1
|
Haaksman M, Ham L, Brom L, Baars A, van Basten JP, van den Borne BEEM, Hendriks MP, de Jong WK, van Laarhoven HWM, van Lindert ASR, Mandigers CMPW, van der Padt-Pruijsten A, Smilde TJ, van Zuylen LC, van Vliet LM, Raijmakers NJH. Open communication between patients and relatives about illness & death in advanced cancer-results of the eQuiPe Study. Support Care Cancer 2024; 32:214. [PMID: 38446248 PMCID: PMC10917842 DOI: 10.1007/s00520-024-08379-5] [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: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To assess the degree of openness of communication about illness and death between patients with advanced cancer and their relatives during the last three months of the patient's life, and its association with relatives' characteristics and bereavement distress. METHODS We used data from bereaved relatives of patients with advanced cancer from the prospective, longitudinal, multicenter, observational eQuipe study. Univariate and multivariable linear regression analyses were used to assess the association between the degree of openness of communication (measured using the validated Caregivers' Communication with patients about Illness and Death scale), the a priori defined characteristics of the relatives, and the degree of bereavement distress (measured using the Impact of Event Scale). RESULTS A total of 160 bereaved relatives were included in the analysis. The average degree of open communication about illness and death between patients with advanced cancer and their relatives was 3.86 on a scale of 1 to 5 (SE=0.08). A higher degree of open communication was associated with a lower degree of bereavement distress (p=0.003). No associations were found between the degree of open communication and the relatives' age (p=0.745), gender (p=0.196), level of education (p>0.773), (religious) worldview (p=0.435), type of relationship with the patient (p>0.548), or level of emotional functioning before the patient's death (p=0.075). CONCLUSIONS Open communication about illness and death between patients and relatives seems to be important, as it is associated with a lower degree of bereavement distress. Healthcare professionals can play an important role in encouraging the dialogue. However, it is important to keep in mind that some people not feel comfortable talking about illness and death.
Collapse
Affiliation(s)
- Michelle Haaksman
- Department of Health, Medical and Neuropsychology, University of Leiden, Leiden, the Netherlands.
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands.
| | - Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Linda Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, the Netherlands
| | | | | | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne S R van Lindert
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Lia C van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Liesbeth M van Vliet
- Department of Health, Medical and Neuropsychology, University of Leiden, Leiden, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501, DB, Utrecht, the Netherlands
| |
Collapse
|
2
|
Versluis MAJ, Raijmakers NJH, Baars A, van den Beuken-van Everdingen MHJ, de Graeff A, Hendriks MP, de Jong WK, Kloover JS, Kuip EJM, Mandigers CMPW, Sommeijer DW, van der Linden YM, van de Poll-Franse LV. Trajectories of health-related quality of life and symptom burden in patients with advanced cancer towards the end of life: Longitudinal results from the eQuiPe study. Cancer 2024; 130:609-617. [PMID: 37831749 DOI: 10.1002/cncr.35060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Support for health-related quality of life (HRQOL) is an essential part of cancer care in the final stages of life, yet empirical guidance regarding HRQOL and symptom trajectories is lacking. AIM To assess the change in HRQOL and symptom burden in the last year of life in patients with advanced cancer and its association with health care-related factors, cancer-specific treatment, and comorbidity. METHODS A prospective, multicenter, observational study in patients with advanced cancer (eQuiPe). Three monthly questionnaires included European Organization for Research and Treatment of Cancer Quality of Life-C30 and reported continuity of care. Multivariable mixed-effects analysis was used to assess the association between HRQOL and health care-related factors. RESULTS A total of 762 deceased patients were included with a mean age of 66 (SD, 10) years and 52% were male. The most common primary tumors were lung (29%), colorectal (20%), and breast cancer (13%). Mean overall HRQOL decreased in the last 9 months of life, with the greatest decrease in the last 3 months (β -16.2). Fatigue, pain, appetite loss, dyspnea, constipation, and nausea worsened significantly in the last year of life. Multimorbidity (β -7.5) and a better reported continuity of care (β 0.7) were both significantly associated with the trajectory of HRQOL. CONCLUSION Mean overall HRQOL begins to decline 9 months before death, highlighting the need for early identification and (re)assessment of different symptoms as aspects of HRQOL follow different trajectories. Multimorbidity and reported continuity of care may be associated with the trajectory of HRQOL.
Collapse
Affiliation(s)
- Moyke A J Versluis
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Graduate School of Social & Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Natasja J H Raijmakers
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | | | - Alexander de Graeff
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Jeroen S Kloover
- Department of Medical Oncology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Evelien J M Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Dirkje W Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - Yvette M van der Linden
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lonneke V van de Poll-Franse
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Knikman JE, Wilting TA, Lopez-Yurda M, Henricks LM, Lunenburg CATC, de Man FM, Meulendijks D, Nieboer P, Droogendijk HJ, Creemers GJ, Mandigers CMPW, Imholz ALT, Mathijssen RHJ, Portielje JEA, Valkenburg-van Iersel L, Vulink A, van der Poel MHW, Baars A, Swen JJ, Gelderblom H, Schellens JHM, Beijnen JH, Guchelaar HJ, Cats A. Survival of Patients With Cancer With DPYD Variant Alleles and Dose-Individualized Fluoropyrimidine Therapy-A Matched-Pair Analysis. J Clin Oncol 2023; 41:5411-5421. [PMID: 37639651 DOI: 10.1200/jco.22.02780] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/24/2023] [Accepted: 07/11/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE DPYD-guided fluoropyrimidine dosing improves patient safety in carriers of DPYD variant alleles. However, the impact on treatment outcome in these patients is largely unknown. Therefore, progression-free survival (PFS) and overall survival (OS) were compared between DPYD variant carriers treated with a reduced dose and DPYD wild-type controls receiving a full fluoropyrimidine dose in a retrospective matched-pair survival analysis. METHODS Data from a prospective multicenter study (ClinicalTrials.gov identifier: NCT02324452) in which DPYD variant carriers received a 25% (c.1236G>A and c.2846A>T) or 50% (DPYD*2A and c.1679T>G) reduced dose and data from DPYD variant carriers treated with a similarly reduced dose of fluoropyrimidines identified during routine clinical care were obtained. Each DPYD variant carrier was matched to three DPYD wild-type controls treated with a standard dose. Survival analyses were performed using Kaplan-Meier estimates and Cox regression. RESULTS In total, 156 DPYD variant carriers and 775 DPYD wild-type controls were available for analysis. Sixty-one c.1236G>A, 25 DPYD*2A, 13 c.2846A>T, and-when pooled-93 DPYD variant carriers could each be matched to three unique DPYD wild-type controls. For pooled DPYD variant carriers, PFS (hazard ratio [HR], 1.23; 95% CI, 1.00 to 1.51; P = .053) and OS (HR, 0.95; 95% CI, 0.75 to 1.51; P = .698) were not negatively affected by DPYD-guided dose individualization. In the subgroup analyses, a shorter PFS (HR, 1.43; 95% CI, 1.10 to 1.86; P = .007) was found in c.1236G>A variant carriers, whereas no differences were found for DPYD*2A and c.2846A>T carriers. CONCLUSION In this exploratory analysis, DPYD-guided fluoropyrimidine dosing does not negatively affect PFS and OS in pooled DPYD variant carriers. Close monitoring with early dose modifications based on toxicity is recommended, especially for c.1236G>A carriers receiving a reduced starting dose.
Collapse
Affiliation(s)
- Jonathan E Knikman
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tycho A Wilting
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marta Lopez-Yurda
- Biometrics Department, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Linda M Henricks
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Meulendijks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Late Development Oncology, AstraZeneca, Cambridge, UK
| | - Peter Nieboer
- Department of Internal Medicine, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - Helga J Droogendijk
- Department of Internal Medicine, Bravis Hospital, Roosendaal, the Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Haga Hospital, The Hague, the Netherlands
| | | | - Annelie Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | | | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H M Schellens
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemieke Cats
- Department of Gastrointestinal Oncology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
4
|
van den Berg M, Kaal SEJ, Schuurman TN, Braat DDM, Mandigers CMPW, Tol J, Tromp JM, van der Vorst MJDL, Beerendonk CCM, Hermens RPMG. Quality of integrated female oncofertility care is suboptimal: A patient-reported measurement. Cancer Med 2022; 12:2691-2701. [PMID: 36031940 PMCID: PMC9939180 DOI: 10.1002/cam4.5149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend to inform female cancer patients about their infertility risks due to cancer treatment. Unfortunately, it seems that guideline adherence is suboptimal. In order to improve quality of integrated female oncofertility care, a systematic assessment of current practice is necessary. METHODS A multicenter cross-sectional survey study in which a set of systematically developed quality indicators was processed, was conducted among female cancer patients (diagnosed in 2016/2017). These indicators represented all domains in oncofertility care; risk communication, referral, counseling, and decision-making. Indicator scores were calculated, and determinants were assessed by multilevel multivariate analyses. RESULTS One hundred twenty-one out of 344 female cancer patients participated. Eight out of 11 indicators scored below 90% adherence. Of all patients, 72.7% was informed about their infertility, 51.2% was offered a referral, with 18.8% all aspects were discussed in counseling, and 35.5% received written and/or digital information. Patient's age, strength of wish to conceive, time before cancer treatment, and type of healthcare provider significantly influenced the scores of three indicators. CONCLUSIONS Current quality of female oncofertility care is far from optimal. Therefore, improvement is needed. To achieve this, improvement strategies that are tailored to the identified determinants and to guideline-specific barriers should be developed.
Collapse
Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Suzanne E. J. Kaal
- Department of Medical OncologyRadboud University Medical CenterNijmegenthe Netherlands,Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands
| | - Teska N. Schuurman
- Center for Gynecologic Oncology AmsterdamThe Netherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Didi D. M. Braat
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch HospitalDen BoschThe Netherlands
| | - Jacqueline M. Tromp
- Dutch AYA ‘Young and Cancer’ Care NetworkIKNLUtrechtthe Netherlands,Department of Medical OncologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | | | | | | |
Collapse
|
5
|
Kroon LL, van Roij J, Korfage IJ, Reyners AKL, van den Beuken-van Everdingen MHJ, den Boer MO, Creemers GJ, de Graeff A, Hendiks MP, Hunting JCB, de Jong WK, Kuip EJM, van Laarhoven HWM, van Leeuwen L, van Lindert ASR, Mandigers CMPW, Nieboer P, van der Padt-Pruijsten A, Smilde TJ, Sommeijer DW, Thijs MF, Tiemessen MA, Vos AH, Vreugdenhil A, Werner PT, van Zuylen L, van de Poll-Franse LV, Raijmakers NJH. Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer. J Cancer Surviv 2021; 15:380-385. [PMID: 33840000 PMCID: PMC8134301 DOI: 10.1007/s11764-021-01020-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/06/2021] [Indexed: 01/03/2023]
Abstract
Purpose Advance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer. Methods This study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account. Results The majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders. Conclusions Perceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning. Trial registration number NTR6584 Date of registration: 30 June 2017 Implications for Cancer Survivors Patients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising.
Collapse
Affiliation(s)
- Lente L Kroon
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Janneke van Roij
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.,Department of Psychology, Pantein, Boxmeer, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - An K L Reyners
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Marien O den Boer
- Department of Medical Oncology, Laurentius Hospital, Roermond, The Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathijs P Hendiks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Jarmo C B Hunting
- Department of Medical Oncology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Evelien J M Kuip
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Lobke van Leeuwen
- Department of Medical Oncology, Diakonessenhuis, Utrecht, The Netherlands
| | - Anne S R van Lindert
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Peter Nieboer
- Department of Medical Oncology, Wilhelmina Hospital Assen, Assen, The Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Dirkje W Sommeijer
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, FlevoHospital, Almere, The Netherlands
| | - Martine F Thijs
- Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands
| | | | - Allert H Vos
- Department of Medical Oncology, Bernhoven Hospital, Uden, The Netherlands
| | - Art Vreugdenhil
- Department of Medical Oncology, Maxima Medical Center, Eindhoven, The Netherlands
| | - Philo T Werner
- Department of Medical Oncology, VieCuri Medical Center, Venlo, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands.,Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), PO box 19079, 3501 DB, Utrecht, The Netherlands. .,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.
| | | |
Collapse
|
6
|
de Man FM, Veerman GDM, Oomen-de Hoop E, Deenen MJ, Meulendijks D, Mandigers CMPW, Soesan M, Schellens JHM, van Meerten E, van Gelder T, Mathijssen RHJ. Comparison of toxicity and effectiveness between fixed-dose and body surface area-based dose capecitabine. Ther Adv Med Oncol 2019; 11:1758835919838964. [PMID: 31019570 PMCID: PMC6466460 DOI: 10.1177/1758835919838964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/17/2018] [Accepted: 01/28/2019] [Indexed: 12/27/2022] Open
Abstract
Background Capecitabine is generally dosed based on body surface area (BSA). This dosing strategy has several limitations; however, evidence for alternative strategies is lacking. Therefore, we analyzed the toxicity and effectiveness of fixed-dose capecitabine and compared this strategy with a BSA-based dose of capecitabine in a large set of patients. Methods Patients treated with fixed-dose capecitabine between 2003 and 2015 were studied. A comparable group of patients, dosed based on BSA, was chosen as a control cohort. A total of two combined scores were used: capecitabine-specific toxicity (diarrhea, National Cancer Institute Common Toxicity Criteria grade ⩾3, hand-foot syndrome ⩾2, or neutropenia ⩾2), and clinically relevant events due to toxicity, that is, hospital admission, dose reduction, or discontinuation. Per treatment regimen, patients were divided into three BSA groups based on BSA quartiles corrected for sex. Toxicity scores were compared by a Chi-square test between cohorts, and within cohorts using BSA groups. Progression-free survival (PFS) was estimated by the Kaplan-Meier method. Results A total of 2319 patients were included (fixed dosed, n = 1126 and BSA-based dose, n = 1193). Overall, four regimens were evaluated: capecitabine-radiotherapy (n = 1178), capecitabine-oxaliplatin (n = 519), capecitabine triplet (n = 181) and capecitabine monotherapy (n = 441). The incidence of capecitabine-specific toxicity and clinically relevant events was comparable between fixed-dose and BSA-dosed patients, while a small difference (7.1%) in absolute dose was found. Both cohorts showed only a higher incidence of both toxicity scores in the lowest BSA group of the capecitabine-radiotherapy group (p < 0.05). Subgroups of the fixed-dose cohort analyzed for PFS, showed no differences between BSA groups. Conclusions Fixed-dose capecitabine is as comparably well tolerated and effective as BSA-based dosing and could be considered as a reasonable alternative for BSA-based dosing.
Collapse
Affiliation(s)
- Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - G D Marijn Veerman
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Maarten J Deenen
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Marcel Soesan
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands
| | - Jan H M Schellens
- Department of Clinical Pharmacology, Division of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Esther van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Henricks LM, Lunenburg CATC, de Man FM, Meulendijks D, Frederix GWJ, Kienhuis E, Creemers GJ, Baars A, Dezentjé VO, Imholz ALT, Jeurissen FJF, Portielje JEA, Jansen RLH, Hamberg P, Ten Tije AJ, Droogendijk HJ, Koopman M, Nieboer P, van de Poel MHW, Mandigers CMPW, Rosing H, Beijnen JH, van Werkhoven E, van Kuilenburg ABP, van Schaik RHN, Mathijssen RHJ, Swen JJ, Gelderblom H, Cats A, Guchelaar HJ, Schellens JHM. A cost analysis of upfront DPYD genotype-guided dose individualisation in fluoropyrimidine-based anticancer therapy. Eur J Cancer 2018; 107:60-67. [PMID: 30544060 DOI: 10.1016/j.ejca.2018.11.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fluoropyrimidine therapy including capecitabine or 5-fluorouracil can result in severe treatment-related toxicity in up to 30% of patients. Toxicity is often related to reduced activity of dihydropyrimidine dehydrogenase, the main metabolic fluoropyrimidine enzyme, primarily caused by genetic DPYD polymorphisms. In a large prospective study, it was concluded that upfront DPYD-guided dose individualisation is able to improve safety of fluoropyrimidine-based therapy. In our current analysis, we evaluated whether this strategy is cost saving. METHODS A cost-minimisation analysis from a health-care payer perspective was performed as part of the prospective clinical trial (NCT02324452) in which patients prior to start of fluoropyrimidine-based therapy were screened for the DPYD variants DPYD*2A, c.2846A>T, c.1679T>G and c.1236G>A and received an initial dose reduction of 25% (c.2846A>T, c.1236G>A) or 50% (DPYD*2A, c.1679T>G). Data on treatment, toxicity, hospitalisation and other toxicity-related interventions were collected. The model compared prospective screening for these DPYD variants with no DPYD screening. One-way and probabilistic sensitivity analyses were also performed. RESULTS Expected total costs of the screening strategy were €2599 per patient compared with €2650 for non-screening, resulting in a net cost saving of €51 per patient. Results of the probabilistic sensitivity and one-way sensitivity analysis demonstrated that the screening strategy was very likely to be cost saving or worst case cost-neutral. CONCLUSIONS Upfront DPYD-guided dose individualisation, improving patient safety, is cost saving or cost-neutral but is not expected to yield additional costs. These results endorse implementing DPYD screening before start of fluoropyrimidine treatment as standard of care.
Collapse
Affiliation(s)
- Linda M Henricks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Meulendijks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emma Kienhuis
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Vincent O Dezentjé
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, the Netherlands; Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Frank J F Jeurissen
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands
| | - Rob L H Jansen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul Hamberg
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Albert J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | - Helga J Droogendijk
- Department of Internal Medicine, Bravis Hospital, Roosendaal, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter Nieboer
- Department of Internal Medicine, Wilhelmina Hospital Assen, Assen, the Netherlands
| | | | | | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - André B P van Kuilenburg
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, the Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemieke Cats
- Department of Gastrointestinal Oncology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H M Schellens
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
8
|
Henricks LM, Lunenburg CATC, de Man FM, Meulendijks D, Frederix GWJ, Kienhuis E, Creemers GJ, Baars A, Dezentjé VO, Imholz ALT, Jeurissen FJF, Portielje JEA, Jansen RLH, Hamberg P, Ten Tije AJ, Droogendijk HJ, Koopman M, Nieboer P, van de Poel MHW, Mandigers CMPW, Rosing H, Beijnen JH, Werkhoven EV, van Kuilenburg ABP, van Schaik RHN, Mathijssen RHJ, Swen JJ, Gelderblom H, Cats A, Guchelaar HJ, Schellens JHM. DPYD genotype-guided dose individualisation of fluoropyrimidine therapy in patients with cancer: a prospective safety analysis. Lancet Oncol 2018; 19:1459-1467. [PMID: 30348537 DOI: 10.1016/s1470-2045(18)30686-7] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fluoropyrimidine treatment can result in severe toxicity in up to 30% of patients and is often the result of reduced activity of the key metabolic enzyme dihydropyrimidine dehydrogenase (DPD), mostly caused by genetic variants in the gene encoding DPD (DPYD). We assessed the effect of prospective screening for the four most relevant DPYD variants (DPYD*2A [rs3918290, c.1905+1G>A, IVS14+1G>A], c.2846A>T [rs67376798, D949V], c.1679T>G [rs55886062, DPYD*13, I560S], and c.1236G>A [rs56038477, E412E, in haplotype B3]) on patient safety and subsequent DPYD genotype-guided dose individualisation in daily clinical care. METHODS In this prospective, multicentre, safety analysis in 17 hospitals in the Netherlands, the study population consisted of adult patients (≥18 years) with cancer who were intended to start on a fluoropyrimidine-based anticancer therapy (capecitabine or fluorouracil as single agent or in combination with other chemotherapeutic agents or radiotherapy). Patients with all tumour types for which fluoropyrimidine-based therapy was considered in their best interest were eligible. We did prospective genotyping for DPYD*2A, c.2846A>T, c.1679T>G, and c.1236G>A. Heterozygous DPYD variant allele carriers received an initial dose reduction of 25% (c.2846A>T and c.1236G>A) or 50% (DPYD*2A and c.1679T>G), and DPYD wild-type patients were treated according to the current standard of care. The primary endpoint of the study was the frequency of severe (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 grade ≥3) overall fluoropyrimidine-related toxicity across the entire treatment duration. We compared toxicity incidence between DPYD variant allele carriers and DPYD wild-type patients on an intention-to-treat basis, and relative risks (RRs) for severe toxicity were compared between the current study and a historical cohort of DPYD variant allele carriers treated with full dose fluoropyrimidine-based therapy (derived from a previously published meta-analysis). This trial is registered with ClinicalTrials.gov, number NCT02324452, and is complete. FINDINGS Between April 30, 2015, and Dec 21, 2017, we enrolled 1181 patients. 78 patients were considered non-evaluable, because they were retrospectively identified as not meeting inclusion criteria, did not start fluoropyrimidine-based treatment, or were homozygous or compound heterozygous DPYD variant allele carriers. Of 1103 evaluable patients, 85 (8%) were heterozygous DPYD variant allele carriers, and 1018 (92%) were DPYD wild-type patients. Overall, fluoropyrimidine-related severe toxicity was higher in DPYD variant carriers (33 [39%] of 85 patients) than in wild-type patients (231 [23%] of 1018 patients; p=0·0013). The RR for severe fluoropyrimidine-related toxicity was 1·31 (95% CI 0·63-2·73) for genotype-guided dosing compared with 2·87 (2·14-3·86) in the historical cohort for DPYD*2A carriers, no toxicity compared with 4·30 (2·10-8·80) in c.1679T>G carriers, 2·00 (1·19-3·34) compared with 3·11 (2·25-4·28) for c.2846A>T carriers, and 1·69 (1·18-2·42) compared with 1·72 (1·22-2·42) for c.1236G>A carriers. INTERPRETATION Prospective DPYD genotyping was feasible in routine clinical practice, and DPYD genotype-based dose reductions improved patient safety of fluoropyrimidine treatment. For DPYD*2A and c.1679T>G carriers, a 50% initial dose reduction was adequate. For c.1236G>A and c.2846A>T carriers, a larger dose reduction of 50% (instead of 25%) requires investigation. Since fluoropyrimidines are among the most commonly used anticancer agents, these findings suggest that implementation of DPYD genotype-guided individualised dosing should be a new standard of care. FUNDING Dutch Cancer Society.
Collapse
Affiliation(s)
- Linda M Henricks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Didier Meulendijks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Emma Kienhuis
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, Netherlands
| | - Vincent O Dezentjé
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, Netherlands; Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Frank J F Jeurissen
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands; Department of Internal Medicine, Haga Hospital, The Hague, Netherlands
| | - Rob L H Jansen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Paul Hamberg
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
| | - Albert J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, Netherlands
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Peter Nieboer
- Department of Internal Medicine, Wilhelmina Hospital Assen, Assen, Netherlands
| | | | | | - Hilde Rosing
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - André B P van Kuilenburg
- Laboratory of Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology and Metabolism, Amsterdam, Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Annemieke Cats
- Department of Gastrointestinal Oncology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan H M Schellens
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands.
| |
Collapse
|
9
|
Boekhout AH, Gietema JA, Milojkovic Kerklaan B, van Werkhoven ED, Altena R, Honkoop A, Los M, Smit WM, Nieboer P, Smorenburg CH, Mandigers CMPW, van der Wouw AJ, Kessels L, van der Velden AWG, Ottevanger PB, Smilde T, de Boer J, van Veldhuisen DJ, Kema IP, de Vries EGE, Schellens JHM. Angiotensin II-Receptor Inhibition With Candesartan to Prevent Trastuzumab-Related Cardiotoxic Effects in Patients With Early Breast Cancer: A Randomized Clinical Trial. JAMA Oncol 2017; 2:1030-7. [PMID: 27348762 DOI: 10.1001/jamaoncol.2016.1726] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE This is the first randomized placebo-controlled evaluation of a medical intervention for the prevention of trastuzumab-related cardiotoxic effects. OBJECTIVE To determine as the primary end point whether angiotensin II antagonist treatment with candesartan can prevent or ameliorate trastuzumab-related cardiotoxic effects, defined as a decline in left ventricular ejection fraction (LVEF) of more than 15% or a decrease below the absolute value 45%. DESIGN This randomized, placebo-controlled clinical study was conducted between October 2007 and October 2011 in 19 hospitals in the Netherlands, enrolling 210 women with early breast cancer testing positive for human epidermal growth factor receptor 2 (HER2) who were being considered for adjuvant systemic treatment with anthracycline-containing chemotherapy followed by trastuzumab. INTERVENTIONS A total of 78 weeks of candesartan (32 mg/d) or placebo treatment; study treatment started at the same day as the first trastuzumab administration and continued until 26 weeks after completion of trastuzumab treatment. MAIN OUTCOMES AND MEASURES The primary outcome was LVEF. Secondary end points included whether the N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) can be used as surrogate markers and whether genetic variability in germline ERBB2 (formerly HER2 or HER2/neu) correlates with trastuzumab-related cardiotoxic effects. RESULTS A total of 206 participants were evaluable (mean age, 49 years; age range, 25-69 years) 103 in the candesartan group (mean age, 50 years; age range, 25-69 years) and 103 in the placebo group (mean age, 50 years; age range, 30-67 years). Of these, 36 manifested at least 1 of the 2 primary cardiac end points. There were 3.8% more cardiac events in the candesartan group than in the placebo group (95% CI, -7% to 15%; P = .58): 20 events (19%) and 16 events (16%), respectively. The 2-year cumulative incidence of cardiac events was 0.28 (95% CI, 0.13-0.40) in the candesartan group and 0.16 (95% CI, 0.08-0.22) in the placebo group (P = .56). Candesartan did not affect changes in NT-proBNP and hs-TnT values, and these biomarkers were not associated with significant changes in LVEF. The Ala1170Pro homozygous ERBB2 genotype was associated with a lower likelihood of the occurrence of a cardiac event compared with Pro/Pro + Ala/Pro genotypes in multivariate analysis (odds ratio, 0.09; 95% CI, 0.02-0.45; P = .003). CONCLUSIONS AND RELEVANCE The findings do not support the hypothesis that concomitant use of candesartan protects against a decrease in left ventricular ejection fraction during or shortly after trastuzumab treatment in early breast cancer. The ERBB2 germline Ala1170Pro single nucleotide polymorphism may be used to identify patients who are at increased risk of trastuzumab-related cardiotoxic effects. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00459771.
Collapse
Affiliation(s)
- Annelies H Boekhout
- Division of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Renske Altena
- Department of Medical Oncology University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Aafke Honkoop
- Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands
| | - Maartje Los
- Department of Internal Medicine, Antonius Hospital, Nieuwegein, the Netherlands
| | - Willem M Smit
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Peter Nieboer
- Department of Internal Medicine, Wilhelmina Hospital, Assen, the Netherlands
| | | | | | - Agnes J van der Wouw
- Department of Internal Medicine, VieCuri Medical Center Noord-Limburg, Venlo, the Netherlands
| | - Lonneke Kessels
- Department of Internal Medicine, Deventer Hospital, Deventer, the Netherlands
| | | | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tineke Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Jaap de Boer
- Department of Internal Medicine, Hospital de Tjongerschans, Heerenveen, the Netherlands
| | | | - Ido P Kema
- Department of Laboratory Medicine University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan H M Schellens
- Division of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, the Netherlands18Department of Pharmaceutical Sciences, Science Faculty Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
10
|
Deenen MJ, Meulendijks D, Cats A, Sechterberger MK, Severens JL, Boot H, Smits PH, Rosing H, Mandigers CMPW, Soesan M, Beijnen JH, Schellens JHM. Upfront Genotyping of DPYD*2A to Individualize Fluoropyrimidine Therapy: A Safety and Cost Analysis. J Clin Oncol 2015; 34:227-34. [PMID: 26573078 DOI: 10.1200/jco.2015.63.1325] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Fluoropyrimidines are frequently prescribed anticancer drugs. A polymorphism in the fluoropyrimidine metabolizing enzyme dihydropyrimidine dehydrogenase (DPD; ie, DPYD*2A) is strongly associated with fluoropyrimidine-induced severe and life-threatening toxicity. This study determined the feasibility, safety, and cost of DPYD*2A genotype-guided dosing. PATIENTS AND METHODS Patients intended to be treated with fluoropyrimidine-based chemotherapy were prospectively genotyped for DPYD*2A before start of therapy. Variant allele carriers received an initial dose reduction of ≥ 50% followed by dose titration based on tolerance. Toxicity was the primary end point and was compared with historical controls (ie, DPYD*2A variant allele carriers receiving standard dose described in literature) and with DPYD*2A wild-type patients treated with the standard dose in this study. Secondary end points included a model-based cost analysis, as well as pharmacokinetic and DPD enzyme activity analyses. RESULTS A total of 2,038 patients were prospectively screened for DPYD*2A, of whom 22 (1.1%) were heterozygous polymorphic. DPYD*2A variant allele carriers were treated with a median dose-intensity of 48% (range, 17% to 91%). The risk of grade ≥ 3 toxicity was thereby significantly reduced from 73% (95% CI, 58% to 85%) in historical controls (n = 48) to 28% (95% CI, 10% to 53%) by genotype-guided dosing (P < .001); drug-induced death was reduced from 10% to 0%. Adequate treatment of genotype-guided dosing was further demonstrated by a similar incidence of grade ≥ 3 toxicity compared with wild-type patients receiving the standard dose (23%; P = .64) and by similar systemic fluorouracil (active drug) exposure. Furthermore, average total treatment cost per patient was lower for screening (€2,772 [$3,767]) than for nonscreening (€2,817 [$3,828]), outweighing screening costs. CONCLUSION DPYD*2A is strongly associated with fluoropyrimidine-induced severe and life-threatening toxicity. DPYD*2A genotype-guided dosing results in adequate systemic drug exposure and significantly improves safety of fluoropyrimidine therapy for the individual patient. On a population level, upfront genotyping seemed cost saving.
Collapse
Affiliation(s)
- Maarten J Deenen
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Didier Meulendijks
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Annemieke Cats
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Marjolein K Sechterberger
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Johan L Severens
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Henk Boot
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Paul H Smits
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Hilde Rosing
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Caroline M P W Mandigers
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Marcel Soesan
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Jos H Beijnen
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands
| | - Jan H M Schellens
- Maarten J. Deenen, Didier Meulendijks, Annemieke Cats, Marjolein K. Sechterberger, Henk Boot, Hilde Rosing, Jos H. Beijnen, and Jan H.M. Schellens, Netherlands Cancer Institute; Paul H. Smits and Marcel Soesan, Slotervaart Hospital, Amsterdam; Johan L. Severens, Erasmus University Medical Center, Rotterdam; Caroline M.P.W. Mandigers, Canisius Wilhelmina Hospital, Nijmegen; and Jos H. Beijnen and Jan H.M. Schellens, Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
11
|
Aarts MJB, Peters FPJ, Dercksen WMW, Mandigers CMPW, Stouthard J, Nortier HWR, Kamm YJL, van Warmerdam LJC, van der Rijt CCD, van Gastel S, Joore M, Kessels A, Tjan-Heijnen VCG. Abstract P3-15-01: Primary G-CSF Prophylaxis during the First Two Cycles Only or Throughout All Chemotherapy Cycles in Breast Cancer Patients at Risk of Febrile Neutropenia: Final Results from a Phase III Trial of the Dutch Breast Cancer Trialists Group (BOOG). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-15-01] [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: In patients at risk of febrile neutropenia (FN), the highest incidence of FN is seen during the first chemotherapy cycles. This observation questions the effectiveness of continued G-CSF prophylaxis during later chemotherapy cycles.
Methods: We conducted a multicenter phase III study in breast cancer. Patients were randomized to primary G-CSF prophylaxis during the first two chemotherapy cycles only (experimental arm) or to primary G-CSF prophylaxis throughout all chemotherapy cycles (standard arm). Patients were eligible if treated with 3-weekly chemotherapy, being at risk of FN according to criteria of international guidelines. This was an equivalence study, aimed to include 230 patients, with FN as primary endpoint. Results: An independent Data Safety Monitoring Board recommended premature closure of the study because of an unacceptable increase in FN rate in the experimental arm. In total, 85 patients enrolled the experimental arm and 84 patients the standard arm till 15 th December 2009. Baseline characteristics were well belanced: age ≥65years in 93% versus 95%, ECOG PS of zero in 82% versus 88%, treated with docetaxel containing chemotherapy in (neo)-adjuvant setting in 97% versus 100%, respectively. At least one episode of FN was seen in 27 (32%) patients of the experimental arm compared with 4 (5%) patients in the standard arm (P<0.0001). Notably, in the experimental arm FN occurred predominantly in the third cycle, whereas in the standard arm FN was seen throughout all cycles. Fever, infection and/or mucositis led to serious adverse events in 31 (36%) patients in the experimental arm versus in 11 (13%) patients in the standard arm (P<0.001). In both arms, 5% of patients stopped or changed treatment because of toxicity. Most patients experienced only one FN episode. In these, chemotherapy was mostly given as planned, but in 61 % of patients with secondary G-CSF prophylaxis and in 21% of patients with secondary antibiotic prophylaxis (in the experimental arm). Conclusion: We conclude that in patients at risk of FN, primary G-CSF prophylaxis cannot be limited to the first chemotherapy cycles, despite the well known increased FN incidence in the first cycles without prophylaxis. With only 2 cycles protected, FN risk is increased in the third cycle. Support: The Netherlands organization for health research and development (ZonMw) and sanofi-aventis Netherlands B.V.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-15-01.
Collapse
Affiliation(s)
- MJB Aarts
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - FPJ Peters
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - WMW Dercksen
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - CMPW Mandigers
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - J Stouthard
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - HWR Nortier
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - YJL Kamm
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - LJC van Warmerdam
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - CCD van der Rijt
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - S van Gastel
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - M Joore
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - A Kessels
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| | - VCG. Tjan-Heijnen
- Maastricht University Medical Centre, Netherlands; Orbis Medical Centre, Sittard, Netherlands; Maxima Medical Centre, Veldhoven, Netherlands; Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Maasstad Medical Centre, Rotterdam, Netherlands; Leiden University Medical Centre, Netherlands; Radboud University Nijmegen Medical Centre, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Erasmus Medical Centre, Rotterdam, Netherlands; Comprehensive Cancer Centre East, Nijmegen, Netherlands
| |
Collapse
|
12
|
Menke-van der Houven van Oordt CW, Fliervoet HJM, Mandigers CMPW, van Spronsen DJ. [Cardiotoxicity of trastuzumab of significance in the adjuvant treatment of breast cancer]. Ned Tijdschr Geneeskd 2008; 152:158-163. [PMID: 18271465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Three women aged 53, 52 and 36 years, respectively, underwent surgery for breast cancer, i.e. right-sided grade II invasive ductal carcinoma, left-sided grade III invasive ductal carcinoma, and left-sided multifocal grade III invasive ductal carcinoma, respectively. All 3 received adjuvant anthracycline-containing chemotherapy followed by trastuzumab. They developed significant cardiac dysfunction, as determined by a decrease in left ventricular ejection fraction (LVEF), which necessitated trastuzumab discontinuation. Trastuzumab therapy was resumed in the third patient after LVEF recovery but was stopped definitively when the LVEF decreased again. Trastuzumab has been shown to improve both disease-free and overall survival in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, symptomatic cardiac failure due to cardiomyopathy has been observed in 0.6-4.1% of patients treated with trastuzumab after adjuvant anthracycline-based chemotherapy, whereas in 5-19% of the patients the decline in cardiac function led to permanent discontinuation of trastuzumab therapy. Cardiac function should be monitored regularly during trastuzumab therapy. An LVEF less than 50% or an absolute reduction of more than 10% warrant treatment discontinuation and close follow-up. Cardiac dysfunction is usually reversible; however, the long-term consequences of LVEF reduction following trastuzumab therapy are still unknown and warrant close attention, given the relatively young age and long life expectancy of these patients.
Collapse
|
13
|
Mandigers CMPW, Verdonck LF, Meijerink JPP, Dekker AW, Schattenberg AVMB, Raemaekers JMM. Graft-versus-lymphoma effect of donor lymphocyte infusion in indolent lymphomas relapsed after allogeneic stem cell transplantation. Bone Marrow Transplant 2004; 32:1159-63. [PMID: 14647270 DOI: 10.1038/sj.bmt.1704290] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Donor lymphocyte infusions (DLI) are used to treat relapsed haematological diseases after allogeneic stem cell transplantation (SCT). We treated seven patients with DLI for indolent non-Hodgkin's lymphoma relapsed after SCT. In available blood and bone marrow samples, lymphoma cells were analysed by real-time quantitative polymerase chain reaction of t(14;18)-positive cells in follicular lymphoma, and by immunophenotyping in small lymphocytic lymphoma. Before DLI, three patients were treated with chemo- and/or radiotherapy, and one with rituximab. Evaluable responses to pre-DLI therapy were stable disease in one and partial remission (PR) in two patients. Six patients responded to DLI (complete remission (CR) in four and PR in two). After DLI, acute graft-versus-host disease (GVHD) occurred in 3/6 patients, classified as grade 2, whereas only limited chronic GVHD was seen (n=5). The four continuous CR are lasting for median 65+ (43-89) months. In the remaining patient, not responding to DLI, progressive disease was seen later on; chemotherapy followed by another DLI resulted in CR. In three cases, clinical responses to DLI could be substantiated by molecular or immunophenotypic analysis of lymphoma cells. We conclude that DLI is effective for treatment of indolent lymphoma relapsing after SCT.
Collapse
Affiliation(s)
- C M P W Mandigers
- Department of Hematology, University Medical Center Nijmegen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
14
|
Mandigers CMPW, Meijerink JPP, van 't Veer MB, Mensink EJBM, Raemaekers JMM. Dynamics of circulating t(14;18)-positive cells during first-line and subsequent lines of treatment in follicular lymphoma. Ann Hematol 2003; 82:743-9. [PMID: 14513290 DOI: 10.1007/s00277-003-0762-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 06/24/2003] [Accepted: 08/18/2003] [Indexed: 12/01/2022]
Abstract
In follicular lymphoma the t(14;18) might be useful as a tumor marker in predicting the quality of the response to treatment. We investigated whether analyzing numbers of t(14;18)-positive cells in peripheral blood correlated with remission status in individual patients receiving a variety of treatments. Numbers of circulating t(14;18)-positive cells were determined by real-time polymerase chain reaction (PCR) technique. Disease parameters and response to treatment were related to the pre- and post-treatment numbers of circulating t(14;18)-positive cells for 53 follicular lymphoma patients. In these 53 patients, 70 treatment episodes were investigated. A content of more than 328 t(14;18)-positive cells per 75,000 cells prior to therapy correlated with the more advanced stage IV disease ( P=0.01), bone marrow involvement ( P<0.01), and overt leukemic lymphoma ( P=0.04). Therapy episodes that cleared circulation from t(14;18)-positive cells with more than one log resulted in a significantly longer progression-free survival than treatment episodes with less than one log decline (26 versus 12 months, respectively) ( P<0.01). After first-line treatment episodes, numbers of circulating t(14;18)-positive cells declined in fairly all cases, irrespective of the clinical response. However, for second or later lines of treatment, declining numbers of lymphoma cells correlated with a clinical remission, whereas increasing numbers of lymphoma cells were associated with clinically stable or progressive disease. From this, we conclude that quantitation of circulating t(14;18)-positive cells in peripheral blood is of only limited clinical significance in predicting treatment efficacy for the individual follicular lymphoma patient.
Collapse
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Count
- Chemotherapy, Adjuvant
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Cytodiagnosis
- Disease-Free Survival
- Humans
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Neoadjuvant Therapy
- Neoplastic Cells, Circulating/drug effects
- Neoplastic Cells, Circulating/pathology
- Prognosis
- Translocation, Genetic
Collapse
Affiliation(s)
- C M P W Mandigers
- Department of Hematology, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | | | | | | | | |
Collapse
|
15
|
Postema EJ, Raemaekers JMM, Oyen WJG, Boerman OC, Mandigers CMPW, Goldenberg DM, van Dongen GAMS, Corstens FHM. Final results of a phase I radioimmunotherapy trial using (186)Re-epratuzumab for the treatment of patients with non-Hodgkin's lymphoma. Clin Cancer Res 2003; 9:3995S-4002S. [PMID: 14506199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PURPOSE Radioimmunotherapy (RIT) is an effective, new treatment modality for non-Hodgkin's lymphoma (NHL). The aim of this study was to determine the maximum tolerated dose and a first impression of the therapeutic potential of (186)Re-epratuzumab in patients with NHL. EXPERIMENTAL DESIGN Patients with relapsed or refractory CD22-positive NHL of diverse histopathology and prior treatments received (99m)Tc-labeled epratuzumab (anti-CD22 IgG1), followed by RIT with (186)Re-epratuzumab 1 week later. Dose escalation of RIT was started at 0.5 GBq/m(2). Three patients were entered per dose level. If no dose-limiting toxicity occurred, the dose was increased by 0.5 GBq/m(2); otherwise three additional patients were included on that dose level. RESULTS A total of 18 patients received a diagnostic dose of (99m)Tc-epratuzumab. Fifteen patients were actually treated with (186)Re-epratuzumab at four different dose levels, 0.5, 1.0, 1.5, and 2.0 GBq/m(2). During or after infusion of (186)Re-epratuzumab, no adverse reactions were seen. In all patients, a transient decrease of leukocyte and platelet levels was observed 1 month after treatment. At the 1.5-GBq/m(2) dose level, one grade 4 hematological toxicity was observed. At the highest dose level of 2 GBq/m(2), no grade 4 hematological toxicity was seen, but WBC and platelet counts of two of the three patients did not recover completely. One patient had a complete remission lasting 4 months. Four patients had a partial remission, lasting 3, 3, 6, and 14 months, respectively. Four patients had stable disease for 3, 3, 7, and 9 months, respectively. CONCLUSIONS (186)Re-epratuzumab at a dose of 2.0 GBq/m(2) is well tolerated without major toxicity. A single dose of (186)Re-epratuzumab led to objective responses in 5 of 15 treated patients.
Collapse
Affiliation(s)
- Ernst J Postema
- Department of Nuclear Medicine, University Medical Center Nijmegen, 6500 HB Nijmegen, the Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Mandigers CMPW, Keuning JJ, van Dam FE, Broelmann HAM, Wijn PFF. No correlation between chemotherapy dose and treatment outcome in advanced ovarian cancer. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91357-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|