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Ghaur A, Pfeiffer F, Diddens D, Peschel C, Dienwiebel I, Du L, Profanter L, Weiling M, Winter M, Placke T, Nowak S, Baghernejad M. Molecular-Cling-Effect of Fluoroethylene Carbonate Characterized via Ethoxy(pentafluoro)cyclotriphosphazene on SiOx/C Anode Materials - A New Perspective for Formerly Sub-Sufficient SEI Forming Additive Compounds. Small 2023; 19:e2302486. [PMID: 37403278 DOI: 10.1002/smll.202302486] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/20/2023] [Indexed: 07/06/2023]
Abstract
Effective electrolyte compositions are of primary importance in raising the performance of lithium-ion batteries (LIBs). Recently, fluorinated cyclic phosphazenes in combination with fluoroethylene carbonate (FEC) have been introduced as promising electrolyte additives, which can decompose to form an effective dense, uniform, and thin protective layer on the surface of electrodes. Although the basic electrochemical aspects of cyclic fluorinated phosphazenes combined with FEC were introduced, it is still unclear how these two compounds interact constructively during operation. This study investigates the complementary effect of FEC and ethoxy(pentafluoro)cyclotriphosphazene (EtPFPN) in aprotic organic electrolyte in LiNi0.5 Co0.2 Mn0.3 O ∥ SiOx /C full cells. The formation mechanism of lithium ethyl methyl carbonate (LEMC)-EtPFPN interphasial intermediate products and the reaction mechanism of lithium alkoxide with EtPFPN are proposed and supported by Density Functional Theory calculations. A novel property of FEC is also discussed here, called molecular-cling-effect (MCE). To the best knowledge, the MCE has not been reported in the literature, although FEC belongs to one of the most investigated electrolyte additives. The beneficial MCE of FEC toward the sub-sufficient solid-electrolyte interphase forming additive compound EtPFPN is investigated via gas chromatography-mass spectrometry, gas chromatography high resolution-accurate mass spectrometry, in situ shell-isolated nanoparticle-enhanced Raman spectroscopy, and scanning electron microscopy.
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Affiliation(s)
- Adjmal Ghaur
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
| | - Felix Pfeiffer
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstr. 46, 48149, Münster, Germany
| | - Diddo Diddens
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstr. 46, 48149, Münster, Germany
| | - Christoph Peschel
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
| | - Iris Dienwiebel
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
| | - Leilei Du
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
| | - Laurin Profanter
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
| | - Matthias Weiling
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstr. 46, 48149, Münster, Germany
| | - Martin Winter
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstr. 46, 48149, Münster, Germany
| | - Tobias Placke
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
| | - Sascha Nowak
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstr. 46, 48149, Münster, Germany
| | - Masoud Baghernejad
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstr. 46, 48149, Münster, Germany
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von Holtum B, Kubot M, Peschel C, Rodehorst U, Winter M, Nowak S, Wiemers-Meyer S. Accessing the Primary Solid-Electrolyte Interphase on Lithium Metal: A Method for Low-Concentration Compound Analysis. ChemSusChem 2023; 16:e202201912. [PMID: 36594440 DOI: 10.1002/cssc.202201912] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/06/2022] [Accepted: 12/28/2022] [Indexed: 05/06/2023]
Abstract
Despite large research efforts in the fields of lithium ion and lithium metal batteries, there are still unanswered questions. One of them is the formation of the solid-electrolyte interphase (SEI) in lithium-metal-anode-based battery systems. Until now, a compound profile analysis of the SEI on lithium metal was challenging as the amounts of many compounds after simple contact of lithium metal and the electrolyte were too low for detection with analytical methods. This study presents a novel approach on unravelling the SEI compound profile through accumulation in the gas, liquid electrolyte, and solid phase. The method uses the intrinsic behavior of lithium metal to spontaneously react with the liquid electrolyte. In combination with complementary, state-of-the-art analytical instrumentation and methods, this approach provides qualitative and quantitative results on all three phases revealing the vast variety of compounds formed in carbonate-based electrolytes.
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Affiliation(s)
- Bastian von Holtum
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Maximilian Kubot
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Christoph Peschel
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Uta Rodehorst
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Martin Winter
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstr. 46, 48149, Münster, Germany
| | - Sascha Nowak
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Simon Wiemers-Meyer
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
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von Holtum B, Kubot M, Peschel C, Rodehorst U, Winter M, Nowak S, Wiemers-Meyer S. Accessing the Primary Solid-Electrolyte Interphase on Lithium Metal: A Method for Low-Concentration Compound Analysis. ChemSusChem 2023; 16:e202300451. [PMID: 37104827 DOI: 10.1002/cssc.202300451] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Invited for this month's cover is the group of Martin Winter at the University of Münster. The image shows idea of the developed sample treatment method enabling the accumulation of solid electrolyte interphase originating compounds. The Research Article itself is available at 10.1002/cssc.202201912.
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Affiliation(s)
- Bastian von Holtum
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Maximilian Kubot
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Christoph Peschel
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Uta Rodehorst
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Martin Winter
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstr. 46, 48149, Münster, Germany
| | - Sascha Nowak
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
| | - Simon Wiemers-Meyer
- MEET Battery Research Center, University of Münster, Corrensstr. 46, 48149, Münster, Germany
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Haneke L, Pfeiffer F, Bärmann P, Wrogemann J, Peschel C, Neumann J, Kux F, Nowak S, Winter M, Placke T. Insights into Electrolytic Pre-Lithiation: A Thorough Analysis Using Silicon Thin Film Anodes. Small 2023; 19:e2206092. [PMID: 36504320 DOI: 10.1002/smll.202206092] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Pre-lithiation via electrolysis, herein defined as electrolytic pre-lithiation, using cost-efficient electrolytes based on lithium chloride (LiCl), is successfully demonstrated as a proof-of-concept for enabling lithium-ion battery full-cells with high silicon content negative electrodes. An electrolyte for pre-lithiation based on γ-butyrolactone and LiCl is optimized using boron-containing additives (lithium bis(oxalato)borate, lithium difluoro(oxalate)borate) and CO2 with respect to the formation of a protective solid electrolyte interphase (SEI) on silicon thin films as model electrodes. Reversible lithiation in Si||Li metal cells is demonstrated with Coulombic efficiencies (CEff ) of 95-96% for optimized electrolytes comparable to 1 m LiPF6 /EC:EMC 3:7. Formation of an effective SEI is shown by cyclic voltammetry and X-ray photoelectron spectroscopy (XPS). electrolytic pre-lithiation experiments show that notable amounts of the gaseous product Cl2 dissolve in the electrolyte leading to a self-discharge Cl2 /Cl- shuttle mechanism between the electrodes lowering pre-lithiation efficiency and causing current collector corrosion. However, no significant degradation of the Si active material and the SEI due to contact with elemental chlorine is found by SEM, impedance, and XPS. In NCM111||Si full-cells, the capacity retention in the 100th cycle can be significantly increased from 54% to 78% by electrolytic pre-lithiation, compared to reference cells without pre-lithiation of Si.
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Affiliation(s)
- Lukas Haneke
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
| | - Felix Pfeiffer
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstraße 46, 48149, Münster, Germany
| | - Peer Bärmann
- Helmholtz-Zentrum Berlin für Materialien und Energie GmbH (HZB), Albert-Einstein-Straße 15, 12489, Berlin, Germany
| | - Jens Wrogemann
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
| | - Christoph Peschel
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
| | - Jonas Neumann
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
| | - Fabian Kux
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
| | - Sascha Nowak
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
| | - Martin Winter
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
- Helmholtz Institute Münster, IEK-12, Forschungszentrum Jülich GmbH, Corrensstraße 46, 48149, Münster, Germany
| | - Tobias Placke
- University of Münster, MEET Battery Research Center, Institute of Physical Chemistry, Corrensstraße 46, 48149, Münster, Germany
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Nestler S, Peschel C, Horstmann AH, Vahlensieck W, Fabry W, Neisius A. Prospective multicentre randomized double-blind placebo-controlled parallel group study on the efficacy and tolerability of StroVac® in patients with recurrent symptomatic uncomplicated bacterial urinary tract infections. Int Urol Nephrol 2023; 55:9-16. [PMID: 36181584 PMCID: PMC9870822 DOI: 10.1007/s11255-022-03379-y] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/24/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate efficacy and safety of vaccination with StroVac compared to placebo in patients with recurrent urinary tract infections (rUTI). MATERIAL AND METHODS We performed a prospective, double-blinded, placebo-controlled study in patients with uncomplicated rUTI. Patients received three single intramuscular injections with StroVac every two weeks. Primary endpoint was the number of bacterial urinary tract infections (UTI) over 13.5 months after randomization and adjusted by the respective "baseline" value when comparing verum and placebo group. Secondary endpoints were the number of patients with non-recurrence, time to first recurrence, frequency of recurrences, and patients' self-assessment of quality of life using a validated questionnaire. RESULTS 376 patients were randomized to both groups between January 2012 and March 2015. Mean age was 44.4 years. Patients were mainly female (98.4%). In the StroVac group (n = 188), the number of UTIs was reduced from 5.5 to 1.2, in the placebo group (n = 188) from 5.4 to 1.3 (p = 0.63). In patients with ≥ 7 UTIs prior to study inclusion, StroVac was statistically significantly superior to placebo (p = 0.048). However, in all other secondary endpoints, no statistical differences between the two groups could be seen (all p > 0.3). CONCLUSION StroVac reduced the number of clinically relevant UTIs like in former studies but did not show statistically significant better results than the chosen placebo. Most likely, that was due to a, since confirmed, prophylactic effect of the chosen placebo itself. Therefore, placebo-controlled and double-blinded studies using a different ineffective placebo preparation are needed to determine the importance of StroVac in prophylaxis of rUTI.
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Affiliation(s)
- S Nestler
- Urogate, Urological Practice, Bad Vilbel, Germany.
| | - C Peschel
- Strathmann GmbH & Co. KG, Hamburg, Germany
| | | | - W Vahlensieck
- Department of Urology, Kurpark Klinik, Bad Nauheim, Germany
| | - W Fabry
- TFP Laboratory Düsseldorf, Düsseldorf, Germany
| | - A Neisius
- Department of Urology, Brüderkrankenhaus Trier, University of Mainz, Mainz, Germany
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Peschel C, van Wickeren S, Preibisch Y, Naber V, Werner D, Frankenstein L, Horsthemke F, Peuker U, Winter M, Nowak S. Comprehensive Characterization of Shredded Lithium-Ion Battery Recycling Material. Chemistry 2022; 28:e202200485. [PMID: 35188309 PMCID: PMC9311206 DOI: 10.1002/chem.202200485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Indexed: 01/06/2023]
Abstract
Herein we report on an analytical study of dry‐shredded lithium‐ion battery (LIB) materials with unknown composition. Samples from an industrial recycling process were analyzed concerning the elemental composition and (organic) compound speciation. Deep understanding of the base material for LIB recycling was obtained by identification and analysis of transition metal stoichiometry, current collector metals, base electrolyte and electrolyte additive residues, aging marker molecules and polymer binder fingerprints. For reversed engineering purposes, the main electrode and electrolyte chemistries were traced back to pristine materials. Furthermore, possible lifetime application and accompanied aging was evaluated based on target analysis on characteristic molecules described in literature. With this, the reported analytics provided precious information for value estimation of the undefined spent batteries and enabled tailored recycling process deliberations. The comprehensive feedstock characterization shown in this work paves the way for targeted process control in LIB recycling processes.
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Affiliation(s)
- Christoph Peschel
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany
| | - Stefan van Wickeren
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany
| | - Yves Preibisch
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany
| | - Verena Naber
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany
| | - Denis Werner
- TU Bergakademie Freiberg, Institute of Mechanical Process Engineering and Mineral Processing, Agricolastraße 1, 09599, Freiberg, Germany
| | - Lars Frankenstein
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany
| | - Fabian Horsthemke
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany
| | - Urs Peuker
- TU Bergakademie Freiberg, Institute of Mechanical Process Engineering and Mineral Processing, Agricolastraße 1, 09599, Freiberg, Germany
| | - Martin Winter
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany.,Helmholtz-Institute Münster, IEK-12, Forschungszentrum Jülich, Corrensstraße 46, 48149, Münster, Germany
| | - Sascha Nowak
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149, Münster, Germany
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Peschel C, Horsthemke F, Winter M, Nowak S. Implementation of orbitrap mass spectrometry for improved GC-MS target analysis in lithium ion battery electrolytes. MethodsX 2022; 9:101621. [PMID: 35111574 PMCID: PMC8790629 DOI: 10.1016/j.mex.2022.101621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
The implementation of orbitrap mass spectrometry for target analysis of volatile species in aged lithium-ion batteries was performed in a case study on butyl carbonates. In comparison to previously applied single quadrupole-based methods, major improvements were obtained.Sensitivity was improved by effectively background free extracted ion chromatograms of identified marker fragment ions. Typical isobaric interferences of typical carbonate fragment ions e.g. caused by column bleeding were identified and false positive identification avoided. Analysis of isotope labeled electrolytes was optimized regarding mass spectrometric data reliability with mass accuracies <0.5 ppm and mass resolutions >100,000.
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Affiliation(s)
- Christoph Peschel
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149 Münster, Germany
| | - Fabian Horsthemke
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149 Münster, Germany
| | - Martin Winter
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149 Münster, Germany
- Helmholtz-Institute Münster, IEK-12, Forschungszentrum Jülich, Corrensstraße 46, 48149 Münster, Germany
| | - Sascha Nowak
- University of Münster, MEET Battery Research Center, Corrensstraße 46, 48149 Münster, Germany
- Corresponding author.
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8
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Henschel J, Peschel C, Klein S, Horsthemke F, Winter M, Nowak S. Clarification of Decomposition Pathways in a State-of-the-Art Lithium Ion Battery Electrolyte through 13 C-Labeling of Electrolyte Components. Angew Chem Int Ed Engl 2020; 59:6128-6137. [PMID: 32012404 PMCID: PMC7187180 DOI: 10.1002/anie.202000727] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 11/09/2022]
Abstract
The decomposition of state-of-the-art lithium ion battery (LIB) electrolytes leads to a highly complex mixture during battery cell operation. Furthermore, thermal strain by e.g., fast charging can initiate the degradation and generate various compounds. The correlation of electrolyte decomposition products and LIB performance fading over life-time is mainly unknown. The thermal and electrochemical degradation in electrolytes comprising 1 m LiPF6 dissolved in 13 C3 -labeled ethylene carbonate (EC) and unlabeled diethyl carbonate is investigated and the corresponding reaction pathways are postulated. Furthermore, a fragmentation mechanism assumption for oligomeric compounds is depicted. Soluble decomposition products classes are examined and evaluated with liquid chromatography-high resolution mass spectrometry. This study proposes a formation scheme for oligo phosphates as well as contradictory findings regarding phosphate-carbonates, disproving monoglycolate methyl/ethyl carbonate as the central reactive species.
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Affiliation(s)
- Jonas Henschel
- University of MünsterMEET Battery Research CenterCorrensstraße 4648149MünsterGermany
| | - Christoph Peschel
- University of MünsterMEET Battery Research CenterCorrensstraße 4648149MünsterGermany
| | - Sven Klein
- University of MünsterMEET Battery Research CenterCorrensstraße 4648149MünsterGermany
| | - Fabian Horsthemke
- University of MünsterMEET Battery Research CenterCorrensstraße 4648149MünsterGermany
| | - Martin Winter
- University of MünsterMEET Battery Research CenterCorrensstraße 4648149MünsterGermany
- Helmholtz-Institute Münster, IEK-12Forschungszentrum JülichCorrensstraße 4648149MünsterGermany
| | - Sascha Nowak
- University of MünsterMEET Battery Research CenterCorrensstraße 4648149MünsterGermany
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Henschel J, Peschel C, Klein S, Horsthemke F, Winter M, Nowak S. Clarification of Decomposition Pathways in a State‐of‐the‐Art Lithium Ion Battery Electrolyte through
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C‐Labeling of Electrolyte Components. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202000727] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jonas Henschel
- University of MünsterMEET Battery Research Center Corrensstraße 46 48149 Münster Germany
| | - Christoph Peschel
- University of MünsterMEET Battery Research Center Corrensstraße 46 48149 Münster Germany
| | - Sven Klein
- University of MünsterMEET Battery Research Center Corrensstraße 46 48149 Münster Germany
| | - Fabian Horsthemke
- University of MünsterMEET Battery Research Center Corrensstraße 46 48149 Münster Germany
| | - Martin Winter
- University of MünsterMEET Battery Research Center Corrensstraße 46 48149 Münster Germany
- Helmholtz-Institute Münster, IEK-12Forschungszentrum Jülich Corrensstraße 46 48149 Münster Germany
| | - Sascha Nowak
- University of MünsterMEET Battery Research Center Corrensstraße 46 48149 Münster Germany
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Kessel K, Kessel C, Vogel M, Bier H, Biedermann T, Friess H, Herschbach P, Von Eisenhart-Rothe R, Meyer B, Kiechle M, Keller U, Peschel C, Schmid R, Schwaiger M, Combs S. OC-0094: Cancer Clinical Trials - survey evaluating patient participation and attitude in an Oncology Center. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Knoll A, Mewes HW, Schwaiger M, Bode A, Broy M, Daniel H, Feussner H, Gradinger R, Hauner H, Höfler H, Holzmann B, Horsch A, Kemper A, Krcmar H, Kochs EF, Lange R, Leidl R, Mansmann U, Mayr EW, Meitinger T, Molls M, Navab N, Nüsslin F, Peschel C, Reiser M, Ring J, Rummeny EJ, Schlichter J, Schmid R, Wichmann HE, Ziegler S, Kuhn KA. Informatics and Medicine. Methods Inf Med 2018. [DOI: 10.3414/me9117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: To clarify challenges and research topics for informatics in health and to describe new approaches for interdisciplinary collaboration and education. Methods: Research challenges and possible solutions were elaborated by scientists of two universities using an interdisciplinary approach, in a series of meetings over several months. Results and Conclusion: In order to translate scientific results from bench to bedside and further into an evidence-based and efficient health system, intensive collaboration is needed between experts from medicine, biology, informatics, engineering, public health, as well as social and economic sciences. Research challenges can be attributed to four areas: bioinformatics and systems biology, biomedical engineering and informatics, health informatics and individual healthcare, and public health informatics. In order to bridge existing gaps between different disciplines and cultures, we suggest focusing on interdisciplinary education, taking an integrative approach and starting interdisciplinary practice at early stages of education.* See more detailed authors´ affiliations at the end of the article.
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Jilg S, Reidel V, Kauschinger J, Müller-Thomas C, Hauch R, Schauwecker J, Burkhard S, Höckendorf U, Peschel C, Kern W, Haferlach T, Slotta-Huspenina J, Götze K, Jost P. BCL-2 Inhibition by ABT-199 Potently Induces Cell Death in MDS Progenitors Despite High-Risk Mutations in ASXL1, RUNX1, TP53 or EZH2. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Müller-Thomas C, Tüchler H, Hecker J, Wenk C, Peschel C, Götze K. Vitamin D is Associated with Severity of Disease as Expressed by Subdiagnosis and IPSS-R in Patients with Myelodysplastic Syndromes. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zeiser R, Burchert A, Lengerke C, Verbeek M, Maas-Bauer K, Metzelder SK, Spoerl S, Ditschkowski M, Ecsedi M, Sockel K, Ayuk F, Ajib S, de Fontbrune FS, Na IK, Penter L, Holtick U, Wolf D, Schuler E, Meyer E, Apostolova P, Bertz H, Marks R, Lübbert M, Wäsch R, Scheid C, Stölzel F, Ordemann R, Bug G, Kobbe G, Negrin R, Brune M, Spyridonidis A, Schmitt-Gräff A, van der Velden W, Huls G, Mielke S, Grigoleit GU, Kuball J, Flynn R, Ihorst G, Du J, Blazar BR, Arnold R, Kröger N, Passweg J, Halter J, Socié G, Beelen D, Peschel C, Neubauer A, Finke J, Duyster J, von Bubnoff N. Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia 2015; 29:2062-8. [PMID: 26228813 DOI: 10.1038/leu.2015.212] [Citation(s) in RCA: 384] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 12/15/2022]
Abstract
Despite major improvements in allogeneic hematopoietic cell transplantation over the past decades, corticosteroid-refractory (SR) acute (a) and chronic (c) graft-versus-host disease (GVHD) cause high mortality. Preclinical evidence indicates the potent anti-inflammatory properties of the JAK1/2 inhibitor ruxolitinib. In this retrospective survey, 19 stem cell transplant centers in Europe and the United States reported outcome data from 95 patients who had received ruxolitinib as salvage therapy for SR-GVHD. Patients were classified as having SR-aGVHD (n=54, all grades III or IV) or SR-cGVHD (n=41, all moderate or severe). The median number of previous GVHD-therapies was 3 for both SR-aGVHD (1-7) and SR-cGVHD (1-10). The overall response rate was 81.5% (44/54) in SR-aGVHD including 25 complete responses (46.3%), while for SR-cGVHD the ORR was 85.4% (35/41). Of those patients responding to ruxolitinib, the rate of GVHD-relapse was 6.8% (3/44) and 5.7% (2/35) for SR-aGVHD and SR-cGVHD, respectively. The 6-month-survival was 79% (67.3-90.7%, 95% confidence interval (CI)) and 97.4% (92.3-100%, 95% CI) for SR-aGVHD and SR-cGVHD, respectively. Cytopenia and cytomegalovirus-reactivation were observed during ruxolitinib treatment in both SR-aGVHD (30/54, 55.6% and 18/54, 33.3%) and SR-cGVHD (7/41, 17.1% and 6/41, 14.6%) patients. Ruxolitinib may constitute a promising new treatment option for SR-aGVHD and SR-cGVHD that should be validated in a prospective trial.
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Affiliation(s)
- R Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - A Burchert
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - C Lengerke
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - M Verbeek
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - K Maas-Bauer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - S K Metzelder
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - S Spoerl
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - M Ditschkowski
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Ecsedi
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - K Sockel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - F Ayuk
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Ajib
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - F S de Fontbrune
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - I-K Na
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - L Penter
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - U Holtick
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - D Wolf
- Medical Clinic III, Oncology, Hematology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - E Schuler
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - E Meyer
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - P Apostolova
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - H Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Marks
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - M Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - C Scheid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - F Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - R Ordemann
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - G Bug
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - G Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - R Negrin
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - M Brune
- Department of Internal Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - A Spyridonidis
- Department of Bone Marrow Transplantation, Patras University Medical School, Patras, Greece
| | - A Schmitt-Gräff
- Department of Pathology, Freiburg University Medical Center, Freiburg, Germany
| | | | - G Huls
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Mielke
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - G U Grigoleit
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Flynn
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - G Ihorst
- Clinical Trials Unit, Department of Hematology, Freiburg University Medical Center, Freiburg, Germany
| | - J Du
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - B R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - R Arnold
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - J Passweg
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - J Halter
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - G Socié
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - D Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - C Peschel
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - A Neubauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - J Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - J Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - N von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
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Huberle C, Wenk C, Witham D, Garz A, Pagel C, Müller-Thomas C, Kaur-Bollinger P, Oostendorp R, Peschel C, Goetze K. 34 AZACITIDINE DIRECTLY MODULATES FUNCTION OF MESENCHYMAL STROMAL CELLS TO ALTER BONE MARROW NICHE COMPOSTION AND SUPPRESS MALIGNANT HEMATOPOEITIC PROGENITORS IN MDS. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30035-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tomiatti V, Istvánffy R, Pietschmann E, Kratzat S, Hoellein A, Quintanilla-Fend L, von Bubnoff N, Peschel C, Oostendorp RAJ, Keller U. Cks1 is a critical regulator of hematopoietic stem cell quiescence and cycling, operating upstream of Cdk inhibitors. Oncogene 2014; 34:4347-57. [DOI: 10.1038/onc.2014.364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/06/2014] [Accepted: 09/02/2014] [Indexed: 01/14/2023]
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Richard K, Schober S, Rami M, Mall S, Merl J, Slotta-Huspenina J, Stevanovic S, Busch DH, Peschel C, Krackhardt AM. P69. Targeting naturally presented, leukemia-derived HLA ligands with TCR-transgenic T cells for the treatment of therapy refractory leukemias. J Immunother Cancer 2014. [PMCID: PMC4071991 DOI: 10.1186/2051-1426-2-s2-p43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Jilg S, König J, Höckendorf U, Schauwecker J, Huberle C, Müller-Thomas C, Schmidt B, Burgkart R, Götze K, Kolb H, Peschel C, Jost P. P-016 Resistance to apoptosis in high-risk myelodysplastic syndrome can be overcome by pro-apoptotic drug treatment using ABT-737. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Sigl M, Spoerl S, Schnittger S, Meissner J, Rummelt C, Peschel C, Duyster J, Ho AD, von Bubnoff N. Imatinib failure and response to dasatinib in a patient with chronic myeloid leukemia in blast crisis and a novel, nine-nucleotide BCR-ABL insertion mutation. Blood Cancer J 2013; 3:e104. [PMID: 23474746 PMCID: PMC3615216 DOI: 10.1038/bcj.2013.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- M Sigl
- III Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
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20
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Albers C, Leischner H, Verbeek M, Yu C, Illert AL, Peschel C, von Bubnoff N, Duyster J. The secondary FLT3-ITD F691L mutation induces resistance to AC220 in FLT3-ITD+ AML but retains in vitro sensitivity to PKC412 and Sunitinib. Leukemia 2013; 27:1416-8. [PMID: 23392356 DOI: 10.1038/leu.2013.14] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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21
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Brackertz B, Conrad H, Daniel J, Kast B, Krönig H, Busch DH, Adamski J, Peschel C, Bernhard H. FLT3-regulated antigens as targets for leukemia-reactive cytotoxic T lymphocytes. Blood Cancer J 2011; 1:e11. [PMID: 22829124 PMCID: PMC3255276 DOI: 10.1038/bcj.2011.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 01/27/2011] [Accepted: 02/11/2011] [Indexed: 12/16/2022] Open
Abstract
The FMS-like tyrosine kinase 3 (FLT3) is highly expressed in acute myeloid leukemia (AML). Internal tandem duplications (ITD) of the juxtamembrane domain lead to the constitutive activation of the FLT3 kinase inducing the activation of multiple genes, which may result in the expression of leukemia-associated antigens (LAAs). We analyzed the regulation of LAA in FLT3-wild-type (WT)- and FLT3-ITD+ myeloid cells to identify potential targets for antigen-specific immunotherapy for AML patients. Antigens, such as PR-3, RHAMM, Survivin, WT-1 and PRAME, were upregulated by constitutively active FLT3-ITD as well as FLT3-WT activated by FLT3 ligand (FL). Cytotoxic T-cell (CTL) clones against PR-3, RHAMM, Survivin and an AML-directed CTL clone recognized AML cell lines and primary AML blasts expressing FLT3-ITD, as well as FLT3-WT+ myeloid dendritic cells in the presence of FL. Downregulation of FLT3 led to the abolishment of CTL recognition. Comparing our findings concerning LAA upregulation by the FLT3 kinase with those already made for the Bcr-Abl kinase, we found analogies in the LAA expression pattern. Antigens upregulated by both FLT3 and Bcr-Abl may be promising targets for the development of immunotherapeutical approaches against myeloid leukemia of different origin.
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Paessens BJ, von Schilling C, Berger K, Shlaen M, Müller-Thomas C, Bernard R, Peschel C, Ihbe-Heffinger A. Health resource consumption and costs attributable to chemotherapy-induced toxicity in German routine hospital care in lymphoproliferative disorder and NSCLC patients. Ann Oncol 2011; 22:2310-9. [PMID: 21343378 DOI: 10.1093/annonc/mdq759] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multidrug chemotherapy (CT) is still associated with relevant side-effects. We assessed, under current practice patterns, frequency and severity of CT-induced toxicity and its economic consequences. PATIENTS AND METHODS Prospective, multicentre, longitudinal, observational cohort study with lymphoproliferative disorder (LPD) and non-small-cell lung cancer (NSCLC) patients, receiving first- or second-line (immuno-) CT (excluding myeloablative CT). Data were collected from patient interviews and preplanned chart reviews. Costs in 2007 euros are presented from the provider perspective. RESULTS Two hundred and seventy-three patients (n = 153 LPD; n = 120 NSCLC) undergoing a total of 1004 CT cycles were assessable (age ≥65 years, 40%; female, 36%; Eastern Cooperative Oncology Group performance status ≥2, 11%; tumour stage ≥III, 56%; history of comorbidity, 80%). Fifty percent of cycles were associated with grade 3/4 toxicity and 37% (n = 371) with at least one hospital stay (outpatient/day care n = 154; intensive care n = 19). Mean (median) toxicity-related costs amounted to €1032 (€86) per cycle. Costs rose exponentially with the number of grade 3/4 adverse drug reactions (ADRs) and were highest in cycles affected by more than four ADRs, €10 881 (€5455); in cycles with intensive care, €14 121 (€8833); and in cycles affected by grade 3/4 infections and febrile neutropenia/leukopenia, €7093 (€4531) and €5170 (€2899), respectively. Five percent of CT cycles accounted for 56% of total expenses. CONCLUSIONS Individualised supportive care strategies are needed. Future research should focus on identifying toxicity clusters and patient characteristics predictive for high costs.
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Affiliation(s)
- B J Paessens
- Department of Hospital Pharmacy, Technische Universität München, Munich, Germany
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23
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Lordick F, Meyer Zum Bueschenfelde C, Herrmann K, Geinitz H, Schuster T, Friess H, Molls M, Schwaiger M, Peschel C, Krause B. PET-guided treatment in locally advanced adenocarcinoma of the esophagogastric junction (AEG): The MUNICON-II study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
3 Background: Previous studies demonstrated that fluorodeoxyglucose (FDG)-PET can help to detect response early during neoadjuvant chemotherapy. The prognosis of metabolic non-responders is poor. Therefore, we initiated the prospective MUNICON-II study to determine the value of salvage neoadjuvant chemoradiation in early PET nonresponders. Methods: 56 patients (pts) with locally advanced AEG type I and II (cT3/4 Nx M0) were included. Tumor glucose uptake was assessed by FDG-PET before and 14 days after initiation of chemotherapy. PET nonresponse was defined as a decrease of the tumor FDG standard uptake value < 35%. Nonresponders received salvage preoperative chemoradiation consisting of external beam radiation 32 Gy (1.6 Gy/fr x 2/day) plus daily cisplatin 6mg/m2 and then proceeded to surgery. Metabolic responders continued with chemotherapy (platin/5-FU-based) for 3 months. Results: 33 pts had a PET response, 23 had a PET nonresponse. Resection was performed on 54 pts. R0 was achieved in 27 (82%) PET responders versus 16 (70%) nonresponders (p = 0.51). Major histologic remissions (< 10% residual tumor) were observed in 12 PET responders (36%) and 6 PET non responders (26%). After a median follow-up time of 38.0 mon, the median event-free survival (EFS) and the median overall survival (OS) were not yet reached in the PET responders, while EFS was 15.4 mon and OS was 18.3 mon in nonresponders. Conclusions: This study confirms the prognostic value of early metabolic response evaluation during neoadjuvant chemotherapy. Histopathologic responses were observed after salvage chemoradiation, but the clinical outcome of early PET non-responders to chemotherapy remains poor, indicating a dismal tumor biology in this group of pts. No significant financial relationships to disclose.
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Affiliation(s)
- F. Lordick
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - C. Meyer Zum Bueschenfelde
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - K. Herrmann
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - H. Geinitz
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - T. Schuster
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - H. Friess
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - M. Molls
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - M. Schwaiger
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - C. Peschel
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - B. Krause
- Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Institute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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24
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von Bubnoff N, Gorantla SP, Engh RA, Oliveira TM, Thöne S, Aberg E, Peschel C, Duyster J. The low frequency of clinical resistance to PDGFR inhibitors in myeloid neoplasms with abnormalities of PDGFRA might be related to the limited repertoire of possible PDGFRA kinase domain mutations in vitro. Oncogene 2010; 30:933-43. [PMID: 20972453 DOI: 10.1038/onc.2010.476] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Myeloproliferation with prominent eosinophilia is associated with rearrangements of PDGFR-A or -B. The most common rearrangement is FIP1L1-PDGFRA (FP). The majority of patients with PDGFR-rearranged myeloproliferation respond to treatment with imatinib. In contrast to BCR-ABL-positive chronic myelogenous leukemia, only few cases of imatinib resistance and mutations of the FP kinase domain have been described so far. We hypothesized that the number of critical residues mediating imatinib resistance in FP in contrast to BCR-ABL might be limited. We performed an established systematic and comprehensive in vitro resistance screen to determine the pattern and frequency of possible TKI resistance mutations in FP. We identified 27 different FP kinase domain mutations including 25 novel variants, which attenuated response to imatinib, nilotinib or sorafenib. However, the majority of these exchanges did not confer complete inhibitor resistance. At clinically achievable drug concentrations, FP/T674I predominated with imatinib, whereas with nilotinib and sorafenib, FP/D842V and the compound mutation T674I+T874I became prevalent. Our results suggest that the PDGFR kinase domain contains a limited number of residues where exchanges critically interfere with binding of and inhibition by available PDGFR kinase inhibitors at achievable concentrations, which might explain the low frequency of imatinib resistance in this patient population. In addition, these findings would help to select the appropriate second-line drug in cases of imatinib-resistant disease and may be translated to other neoplasms driven by activated forms of PDGFR-A or -B.
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Affiliation(s)
- N von Bubnoff
- III. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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25
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von Bubnoff N, Rummelt C, Menzel H, Sigl M, Peschel C, Duyster J. Identification of a secondary FLT3/A848P mutation in a patient with FLT3-ITD-positive blast phase CMML and response to sunitinib and sorafenib. Leukemia 2010; 24:1523-5. [DOI: 10.1038/leu.2010.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Myelodysplastic syndromes (MDS) are a group of common bone marrow disorders characterized by ineffective hematopoiesis, peripheral cytopenias, and a propensity for transformation to acute myeloid leukemia (AML). For many years, the main treatment option for MDS was best supportive care which alleviates symptoms but has no effect on the natural course of the disease. The recent approval of the demethylating agent azacitidine represents a significant advance in the treatment of MDS. The results of two randomized trials with azacitidine have shown an overall response rate between 40% and 60%, an improved quality of life, a reduced risk of transformation to AML and a definite survival advantage compared to best supportive care or low-dose chemotherapy. Current data on azacitidine and its place in the treatment of MDS are reviewed.
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Affiliation(s)
- KS Götze
- Department of Medicine, Hematology/Oncology, Technische Universität München, Munich, Germany
| | - C Müller-Thomas
- Department of Medicine, Hematology/Oncology, Technische Universität München, Munich, Germany
| | - C Peschel
- Department of Medicine, Hematology/Oncology, Technische Universität München, Munich, Germany
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27
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Lorenzen S, Schuster T, Porschen R, Al-Batran SE, Hofheinz R, Thuss-Patience P, Moehler M, Grabowski P, Arnold D, Greten T, Müller L, Röthling N, Peschel C, Langer R, Lordick F. Cetuximab plus cisplatin-5-fluorouracil versus cisplatin-5-fluorouracil alone in first-line metastatic squamous cell carcinoma of the esophagus: a randomized phase II study of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol 2009; 20:1667-73. [PMID: 19549707 DOI: 10.1093/annonc/mdp069] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study assessed the activity of the mAb cetuximab in combination with cisplatin and 5-fluorouracil (5-FU) in advanced esophageal squamous cell carcinoma. PATIENTS AND METHODS For a maximum of six 29-day cycles, patients received cisplatin 100 mg/m(2), day 1, plus 5-FU 1000 mg/m(2), days 1-5 (CF), either alone or in combination with cetuximab (CET-CF; 400 mg/m(2) initial dose followed by 250 mg/m(2) weekly thereafter). The primary end point was tumor response. Tumor material was obtained for analysis of KRAS mutation status. RESULTS Sixty-two eligible patients were included, 32 receiving CET-CF and 30 CF. Cetuximab did not exacerbate grade 3/4 toxicity, except for rash (6% versus 0%) and diarrhea (16% versus 0%). The overall response rate according to RECIST criteria was 19% and 13% and the disease control rate 75% and 57% for the CET-CF and CF arms, respectively. With a median follow-up of 21.5 months, the median progression-free survival was 5.9 and 3.6 months and median overall survival 9.5 and 5.5 months for CET-CF and CF, respectively. No KRAS codon 12/13 tumor mutations were identified in 37 evaluated samples. CONCLUSION Cetuximab can be safely combined with CF chemotherapy and may increase the efficacy of standard CF chemotherapy.
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Affiliation(s)
- S Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Technical University of Munich, Munich.
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Lordick F, Meyer zum Büschenfelde C, Thuss-Patience P, Röthling N, Geinitz H, Budach V, Schumacher G, Friess H, Siewert JR, Peschel C. Weekly cetuximab (CET) plus oxaliplatin (OX), infusional 5-fluorouracil (5-FU) and radiation therapy (RT) as neoadjuvant treatment for esophageal squamous cell carcinoma (ESCC): A phase I study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15507] [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
e15507 Background: CET, a chimeric monoclonal IgG1 antibody that targets the epidermal growth factor receptor (EGFR), has proven activity in a variety of SCC models in vitro and in vivo and has also been shown to enhance the activity of both chemo- and radiotherapy. Methods: Patients (pts) with locally advanced ESCC received CET for 2 weeks at an initial dose of 400mg/m2 (d - 15) i.v. followed by 250mg/m2(d -8) before they started a neoadjuvant dose escalation regimen. Pts received weekly CET 250mg/m2 plus RT 25 x 1.8 Gy (cumulative dose 45 Gy) d1–33. Cohort 1–3 received escalating doses of OX 45–50 mg/m2 d1,8,22,29 plus 5-FU 180–200–225 mg/m2/d; d1–5,8–12,15–19,22–26,29–33). Surgery was scheduled 4–6 weeks after RT. Toxicity was assessed according to NCI-CTC. Response was categorized according to the histopathologic score. Results: 15 pts were enrolled (2 female, 13 male; mean age 62 years, ECOG-PS 0 or 1). All pts had locally advanced SCC (uT2–4, cNx, cM0–1a) of the cervical (n=1), the upper (n=5) or the distal (n=7) esophagus. 6 pts were treated in cohort 1 and 3 pts in cohort 2 without any dose limiting toxicity (DLT). Of 6 pts treated in cohort 3, 1 pt developed grade 3 diarrhea and mucositis. All other observed toxicities were mild or moderate: anemia n=12, neutropenia n=2, thrombocytopenia n=3, nausea/vomiting n=8, mucositis n=6, diarrhea n=4, neuropathy n=4, hand-foot-syndrome n=8, skin rash n=14, no infection and no infusion-related reactions were observed. 12 pts underwent abdomino-thoracic esophagectomy with no postop. mortality; 3 pts were not resected. 8/12 resected pts had an R0 resection (67%) and 4 pts (33%) achieved a histopathological complete response (score 1a). Conclusions: 2 weeks of CET (400mg/m2 and 250mg/m2) followed by weekly CET (250mg/m2) plus OX 50mg/m2 d1,8,22,29, 5-FU 225 mg/m2/d d1–5,8–12,15–19,22–26,29–33 and RT 45 Gy (1.8Gy/f) was shown to be safe as neoadjuvant treatment for locally advanced ESCC. The anti-tumor activity of this regimen is promising and is being further investigated in an ongoing phase II study. [Table: see text]
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Affiliation(s)
- F. Lordick
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - C. Meyer zum Büschenfelde
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - P. Thuss-Patience
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - N. Röthling
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - H. Geinitz
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - V. Budach
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - G. Schumacher
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - H. Friess
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - J. R. Siewert
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - C. Peschel
- National Center for Tumor Diseases, Heidelberg, Germany; Klinikum rechts der Isar, Munich, Germany; Charité Campus Virchow, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
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Lorenzen S, Brücher B, Zimmermann F, Geinitz H, Riera J, Schuster T, Roethling N, Höfler H, Ott K, Peschel C, Siewert JR, Molls M, Lordick F. Neoadjuvant continuous infusion of weekly 5-fluorouracil and escalating doses of oxaliplatin plus concurrent radiation in locally advanced oesophageal squamous cell carcinoma: results of a phase I/II trial. Br J Cancer 2008; 99:1020-6. [PMID: 18797462 PMCID: PMC2567089 DOI: 10.1038/sj.bjc.6604659] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Oxaliplatin and 5-fluorouracil have a significant activity in locally advanced oesophageal squamous cell cancer (OSCC). However, their optimal dosage and efficacy when combined with concurrent radiotherapy as neoadjuvant treatment are unknown. This non-randomised, phase I/II study aimed to define the maximum tolerated dose (MTD) and assessed the histopathological tumour response rate to neoadjuvant oxaliplatin in weekly escalating doses (40, 45, 50 mg m−2) and continuous infusional 5-fluorouracil (CI-5FU; 225 mg m−2) plus concurrent radiotherapy. Patients had resectable OSCC. Resection was scheduled for 4–6 weeks after chemoradiotherapy. During phase I (dose escalation; n=19), weekly oxaliplatin 45 mg m−2 plus CI-5FU 225 mg m−2 was established as the MTD and was the recommended dosage for phase II. Oesophageal mucositis was the dose-limiting toxicity at higher doses. During phase II, histopathological responses (<10% residual tumour cells within the specimen) were observed in 10 of 16 patients (63%; 95% confidence interval: 39–82%). Overall, 16 of the 25 patients (64%) who underwent resection had a histopathological response; tumour-free resection (R0) was achieved in 80%. Neoadjuvant weekly oxaliplatin 45 mg m−2 plus CI-5FU 225 mg m−2 with concurrent radiotherapy provides promising histological response rates and R0 resection rates in locally advanced OSCC.
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Affiliation(s)
- S Lorenzen
- Third Department of Internal Medicine (Haematology/Medical Oncology), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Dank M, Zaluski J, Barone C, Valvere V, Yalcin S, Peschel C, Wenczl M, Goker E, Cisar L, Wang K, Bugat R. Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol 2008; 19:1450-1457. [PMID: 18558665 DOI: 10.1093/annonc/mdn166] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aimed to establish the superiority (or noninferiority if superiority was not achieved) in terms of time to progression (TTP) of irinotecan/5-fluorouracil (IF) over cisplatin/5-fluorouracil (CF) in chemonaive patients with adenocarcinoma of the stomach/esophagogastric junction. PATIENTS AND METHODS Patients received either IF: i.v. irinotecan 80 mg/m(2) 30 min, folinic acid 500 mg/m(2) 2 h, 5-fluorouracil (5-FU) 2000 mg/m(2) 22 h, for 6/7 weeks or CF: cisplatin 100 mg/m(2) 1-3 h, with 5-FU 1000 mg/m(2)/day 24 h, days 1-5, every 4 weeks. RESULTS In all, 333 patients were randomized and treated (IF 170, CF 163). Patient characteristics were balanced except more IF patients had Karnofsky performance status 100%. TTP for IF was 5.0 months [95% confidence interval (CI) 3.8-5.8] and 4.2 months (95% CI 3.7-5.5) for CF (P = 0.088). Overall survival (OS) was 9.0 versus 8.7 months, response rate 31.8% versus 25.8%, time to treatment failure (TTF) 4.0 versus 3.4 months for IF and CF, respectively. The difference in TTF was statistically significant (P = 0.018). IF was better in terms of toxic deaths (0.6% versus 3%), discontinuation for toxicity (10.0% versus 21.5%), severe neutropenia, thrombocytopenia and stomatitis, but not diarrhea. CONCLUSION IF did not yield a significant TTP or OS superiority over CF, and the results of noninferiority of IF were borderline. However, IF may provide a viable, platinum-free front-line treatment alternative for metastatic gastric cancer.
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Affiliation(s)
- M Dank
- Semmelweis University, Budapest, Hungary
| | - J Zaluski
- Wielkopolskie Centrum Onkologii Poznan, Poznan, Poland
| | - C Barone
- Catholic University of Sacred Heart, Rome, Italy
| | - V Valvere
- Estonian Oncology Center, Tallinn, Estonia
| | - S Yalcin
- Hacettepe University Medical Faculty Institute of Oncology, Sihhiye, Ankara, Turkey
| | | | - M Wenczl
- Markusovszky County Hospital, Szombathely, Markusovszky, Hungary
| | - E Goker
- Ege University Medical School, Izmir, Turkey
| | | | - K Wang
- Pfizer, New York, NY, USA
| | - R Bugat
- Institut Claudius Regaud, Toulouse, France.
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Paessens BJ, Ihbe-Heffinger A, von Schilling C, Bernard R, Peschel C, Schramm W, Berger K. Impact of chemotherapy induced haematotoxicity on blood component use and associated costs in NSCLC and lymphoma patients in Germany. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ihbe-Heffinger A, Paessens BJ, von Schilling C, Ehlken B, Shlaen M, Berger K, Görtz A, Bernard R, Peschel C, Jacobs VR. Cost analysis of febrile neutropenia (FN) management in three tumour types in Germany. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lordick F, Lorenzen S, Al-Batran S, Hofheinz R, Thuss-Patience PC, Porschen R, Röthling N, Schuster T, Peschel C. Cetuximab and cisplatin/5-FU (CF) versus CF in first-line metastatic squamous cell carcinoma of the esophagus (MESCC): A randomized phase II study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abbrederis K, Lorenzen S, von Weikersthal LF, Vehling-Kaiser U, Schuster T, Rothling N, Peschel C, Lordick F. Weekly docetaxel monotherapy for advanced gastric or esophagogastric junction cancer. Results of a phase II study in elderly patients or patients with impaired performance status. Crit Rev Oncol Hematol 2008; 66:84-90. [PMID: 18243012 DOI: 10.1016/j.critrevonc.2007.12.001] [Citation(s) in RCA: 10] [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] [Received: 06/27/2007] [Revised: 10/23/2007] [Accepted: 12/05/2007] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Three-weekly docetaxel is active in patients with advanced esophagogastric cancer but myelosuppression may make this schedule unsuitable for some patient groups such as elderly, pretreated, or poor performance status patients. PATIENTS AND METHODS Eligible patients were chemonaive with Karnofsky index < or =70% and/or had received prior platinum-based chemotherapy. Docetaxel 35 mg/m(2) was administered on days 1, 8, 15, 22, 29, and 36 of a 49-day cycle. The primary endpoint was disease stabilization rate. RESULTS Of 46 patients (median age, 68.5 years; 47% > or =70 years) included, 87% had Karnofsky index < or =70 and 50% had prior treatment. The safety profile was acceptable. Principal grade 3/4 toxicities were leukopenia (9%) and fatigue (14%). Fifteen patients experienced no progression for > or =100 days (disease stabilization rate: 36%). Overall response rate was 9%; median overall survival was 7.0 months. CONCLUSIONS Weekly docetaxel was well tolerated and achieved disease stabilization in one-third of difficult-to-treat patients.
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Affiliation(s)
- K Abbrederis
- 3rd Department of Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technical University of Munich, Germany
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Kuhn KA, Knoll A, Mewes HW, Schwaiger M, Bode A, Broy M, Daniel H, Feussner H, Gradinger R, Hauner H, Höfler H, Holzmann B, Horsch A, Kemper A, Krcmar H, Kochs EF, Lange R, Leidl R, Mansmann U, Mayr EW, Meitinger T, Molls M, Navab N, Nüsslin F, Peschel C, Reiser M, Ring J, Rummeny EJ, Schlichter J, Schmid R, Wichmann HE, Ziegler S. Informatics and medicine--from molecules to populations. Methods Inf Med 2008; 47:283-295. [PMID: 18690362] [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: 05/26/2023]
Abstract
OBJECTIVES To clarify challenges and research topics for informatics in health and to describe new approaches for interdisciplinary collaboration and education. METHODS Research challenges and possible solutions were elaborated by scientists of two universities using an interdisciplinary approach, in a series of meetings over several months. RESULTS AND CONCLUSION In order to translate scientific results from bench to bedside and further into an evidence-based and efficient health system, intensive collaboration is needed between experts from medicine, biology, informatics, engineering, public health, as well as social and economic sciences. Research challenges can be attributed to four areas: bioinformatics and systems biology, biomedical engineering and informatics, health informatics and individual healthcare, and public health informatics. In order to bridge existing gaps between different disciplines and cultures, we suggest focusing on interdisciplinary education, taking an integrative approach and starting interdisciplinary practice at early stages of education.
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Affiliation(s)
- K A Kuhn
- Technische Universität München, Munich, Germany.
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Lorenzen S, Herrmann K, Weber WA, Wieder H, Hennig M, Ott K, Bredenkamp R, Peschel C, Schwaiger M, Lordick F. Visualisation of metastatic oesophageal and gastric cancer and prediction of clinical response to palliative chemotherapy using 18FDG PET. Nuklearmedizin 2007; 46:263-70. [PMID: 18084682 DOI: 10.3413/nukmed-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM This study assessed the value of (18)F-deoxyglucose positron emission tomography (FDG-PET) for visualisation and early metabolic response assessment in metastatic gastro-oesophageal cancer. PATIENTS, METHODS Twenty-six patients who were treated for metastatic disease (20 adenocarcinomas, 6 squamous cell cancers) underwent FDG-PET before and two weeks after the onset of palliative chemotherapy with either oxaliplatin + 5-FU/LV or with docetaxel + capecitabine. PET results were validated according to clinical response based on RECIST criteria. RESULTS Twenty-four tumours (92%) could be visualised by FDG-PET and were also assessable by a second PET scan at 2 weeks. The 2 tumours that were not detectable by PET were both gastric cancers belonging to the non-intestinal subtype according to Lauren. Median time to progression and overall survival were not significantly different for metabolic responders and non-responders (6.3 vs 5.3 months and 14.1 vs 12.5 months, respectively). CONCLUSION In this heterogeneous study population, FDG-PET had a limited accuracy in predicting clinical response. However, the metabolic response prediction was particularly good in the subgroup of patients with oesophageal squamous cell cancer. Therefore, FDG-PET and assessment of cancer therapy clearly merits further investigation in circumscribed patient populations with metastatic disease.
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Affiliation(s)
- S Lorenzen
- 3rd Department of Internal Medicine (Haematology/Medical Oncology), Klinikum rechts der Isar, Technical University, Ismaninger Strasse 22, Munich, Germany
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Ringshausen I, Oelsner M, Bogner C, Peschel C, Decker T. The immunomodulatory drug Leflunomide inhibits cell cycle progression of B-CLL cells. Leukemia 2007; 22:635-8. [PMID: 17805332 DOI: 10.1038/sj.leu.2404922] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Escudier B, Srinivas S, Roigas J, Gillessen S, Harmenberg U, De Mulder P, Fountzilas G, Vogelzang N, Peschel C, Flodgren P. 4504 ORAL A phase II study of continuous daily administration of sunitinib in patients with cytokine-refractory metastatic renal cell carcinoma (mRCC) – final results. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71135-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lorenzen S, Hentrich M, Haberl C, Heinemann V, Schuster T, Seroneit T, Roethling N, Peschel C, Lordick F. Split-dose docetaxel, cisplatin and leucovorin/fluorouracil as first-line therapy in advanced gastric cancer and adenocarcinoma of the gastroesophageal junction: results of a phase II trial. Ann Oncol 2007; 18:1673-9. [PMID: 17660494 DOI: 10.1093/annonc/mdm269] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Phase II and III trials of docetaxel, cisplatin and fluorouracil (DCF) have shown superior efficacy versus cisplatin and fluorouracil alone but high rates of hematologic toxicity in advanced gastric cancer. To reduce toxicity while maintaining the efficacy of DCF, we investigated split doses of docetaxel (T), cisplatin (P), leucovorin (L) and fluorouracil (F). PATIENTS AND METHODS Chemotherapy-naive patients with advanced gastric-/esophageal adenocarcinomas received T 50 mg/m(2) and P 50 mg/m(2) on days 1, 15 and 29 and L 500 mg/m(2) plus F 2000 mg/m(2) weekly, every 8 weeks. Because significant dose reductions to <80% became necessary in 80% of patients, the regimen was amended after the first 15 patients to T 40 mg/m(2), P 40 mg/m(2), L 200 mg/m(2) and F 2000 mg/m(2). The primary endpoint was response rate. RESULTS Sixty patients were enrolled: 24 had locally advanced (LA) tumors and 36 had metastatic disease. Grade 3/4 toxicities included neutropenia (22%), febrile neutropenia (5%), diarrhea (20%) and lethargy (18%). The overall response rate was 47%. Twenty-three LA patients underwent secondary surgical resection (96%); complete resection was achieved in 87%. Overall, median time to progression and overall survival were 9.4 and 17.9 months, respectively (8.1 and 15.1 months, respectively, for patients with metastatic disease). CONCLUSION T-PLF regimen is highly active and has a favorable toxicity profile.
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Affiliation(s)
- S Lorenzen
- Technical University Munich, 3rd Department of Internal Medicine (Hematology/Medical Oncology), Munich, Germany
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40
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Lorenzen S, Weigert N, Heinemann V, Hentrich M, Schuster T, Seroneit T, Röthling N, Peschel C, Lordick F. Docetaxel, cisplatin and leucovorin/fluorouracil in first-line advanced gastric cancer and adenocarcinoma of the esophagogastric junction: Results of the phase II GASTRO-TAX-1 trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4561] [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
4561 Background: Phase II and III trials combining docetaxel, cisplatin and fluorouracil (DCF) every 3 weeks (wks) have shown superior efficacy but high rates of hematological toxicity in advanced gastric cancer. To reduce toxicity while containing the efficacy of DCF, we conducted a protocol using split doses of docetaxel (T), cisplatin (P), leucovorin (L), fluorouracil (F) (T-PLF). Methods: Chemo-naive patients (pts) with advanced gastroesophageal adenocarcinomas received T 50 mg/m2, P 50 mg/m2 day 1, 15, 29 and L 500 mg/m2 plus F 2,000 mg/m2 d1, 8, 15, 22, 29, 36 qd49. Because significant reductions to <80% of initial drug doses became necessary in 80% of pts, the regimen was amended after the first 15 pts. After the amendment the agents were administered as follows: T 40 mg/m2, P 40 mg/m2, L 200 mg/m2, F 2,000 mg/m2. The primary objective was the overall response rate (ORR) according to RECIST. Results: From 03/04 to 08/05 we included 60 pts: median age 53 yrs, (26–76); 24 pts had locally advanced tumors (LA) and 36 pts had metastatic disease (MET). Pts received a median of 2 (range 0–4) cycles. Reductions to <80% of drug doses were reported in 80% versus 60% of pts pre/post amendment. Reported adverse events were: neutropenia 23%, febrile neutropenia 5%, diarrhea 20%, nausea 8%, emesis 8% and fatigue 20%. The ORR according to RECIST was 46.6% (95%CI 33.3–61.4). Only 6.6% were primarily progressive. 23/24 pts with LA underwent secondary resection (96%). Complete resections (R0) were achieved in 87%. After a median follow-up of 25.5 months, median overall survival (OS) is 17.9 months (95%CI 11.5 -24.3). Median TTP is 9.4 months (95% CI 8.3–10.5). For pts with MET, median TTP is 8.1 months and median OS is 15.1 months. Conclusion: The T-PLF regimen is highly active, safe and has a favorable toxicity profile. [Table: see text]
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Affiliation(s)
- S. Lorenzen
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - N. Weigert
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - V. Heinemann
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - M. Hentrich
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - T. Schuster
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - T. Seroneit
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - N. Röthling
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - C. Peschel
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
| | - F. Lordick
- Technical-University Munich, Munich, Germany; Elisabeth Hospital, Straubing, Germany; Clinic Grosshadern, Munich, Germany; Clinic Harlaching, Munich, Germany; Institute for Medical Statistics and Epidemiology, Munich, Germany; Sanofi-Aventis GmbH, Berlin, Germany; Munich Center for Clinical Studies, Munich, Germany
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Srinivas S, Roigas J, Gillessen S, Harmenberg U, De Mulder PH, Fountzilas G, Vogelzang N, Peschel C, Flodgren P, Escudier B. Continuous daily administration of sunitinib in patients (pts) with cytokine-refractory metastatic renal cell carcinoma (mRCC): Updated results. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5040] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5040 Background: Sunitinib malate, an oral, multitargeted tyrosine kinase inhibitor of multiple receptors, showed significant efficacy in 168 pts with cytokine refractory mRCC, with a 42% objective response rate (ORR) and progression-free survival (PFS) of 8.2 months at 50 mg/day (4 weeks on treatment, 2 weeks off) per investigator assessment (Motzer et al. JAMA 2006;295:2516–24). This study was designed to determine the efficacy and safety of single-agent sunitinib when administered in a continuous 37.5 mg/day regimen. Methods: Pts with histologically proven mRCC, refractory to a cytokine-based regimen, were enrolled in this open-label, multicenter, phase II study. Eligibility criteria included measurable disease, ECOG PS 0/1, and adequate organ function. Pts were randomized to receive sunitinib in the morning (AM) or in the evening (PM) at a dose of 37.5 mg/day, with individual doses subsequently titrated based on tolerability. The primary endpoint was RECIST-defined ORR. Secondary endpoints included PFS, adverse events (AEs) and quality of life measures. Results: 107 pts were randomized to AM (54) or PM (53) dosing and have been on study a median of 6.8 months (0.4 to 13.3). As of October 2006, 55 pts have discontinued due to progression (37 pts [35%]), AEs (17 pts [16%]), and 1 consent withdrawal (1%); 47 pts (44%) were dose reduced to 25 mg/day due to grade 2/3 AEs, the most frequent being: asthenia (12%), hand-foot syndrome (8%), and diarrhea (5%). The most commonly reported (=5% of pts) grade 3/4 AEs were hypertension (10%), asthenia (9%), hand-foot syndrome (9%), anorexia (8%), and diarrhea (6%). 31 pts (29%) were maintained on continuous sunitinib at 37.5 mg/day, and 29 (27%) were escalated to 50 mg/day. There were no significant differences between pts who received AM or PM dosing. Quality of life results will be presented. The best response by RECIST per investigator assessment shows an ORR of 19% with 43 pts (40%) with =6 months of stable disease. The median PFS is 8.3 months. Conclusions: Sunitinib 37.5 mg/day continuous dosing has a manageable safety profile and demonstrates promising clinical benefit as second-line therapy in mRCC. This regimen provides alternative sunitinib dosing that can be explored in combination studies. No significant financial relationships to disclose.
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Affiliation(s)
- S. Srinivas
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - J. Roigas
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - S. Gillessen
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - U. Harmenberg
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - P. H. De Mulder
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - G. Fountzilas
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - N. Vogelzang
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - C. Peschel
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - P. Flodgren
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
| | - B. Escudier
- Stanford University, Stanford, CA; Charite University Hospital, Berlin, Germany; Kantonsspital St Gallen, St Gallen, Switzerland; Karolinska University Hospital, Stockholm, Sweden; Radboud University Medical Center, Nijmegen, The Netherlands; Papageorgiou Hospital, Thessaloniki, Greece; Nevada Cancer Institute, Las Vegas, NV; Klinikum rechts der Isar, Munich, Germany; Lund University Hospital, Lund, Sweden; Institut Gustave Roussy, Villejuif, France
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Lordick F, Lorenzen S, Hegewisch-Becker S, Folprecht G, Wöll E, Decker T, Endlicher E, Röthling N, Fend F, Peschel C. Cetuximab plus weekly oxaliplatin/5FU/FA (FUFOX) in 1st line metastatic gastric cancer. Final results from a multicenter phase II study of the AIO upper GI study group. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4526] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4526 Background: Cetuximab and oxaliplatin-5FU/FA are active in first-line metastatic colorectal cancer. Here we report on the final results from a trial assessing the efficacy of this combination in advanced gastric cancer. Methods: Pts received cetuximab 400mg/m2 at first infusion followed by weekly 250mg/m2 combined with the FUFOX regimen (oxaliplatin 50mg/m2 plus 5FU 2,000mg/m2 plus DL-folinic acid 200mg/m2 d1,8,15,22 qd36). The primary endpoint was response according to RECIST. Toxicity was reported according to NCI.CTC v3.0. Results: From 4/05 until 03/06 we included 52 pts at 7 study centers: 13 women and 39 men; median age 63 years (38–80). ECOG-PS 0/1/2 in 19/25/8 patients. Median number of involved organ sites 3 (1–5), 46% liver and 31% peritoneal involvement. EGFR was detectable by immunohistochemistry (IHC) in 59.5%. 5 pts (9.6%) died within 60 days after study inclusion, two deaths were treatment-related (1 hypersensitivity reaction, 1 septic diarrhea). One patient withdrew consent during the first infusion cycle and is therefore excluded from the following analyses. Reported grade 3/4 adverse events in 51 evaluable pts were: leukopenia 2.0%, febrile neutropenia 5.9%, thrombocytopenia 2.0%, nausea 5.9%, diarrhea 33.3%, fatigue 9.8%, sensory neuropathy 3.9%, hand-foot-syndrome 5.9%, skin-reactions 23.5%. Response is evaluable in 46 patients showing an overall response rate of 65.2% [CI 95%: 49.8; 78.6] including 4 complete and 26 partial responses. Eighteen (39.1%) responses have been confirmed. The reponse rate according to the EGFR-status is 76.5% in undetectable and 54.2% in detectable tumors. Intention-to-treat analysis reveals a time to progression (TTP) of 7.6 months [CI 95% 5.0; 10.1] and an overall survival (OS) of 9.5 months [CI 95%: 7.9; 11.1]. Conclusions: Cetuximab plus FUFOX is highly active in metastatic gastric cancer, irrespective of the EGFR detection by IHC. No significant financial relationships to disclose.
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Affiliation(s)
- F. Lordick
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - S. Lorenzen
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - S. Hegewisch-Becker
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - G. Folprecht
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - E. Wöll
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - T. Decker
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - E. Endlicher
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - N. Röthling
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - F. Fend
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
| | - C. Peschel
- Technische Universität München, Munich, Germany; Onkologische Schwerpunktpraxis Eppendorf, Hamburg, Germany; Universitätsklinikum Carl Gustav Carus, Dresden, Germany; Krankenhaus St. Vinzenz, Zams, Austria; Onkologische Schwerpunktpraxis Ravensburg, Weingarten, Germany; Klinikum der Universität, Regensburg, Germany
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Menzel H, von Bubnoff N, Hochhaus A, Haferlach C, Peschel C, Duyster J. Successful allogeneic stem cell transplantation in second chronic-phase CML induced by the tyrosine kinase inhibitor nilotinib (AMN107) after blast crisis under imatinib. Bone Marrow Transplant 2007; 40:83-4. [PMID: 17450179 DOI: 10.1038/sj.bmt.1705683] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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44
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Witzig R, Schönberger B, Fink U, Busch R, Gundel H, Sendler A, Peschel C, Siewert JR, Lordick F. Delays in diagnosis and therapy of gastric cancer and esophageal adenocarcinoma. Endoscopy 2006; 38:1122-6. [PMID: 17111334 DOI: 10.1055/s-2006-944847] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS In the past, there were long delays in the diagnosis of patients with cancer of the stomach or esophagus. The objective of this study was to describe current delays in the diagnosis and treatment of gastric and esophageal adenocarcinoma and to compare the findings with those from an historical control population treated at the same institutions 10 years earlier. PATIENTS AND METHODS Patients with biopsy-proven gastric cancer or esophageal adenocarcinoma who were treated at two academic medical centers in Germany between April and October 2003 were consecutively screened for eligibility to take part in the study. Medical charts for each patient were reviewed. Additional data were obtained via structured interviews. Main outcome measures were the total delay, and the delays related to patients themselves, to doctors, and to the hospital. Data were compared with those from a historic control group assessed in 1993. RESULTS The median total delay for patients with gastric cancer (n = 104) was 3.5 months (range 0.3 - 29.6), and in patients with esophageal adenocarcinoma (n = 22) the total delay was significantly shorter (median 2.2 months, range 1.2 - 11.7; P < 0.05). Comparing these findings with those from an historic cohort of patients with gastric cancer (n = 100) revealed a significant decrease in the total delay (3.5 versus 8.0 months, P < 0.001). CONCLUSIONS The current findings indicate that delays in the diagnosis and treatment of gastric cancer have become significantly shorter within the last 10 years as our understanding of and ability to treat this form of cancer have improved.
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Affiliation(s)
- R Witzig
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
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45
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Abstract
The development of lymphomas and leukemias is frequently caused by chromosomal translocations that deregulate cellular pathways of differentiation, proliferation or survival. The molecules that are involved in these aberrations provide rational targets for selective drug therapies. Recently, several disease specific translocations have been identified in human MALT lymphoma. These aberrations either upregulate the expression of BCL10 or MALT1 or induce the formation of API2-MALT1 fusion proteins. Genetic and biochemical experiments identified BCL10 and MALT1 as central components of an oligomerization-ubiquitinylation-phosphorylation cascade that activates the transcription factor NF-kappaB in response to antigen receptor ligation. Deregulation of the signaling cascade is directly associated with antigen independent MALT lymphoma growth. Here we provide an overview of the physiological and pathological functions of BCL10/MALT1 signal transduction and discuss the potential of this pathway as a drug target.
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Affiliation(s)
- P Jost
- Third Medical Department, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
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46
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Miething C, Feihl S, Mugler C, Grundler R, von Bubnoff N, Lordick F, Peschel C, Duyster J. The Bcr-Abl mutations T315I and Y253H do not confer a growth advantage in the absence of imatinib. Leukemia 2006; 20:650-7. [PMID: 16482207 DOI: 10.1038/sj.leu.2404151] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mutations in the Bcr-Abl kinase domain are a frequent cause of imatinib resistance in patients with advanced CML or Ph+ ALL. The impact of these mutations on the overall oncogenic potential of Bcr-Abl and on the clinical course of the disease in the absence of imatinib is presently unclear. In this study, we analyzed the effects of the Bcr-Abl P-loop mutation Y253H and the highly imatinib resistant T315I mutation on kinase activity in vitro and transforming efficiency of Bcr-Abl in vitro and in vivo. Immunoprecipitated Bcr-AblY253H and Bcr-AblT315I proteins displayed similar kinase activities and substrate phosphorylation patterns as Bcr-Abl wildtype. We directly compared the proliferative capacity of mutant to wildtype Bcr-Abl in primary BM cells in vitro and in a murine transplantation model of CML by using a competitive repopulation assay. The results implicate that in the absence of imatinib, there is no growth advantage for cells carrying Bcr-AblT315I or Bcr-AblY253H compared to Bcr-Ablwt, whereas imatinib treatment clearly selects for leukemic cells expressing mutant Bcr-Abl both in vitro and in vivo. Thus, the analysed Bcr-Abl mutants confer imatinib resistance, but do not induce a growth advantage in the absence of imatinib.
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Affiliation(s)
- C Miething
- Department of Internal Medicine III, Klinikum rechts der Isar, Technical University of Munich, Trogerstr, Munich, Germany
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De Mulder PH, Roigas J, Gillessen S, Srinivas S, Pisa P, Vogelzang N, Fountzilas G, Peschel C, Baum C, Escudier B. A phase II study of sunitinib administered in a continuous daily regimen in patients with cytokine-refractory metastatic renal cell carcinoma (mRCC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4529] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4529 Background: Renal cell carcinomas are known for their vascularity and production of high levels of VEGF. Sunitinib malate (SU11248), an oral, multitargeted tyrosine kinase inhibitor of multiple receptors including VEGFR, PDGFR, KIT, RET, and FLT3, has previously demonstrated significant efficacy in 168 patients (pts) with mRCC, with a 42% objective response rate (ORR) at 50 mg/day in 6-week (wk) cycles of 4 wks on treatment followed by 2 wks off. This study sought to determine the efficacy and safety of single-agent sunitinib in mRCC when administered in a continuous 37.5 mg/day regimen. Methods: Pts with histologically proven mRCC, refractory to a cytokine-based regimen, were enrolled in this open-label, multicenter, phase II study. Eligibility criteria included measurable disease, ECOG PS 0/1, and adequate organ function. Pts were randomized to receive sunitinib in the morning (AM) or in the evening (PM) at a dose of 37.5 mg/day, with individual doses subsequently titrated based on tolerability. The primary endpoint was RECIST-defined ORR. Secondary endpoints includedprogression-free survival, adverse events (AEs) and quality of life measures. Results: A total of 88/100 planned pts have been randomized to date: AM (43) and PM (45), and enrollment will be completed by end January 2006. 44 pts have been on continuous sunitinib treatment at 37.5 mg/day for >16 wks (3), >12 wks (9), >8 wks (12), and >4 wks (20). 2 pts (2.3%) discontinued (colon perforation and renal insufficiency) and 9 (10.2%) dose reduced to 25 mg/day due to grade 2/3 AEs: mucositis (2), hand-foot syndrome (2), thrombocytopenia (2), asthenia (1), nausea/diarrhea (1), and neutropenia (1). Preliminary efficacy data show some tumor shrinkage in the majority of patients evaluated at 4 wks, with 3 initial partial responses. There has been no significant difference between pts who received AM or PM doses. The most commonly reported AEs were mucositis, fatigue, hair/skin discoloration, and hand-foot syndrome. Conclusions: Sunitinib administered at a continuous dose of 37.5 mg/day was generally well tolerated; only a few patients required treatment breaks and/or dose reduction. Preliminary efficacy data are encouraging. Mature data will be presented. [Table: see text]
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Affiliation(s)
- P. H. De Mulder
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - J. Roigas
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - S. Gillessen
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - S. Srinivas
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - P. Pisa
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - N. Vogelzang
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - G. Fountzilas
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - C. Peschel
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - C. Baum
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
| | - B. Escudier
- Universitair Medisch Centrum St. Radboud, Nijmegen, The Netherlands; Charité University Medicine Berlin, Berlin, Germany; Kantonsspital St. Gallen, St. Gallen, Switzerland; Stanford University, Stanford, CA; Karolinska Institutet, Stockholm, Sweden; Nevada Cancer Institute, Las Vegas, NV; Aristotle University, Thessaloniki, Greece; Medizinische Klinik und Poliklinik, Muenchen, Germany; Pfizer Research and Development, La Jolla, CA; Institut Gustave Roussy, Villejuif, France
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Abstract
Constitutively activated signaling pathways contribute to the apoptosis-defect of B-CLL cells. Protein kinase C-delta is a permanently activated kinase and a putative downstream target of phosphatidylinositol-3 kinase in B-CLL. Blockade of protein kinase C-delta (PKC-delta) by the highly specific inhibitor rottlerin induces apoptosis in chronic lymphocytic leukaemia (CLL) cells. By co-culturing bone marrow stromal and CLL cells, we determined that the proapoptotic effect of rottlerin is not abolished in the presence of survival factors, indicating that a targeted therapy against PKC-delta might be a powerful approach for the treatment of CLL patients. The downstream events following rottlerin treatment engage mitochondrial and non-mitochondrial pathways and ultimately activate caspases that execute the apoptotic cell death. Herein we report that the inhibition of PKC-delta decreases the expression of the important antiapoptotic proteins Mcl-1 and XIAP accompanied by a loss of the mitochondrial membrane potential Deltapsi. In addition, we discovered that ZAP-70-expressing cells are significantly more susceptible to rottlerin-induced cell death than ZAP-70 negative cells. We finally observed that rottlerin can augment cell toxicity induced by standard chemotherapeutic drugs. Conclusively, PKC-delta is a promising new target in the combat against CLL.
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MESH Headings
- Acetophenones/pharmacology
- Acetophenones/therapeutic use
- Apoptosis/drug effects
- Benzopyrans/pharmacology
- Benzopyrans/therapeutic use
- Bone Marrow Cells/drug effects
- Bone Marrow Cells/enzymology
- Bone Marrow Cells/metabolism
- Caspases/metabolism
- Cells, Cultured
- Coculture Techniques
- Electrophoretic Mobility Shift Assay
- Enzyme Activation
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/enzymology
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Protein Kinase C-delta/antagonists & inhibitors
- Stromal Cells/drug effects
- Stromal Cells/metabolism
- ZAP-70 Protein-Tyrosine Kinase/metabolism
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Affiliation(s)
- I Ringshausen
- 3rd Department of Medicine, Technical University of Munich, Munich, Germany.
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49
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Jacobs VR, Niemeyer M, Gottschalk N, Schneider KTM, Kiechle M, Oostendorp RAJ, Peschel C, Hönicka M, Lehle K, Birnbaum D, Meyer TPH, Rapp S, Burkhart J, Aigner J, Eblenkamp M, Wintermantel E. Das STEMMAT-Projekt als Teil der Gesundheitsinitiative BayernAktiv: Adulte Stammzellen aus Nabelschnur und -blut als Alternative zur embryonalen Stammzellforschung. ACTA ACUST UNITED AC 2006; 127:368-72. [PMID: 16341979 DOI: 10.1055/s-2005-836498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Adult stem cells from umbilical cord and cord blood are an interesting alternative to embryonic stem cells because such research is commonly recognized as ethical undisputed and many aspects are still insufficiently investigated. In the context of the STEMMAT research project (STEM = Stem Cell and MAT = Material) different aspects of stem cells from umbilical cord and cord blood are investigated, to improve basic science understanding and potentially leading someday to a clinical application.
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Affiliation(s)
- V R Jacobs
- Frauenklinik, Klinikum Rechts der Isar, Technische Universität München.
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50
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Lorenzen S, Duyster J, Lersch C, von Delius S, Hennig M, Bredenkamp R, Peschel C, Lordick F. Capecitabine plus docetaxel every 3 weeks in first- and second-line metastatic oesophageal cancer: final results of a phase II trial. Br J Cancer 2005; 92:2129-33. [PMID: 15942631 PMCID: PMC2361804 DOI: 10.1038/sj.bjc.6602645] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Capecitabine and docetaxel have single-agent activity in upper gastrointestinal tumours, and have together demonstrated preclinical synergy and a survival benefit in breast cancer, and high response rates in first-line metastatic gastric cancer. This trial assessed the efficacy, safety and feasibility of capecitabine in combination with docetaxel in patients with metastatic oesophageal cancer. In all, 24 patients with advanced disease (17 squamous cell carcinoma and seven adenocarcinoma) received oral capecitabine (1000 mg m(-2) twice daily on days 1-14) plus intravenous docetaxel (75 mg m(-2) on day 1) every 3 weeks as first- (n = 16) or second-line (n = 8) therapy. Patients received a median of four cycles of treatment (range, 0-6). The median follow-up is 16.5 months (range, 7.9-21.4 months). Intent-to-treat efficacy analysis showed an overall response rate of 46%. Of the 11 responders (one complete and 10 partial), nine of 16 (56%) received first-line and two of eight (25%) received second-line therapy. The median time to progression was 6.1 months (95% confidence interval (CI), 4.5-7.7 months). The median survival was 15.8 months (95% CI, 7.8-23.9 months). Severe adverse events (grade 3/4) reported were: neutropenia (42%, including febrile neutropenia 8%), hand-foot syndrome (29%), diarrhoea (13%), sensory neuropathy (13%), anaemia (8%) and fatigue (8%). Capecitabine plus docetaxel has a manageable adverse event profile and very promising activity in metastatic oesophageal cancer, at least comparable to other doublet regimens. Therefore, the combination merits further investigation in this setting.
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Affiliation(s)
- S Lorenzen
- 3rd Department of Internal Medicine (Haematology/Medical Oncology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany
| | - J Duyster
- 3rd Department of Internal Medicine (Haematology/Medical Oncology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany
| | - C Lersch
- 2nd Department of Internal Medicine (Gastroenterology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany
| | - S von Delius
- 2nd Department of Internal Medicine (Gastroenterology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany
| | - M Hennig
- Institute for Medical Statistics and Epidemiology, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany
| | - R Bredenkamp
- Munich Center for Clinical Studies, Klinikum rechts der Isar, Ismaninger Strasse 22, Munich D-81675, Germany
| | - C Peschel
- 3rd Department of Internal Medicine (Haematology/Medical Oncology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany
| | - F Lordick
- 3rd Department of Internal Medicine (Haematology/Medical Oncology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany
- 3rd Department of Internal Medicine (Haematology/Medical Oncology), Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich D-81675, Germany. E-mail:
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