1
|
Flood E, Krasnow A, Orbegoso C, Karantzoulis S, Bailey J, Bayet S, Elghouayel A, Foxley A, Sommavilla R, Schiavon G. Using qualitative interviews to identify patient-reported clinical trial endpoints and analyses that are the most meaningful to patients with advanced breast cancer. PLoS One 2023; 18:e0280259. [PMID: 36649275 PMCID: PMC9844842 DOI: 10.1371/journal.pone.0280259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Designing clinical trials with the emphasis on the patient-centered approach and focusing on clinical outcomes that are meaningful to patients is viewed as a priority by drug developers, regulatory agencies, payers, clinicians, and patients. This study aimed to capture information on clinical trial endpoints that would be most important and relevant for patients with advanced breast cancer, based on patient-reported outcomes. METHODS Patients with either advanced triple-negative breast cancer [TNBC] and a maximum of two lines of systemic therapy or hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR+/HER2-] breast cancer and a maximum of three lines of systemic therapy, participated in semi-structured concept elicitation interviews. Concept saturation was assessed. A sign, symptom, or impact was defined as "salient" if mentioned by ≥ 60% of participants, with an average bother rating of ≥ 5 (0-10 Scale). Participants were also asked about treatment priorities and to evaluate hypothetical scenarios showing different health-related functioning and quality-of-life treatment outcomes, using graphical representations. RESULTS Thirty-two participants (97% women; aged 29+ years) with TNBC (n = 17) or HR+/HER2- breast cancer (n = 15) provided generally similar reports on symptom experience, with fatigue and pain being most salient, though importance of certain treatment-related symptoms varied between the two groups. Patients reported consistent perspectives on the importance of treatment outcomes: when considering a new treatment, they prioritized efficacy of the therapy, acceptable tolerability, stability, predictability of symptoms over time, and the duration of preserved health-related quality of life and physical functioning. The meaningful difference in preserved physical functioning was 2-3 months for 46% of participants with TNBC, whereas for most participants with HR+/HER2- breast cancer it started from 6-7 months. Both groups of participants found it easier to accept some toxicity at the beginning of therapy if it was followed by improvement, as opposed to improvement followed by deterioration. CONCLUSION The results may help to inform the design of patient-centered clinical trials, to interpret health-related quality of life and/or patient-reported outcomes, and to optimize care for patients with advanced breast cancer.
Collapse
Affiliation(s)
- Emuella Flood
- AstraZeneca plc, Patient-Centered Science, Gaithersburg, Maryland, United States of America
- * E-mail:
| | - Anna Krasnow
- IQVIA Real World Solutions, Patient-Centered Solutions, London, United Kingdom
| | | | - Stella Karantzoulis
- IQVIA Real World Solutions, Patient-Centered Solutions, New York, New York, United States of America
| | - Julie Bailey
- IQVIA Real World Solutions, Patient-Centered Solutions, New York, New York, United States of America
| | - Solène Bayet
- IQVIA Real World Solutions, Patient-Centered Solutions, Courbevoie, France
| | - Arthur Elghouayel
- IQVIA Real World Solutions, Patient-Centered Solutions, New York, New York, United States of America
| | - Andrew Foxley
- AstraZeneca plc, R&D Oncology, Cambridge, United Kingdom
| | | | - Gaia Schiavon
- AstraZeneca plc, R&D Oncology, Cambridge, United Kingdom
| |
Collapse
|
2
|
Saini KS, de las Heras B, Plummer R, Moreno V, Romano M, de Castro J, Aftimos P, Fredriksson J, Bhattacharyya GS, Olivo MS, Schiavon G, Punie K, Garcia-Foncillas J, Rogata E, Pfeiffer R, Orbegoso C, Morrison K, Curigliano G, Chin L, Saini ML, Rekdal Ø, Anderson S, Cortes J, Leone M, Dancey J, Twelves C, Awada A. Reimagining Global Oncology Clinical Trials for the Postpandemic Era: A Call to Arms. JCO Glob Oncol 2020; 6:1357-1362. [PMID: 32897732 PMCID: PMC7529519 DOI: 10.1200/go.20.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Kamal S. Saini
- Covance, Princeton, NJ,East Suffolk and North Essex NHS Foundation Trust, Ipswich, United Kingdom,Kamal S. Saini, MD, MBBS, Covance, 206 Carnegie Center, Princeton, NJ 08540-6233; Twitter: @KSainiMD; e-mail:
| | | | - Ruth Plummer
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Victor Moreno
- START Madrid-FJD, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Philippe Aftimos
- Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | - Gaia Schiavon
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jesus Garcia-Foncillas
- University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | - Ernesto Rogata
- Leeds Cancer Centre, Patient and Public Involvement Group, Leeds, United Kingdom
| | | | | | | | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy,University of Milano, Milan, Italy
| | - Lynda Chin
- Apricity Health, Houston, TX,Dell Medical School at the University of Texas at Austin, Austin, TX
| | | | | | | | - Javier Cortes
- IOB Institute of Oncology, Quiron Group, Madrid, Spain
| | | | - Janet Dancey
- Canadian Cancer Trials Group, Queen’s University, Kingston, Ontario, Canada
| | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Ahmad Awada
- Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
3
|
Morgan RD, Banerjee S, Hall M, Clamp AR, Zhou C, Hasan J, Orbegoso C, Taylor S, Tugwood J, Lyon AR, Dive C, Rustin GJS, Jayson GC. Pazopanib and Fosbretabulin in recurrent ovarian cancer (PAZOFOS): A multi-centre, phase 1b and open-label, randomised phase 2 trial. Gynecol Oncol 2020; 156:545-551. [PMID: 31932108 DOI: 10.1016/j.ygyno.2020.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/20/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Vascular co-option is a resistance mechanism to anti-angiogenic agents, but combinations of anti-vascular agents may overcome this resistance. We report a phase 1b and randomised phase 2 trial to determine the safety and efficacy of pazopanib with fosbretabulin. METHODS Eligible patients had recurrent, epithelial ovarian cancer with a platinum-free interval (PFI) of 3 to 12 months. Patients were stratified according to PFI (>6 versus ≤6 months) and prior bevacizumab use. RESULTS Twelve patients were treated in the phase 1b. Commonest grade ≥ 2 adverse events (AEs) were hypertension (100%), neutropenia (50%), fatigue (50%), vomiting (50%). There was one DLT (grade 3 fatigue). The recommended phase 2 dose level was fosbretabulin 54 mg/m2 on days 1, 8 and 15 and pazopanib 600 mg once daily (od), every 28 days, which was then compared to pazopanib 800 mg od in a randomised phase 2 trial. Twenty-one patients were randomised (1:1) in the phase 2 trial. In phase 1b and phase 2, four patients treated with pazopanib and fosbretabulin developed reversible, treatment-related cardiac AEs, leading to premature discontinuation of the study. In the phase 2 trial, the median PFS was 7.6 months (95% CI 4.1-not estimated) versus 3.7 months (95% CI 1.0-8.1) in favour of the experimental arm (HR 0.30, 95% CI 0.09-1.03, P = .06). CONCLUSIONS It remains unclear whether pazopanib with with fosbretabulin is an efficacious regimen to treat epithelial ovarian cancer. Effective cardiac risk mitigation is needed to increase the tolerability and maximize patient safety in future trials.
Collapse
Affiliation(s)
- Robert D Morgan
- Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Marcia Hall
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Andrew R Clamp
- Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Cong Zhou
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK
| | | | | | - Sarah Taylor
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK
| | - Jonathan Tugwood
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK
| | - Alexander R Lyon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK; Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, Manchester, UK
| | | | - Gordon C Jayson
- Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| |
Collapse
|
4
|
Banerjee S, Lewsley LA, Clamp A, krell J, Herbertson R, Glasspool R, Orbegoso C, Green C, Kristeleit R, Gourley C, Cambell C, Banerji U, Shepherd C, Brugger W, Chudleigh L, Hanif A, McNeish I, Paul J. OCTOPUS: A randomised, multi-centre phase II umbrella trial of weekly paclitaxel+/- novel agents in platinum-resistant ovarian cancer: Vistusertib. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
Scaranti M, Murali K, Orbegoso C, Vroobel K, Banerjee SN, Gore ME, Attygalle A, George A. Prevalence and clinical implications of mismatch repair (MMR) deficiency in unselected non-serous epithelial ovarian cancer (EOC) patients (pts). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1521] [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
1521 Background: It has previously been reported that 6-7% of clear cell (CC) and endometrioid (E) ovarian cancers are MMR deficient (MMRd). The prevalence of MMRd in other histological subtypes and correlation with germline (g) MMR (Lynch Syndrome) mutations in unselected non-serous EOC pts is less clear. MMRd in solid tumors has been associated with enhanced response to immunotherapy, hence knowledge of MMR status has therapeutic and familial implications. We aimed to study the prevalence and implications of MMRd and gMMRd in unselected pts with non-serous EOC. Methods: Routine immunohistochemistry (IHC) was performed for the MMR proteins MLH1, MSH2, MSH6 and PMS2 in all non-serous EOC pts from June 2016; retrospective MMR IHC testing in pts in follow-up was performed. Pts with MMRd tumors were referred for gMMR testing. Results: We analyzed 66 unselected pts with non-serous EOC. Median age was 56.4 years (yrs). The majority had E ovarian cancer (54.5%) followed by CC (25.8%), mixed histology (12.1%), mucinous (4.5%) and mullerian (3%) subtypes. Endometriosis was noted in 45.5% of pts, and 75% were FIGO stage I and II at diagnosis. Seventeen pts (25.8%) had concurrent endometrial cancer, all Grade I. On IHC, 15.2% were MMRd: 5 E, 2 CC, 2 mixed and 1 mullerian-type. Of these, 3 pts (30%) had gMMR mutation, 2/3 did not meet the Revised Bethesda criteria for testing. A lower average body mass index (Kg/m2) was noted in MMRd 25.9 versus 30.1 in MMR proficient (MMRp). Median age at diagnosis was 53.5 yrs in the MMRd and 57.7 yrs in MMRp. A higher frequency of concurrent endometrial cancer was observed on the MMRd group (60%) versus (20%) on MMRp (p = 0.007). No statistically significant difference in overall survival or disease-free survival was observed between the MMRd and MMRp population. Conclusions: Our study has shown a higher prevalence of somatic MMRd in non-serous EOC (15.2%) than in previously published literature with a significant proportion found to carry gMMR mutations (4.5%). These interim findings support the role of universal MMR IHC testing in non-serous EOC regardless of family history. [Table: see text]
Collapse
Affiliation(s)
- Mariana Scaranti
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Krithika Murali
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Susana N. Banerjee
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Ayoma Attygalle
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Angela George
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
6
|
Heindl A, Khan AM, Rodrigues DN, Eason K, Sadanandam A, Orbegoso C, Punta M, Sottoriva A, Lise S, Banerjee S, Yuan Y. Microenvironmental niche divergence shapes BRCA1-dysregulated ovarian cancer morphological plasticity. Nat Commun 2018. [PMID: 30254278 DOI: 10.1038/s41467-018-06130-3] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
How tumor microenvironmental forces shape plasticity of cancer cell morphology is poorly understood. Here, we conduct automated histology image and spatial statistical analyses in 514 high grade serous ovarian samples to define cancer morphological diversification within the spatial context of the microenvironment. Tumor spatial zones, where cancer cell nuclei diversify in shape, are mapped in each tumor. Integration of this spatially explicit analysis with omics and clinical data reveals a relationship between morphological diversification and the dysregulation of DNA repair, loss of nuclear integrity, and increased disease mortality. Within the Immunoreactive subtype, spatial analysis further reveals significantly lower lymphocytic infiltration within diversified zones compared with other tumor zones, suggesting that even immune-hot tumors contain cells capable of immune escape. Our findings support a model whereby a subpopulation of morphologically plastic cancer cells with dysregulated DNA repair promotes ovarian cancer progression through positive selection by immune evasion.
Collapse
Affiliation(s)
- Andreas Heindl
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK.,Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Adnan Mujahid Khan
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK.,Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Daniel Nava Rodrigues
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Katherine Eason
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Anguraj Sadanandam
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK.,Centre for Molecular Pathology, Royal Marsden Hospital, London, SM2 5NG, UK
| | - Cecilia Orbegoso
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Marco Punta
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Andrea Sottoriva
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Stefano Lise
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.,Division of Clinical Studies, the Institute of Cancer Research, London, UK, SM2 5NG
| | - Yinyin Yuan
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK. .,Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK.
| |
Collapse
|
7
|
Heindl A, Khan AM, Rodrigues DN, Eason K, Sadanandam A, Orbegoso C, Punta M, Sottoriva A, Lise S, Banerjee S, Yuan Y. Microenvironmental niche divergence shapes BRCA1-dysregulated ovarian cancer morphological plasticity. Nat Commun 2018; 9:3917. [PMID: 30254278 PMCID: PMC6156340 DOI: 10.1038/s41467-018-06130-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 08/18/2017] [Accepted: 08/15/2018] [Indexed: 12/22/2022] Open
Abstract
How tumor microenvironmental forces shape plasticity of cancer cell morphology is poorly understood. Here, we conduct automated histology image and spatial statistical analyses in 514 high grade serous ovarian samples to define cancer morphological diversification within the spatial context of the microenvironment. Tumor spatial zones, where cancer cell nuclei diversify in shape, are mapped in each tumor. Integration of this spatially explicit analysis with omics and clinical data reveals a relationship between morphological diversification and the dysregulation of DNA repair, loss of nuclear integrity, and increased disease mortality. Within the Immunoreactive subtype, spatial analysis further reveals significantly lower lymphocytic infiltration within diversified zones compared with other tumor zones, suggesting that even immune-hot tumors contain cells capable of immune escape. Our findings support a model whereby a subpopulation of morphologically plastic cancer cells with dysregulated DNA repair promotes ovarian cancer progression through positive selection by immune evasion.
Collapse
Affiliation(s)
- Andreas Heindl
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Adnan Mujahid Khan
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Daniel Nava Rodrigues
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Katherine Eason
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Anguraj Sadanandam
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
- Centre for Molecular Pathology, Royal Marsden Hospital, London, SM2 5NG, UK
| | - Cecilia Orbegoso
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Marco Punta
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Andrea Sottoriva
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Stefano Lise
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
- Division of Clinical Studies, the Institute of Cancer Research, London, UK, SM2 5NG
| | - Yinyin Yuan
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, SM2 5NG, UK.
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK.
| |
Collapse
|
8
|
Orbegoso C, Murali K, Banerjee S. The current status of immunotherapy for cervical cancer. Rep Pract Oncol Radiother 2018; 23:580-588. [PMID: 30534022 DOI: 10.1016/j.rpor.2018.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/13/2018] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
Immunotherapy has been proven effective in several tumours, hence diverse immune checkpoint inhibitors are currently licensed for the treatment of melanoma, kidney cancer, lung cancer and most recently, tumours with microsatellite instability. There is much enthusiasm for investigating this approach in gynaecological cancers and the possibility that immunotherapy might become part of the therapeutic landscape for gynaecological malignancies. Cervical cancer is the fourth most frequent cancer in women worldwide and represents 7.9% of all female cancers with a higher burden of the disease and mortality in low- and middle-income countries. Cervical cancer is largely a preventable disease, since the introduction of screening tests, the recognition of the human papillomavirus (HPV) as an etiological agent, and the subsequent development of primary prophylaxis against high risk HPV subtypes. Treatment for relapsed/advanced disease has improved over the last 5 years, since the introduction of antiangiogenic therapy. However, despite advances, the median overall survival for advanced cervical cancer is 16.8 months and the 5-year overall survival for all stages is 68%. There is a need to improve outcomes and immunotherapy could offer this possibility. Clinical trials aim to understand the best timing for immunotherapy, either in the adjuvant setting or recurrent disease and whether immunotherapy, alone or in combination with other agents, improves outcomes.
Collapse
Key Words
- APC, antigen-presenting cell
- Adoptive T cell therapy
- CAR, chimeric antigen receptor
- CD4, -8, -80, cluster of differentiation 4, -8, -80
- CTL, cytotoxic-T lymphocyte
- CTLA-4, cytotoxic T-lymphocyte-associated protein 4
- Cervical cancer
- DC, dendritic cell
- DFS, disease free survival
- DNA, deoxyribonucleic acid
- FIGO, International Federation of Gynecology and Obstetrics
- HLA, human leucocyte antigen
- HPV, human papilloma virus
- Human papillomavirus
- IL-2, interleukin 2
- ILT's, Ig-like transcripts
- Immune checkpoints inhibitors
- LLO, listerolysin O
- Lm, Listeria monocytogenes
- MAGE-A3, melanoma-associated antigen 3
- MCH, major histocompatibility complex
- ORR, objective response rate
- OS, overall survival
- PD-1, programmed cell death protein 1
- PD-L1, programmed death-ligand 1
- PFS, progression free survival
- RNA, ribonucleic acid
- SLP, synthetic long-peptide
- TCR, T-cell receptor
- TGFβ, transforming growth factor beta
- TILs, tumor-infiltrating lymphocytes
- TRAEs, treatment related adverse events
- Therapeutic vaccines
Collapse
Affiliation(s)
- Cecilia Orbegoso
- Gynae Oncology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Krithika Murali
- Gynae Oncology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Susana Banerjee
- Gynae Oncology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| |
Collapse
|
9
|
Affiliation(s)
- Cecilia Orbegoso
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Gloria Marquina
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Angela George
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Susana Banerjee
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
- Division of Clinical Studies, The Institiute of Cancer Research, London, UK
| |
Collapse
|
10
|
Banerjee SN, Lewsley LA, Clamp AR, Gabra H, Herbertson R, Green C, Orbegoso C, Wilson C, Banerji U, Hanif A, McNeish IA, Paul J. OCTOPUS: A randomised, multi-centre phase II umbrella trial of weekly paclitaxel+/- novel agents in platinum-resistant ovarian cancer—Vistusertib (AZD2014). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps5609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
TPS5609 Background: There is an urgent need to improve outcomes for patients with platinum-resistant and refractory ovarian cancer (PROC). OCTOPUS is an umbrella phase II framework for testing whether the addition of novel targeted agents to weekly paclitaxel (wPxl) improves efficacy in PROC. The first agent to be evaluated is the dual mTORC1/mTORC2 inhibitor, vistusertib (AZD2014), as preclinical studies support targeting the PI3kinase/Akt/mTOR pathway in PROC and the combination of vistusertib and wPxl has shown promising preliminary activity in high grade serous ovarian cancer (HGS) patients in a phase I trial (Banerji et al poster discussion ESMO 2016). This is the first randomised trial of wPxl and a dual mTORC1/2 inhibitor in ovarian cancer. Methods: OCTOPUS is an investigator-initiated, randomised, double-blind, placebo-controlled, multicentre, phase II trial. 140 patients with PROC (histologically confirmed HGS) are randomised 1:1 to receive wPxl (80mg/m2 D1, D8, D15 of 28 day cycle) plus oral vistusertib (50mg BD) or placebo (D1-3, D8-10, D15-17). The primary endpoint is progression-free survival (PFS) based on combined RECIST v1.1/GCIG CA125 criteria. The study is designed to detect a 50% improvement in median PFS from 3.7 months on placebo to 5.55 months on the experimental arm with 90% power, at the 20% 1-sided level of statistical significance (or equivalently with 80% power at the 10% level of statistical significance) using a 3-outcome design. Secondary endpoints include response (based on RECIST 1.1 and GCIG CA125 criteria), overall survival, toxicity and quality of life. Patients whom received prior wPxl for PROC are not eligible. A mandatory pre-treatment biopsy (if technically feasible), archival tissue, and serial blood samples will be collected for translational research studies. 49 patients have been recruited. The study is part of the NIHR CRN Cancer/Astrazeneca Alliance, sponsored by NHS Greater Glasgow and Clyde/University of Glasgow and endorsed by Cancer Research UK (CRUKE/14/052). Clinical trial information: ISRCTN16426935.
Collapse
Affiliation(s)
| | | | - Andrew R. Clamp
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Hani Gabra
- Imperial College London, London, United Kingdom
| | | | - Clare Green
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Cheryl Wilson
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | | | - Iain A. McNeish
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - James Paul
- University of Glasgow, Cancer Research UK Clinical Trials Unit, Glasgow, United Kingdom
| |
Collapse
|
11
|
Romero I, Rubio M, Serrano R, Medina M, Minig L, Casado A, Coronado P, Martínez S, Orbegoso C, Fusté P, Alia EG, Sánchez-Martínez M, Rubio D, Santacana M, Ruiz M, Llombart-Cussac A, Matias-Guiu X, Poveda A. Preoperative olaparib in early-stage endometrial cancer (EC): A phase 0, window of opportunity trial to evaluate the PARP inhibition effect, targeting cell cycle-related proteins (POLEN study). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Sebbagh S, Roux J, Dreyer C, Neuzillet C, de Gramont A, Orbegoso C, Hentic O, Hammel P, de Gramont A, Raymond E, André T, Chibaudel B, Faivre S. Efficacy of a sequential treatment strategy with GEMOX-based followed by FOLFIRI-based chemotherapy in advanced biliary tract cancers. Acta Oncol 2016; 55:1168-1174. [PMID: 27333436 DOI: 10.1080/0284186x.2016.1191670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gemcitabine (GEM)-platinum chemotherapy stands as first-line therapy for patients with recurrent/advanced biliary tract cancer (BTC), yielding progression-free survival (PFS) of 3.4-6.4 months. No standard second-line chemotherapy after GEM-platinum failure exists and data on survival benefit remain limited. MATERIAL AND METHODS We retrospectively reviewed patients with recurrent/advanced BTC who received gemcitabine-oxaliplatin (GEMOX)-based chemotherapy followed by 5-fluorouracil-irinotecan (FOLFIRI)-based chemotherapy to evaluate the efficacy of the sequential treatment strategy. Overall survival (OS) and PFS were calculated by Kaplan-Meier method. RESULTS Fifty-two patients were analyzed, 21 (40%) had intrahepatic, 14 (27%) had hilar/extrahepatic, and 17 (33%) had gallbladder cancer. Median age was 64 years (range 38-79 years). Prior curative intent resection of the primary tumor was performed in 23 (44.2%) patients and GEMOX adjuvant chemotherapy was given in 12 (23.1%) patients. After a median follow-up of 36.3 months, 47 (90.4%) patients completed the treatment strategy. First-sequence GEMOX and second sequence FOLFIRI achieved 4.8 months and 3.2 months median PFS, respectively. The global OS for the sequential chemotherapy was 21.9 months. The sequence of FOLFIRI resulted in a median OS of 8.4 months. CONCLUSION The sequence of GEMOX-FOLFIRI is a potential treatment strategy for patients with recurrent/advanced BTC.
Collapse
Affiliation(s)
- Sihem Sebbagh
- Department of Medical Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | - Julia Roux
- Department of Medical Oncology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Paris, France
| | - Chantal Dreyer
- Department of Medical Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | - Cindy Neuzillet
- Department of Medical Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | - Armand de Gramont
- Department of Medical Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | - Cecilia Orbegoso
- Department of Medical Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | - Olivia Hentic
- Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | - Pascal Hammel
- Department of Gastroenterology and Pancreatology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | | | - Eric Raymond
- Department of Medical Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| | - Thierry André
- Department of Medical Oncology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Paris, France
| | | | - Sandrine Faivre
- Department of Medical Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux De Paris (AP-HP), Clichy, France
| |
Collapse
|
13
|
Sebbagh S, Roux J, Dreyer C, Neuzillet C, de Gramont A, Orbegoso C, Hentic O, Hammel P, de Gramont A, Raymond E, André T, Chibaudel B, Faivre S. P-139 Efficacy of a Sequential Treatment Strategy with GEMOX Followed by FOLFIRI in Advanced Cholangiocarcinoma. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
Cruz Jurado J, Valverde Morales C, Vaz M, Alvarez Alvarez R, Lopez-Pousa A, Sancho Marquez P, Carrasco J, Martinez-Trufero J, Sala Gonzalez M, Arranz J, De Sande González L, Blanco Sanchez M, Orbegoso C, Pérez-Fidalgo J, Martinez García J, Lavernia J, Sevilla I, Cano J, Meana A, Martin Broto J. Solitary Fibrous Tumor (Sft): a Registry Program to Assess Frequency and Managemente in Our Country. a Spanish Group for Research on Sarcoma (Geis) Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Martinez-Trufero J, Alvarez Alvarez R, Lopez Pousa A, Sevilla I, Sancho Marquez P, Orbegoso C, Cruz Jurado J, Sala Gonzalez M, Valverde Morales C, Blanco Sanchez M, Pérez-Fidalgo J, Berros J, Martinez García J, Arranz J, Meana A, López-Martín J, Rubió J, Cano J, Juez-Martel I, Martin Broto J. Multidisciplinary Treatment Outcome of Desmoid-Type Fibromatosis (Dtf). a Registry-Based Study from Spanish Group for Research on Sarcoma (Geis). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|