PMID: 22233926 PMCID: PMC3273356 DOI: 10.1038/bjc.2011.597] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 12/07/2011] [Accepted: 12/16/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Brain metastases (BM) are frequently diagnosed in patients with HER-2-positive metastatic breast cancer; in addition, an increasing incidence was reported for triple-negative tumours. We aimed to compare brain metastases free survival (BMFS) of breast cancer subtypes in patients treated between 1996 until 2010. METHODS Brain metastases free survival was measured as the interval from diagnosis of extracranial breast cancer metastases until diagnosis of BM. HER-2 status was analysed by immunohistochemistry and reanalysed by fluorescent in situ hybridisation if a score of 2+ was gained. Oestrogen-receptor (ER) and progesterone-receptor (PgR) status was analysed by immunohistochemistry. Brain metastases free survival curves were estimated with the Kaplan-Meier method and compared with the log-rank test. RESULTS Data of 213 patients (46 luminal/124 HER-2/43 triple-negative subtype) with BM from breast cancer were available for the analysis. Brain metastases free survival differed significantly between breast cancer subtypes. Median BMFS in triple-negative tumours was 14 months (95% CI: 11.34-16.66) compared with 18 months (95% CI: 14.46-21.54) in HER-2-positive tumours (P=0.001) and 34 months (95% CI: 23.71-44.29) in luminal tumours (P=0.001), respectively. In HER-2-positive patients, co-positivity for ER and HER-2 prolonged BMFS (26 vs 15 m; P=0.033); in luminal tumours, co-expression of ER and PgR was not significantly associated with BMFS. Brain metastases free survival in patients with lung metastases was significantly shorter (17 vs 21 months; P=0.014). CONCLUSION Brain metastases free survival in triple-negative breast cancer, as well as in HER-2-positive/ER-negative, is significantly shorter compared with HER-2/ER co-positive or luminal tumours, mirroring the aggressiveness of these breast cancer subtypes.
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Affiliation(s)
- A Berghoff
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Z Bago-Horvath
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - C De Vries
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - P Dubsky
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - U Pluschnig
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Rudas
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - A Rottenfusser
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - M Knauer
- Department of Surgery, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - H Eiter
- Department of Radiotherapy, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - F Fitzal
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - R M Mader
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Gnant
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - C C Zielinski
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - G G Steger
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - M Preusser
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - R Bartsch
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Bartsch R, Berghoff A, Bago-Horvath Z, DeVries C, Dubsky P, Pluschnig U, Rudas M, Rottenfusser A, Fitzal F, Dieckmann K, Mader RM, Gnant M, Zielinski CC, Steger GG. P4-17-05: Brain Metastasis Free Survival (BMFS) Differs between Breast Cancer Subtypes. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-17-05] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND Brain metastases (BM) are frequently diagnosed in patients (pts) with Her2-positive metastatic breast cancer (BC); a rising incidence was also reported in triple-negative disease. We hypothesized that pts with triple-negative or Her2-positive tumours had shorter BMFS as compared to other BC subtypes.
Therefore, we aimed to compare BMFS in pts with Her2-positive, estrogen receptor (ER) positive and triple-negative BC treated at the Medical University of Vienna from 1999–2009. In Her2-positive tumours, we further investigated the influence of ER co-expression on BMFS, as Her2-positive / ER-positive tumours were reported to express less aggressive biological properties.
METHODS BMFS was defined as primary study endpoint and measured as the interval from diagnosis of metastatic BC until diagnosis of BM. A total of 168 pts were identified from a breast cancer database. 34 pts were excluded from this analysis as brain was the first site of disease progression; hence complete datasets from 134 pts were available (69 Her2-positive; 33 triple-negative; 32 ER-positive).
Her2 status was analyzed by immunohistochemistry (IHC) and reanalyzed by FISH if a score of 2+ was gained. ER was analyzed by IHC; ER negative tumours were defined by a cut-off value of <10% positively stained tumour cells. BMFS was estimated with the Kaplan-Meier product limit method and compared with the log-rank test; factors significantly associated with BMFS in the univariate analysis were included into a Cox proportional hazard model.
RESULTS Median BMFS in triple-negative pts was 14 months (m) (95% CI 12.17−15.83), as compared to 25 m (95% CI 13.37−36.62) in Her2-positive (p=0.001) and 35 m (95% CI 19.79−50.22) in ER-positive pts (p<0.001), respectively.
In Her2-positive pts, prior trastuzumab treatment for metastatic disease prolonged median BMFS (29 vs. 11 m; p<0.001); BMFS was further improved by trastuzumab in multiple lines (p=0.045) and co-positivity for ER and Her2 (30 vs. 15 m; p<0.001).
ER-expression (HR 2.03; 95%CI 1.22−3.36; p<0.05) and prior trastuzumab (HR 2.72; 95%CI 1.20−6.17; p=0.017) remained independent predictors of longer BMFS in the Cox regression model. In ER-positive, triple-negative as well as Her2-positive pts, no correlation was found between BMFS and factors such as grading, histological subtype, stage IV disease at primary diagnosis, disease-free interval <24 months from primary treatment to diagnosis of metastatic disease, presence of visceral metastases, presence of lung metastases, and prior capecitabine exposure.
CONCLUSIONS BMFS in triple-negative disease is significantly shorter as compared to Her2-positive or ER-positive tumours, mirroring the aggressiveness of this breast cancer subtype. Probably due to improved systemic disease control, trastuzumab significantly prolonged BMFS in Her2-positive pts. Longer BMFS in ER/Her2 co-positive disease reflects a less aggressive subtype of Her2-positive breast cancer which is less likely to benefit from strategies of BM screening or prevention.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-17-05.
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Affiliation(s)
- R Bartsch
- 1Medical University of Vienna, Vienna, Austria
| | - A Berghoff
- 1Medical University of Vienna, Vienna, Austria
| | | | - C DeVries
- 1Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- 1Medical University of Vienna, Vienna, Austria
| | - U Pluschnig
- 1Medical University of Vienna, Vienna, Austria
| | - M Rudas
- 1Medical University of Vienna, Vienna, Austria
| | | | - F Fitzal
- 1Medical University of Vienna, Vienna, Austria
| | - K Dieckmann
- 1Medical University of Vienna, Vienna, Austria
| | - RM Mader
- 1Medical University of Vienna, Vienna, Austria
| | - M Gnant
- 1Medical University of Vienna, Vienna, Austria
| | | | - GG Steger
- 1Medical University of Vienna, Vienna, Austria
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21
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Brodowicz T, Schwameis E, Widder J, Amann G, Wiltschke C, Dominkus M, Windhager R, Ritschl P, Pötter R, Kotz R, Zielinski CC. Intensified Adjuvant IFADIC Chemotherapy for Adult Soft Tissue Sarcoma: A Prospective Randomized Feasibility Trial. Sarcoma 2011; 4:151-60. [PMID: 18521295 DOI: 10.1080/13577140020025869] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
Purpose. The present prospective randomized adjuvant trial was carried out to compare the toxicity, feasibility and efficacy of augmented chemotherapy added to hyperfractionated accelerated radiotherapy after wide or marginal resection of grade 2 and grade 3 soft tissue sarcoma (STS).Patients and methods. Fifty-nine patients underwent primary surgery by wide or marginal excision and were subsequently randomized to receive radiotherapy alone or under the addition of six courses of ifosfamide (1500 mg/m(2) , days 1-4), dacarbazine (DTIC) (200 mg/m(2) , days 1-4) and doxorubicin (25 mg/m(2) , days 1-2) administered in 14-day-intervals supported by granulocyte-colony stimulating factor (30 x 10(6) IU/day, s.c.) on days 5-13. According to the randomization protocol, 28 patients received radiotherapy only, whereas 31 patients were treated with additional chemotherapy.Results. The relative ifosfamide-doxorubicin-DTIC (IFADIC) dose intensity achieved was 93%. After a mean observation period of 41+/-19.7 months (range, 8.1-84 months), 16 patients (57%) in the control group versus 24 patients (77%) in the chemotherapy group were free of disease (p>0.05).Within the control group, tumor relapses occurred in 12 patients (43%;six patients with distant metastases, two with local relapse, four with both) versus seven patients (23%; five patients with distant metastases, one with local recurrence, one with both) from the chemotherapy group. Relapse-free survival (RFS) (p=0.1), time to local failure (TLF) (p=0.09), time to distant failure (TDF) (p=0.17) as well as overall survival (OS) (p=0.4) did not differ significantly between the two treatment groups. Treatment-related toxicity was generally mild in both treatment arms.Conclusion. We conclude that the safety profile of intensified IFADIC added to radiotherapy was manageable and tolerable in the current setting. Inclusion of intensified IFADIC was not translated into a significant benefit concerning OS, RFS, TLF andTDF as compared with radiotherapy only, although a potential benefit of chemotherapy for grade 3 STS patients needs to be validated in prospective randomized trials including larger patient numbers.
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Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology Vienna Austria
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22
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Fuchs EM, Köstler WJ, Horvat R, Hudelist G, Kubista E, Zielinski CC, Singer CF. Abstract PD10-04: An ERBB2 Gene Dosage Effect Confers Biological Aggressiveness to Breast Cancers and Trastuzumab Sensitivity in Patients with Metastatic Disease. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd10-04] [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: 11/16/2022]
Abstract
Abstract
Background: Despite patient selection based on ERBB2 overexpression, response to trastuzumab-based therapy is not always achieved. The reasons for response failure to ERBB2-targeted therapy are still largely unknown. We have investigated whether a gene dosage effect, conferred by an increased number of ERBB2 copies, might provoke increased biological aggressiveness and altered trastuzumab sensitivity. Methods: Vysis PathVysion DNA-based FISH technology was used to measure absolute ERBB2 copy numbers (“CN”) and ERBB2/centromer 17 ratios (“R”) in tumor specimens of 137 patients who had received trastuzumab-based treatment for Her-2/neu over-expressing metastatic breast cancer.
Results: An R of > 2.2 was identified as independent negative predictor for time to first metastasis (TTM). Upon trastuzumab-initiation, progressionfree survival (PFS), albeit not overall survival (OS), was significantly longer in patients with R of ≥2.2 (p=0.006 and p=0.123, respectively). Within the amplified patient population a CN > 13 (“high-amplified”) predicted for a significantly shorter TTM and, upon trastuzumab-initiation, a significant longer PFS and showed a trend towards a higher OS (p= 0.020 and p=0.086, respectively; Log Rank test) compared with the low-amplified (CN ≥13) patient population. Multivariate Cox regression analysis revealed that within our patient population higher CN and R were both associated with improved PFS (p=0.003 and p=0.004, respectively) and OS (p=0.004 and p=0.038, respectively).
Furthermore, Logistic Regression analysis showed that higher CN and R values were associated with improved overall responses (OR: 1.151, 95% CI: 1.034-1.269 and OR: 1.501, 95% CI 1.169-1.964, respectively). Conclusion: In ERBB2 over-expressing FISH-amplified breast cancers CN can discriminate between two groups of breast cancer patients with different prognosis in the adjuvant setting as well as in the metastatic setting under the influence of trastuzumab-based therapy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD10-04.
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Affiliation(s)
- E-M Fuchs
- Medical University of Vienna, Austria
| | | | - R Horvat
- Medical University of Vienna, Austria
| | | | - E Kubista
- Medical University of Vienna, Austria
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Lamm W, Willenbacher W, Lang A, Zojer N, Müldür E, Ludwig H, Schauer-Stalzer B, Zielinski CC, Drach J. Efficacy of the combination of bortezomib and dexamethasone in systemic AL amyloidosis. Ann Hematol 2010; 90:201-6. [PMID: 20821326 DOI: 10.1007/s00277-010-1062-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 08/19/2010] [Indexed: 01/01/2023]
Abstract
Bortezomib-dexamethasone (Btz/Dex) is an active regimen in patients with multiple myeloma and has been used in few patients with amyloidosis. Here, we report a retrospective evaluation of the efficacy and toxicity of Btz/Dex in 26 patients with AL amyloidosis (AL). Eighteen patients (69%) received Btz/Dex as first-line treatment. Organs most frequently involved were kidneys (100%) and heart (35%); five patients (19%) had less than two organs involved. The overall response rate was 54% (14 of 26 patients), with eight patients (31%) achieving a hematologic complete remission (CR). All patients who reached a CR received Btz/Dex as first-line therapy. Median time to response was 7.5 weeks. Improvement in organ function was noticed in three patients (12%). Median progression-free survival (PFS) and overall survival (OS) was 5.0 and 18.7 months, respectively; in CR patients, however, median PFS and OS have not yet been reached. Toxicities were manageable, with hematological side effects being most common. No grade 3/4 neuropathy was observed. Our results confirm the activity of bortezomib/dexamethasone in patients with AL amyloidosis and suggest that patients achieving a CR have a marked benefit for survival.
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Affiliation(s)
- W Lamm
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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24
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Fuchs EM, Köstler WJ, Horvat R, Hudelist G, Dressler C, Pfeiler G, Fink-Retter A, Gschwantler-Kaulich D, Attems J, Zielinski CC, Singer CF. ErbB2/CEP17 Ratio und Gesamt ErbB2 Copy Number als unabhängige Prognosefaktoren für Time to First Metastasis (TTM) und Ansprechen auf eine trastuzumab-basierte Therapie in HER2-überexprimierenden metastasierten Mammakarzinomen. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1252093] [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: 10/19/2022] Open
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Abstract
BACKGROUND Patients with metastatic central nervous system (mCNS) disease progression from breast cancer have a poor prognosis and often develop associated neurological complications. Human epidermal growth factor receptor 2 (HER2)-positivity status increases the risk of developing mCNS disease. Trastuzumab is an mAb that targets HER2 and is known to extend survival across all stages of HER2-positive breast cancer. DESIGN This review considers evidence from preclinical and clinical studies examining the value of continuing trastuzumab treatment in patients who develop mCNS disease. A wealth of data from clinical studies showed that trastuzumab prolonged survival in patients with mCNS disease, compared with no trastuzumab treatment, by effectively controlling their non-CNS disease. Trastuzumab has also been shown to penetrate an impaired blood-brain barrier to a limited degree, such as during radiotherapy, and intrathecal delivery of trastuzumab to the central nervous system (CNS) has shown promise. Research efforts are focussing on improving the delivery of trastuzumab to the CNS. CONCLUSION Evidence indicates that patients with mCNS disease from HER2-positive breast cancer should continue to receive trastuzumab to control HER2-positive metastases outside the CNS and receive established therapies to control the mCNS disease.
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Affiliation(s)
- T Pieńkowski
- Department of Breast Cancer and Reconstructive Surgery, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
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26
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Zeitlinger MA, Schmidinger M, Zielinski CC, Chott A, Raderer M. Effective treatment of a peripheral T-cell lymphoma/lymphoepitheloid cell variant (Lennert's lymphoma) refractory to chemotherapy with the CD-52 antibody alemtuzumab. Leuk Lymphoma 2009; 46:771-4. [PMID: 16019517 DOI: 10.1080/10428190400028959] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lymphoepitheloid cell lymphoma (Lennert's lymphoma) is a rare malignant disease usually affecting patients at advanced age. Although classified as a "low-grade" lymphoma in the past, the clinical course is highly unfavorable and currently available chemotherapeutic regimens have given disappointing results. We present the case of a 74-year-old male suffering from disseminated Lennert's lymphoma. The patient underwent standard treatment approaches including chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP); fludarabin and cyclophosphamide; and ifosfamide, carboplatin and etoposide (ICE). Due to progressive disease with all these regimens, chemotherapy was discontinued. As cells stained highly positive for CD52, immunotherapy with alemtuzumab (Campath-1H) was started using a standard dosing regime of 30 mg every third day. Although the patient received prophylactic anti-infective medication, leucocytopenia with reactivation of cytomegalovirus (CMV) infection was observed and the administration of alemtuzumab had to be stopped temporarily. Re-assessment of disease 5 weeks after the start of alemtuzumab disclosed a significant reduction of all thoracic and abdominal lesions, and therapy with alemtuzumab was continued after normalization of the number of CMV copies and is currently ongoing. Our observations indicate clinical activity of alemtuzumab in the treatment of Lennert's lymphoma, including even bulky nodal disease, particularly for patients who have failed conventional therapies.
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MESH Headings
- Aged
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antigens, CD/immunology
- Antigens, Neoplasm/immunology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- CD52 Antigen
- Glycoproteins/immunology
- Humans
- Immunotherapy/methods
- Lymphoma, T-Cell, Peripheral/drug therapy
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
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Affiliation(s)
- M A Zeitlinger
- Department of Medicine I, Division of Oncology, Medical University Vienna, Austria
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27
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Bartsch R, Wenzel C, Pluschnig U, Dubsky P, Gampenrieder SP, Rudas M, Mader R, Gnant M, Zielinski CC, Steger GG. Predicting response to second-line trastuzumab-based therapy in patients (pts) with HER2-positive advanced breast cancer (ABC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1090] [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
1090 Background: In HER2-positive ABC, the upfront use of trastuzumab (T) is well established. Following progression upon first-line therapy, pts may be switched to lapatinib. Others however may be candidates for continued antibody therapy. Finding the optimal treatment approach therefore is pertinent. Here, we aimed to identify factors predicting response to second-line T-based therapy. Methods: 80 pts (median age 50.5 years) with ABC treated with >1 line of T-containing therapy were identified from a breast cancer database. HER-2-status was determined by immunohistochemistry (HercepTest) and re-analyzed by FISH if a score of 2+ was gained. Response rate (RR; CR+PR), clinical benefit rate (CBR; CR+PR+SD >6 months), time to progression (TTP), overall survival (OS), and cardiac toxicity were recorded. Response was evaluated every three months (m) using UICC criteria. TTP and OS were estimated using the Kaplan-Meier product limit method. In order to identify factors associated with TTP, the following variables were included in a Cox regression model: age (≤65 y/>65 y), initial tumor stage (<IV/IV), grading, ductal/lobular carcinoma, endocrine receptor status, prior non T-containing palliative chemotherapy, metastatic sites (visceral/non-visceral only), and clinical benefit (CB) from T-based first-line therapy. The same variables were used in a multinomial logistic regression model to evaluate their influence on treatment response. P values <0.05 were considered to indicate statistical significance. Results: Median time of observation was 28 m. TTP was median 9.3 m (95% CI 7.73–10.96) in the first-line and 7.5 m (95% CI 6.14–8.82) in the second-line setting (n.s.). First-line treatment yielded an 83% CBR, as compared to 54% in second-line. None of the factors included in the multivariate model independently predicted outcome. A significant deterioration of cardiac function was observed in a single patient; 22.5% developed brain metastases. Conclusions: T in multiple lines showed considerable activity. None of the variables investigated could independently predict response to second-line therapy. In order to reliably predict activity of second-line T-based therapy evaluation of other factors such as truncated HER2 or PTEN-loss appears necessary. [Table: see text]
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Affiliation(s)
- R. Bartsch
- Medical University of Vienna, Vienna, Austria
| | - C. Wenzel
- Medical University of Vienna, Vienna, Austria
| | | | - P. Dubsky
- Medical University of Vienna, Vienna, Austria
| | | | - M. Rudas
- Medical University of Vienna, Vienna, Austria
| | - R. Mader
- Medical University of Vienna, Vienna, Austria
| | - M. Gnant
- Medical University of Vienna, Vienna, Austria
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Koza I, Wrba F, Vrbanec D, Ocvirk J, Ciuleanu TE, Beslija S, Papamichael D, Messinger D, Zielinski CC, Brodowicz T. Correlation of KRAS status with clinical outcome in patients (pts) with metastatic colorectal cancer (mCRC) treated first-line with FOLFOX6 + cetuximab (FX+C) or FOLFIRI + cetuximab (FF+C): The CECOG/CORE1.2.001 trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4055] [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
4055 Background: Previous retrospective analyses of KRAS mutation status from the randomized CECOG/CORE 1.2.001 phase II trial has shown that treatment with cetuximab plus standard chemotherapy (CT) in pts with KRAS wild-type (wt) tumors leads to significantly better progression-free survival (PFS) and overall survival (OS) compared with KRAS mutant (mt) tumors. Methods: CECOG investigators performed a post-study survival update, re-assessing the impact of KRAS status and other possible predictive factors for OS using multivariable Cox proportional hazard methods. Results: KRAS-evaluable tissue was available from 117 (77%) of 151 pts in the ITT population. KRAS wt status was detected in 53% (n=62) of tumors (34/57 and 28/60 in the FX+C and FF+C arm, respectively). After a median follow up of 29 months (mo), OS in pts with KRAS wt tumors was significantly improved compared to pts with KRAS mt tumors (median 20.8 vs 15.9 mo; hazard ratio (HR)=1.62; p=0.0296). OS analysis by treatment arm revealed a statistically significant difference in favor of pts with KRAS wt tumors in the FX+C arm (median 22.5 vs 15.2; HR=2.06; p=0.0201) and no significant differences in the FF+C arm. Exploratory multivariable Cox proportional hazard analysis showed that as well as KRAS wt status (vs KRAS mt), an acne-like rash of grade 2/3 (vs grade 0/1) in the first 6 weeks and no prior treatment (vs prior neo-/adjuvant treatment) were the strongest independent predictors for prolonged survival (each p<0.005). Conclusions: This analysis confirmed the results of previous studies: treatment with cetuximab plus standard CT in pts with KRAS wt tumors leads to significantly better OS compared to pts with KRAS mt tumors. The early occurrence of a cetuximab-related grade 2/3 acne-like rash seems to be an independent predictor for prolonged survival in addition to KRAS status. The relevance of the lower predictive value of KRAS status noted for OS in the FF+C arm pts vs the significant effect in the FX+C arm is undetermined due to the low sample size of the subgroup analyses. [Table: see text]
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Affiliation(s)
- I. Koza
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - F. Wrba
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - D. Vrbanec
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - J. Ocvirk
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - T. E. Ciuleanu
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - S. Beslija
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - D. Papamichael
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - D. Messinger
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - C. C. Zielinski
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
| | - T. Brodowicz
- National Cancer Center, Bratislava, Slovakia; Medical University of Vienna, Vienna, Austria; University Hospital Rebro, Zagreb, Croatia; Institute of Oncology, Ljublijana, Slovenia; Universitatea de Medicina, Cluj-Napoca, Romania; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Bank of Cyprus Oncology Center, Nikosia, Cyprus; Data Management, Mannheim, Germany; Medical University of Vienna, Vienna, Austria
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Brodowicz T, Steiner I, Beslija S, Ciuleanu TE, Inbar M, Krzakowski M, Kahan Z, Tzekova V, Vrbanec D, Zielinski CC. Time interval between final protocol approval (FPA) and inclusion of the first patient into randomized clinical trials (RCTs) performed by the Central European Cooperative Oncology Group (CECOG): A 10-year experience. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6546] [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
6546 Background: CECOG has been formed in 1999 to unite centers of clinical oncology from Central and Southeastern Europe and Israel in order to conduct and coordinate multicenter oncology RCTs. Based on the European legislation passed in 2001 (Directive 2001/20/EC), clinical trials must get ethical approval and approval from the competent authorities (CA). However, the duration of these regulatory procedures to initiate a clinical trial is a factor determining the competitive position in clinical research. Methods: Within the last 10 years, CECOG conducted trials in breast, colorectal, esophago-gastric, NSCLC, pancreatic, prostate cancer and GIST. We analyzed the dates of FPA, the approvals by Ethics Review Boards (ERB) and CAs, the letters of agreement between sponsor and site (LoA), the site initiation and the inclusion of the first patient in a total of 6 multicenter trials in 25 CECOG study centers in Austria, Bosnia, Bulgaria, Croatia, the Czech Republic, Hungary, Israel, Poland, Romania, Serbia, and Slovakia. Results: The average time interval from FPA to the inclusion of the first patient was 18.4 ± 9.4 months. Most of this time has been spent for regulatory procedures, i.e. the approval by ERBs (9.6 ± 7.2 months) and CAs (10.0 ± 6.6 months). The LoA were signed 11.5 ± 9.4 months after FPA. The time interval from approval by the CAs to site initiation was 3.3 ± 3.7 months and the interval between site initiation and the inclusion of the first patient was 4.2 ± 4.5 months. Conclusions: The ‘paper to patient process‘ - the time interval between the approval of the final study protocol and the inclusion of the first patient - required 18.4 months on average in 6 multicenter trials conducted by CECOG. As the regulatory procedures used up more than 50% of duration of the whole process, optimization is necessary and realistic in order to make novel therapies available to patients more quickly. No significant financial relationships to disclose.
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Affiliation(s)
- T. Brodowicz
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - I. Steiner
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - S. Beslija
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - T. E. Ciuleanu
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - M. Inbar
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - M. Krzakowski
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - Z. Kahan
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - V. Tzekova
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - D. Vrbanec
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
| | - C. C. Zielinski
- Medical University of Vienna, Vienna, Austria; Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina; Universitatea de Medicina, Cluj-Napoca, Romania; Tel Aviv Medical Center, Tel Aviv, Israel; Maria Skolodowska-Curie Memorial Cancer Center, Warsaw, Poland; Onkotherapias Klinika, Szeged, Hungary; University Hospital Queen Joanna, Sofia, Bulgaria; University Hospital Rebro, Zagreb, Croatia
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Marosi C, Elandt K, Preusser M, Dieckmann K, Nevinny M, Knocke-Abulesz T, Pfeifer W, Stockhammer G, Hammer J, Zielinski CC. Phase II study: WBRT ±temozolomide (TMZ) in patients with multiple brain metastases from non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e13008] [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
e13008 Background: Brain metastases cause increasingly morbidity and mortality in patients with NSCLC. In a multicentric Austrian phase II study, we investigated feasibility and toxicity of the addition of temozolomide to whole brain radiotherapy (WBRT) in patients with multiple brain metastases of NSCLC. Methods: Consenting patients with previously untreated, multiple, and measurable brain metastases from histologically confirmed NSCLC were eligible if they were 18 years or older, were at least in RPA (recursive partitioning analysis class) class II and showed adequate organ function. Treatment consisted of WBRT (arm A) +TMZ 75mg/m2 during radiation, followed at day 28 by TMZ 100 mg/m2 day 1–14, q28 for six cycles (arm B). The primary endpoint was objective radiographic response in CNS 10 weeks after the end of WBRT. Results: 35 patients (14 women) aged 35 to 86 years, median 65 years were randomized. Eight patients were in RPA class I and 27 were in RPA class II. 13 patients were enrolled in arm A and 22 in arm B. Toxicity was mainly haematological with WHO grade 3 and 4 thrombocytopenia observed in 0/13 versus 3/22 patients, leucocytopenia in 0/13 versus 1/22 patients, and lymphocytepenia in 12/13 and 7/22 patients respectively. No severe nonhematologic toxicity occured in arm A, whereas two episodes of transient hepatic toxicity were reported in arm B. 10/13 patients of arm A and 13/22 patients of arm B showed progressive disease and dropped out of study before restaging 10 weeks after completion of WBRT. Two patients of arm A had progressive disease in CNS, all other progresses noted were systemic. At restaging there were 2 PR, 1 SD in arm A, and 1 CR, 3 PR, 6 SD in arm B. Median time to progression was 40 days in arm A and 74 days in arm B (p = 0.027). Conclusions: The addition of temozolomide to WBRT in patients with brain metastases of NSCLC yielded acceptable toxicity and promising activity, although systemic progression remained the main cause of morbidity and mortality. [Table: see text]
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Affiliation(s)
- C. Marosi
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - K. Elandt
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - M. Preusser
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - K. Dieckmann
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - M. Nevinny
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - T. Knocke-Abulesz
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - W. Pfeifer
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - G. Stockhammer
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - J. Hammer
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
| | - C. C. Zielinski
- University of Vienna, Wien, Austria; Medical University of Vienna, Vienna, Austria; Medical University of Innsbruck, Innsbruck, Austria; Hietzing Hospital, Vienna, Austria; General Hospital of the City of Linz, Linz, Austria; Hospital of the Barmherzigen Schwestern, Linz, Austria
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Abstract
BACKGROUND In a variety of malignant diseases, molecular targeting represents a therapeutic option, whereby, when compared with chemotherapy, fewer side effects are thought to be expected. Especially in renal cell cancer (RCC), tyrosine kinase-inhibitors have been established as useful and highly effective therapy. However, tyrosine kinase-inhibitors currently approved for RCC treatment lack single molecule specificity and bear a variety of side effects of the gastro-intestinal tract, skin, heart and haematopoietic system. Therefore, the identification of novel cell surface markers is sought, which might lead to novel diagnostic and therapeutic strategies in cancer. MATERIAL AND METHODS Paraffin-embedded RCCs from a well characterized tissue bank were immunohistochemically quantified for embryonic transmembrane antigen CD98hc (SLC3A2) expression and semi-quantitative analyses were correlated with subtype or grade of differentiation. RESULTS We found increased CD98hc expression in different types of malign RCCs, among them clear cell (cc)RCC, papillary (p)RCC and chromophobe (ch)RCC, but lack of expression in the benign renal oncocytoma. Thereby, the extent of CD98hc expression directly complies with grade of malignancy. Furthermore, the more malignant type II pRCC significantly higher expressed CD98hc than the less malignant and more differentiated type I pRCC (type II 83.34%, type I 4.76% CD98hc positive, P < 0.00001; n = 51). The established marker for type I pRCC, Cytokreatin 7, showed 95.24% expression in type I and 26.67% expression in type II pRCC (P < 0.00001, n = 51). CONCLUSIONS From these data, we conclude that CD98hc is expressed in RCCs, whereby the extent of expression is likely to correlate directly with grade of malignancy. In pRCCs, CD98hc might represent a novel and reliable marker for type II pRCC.
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Affiliation(s)
- G W Prager
- Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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Carteni G, Manegold C, Garcia GM, Siena S, Zielinski CC, Amadori D, Liu Y, Blatter J, Visseren-Grul C, Stahel R. Malignant peritoneal mesothelioma-Results from the International Expanded Access Program using pemetrexed alone or in combination with a platinum agent. Lung Cancer 2008; 64:211-8. [PMID: 19042053 DOI: 10.1016/j.lungcan.2008.08.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/07/2008] [Accepted: 08/22/2008] [Indexed: 12/24/2022]
Abstract
AIM Peritoneal mesothelioma (PM) has rarely been studied. The Expanded Access Program (EAP) provided access to 109 patients with PM. METHODS This was a nonrandomized, open-label study conducted in chemo-naïve or previously treated patients with PM not amenable to curative surgery. Patients received pemetrexed (PEM) 500 mg/m2 alone or with cisplatin (CIS) 75 mg/m2 or carboplatin (CARBO) AUC 5 every 21 days, supplemented with standard vitamin B(12), folate, and dexamethasone. RESULTS Response rates (95% CI) for PEM, PEM/CIS, and PEM/CARBO were 12.5% (3.5, 29.0), 20.0% (7.7, 38.6), and 24.1% (10.3, 43.5), respectively. Median survival for PEM was 10.3 months. One-year survival rates for PEM/CIS and PEM were 57.4% (95% CI: 10.3, 100) and 41.5% (95% CI: 4.6, 78.4), respectively, and were not available for PEM/CARBO. Anemia was the most common serious adverse event (6.4%). Neutropenia (34.6%) was the most frequent CTC grade 3 or 4 toxicity reported. CONCLUDING STATEMENT PEM with or without a platinum agent was both active and well tolerated in patients with peritoneal mesothelioma.
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Affiliation(s)
- G Carteni
- Cardarelli Hospital, Medical Oncology, Via Cardarelli 9, 80100 Naples, Italy.
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Grim-Stieger M, Keilani M, Mader RM, Marosi C, Schmidinger M, Zielinski CC, Fialka-Moser V, Crevenna R. Serum levels of tumour necrosis factor-alpha and interleukin-6 and their correlation with body mass index, weight loss, appetite and survival rate--preliminary data of Viennese outpatients with metastatic cancer during palliative chemotherapy. Eur J Cancer Care (Engl) 2008; 17:454-62. [PMID: 18637115 DOI: 10.1111/j.1365-2354.2007.00874.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha)) of 61 advanced stage cancer patients receiving palliative chemotherapy as outpatients were determined with quantikine immunoassays. The values were correlated with body mass index (BMI), weight loss and appetite. Furthermore cytokine levels of patients who have died within one year were compared with those of patients who have survived more than a year. Serum levels of IL-6 (median: 1.93 pg/ml, range: 0.32-42.87) and of TNF-alpha (median: 2.55 pg/ml, range: 1.03-34.06) did not correlate with BMI, weight loss and appetite. Serum IL-6 levels of patients with survival time less than one year were significantly higher than the levels of patients who survived more than one year, no significant differences in TNF-alpha serum levels were evident. The data of this observation are consistent with current literature. Due to changes in serum levels of proinflammatory cytokines in response to chemotherapy and additional therapy, it is unlikely that IL-6 and TNF-alpha can be used as independent indicators for weight loss and appetite. Nevertheless, high serum levels of IL-6 correlate with short-time mortality.
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Affiliation(s)
- M Grim-Stieger
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
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Gruenberger T, Kaczirek K, Bergmann M, Zielinski CC, Gruenberger B. Progression-free survival in a phase II study of perioperative bevacizumab plus XELOX in patients with potentially curable metastatic colorectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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35
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Ciuleanu TE, Kurteva G, Ocvirk J, Beslija S, Koza I, Papamichael D, Vrbanec D, Brodowicz T, Scheithauer W, Zielinski CC. A randomized, open-label CECOG phase II study evaluating the efficacy and safety of FOLFOX6 + cetuximab versus FOLFIRI + cetuximab as first-line therapy in patients (pts) with metastatic colorectal cancer (mCRC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4032] [Citation(s) in RCA: 3] [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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36
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Ciuleanu TE, Brodowicz T, Belani CP, Kim J, Krzakowski M, Laack E, Wu Y, Peterson P, Adachi S, Zielinski CC. Maintenance pemetrexed plus best supportive care (BSC) versus placebo plus BSC: A phase III study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [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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37
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Schmidinger M, Vogl UM, Lamm W, Bojic M, Bojic A, Zielinski CC. Temsirolimus in heavily pretreated patients with metastatic renal cell carcinoma: Preliminary results from the Austrian Compassionate Use Program. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16125] [Citation(s) in RCA: 3] [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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Elandt K, Hassler MR, Oberndorfer S, Brücke T, Zielinski CC, Marosi C. Severe thrombocytopenia after the first cycle of temozolomide: Who is at risk? J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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39
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Knauer M, Rottenfusser A, Bartsch R, Dieckmann K, Wenzel C, Fromm S, Eiter H, Steger GG, Zielinski CC, de Vries A. Analysis of risk factors predicting time to development of brain metastases. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Tomova A, Brodowicz T, Tzekova V, Timcheva C, Wiltschke C, Gerges DA, Pawlega J, Spanik S, Inbar MJ, Zielinski CC. Concomitant docetaxel plus gemcitabine versus sequential docetaxel followed by gemcitabine. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1106] [Citation(s) in RCA: 2] [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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41
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Wiltschke C, Wiedermann U, Zurbriggen R, Elandt K, Brämswig K, Jasinska J, Pehamberger H, Scheiner O, Zielinski CC. A phase I study to evaluate safety, immunogenicity and antitumor activity of a HER2 multi-peptide virosome vaccine in patients with metastatic breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3055] [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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42
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Zielinski CC, Yang S, Santoro A, Ramlau R, Liepa AM, Peterson P, Brodowicz T, Madhavan J, Franke FA, Cucevic B. Tolerability of pemetrexed versus placebo as a maintenance therapy in advanced non-small cell lung cancer: Evidence from a large randomized study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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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Gleixner KV, Mayerhofer M, Vales A, Gruze A, Pickl WF, Lackner E, Sillaber C, Zielinski CC, Maeda H, Valent P. The Hsp32/HO-1-targeted drug SMA-ZnPP counteracts the proliferation and viability of neoplastic cells in solid tumors and hematologic neoplasms. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14122] [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
14122 Background: Heat shock protein 32 (Hsp32) is a stress-related survival factor that is overexpressed in various neoplastic cells. Recently, specific Hsp32- targeting drugs such as styrene maleic acid encapsulated zinc protoporphyrin (SMA-ZnPP) have been developed. Methods: We examined the effects of SMA-ZnPP on proliferation and survival of various tumor cell-lines, including U97MG (glioblastoma), A549 (lung cancer), MDA-MB-231 (breast cancer), BxPC-3 (pancreatic), HepG2 (hepatocellular), Colo201, Colo320DM, DLD-1 (colon), OvCar3 (ovarian carcinoma), KG1, U937, HL60, K562 (myeloid leukemias), RAJI, NALM-6 (lymphatic leukemias), RPMI 8226, U266 (multiple myeloma) as well as on primary neoplastic cells. Moreover, Ba/F3 cells with doxycycline-inducible expression of oncoproteins (RAS-G12V, BCR/ABL, KIT-D816V) were analyzed. Expression of Hsp32 mRNA was examined by RT-PCR and Northern blotting, and expression of the Hsp32 protein by Western blotting. To silence Hsp32 in neoplastic cells, we used specific siRNA as well as SMA-ZnPP. Proliferation was analyzed by 3H-thymidine uptake and apoptosis by light microscopy. Results: All neoplastic cells tested were found to express Hsp32 mRNA and the Hsp32 protein in a constitutive manner. In Ba/F3 cells, induction of RAS-G12V, BCR/ABL, or KIT D816V enhanced the expression of Hsp32. The Hsp32 siRNA was found to lead to a reduced viability and induction of apoptosis. Treatment of malignant cells with SMA-ZnPP resulted in a significant decrease in proliferation and induction of apoptosis. The effects of SMA- ZnPP on primary neoplastic cells and cell lines were dose-dependent and occurred at pharmacologic concentrations (IC50 1–30 μM). Moreover, SMA-ZnPP was found to synergize with various anti-neoplastic drugs (cisplatin, cytarabine, tyrosine kinase inhibitors, bortezomib) in producing growth-inhibition in neoplastic cells. Conclusions: The Hsp32-targeting drug SMA-ZnPP counteracts malignant cell growth and sensitizes neoplastic cells against various other targeted or conventional antineoplastic drugs. Hsp32-targeting drugs may represent an interesting new aproach to inhibit malignant cell growth in solid tumors and leukemias. No significant financial relationships to disclose.
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Affiliation(s)
- K. V. Gleixner
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - M. Mayerhofer
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - A. Vales
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - A. Gruze
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - W. F. Pickl
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - E. Lackner
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - C. Sillaber
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - C. C. Zielinski
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - H. Maeda
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
| | - P. Valent
- Medical University of Vienna, Vienna, Austria; Sojo University, Kumamoto, Japan
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Hejna M, Zacherl J, Ba-Ssalamah A, Püspök A, Pluschnig U, Brodowicz T, Zielinski CC, Raderer M. Phase II study of docetaxel in combination with oxaliplatin in patients with metastatic or locally advanced esophagogastric cancer previously untreated with chemotherapy for advanced disease. Results of the CECOG-Study ESGAS.1.2.001. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4527] [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
4527 Background: A phase II trial was performed to determine the antitumor efficacy and tolerance of combined docetaxel and oxaliplatin in previously untreated, advanced patients with gastroesophageal adenocarcinoma. Methods: Thirty-six patients with histologically confirmed advanced gastroesophageal adenocarcinoma were entered in this trial. Treatment consisted of 3-weekly courses of docetaxel 80 mg/m2 and oxaliplatin 100 mg/m2 both given on day 1. A 5-day course of human granulocyte colony stimulating factor (G-CSF) 5 μg/kg/day was given subcutaneously to prevent neutropenia; in addition, if haemoglobin was <12.0 mg/dl, erythropoietin 10,000 IU was administered subcutaneously 3 times per week. Primary objective was to evaluate the time to progression. Results: The confirmed overall response rate was 36%, including 3 complete responses (8.3%) and 10 partial responses (27.7%). Fifteen patients (41.7%) had stable disease and 8 (22.3%) progressed while on treatment. The median time to response was 2.5 months, the median time to progression was 5.3 (1- 33+) months and the median overall survival time was 9.8 (2.5–35+) months with 8 (22%) patients currently alive. Hematologic toxicity was common, though WHO grade 3/4 neutropenia occurred only in 6 (17%) patients and anaemia also in 6 (17%) patients, respectively. Nonhematologic adverse reactions were usually mild to moderate; grade 3 toxicities included emesis, diarrhoea and mucositis each in 1 patient (3%). Conclusion: Our data suggest that the combination of docetaxel and oxaliplatin with G-CSF and erythropoietin has a promising therapeutic index in patients with advanced gastroesophageal adenocarcinoma. No significant financial relationships to disclose.
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Affiliation(s)
- M. Hejna
- Medical University of Vienna, Vienna, Austria
| | - J. Zacherl
- Medical University of Vienna, Vienna, Austria
| | | | - A. Püspök
- Medical University of Vienna, Vienna, Austria
| | | | | | | | - M. Raderer
- Medical University of Vienna, Vienna, Austria
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Brämswig K, Knittelfelder R, Gruber S, Riemer AB, Kammerer R, Zimmermann W, Horvat R, Zielinski CC, Scheiner O, Jensen-Jarolim E. Vaccination with a CEA epitope mimic leads to reduced growth of tumor transplants. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3076] [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
3076 Background: The carcinoembryonic antigen (CEA) is a glycoprotein which is overexpressed on nearly 50% of all human tumors. We aimed to establish an active immunotherapy by replacing the poorly immunogenic glycoprotein with highly immunogenic peptides. Methods: Col-1 is a monoclonal antibody directed against CEA on tumor cells. To generate structural mimics of the Col-1 epitope, we used the Col-1 antibody and the biopanning method in order to select immunreactive peptide mimotopes from random phage libraries. Subsequently, immunogenicity of a selected mimotope was examined in BALB/c mice. We assessed antibody-dependent cytotoxicity (ADDC) and complement-dependent cytotoxicity (CDC) mediated by the induced antibodies on CEA expressing HT29 cells. Furthermore, after immunisation the BALB/c mice were transplanted subcutaneously with Meth-A/CEA tumor cells. Results: All peptides selected were exclusively recognized by the anti-CEA antibody. In addition, true mimicry of the peptides with the natural antigen was confirmed by competition ELISA using purified human CEA. The best mimotope was chosen for synthesis in a multiple antigenic peptide (MAP) configuration rendering, therefore, a multiple antigenic mimotope (MAM). BALB/c mice immunized with the MAM developed antibodies against the immunogen and the original antigen CEA. In vitro, the anti-mimotope antibodies were capable of inducing high specific lysis of CEA-expressing HT29 cells via antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity. Moreover, after s.c tumor transplantation no tumor growth was seen in MAM immunized mice, compared to the groups receiving a control mimotope or the naïve group. The CEA-mimotope immunized group showed a capsuled necrotic region without tumor cells but granulocytes and limited vascularisation. The non treated group showed tumor cells in different proliferation stages and neovascularisation. Conclusions: We conclude that the Col-1 epitope of the glycoprotein CEA can be translated into an immunogenic peptide mimic. The mimotope-induced antibodies recognize CEA and do effectively inhibit growth of CEA positive tumors. Based on these findings we suggest that generated mimotopes are candidates for active immunotherapy of CEA- expressing tumors. No significant financial relationships to disclose.
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Affiliation(s)
- K. Brämswig
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - R. Knittelfelder
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - S. Gruber
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - A. B. Riemer
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - R. Kammerer
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - W. Zimmermann
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - R. Horvat
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - C. C. Zielinski
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - O. Scheiner
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
| | - E. Jensen-Jarolim
- Medical University of Vienna, Vienna, Austria; Ludwig-Maximilians-University, Munich, Germany
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Lackner EM, Krauth MT, Kondo R, Rebuzzi L, Eigenberger K, Vales A, Kornek GV, Zielinski CC, Valent P. Expression and secretion of VEGF in solid tumor cells is mediated by the mammalian target of rapamycin (mTOR). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14123] [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
14123 Background: Tumor progression and metastasis formation are often associated with enhanced angiogenesis and with the formation of malignant effusions. Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis and a mediator of vascular permeability. We here describe that VEGF is produced and secreted by neoplastic cells in various solid tumors and its production mediated through mTOR. Methods and Results: As assessed by ELISA, the VEGF protein was detected in supernatants of cell lines derived from breast cancer (MDA-MB231), pancreatic carcinoma (BxPC-3), lung cancer (A-427), colon carcinoma (HCT8), and cholangiocellular carcinoma (EGI-1). In addition, VEGF was detected in supernatants of primary tumor cells obtained from malignant effusions in various malignancies (breast cancer, n=4; pancreatic cancer, n=1; ovarial cancer, n=1; parotic carcinoma, n=1; oesophageal carcinoma, n=1). In each case, VEGF protein was detectable in neoplastic cells by immunocytochemistry, and was found to accumulate in supernatants of cultured tumor cells over time, suggesting constant production and secretion. Correspondingly, as assessed by RT-PCR, primary tumor cells as well as the cell lines tested were found to express VEGF mRNA in a constitutive manner. Since mTOR is a well known regulator of VEGF synthesis, we applied rapamycin on primary neoplastic cells and on tumor cell lines. Rapamycin (20–200 nM) was found to counteract the production and secretion of VEGF in all tumor cells tested (VEGF in supernatants in cultures supplemented with rapamycin at 100 nM compared to control=100% on day 6: MDA-MB231: 11.8±0.2%; BxPC-3: 23.6±18.8%; A-427: 30.1±3.4%; HCT8 17.2±0.5%; EGI-1 28.4±1.1%; p<0.05). By contrast, neither rapamycin nor VEGF were found to modulate growth of primary tumor cells or the growth of the tumor cell lines tested. Conclusions: Various human tumor cells express and secrete VEGF. VEGF production is mediated through mTOR. These observations may have implications for the design of new treatment approaches attempting to counteract VEGF production/secretion and thus VEGF-dependent angiogenesis and effusion- formation in solid tumors. No significant financial relationships to disclose.
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Affiliation(s)
- E. M. Lackner
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - M. T. Krauth
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - R. Kondo
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - L. Rebuzzi
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - K. Eigenberger
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - A. Vales
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - G. V. Kornek
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - C. C. Zielinski
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
| | - P. Valent
- Medical University Vienna, Vienna, Austria; University of Veterinary Medicine, Vienna, Austria
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Schmidinger M, Vogl UM, Schukro C, Bojic A, Bojic M, Schmidinger H, Zielinski CC. Cardiac involvement in patients with sorafenib or sunitinib treatment for metastatic renal cell carcinoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5110 Background: Tyrosine-kinase inhibitors (TKI) of the VEGF and PDGF-receptor have significant clinical activity in patients with renal cell carcinoma (RCC). These agents target the VHL-hypoxia-inducible gene pathway and lead to inhibition of hypoxia- inducible factor (HIF)-induced gene products. Physiologically, HIF-1 related gene products are important mediators of myocardial response to ischemia, myocardial remodeling, peri-infarct vascularisation and vascular permeability. The aim of this prospective observational study was to investigate clinical and biochemical signs of myocardial damage in patients undergoing TKI-treatment for RCC. Methods: 73 consecutive patients (median age 65, range 44–68) intended for TKI treatment were analyzed for medical history of coronary artery disease (CAD) and risk-factors. Measurements of biochemical markers of cardiac damage (creatine kinase MB -CK-MB- and cardiac troponin T -cTNT-) and electrocardiogram (ECG) were performed before treatment. In patients developing cardiac symptoms during TKI treatment and/or at occurrence of CK-MB or TNT elevations, changes in ECG were analyzed and patients underwent echocardiography. Results: All patients had normal CK-MB and TNT levels at baseline. 17 patients (23%) developed (week 2–32 of treatment) significant CK-MB elevation, (TNT n=5), with clinical symptoms in 7 patients. No patient had uncontrolled hypertension. Detailed ECG’s comparison before and during treatment revealed significant changes in 10 out of 17 patients, such as ST-segment depression or elevation, T-wave changes and symptomatic AV-conduction disturbance, requiring pacemaker-implantation. 3 patients underwent coronary angiography with one patient showing acute coronary artery occlusion and myocardial infarction. 6 out of 17 patients had abnormal findings on echocardiography, such as reduced left ventricular function Conclusions: TKI-induced HIF-inhibition may be associated with severe myocardial damage. The underlying mechanism may not necessarily be caused by overt coronary artery occlusion. ECG-changes and biochemical markers are the most important indicators in the preclinical stage. Therefore, careful cardiac monitoring during TKI-treatment is strongly recommended. No significant financial relationships to disclose.
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Affiliation(s)
- M. Schmidinger
- Internal Medicine I, Vienna, Austria; Internal Medicine II, Vienna, Austria
| | - U. M. Vogl
- Internal Medicine I, Vienna, Austria; Internal Medicine II, Vienna, Austria
| | - C. Schukro
- Internal Medicine I, Vienna, Austria; Internal Medicine II, Vienna, Austria
| | - A. Bojic
- Internal Medicine I, Vienna, Austria; Internal Medicine II, Vienna, Austria
| | - M. Bojic
- Internal Medicine I, Vienna, Austria; Internal Medicine II, Vienna, Austria
| | - H. Schmidinger
- Internal Medicine I, Vienna, Austria; Internal Medicine II, Vienna, Austria
| | - C. C. Zielinski
- Internal Medicine I, Vienna, Austria; Internal Medicine II, Vienna, Austria
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Bartsch R, Wenzel C, Altorjai G, Pluschnig U, Locker GJ, Rudas M, Mader RM, Zielinski CC, Steger GG. Trastuzumab (T) plus capecitabine (C) in heavily pretreated patients (pts) with advanced breast cancer (ABC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1055] [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
1055 Background: In pts with Her2 positive ABC, taxane or vinorelbine plus T are among the most widely applied options in the first line setting. We evaluated the efficacy and tolerability of TC in pts with Her2 positive ABC after anthracycline and docetaxel or vinorelbine failure. Methods: Forty consecutive pts (median age 57.5 years) were included. As of December 2006, all are evaluable for toxicity and 35 for response. C was administered at a daily dose of 2,500 mg for two consecutive weeks (w) every 3 w, with dose modifications if necessary. T was administered in 3 w cycles at a dose of 6 mg/kg bodyweight after a loading dose of 8 mg/kg. Time to progression (TTP) was defined as primary endpoint. Response was evaluated every three months (m) using UICC criteria. TTP and overall survival (OS) were estimated using the Kaplan-Meier product limit method. Differences in TTP for 2nd line and beyond 2nd line were analyzed with the log-rang test. Results: All pts had prior exposure to an anthracycline and at least one anti-microtuble agent (i.e. a taxane or vinorelbine). All had at least one earlier T containing treatment line for ABC. Median time of observation was 18.5 m. We observed a complete response in 2.9%, partial response in 20%, stable disease = 6 months in 48.6%, and progression in 28.6% of pts. OS was median 24 m (95% CI 20.3–27.7), and TTP 8 m (95% CI 5.8–10.1). No significant difference was found for 2nd and beyond 2nd line treatment. Diarrhoea (5%) and hand foot syndrome (16%) were the only treatment-related adverse events that occurred with grade 3 or 4 intensity. A dose reduction was necessary in 22.5%. Two pts developed brain metastases (BM) while on therapy, 6 had BM at time of treatment initiation, a further 5 developed BM during follow up. Of 6 pts with BM, 3 gained clinical benefit from treatment (one pt not yet evaluable). Conclusions: TC appears to be an effective and safe option as salvage therapy in a heavily pretreated population. TTP and response rates are similar to results from C plus lapatinib. Of note is the activity in pts with BM. Further, only 2 pts (5%) developed BM while on treatment. Therefore, a direct comparison of TC with C plus lapatinib or T plus lapatinib seems warranted. No significant financial relationships to disclose.
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Affiliation(s)
- R. Bartsch
- Medical University of Vienna, Vienna, Austria
| | - C. Wenzel
- Medical University of Vienna, Vienna, Austria
| | - G. Altorjai
- Medical University of Vienna, Vienna, Austria
| | | | | | - M. Rudas
- Medical University of Vienna, Vienna, Austria
| | - R. M. Mader
- Medical University of Vienna, Vienna, Austria
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Wöhrer S, Troch M, Zwerina J, Schett G, Skrabs C, Gaiger A, Jaeger U, Zielinski CC, Raderer M. Influence of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone on serologic parameters and clinical course in lymphoma patients with autoimmune diseases. Ann Oncol 2007; 18:647-51. [PMID: 17218490 DOI: 10.1093/annonc/mdl467] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 01/02/2023] Open
Abstract
BACKGROUND As patients with B-cell lymphomas suffering from an underlying autoimmune condition undergoing therapy with the CD20 antibody rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) offer the unique possibility of monitoring effects of therapy on various rheumatologic parameters, we have evaluated serologic autoimmune markers and the clinical outcome of patients with autoimmune diseases (ADs) who received lymphoma treatment with R-CHOP during the course of their disease. PATIENTS AND METHODS We have retrospectively analysed 13 patients with non-Hodgkin's lymphoma who concurrently suffered from ADs and were treated with the R-CHOP regimen. Subjective parameters along with rheumatoid factor (RF) and antinuclear antibodies (ANA) were serially measured. RESULTS The median levels of RF were 901 IU/ml [inter-quartile-range (IQR) 189-2520] before and 75 IU/ml (IQR 45-644) after therapy (P = 0.028). The median levels of ANA were 800 (IQR 140-2560) before and 100 (40-1280) after therapy (P = 0.027). Ten (77%) patients showed clinical improvement of their autoimmune symptoms, two (15%) reported no difference and one (7%) patient with rheumatoid arthritis-related worsening symptoms during therapy with R-CHOP. The autoimmune-related symptoms recurred after a median time of 7 weeks (IQR 6-8) in seven patients. In terms of lymphoma response, 11 patients achieved a complete remission and two a partial remission. CONCLUSIONS This analysis indicates that R-CHOP given for lymphoma treatment is also effective for therapy of concurrent rheumatoid diseases. Both rheumatoid parameters as well as clinical symptoms showed a significant decrease during treatment with this immunochemotherapy. The effects on the rheumatic diseases, however, seem to be of limited duration.
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Affiliation(s)
- S Wöhrer
- Division of Bone Marrow Transplantation, Department of Internal Medicine 1, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
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Vogl UM, Zehetgruber H, Dominkus M, Hejna M, Zielinski CC, Haitel A, Schmidinger M. Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable. Br J Cancer 2006; 95:691-8. [PMID: 16940978 PMCID: PMC2360513 DOI: 10.1038/sj.bjc.6603327] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prognostic and predictive factors in patients with metastatic renal cell carcinoma (MRCC) have been evaluated from untreated patients or patients on several different treatment approaches. The aim of this analysis was to define prognostic and predictive factors in patients treated uniformly with a low-dose outpatient cytokine combination. The relationship between patient-, tumour-, and treatment-related factors was analysed in 99 patients with MRCC. These features were first examined in univariate analyses, then a stepwise modelling approach based on Cox regression was used to form a multivariate model. Nuclear grade, metastasectomy – even incomplete – C-reactive protein and lactate dehydrogenase were identified as independent prognostic factors for survival. Patients assigned to three different risk groups had statistically significant survival differences (30, 22 and 6 months, respectively). A total of 43.4% had undergone metastasectomy, mostly incomplete. Risk group affiliation was correlated with response to treatment. Our findings strongly suggest the consideration of metastasectomy in the management of patients with metastatic renal cell cancer undergoing either immunotherapy or targeted treatment.
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Affiliation(s)
- U M Vogl
- Department of Medicine I, Clinical Division of Oncology, University Hospital, Waehringer Guertel 18-20, Vienna A-1090, Austria.
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