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Koinis F, Zafeiriou Z, Messaritakis I, Katsaounis P, Koumarianou A, Kontopodis E, Chantzara E, Aidarinis C, Lazarou A, Christodoulopoulos G, Emmanouilides C, Hatzidaki D, Kallergi G, Georgoulias V, Kotsakis A. Prognostic Role of Circulating Tumor Cells in Patients with Metastatic Castration-Resistant Prostate Cancer Receiving Cabazitaxel: A Prospective Biomarker Study. Cancers (Basel) 2023; 15:4511. [PMID: 37760481 PMCID: PMC10527446 DOI: 10.3390/cancers15184511] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
RATIONAL Circulating tumor cells (CTCs) appear to be a promising tool for predicting the clinical outcome and monitoring the response to treatment in patients with solid tumors. The current study assessed the clinical relevance of monitoring CTCs in patients with metastatic castration resistant prostate cancer (mCRPC) treated with cabazitaxel. PATIENTS AND METHODS Patients with histologically confirmed mCRPC who were previously treated with a docetaxel-containing regimen and experienced disease progression were enrolled in this multicenter prospective study. CTC counts were enumerated using the CellSearch system at baseline (before cabazitaxel initiation), after one cabazitaxel cycle (post 1st cycle) and at disease progression (PD). Patients were stratified into predetermined CTC-positive and CTC-negative groups. The phenotypic characterization was performed using double immunofluorescence staining with anti-CKs and anti-Ki67, anti-M30 or anti-vimentin antibodies. RESULTS The median PFS and OS were 4.0 (range, 1.0-17.9) and 14.5 (range, 1.2-33.9) months, respectively. At baseline, 48 out of 57 (84.2%) patients had ≥1 CTCs/7.5 mL of peripheral blood (PB) and 37 (64.9%) had ≥5 CTCs/7.5 mL of PB. After one treatment cycle, 30 (75%) out of the 40 patients with available measurements had ≥1 detectable CTC/7.5 mL of PB and 24 (60%) ≥ 5CTCs/7.5 mL of PB; 12.5% of the patients with detectable CTCs at the baseline sample had no detectable CTCs after one treatment cycle. The detection of ≥5CTCs/7.5 mL of PB at baseline and post-cycle 1 was associated with shorter PFS and OS (p = 0.002), whereas a positive CTC status post-cycle 1 strongly correlated with poorer OS irrespective of the CTC cut-off used. Multivariate analysis revealed that the detection of non-apoptotic (CK+/M30-) CTCs at baseline is an independent predictor of shorter OS (p = 0.005). CONCLUSIONS In patients with mCRPC treated with cabazitaxel, CTC counts both at baseline and after the first cycle retain their prognostic significance, implying that liquid biopsy monitoring might serve as a valuable tool for predicting treatment efficacy and survival outcomes.
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Affiliation(s)
- Filippos Koinis
- Department of Medical Oncology, University General Hospital of Larissa, 41334 Larisa, Greece; (E.C.); (C.A.); (A.L.); (G.C.)
- Faculty οf Medicine, School of Health Sciences, University of Thessaly, 41335 Larissa, Greece
| | - Zafeiris Zafeiriou
- Second Department of Medical Oncology, Theageneion Anticancer Hospital, 54007 Thessaloniki, Greece;
| | - Ippokratis Messaritakis
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Heraklion, 70013 Crete, Greece;
| | - Panagiotis Katsaounis
- First Department of Medical Oncology, Metropolitan General Hospital, 15562 Athens, Greece; (P.K.); (V.G.)
| | - Anna Koumarianou
- Medical Oncology Unit, 4th Department of Internal Medicine, “ATTIKON” University Hospital of Athens, 11528 Athens, Greece;
| | - Emmanouil Kontopodis
- Department of Medical Oncology, “Venizelion” General Hospital of Heraklion, 71409 Crete, Greece;
| | - Evangelia Chantzara
- Department of Medical Oncology, University General Hospital of Larissa, 41334 Larisa, Greece; (E.C.); (C.A.); (A.L.); (G.C.)
| | - Chrissovalantis Aidarinis
- Department of Medical Oncology, University General Hospital of Larissa, 41334 Larisa, Greece; (E.C.); (C.A.); (A.L.); (G.C.)
| | - Alexandros Lazarou
- Department of Medical Oncology, University General Hospital of Larissa, 41334 Larisa, Greece; (E.C.); (C.A.); (A.L.); (G.C.)
| | - George Christodoulopoulos
- Department of Medical Oncology, University General Hospital of Larissa, 41334 Larisa, Greece; (E.C.); (C.A.); (A.L.); (G.C.)
| | - Christos Emmanouilides
- Department of Medical Oncology, Diavalkanikon General Hospital of Thessaloniki, 55535 Thessaloniki, Greece;
| | - Dora Hatzidaki
- Hellenic Oncology Research Group (HORG), 11526 Athens, Greece;
| | - Galatea Kallergi
- Division of Genetics, Cell and Developmental Biology, Department of Biology, University of Patras, 26504 Patras, Greece;
| | - Vassilis Georgoulias
- First Department of Medical Oncology, Metropolitan General Hospital, 15562 Athens, Greece; (P.K.); (V.G.)
- Hellenic Oncology Research Group (HORG), 11526 Athens, Greece;
| | - Athanasios Kotsakis
- Department of Medical Oncology, University General Hospital of Larissa, 41334 Larisa, Greece; (E.C.); (C.A.); (A.L.); (G.C.)
- Faculty οf Medicine, School of Health Sciences, University of Thessaly, 41335 Larissa, Greece
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Kokkali S, Saloustros E, Stefanou D, Makrantonakis P, Kentepozidis N, Boukovinas I, Xenidis N, Katsaounis P, Ardavanis A, Ziras N, Christopoulou A, Rigas G, Kalbakis K, Vardakis N, Emmanouilides C, Athanasiadis I, Anagnostopoulos A, Hatzidaki D, Prinarakis E, Simopoulou F, Kotsakis A, Georgoulias V. Front-Line Bevacizumab plus Chemotherapy with or without Maintenance Therapy for Metastatic Breast Cancer: An Observational Study by the Hellenic Oncology Research Group. Curr Oncol 2022; 29:1237-1251. [PMID: 35200604 PMCID: PMC8871254 DOI: 10.3390/curroncol29020105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Front-line bevacizumab (BEV) in combination with taxanes offers benefit in progression-free survival (PFS) in metastatic breast cancer (mBC). The medical records of mBC patients, treated with front-line BEV-based chemotherapy, were retrospectively reviewed in order to generate real life safety and efficacy data. Patients with human epidermal growth factor receptor 2 (HER2)-negative mBC treated with front-line BEV in combination with chemotherapy were eligible. Maintenance therapy with BEV and/or hormonal agents was at the physicians’ discretion. Among the 387 included patients, the most common adverse events were anemia (61.9%, mainly grade 1), grade 3/4 neutropenia (16.5%), grade 1/2 fatigue (22.3%), and grade 1/2 neuropathy (19.6%). Dose reductions were required in 164 cycles (7.1%) and toxicity led to treatment discontinuation in 21 patients (5.4%). The median PFS and the median overall survival (OS) were 13.3 (95% CI: 11.7–14.8) and 32.3 months (95% CI: 27.7–36.9), respectively. Maintenance therapy, with hormonal agents (ET) and/or BEV, was associated with longer OS versus no maintenance therapy (47.2 versus 23.6 months; p < 0.001) in patients with hormone receptor (HR)-positive disease and BEV maintenance offered longer OS versus no maintenance in patients with HR-negative disease (52.8 versus 23.3; p = 0.023). These real-life data show that front-line BEV-based chemotherapy in HER2-negative mBC patients is an effective treatment with an acceptable toxicity profile. The potential benefit of maintenance treatment, especially ET, is important and warrants further research.
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Affiliation(s)
- Stefania Kokkali
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | | | - Dimitra Stefanou
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Paris Makrantonakis
- 2nd Department of Medical Oncology, Theageneio Anticancer Hospital, 54639 Thessaloniki, Greece;
| | - Nikolaos Kentepozidis
- Department of Medical Oncology, 251 Airforce General Hospital, 11525 Athens, Greece;
| | | | - Nikolaos Xenidis
- Department of Medical Oncology, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece;
| | - Panagiotis Katsaounis
- 1st Department of Medical Oncology, Metropolitan General Hospital, 11522 Athens, Greece;
| | - Alexandros Ardavanis
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Nikolaos Ziras
- 2nd Department of Medical Oncology, Metaxas’ Anticancer Hospital, 18537 Piraeus, Greece;
| | | | - George Rigas
- Medical Oncology Unit, General Hospital of Volos, 38222 Volos, Greece;
| | - Kostas Kalbakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | - Nikolaos Vardakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | | | - Ilias Athanasiadis
- 2nd Department of Medical Oncology, MITERA Hospital, 11522 Athens, Greece;
| | | | - Dora Hatzidaki
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Efthimios Prinarakis
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Foteini Simopoulou
- Department of Radiation Oncology, Iaso Thessaly Hospital, 41005 Larissa, Greece;
| | - Athanasios Kotsakis
- Department of Oncology, University Hospital of Larissa, 41221 Larissa, Greece;
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
| | - Vassilis Georgoulias
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
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Mountzios G, Samantas E, Senghas K, Zervas E, Krisam J, Samitas K, Bozorgmehr F, Kuon J, Agelaki S, Baka S, Athanasiadis I, Gaissmaier L, Elshiaty M, Daniello L, Christopoulou A, Pentheroudakis G, Lianos E, Linardou H, Kriegsmann K, Kosmidis P, El Shafie R, Kriegsmann M, Psyrri A, Andreadis C, Fountzilas E, Heussel CP, Herth FJ, Winter H, Emmanouilides C, Oikonomopoulos G, Meister M, Muley T, Bischoff H, Saridaki Z, Razis E, Perdikouri EI, Stenzinger A, Boukovinas I, Reck M, Syrigos K, Thomas M, Christopoulos P. Association of the advanced lung cancer inflammation index (ALI) with immune checkpoint inhibitor efficacy in patients with advanced non-small-cell lung cancer. ESMO Open 2021; 6:100254. [PMID: 34481329 PMCID: PMC8417333 DOI: 10.1016/j.esmoop.2021.100254] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 04/29/2021] [Revised: 07/08/2021] [Accepted: 08/01/2021] [Indexed: 12/26/2022] Open
Abstract
Background The advanced lung cancer inflammation index [ALI: body mass index × serum albumin/neutrophil-to-lymphocyte ratio (NLR)] reflects systemic host inflammation, and is easily reproducible. We hypothesized that ALI could assist guidance of non-small-cell lung cancer (NSCLC) treatment with immune checkpoint inhibitors (ICIs). Patients and methods This retrospective study included 672 stage IV NSCLC patients treated with programmed death-ligand 1 (PD-L1) inhibitors alone or in combination with chemotherapy in 25 centers in Greece and Germany, and a control cohort of 444 stage IV NSCLC patients treated with platinum-based chemotherapy without subsequent targeted or immunotherapy drugs. The association of clinical outcomes with biomarkers was analyzed with Cox regression models, including cross-validation by calculation of the Harrell's C-index. Results High ALI values (>18) were significantly associated with longer overall survival (OS) for patients receiving ICI monotherapy [hazard ratio (HR) = 0.402, P < 0.0001, n = 460], but not chemo-immunotherapy (HR = 0.624, P = 0.111, n = 212). Similar positive correlations for ALI were observed for objective response rate (36% versus 24%, P = 0.008) and time-on-treatment (HR = 0.52, P < 0.001), in case of ICI monotherapy only. In the control cohort of chemotherapy, the association between ALI and OS was weaker (HR = 0.694, P = 0.0002), and showed a significant interaction with the type of treatment (ICI monotherapy versus chemotherapy, P < 0.0001) upon combined analysis of the two cohorts. In multivariate analysis, ALI had a stronger predictive effect than NLR, PD-L1 tumor proportion score, lung immune prognostic index, and EPSILoN scores. Among patients with PD-L1 tumor proportion score ≥50% receiving first-line ICI monotherapy, a high ALI score >18 identified a subset with longer OS and time-on-treatment (median 35 and 16 months, respectively), similar to these under chemo-immunotherapy. Conclusions The ALI score is a powerful prognostic and predictive biomarker for patients with advanced NSCLC treated with PD-L1 inhibitors alone, but not in combination with chemotherapy. Its association with outcomes appears to be stronger than that of other widely used parameters. For PD-L1-high patients, an ALI score >18 could assist the selection of cases that do not need addition of chemotherapy. ALI is prognostic and predictive for patients with advanced NSCLC treated with immunotherapy monotherapy, but not chemo-immunotherapy. Its association with outcomes is stronger than that of other parameters (PD-L1 TPS, NLR, lung immune prognostic index, EPSILoN). For PD-L1-high patients, an ALI score >18 could assist the selection of cases that do not need addition of chemotherapy.
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Affiliation(s)
- G Mountzios
- Fourth Oncology Department and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece.
| | - E Samantas
- Second Oncology Department, Metropolitan Hospital, Pireaus, Athens, Greece
| | - K Senghas
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
| | - E Zervas
- 7th Pneumonology Department 'Sotiria' Hospital, Athens, Greece
| | - J Krisam
- Institute of Medical Biometry and Statistics, Heidelberg University Hospital, Heidelberg, Germany
| | - K Samitas
- Department of Medical Oncology, University of Irakleion School of Medicine, Iraklion, Greece
| | - F Bozorgmehr
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
| | - J Kuon
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
| | - S Agelaki
- Department of Medical Oncology, University of Irakleion School of Medicine, Iraklion, Greece
| | - S Baka
- Department of Medical Oncology, Interbalkan Medical Center, Thessaloniki, Greece
| | - I Athanasiadis
- Department of Medical Oncology, 'Mitera' Hospital, Athens, Greece
| | - L Gaissmaier
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - M Elshiaty
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - L Daniello
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
| | - A Christopoulou
- Department of Medical Oncology, General Hospital of Patras 'Agios Andreas', Patras, Greece
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina School of Medicine, Ioannina, Greece
| | - E Lianos
- Department of Medical Oncology, 'Metaxa' Cancer Hospital, Pireaus, Greece
| | - H Linardou
- Fourth Oncology Department, Metropolitan Hospital, Pireaus, Athens, Greece
| | - K Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - P Kosmidis
- Second Oncology Department, 'Hygeia' Hospital, Athens, Greece
| | - R El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Kriegsmann
- Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany; Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Psyrri
- Department of Medical Oncology, 'Attikon' University Hospital, Athens, Greece
| | - C Andreadis
- Third Department of Medical Oncology, 'Theageneion' Cancer Hospital, Thessaloniki, Greece
| | - E Fountzilas
- Department of Medical Oncology, 'Euromedica' Clinic, Thessaloniki, Greece
| | - C-P Heussel
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - F J Herth
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - H Winter
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - C Emmanouilides
- Department of Medical Oncology, Interbalkan Medical Center, Thessaloniki, Greece
| | - G Oikonomopoulos
- Second Oncology Department, Metropolitan Hospital, Pireaus, Athens, Greece
| | - M Meister
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - T Muley
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - H Bischoff
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
| | - Z Saridaki
- Department of Medical Oncology, 'Asclepius' Clinic, Iraklion, Greece
| | - E Razis
- Third Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - E-I Perdikouri
- Department of Medical Oncology, 'Achilopouleio' General Hospital of Volos, Volos, Greece
| | - A Stenzinger
- Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany; Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - I Boukovinas
- Department of Medical Oncology, 'Bioclinica' Hospital, Thessaloniki, Greece
| | - M Reck
- LungenClinic Großhansdorf GmbH, Großhansdorf, Germany; Airway Research Center North, German Center for Lung Research, Großhansdorf, Germany
| | - K Syrigos
- Department of Medical Oncology, Sotiria General Hospital of Athens, Athens, Greece
| | - M Thomas
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - P Christopoulos
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.
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Fragkou N, Sideras L, Panas P, Emmanouilides C, Sinakos E. Update on the association of hepatitis B with intrahepatic cholangiocarcinoma: Is there new evidence? World J Gastroenterol 2021; 27:4252-4275. [PMID: 34366604 PMCID: PMC8316913 DOI: 10.3748/wjg.v27.i27.4252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/12/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a subgroup of cholangiocarcinoma that accounts for about 10%-20% of the total cases. Infection with hepatitis B virus (HBV) is one of the most important predisposing factors leading to the formation of iCCA. It has been recently estimated based on abundant epidemiological data that the association between HBV infection and iCCA is strong with an odds ratio of about 4.5. The HBV-associated mechanisms that lead to iCCA are under intense investigation. The diagnosis of iCCA in the context of chronic liver disease is challenging and often requires histological confirmation to distinguish from hepatocellular carcinoma. It is currently unclear whether antiviral treatment for HBV can decrease the incidence of iCCA. In terms of management, surgical resection remains the mainstay of treatment. There is a need for effective treatment modalities beyond resection in both first- and second-line treatment. In this review, we summarize the epidemiological evidence that links the two entities, discuss the pathogenesis of HBV-associated iCCA, and present the available data on the diagnosis and management of this cancer.
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Affiliation(s)
- Nikolaos Fragkou
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Lazaros Sideras
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Panteleimon Panas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | | | - Emmanouil Sinakos
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Souglakos J, Boukovinas I, Kakolyris S, Xynogalos S, Ziras N, Athanasiadis A, Androulakis N, Christopoulou A, Vaslamatzis M, Ardavanis A, Emmanouilides C, Bompolaki I, Kourousis C, Makrantonakis P, Christofyllakis C, Athanasiadis E, Kentepozidis N, Karampeazis A, Katopodi U, Anagnosopoulos A, Papadopoulos G, Prinarakis E, Kalisperi A, Mavroudis D, Georgoulias V. Three- versus six-month adjuvant FOLFOX or CAPOX for high-risk stage II and stage III colon cancer patients: the efficacy results of Hellenic Oncology Research Group (HORG) participation to the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) project. Ann Oncol 2020; 30:1304-1310. [PMID: 31228203 DOI: 10.1093/annonc/mdz193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) aimed to investigate whether a 3 months (3M) of oxaliplatin/fluoropyrimidine-based adjuvant chemotherapy (CT) is non-inferior to the 6-month (6M) administration in 3-year disease-free survival (3yDFS) in high-risk (HR) stage II or stage III colon cancer (CC). METHODS Hellenic Oncology Research Group (HORG)-IDEA randomized patients between 3M and 6M of CT with FOLFOX4 or CAPOX. RESULTS In total 1115 patients, 413 with HR stage II and 702 with stage III CC, were randomized. The median follow-up was 67.0 (38.3-126.0) months. Overall, 394 DFS events (202 in 3M arm and 192 in 6M arm) where recorded. The 3yDFS rate was 77.2% [95% confidence interval (CI) 72.1% to 82.3%] for 3M and 77.9% (72.6% to 82.5%) for 6M of treatment [hazard ratio (HR) 1.05 (95% CI 0.61-1.55); P = 0.647]. Eighty DFS events (3M N = 41; 6M N = 39) were observed in HR stage II patients for a 3yDFS rate of 82.7% and 83.4%, respectively (HR 1.05; 95% CI 0.68-1.63, P = 0.829). For stage III patients, 314 DFS events (3M N = 161 and 6M N = 153) were observed, for a 3yDFS rate of 72.9% for 3M versus 74.1% for 6M (HR 1.06; 95% CI 0.81-1.42, P = 0.622). For HR stage II patients receiving FOLFOX4, 3yDFS rate was 76.7% for 3M and 79.3% for 6M (HR 1.21; 95% CI 0.54-2.70). For HR stage II patients receiving CAPOX the 3yDFS rate was 85.4% for 3M and 83.8% for 6M (HR 0.99; 95% CI 0.59-1.67). For stage III patients receiving FOLFOX4, the 3yDFS rate was 71.5% for 3M and 77.3% for 6M (HR 1.18; 95% CI 0.74-1.86). For stage III patients receiving CAPOX, the 3yDFS rate was 74.5% for 3M and 74.7% for 6M (HR 0.99; 95% CI 0.70-1.44). CONCLUSIONS The results of the HORG-IDEA study are in line with those of the global IDEA project, indicating that the 3yDFS is dependent on the administered adjuvant regimen and the choice and duration of regimen should be personalized. CLINICALTRIALS.GOV REGISTRATION NUMBER NCT01308086.
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Affiliation(s)
- J Souglakos
- Hellenic Oncology Research Group, Athens, Greece.
| | - I Boukovinas
- Hellenic Oncology Research Group, Athens, Greece
| | - S Kakolyris
- Hellenic Oncology Research Group, Athens, Greece
| | - S Xynogalos
- Hellenic Oncology Research Group, Athens, Greece
| | - N Ziras
- Hellenic Oncology Research Group, Athens, Greece
| | | | | | | | | | - A Ardavanis
- Hellenic Oncology Research Group, Athens, Greece
| | | | - I Bompolaki
- Hellenic Oncology Research Group, Athens, Greece
| | - C Kourousis
- Hellenic Oncology Research Group, Athens, Greece
| | | | | | | | | | | | - U Katopodi
- Hellenic Oncology Research Group, Athens, Greece
| | | | | | - E Prinarakis
- Hellenic Oncology Research Group, Athens, Greece
| | - A Kalisperi
- Hellenic Oncology Research Group, Athens, Greece
| | - D Mavroudis
- Hellenic Oncology Research Group, Athens, Greece
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Filippou D, Kleontas A, Tentzeris V, Emmanouilides C, Tryfon S, Baka S, Filippou I, Papagiannopoulos K. Extended resections for the treatment of patients with T4 stage IIIA non-small cell lung cancer (NSCLC) (T 4N 0-1M 0) with or without cardiopulmonary bypass: a 15-year two-center experience. J Thorac Dis 2020; 11:5489-5501. [PMID: 32030268 DOI: 10.21037/jtd.2019.11.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Stage IIIA non-small cell lung cancer (NSCLC) is a heterogeneous group of patients, often requiring variable and individualized approaches. The dilemma to operate or not frequently arises, since more than 75% of the cases of NSCLC are diagnosed in advanced stages (IIIA). The main objective of this study was to assess whether the benefits outweigh surgical risks for the T4N0-1M0 subgroup. Methods Data from 857 patients with locally advanced T4 NSCLC were retrospectively collected from two different institutions, between 2002 and 2017. Clinical data that were retrieved and analyzed, included demographics, comorbidities, surgical details, neoadjuvant or/and adjuvant therapy and postoperative complications. Results Twelve patients were in the cardiopulmonary bypass (CPB) group and thirty in the non-CPB. The most common types of lung cancer were squamous cell carcinoma (50.0%) and adenocarcinoma (35.7%). The most frequent invasion of the tumor was seen in main pulmonary artery and the superior vena cava. Significantly more patients of the CPB group underwent pneumonectomy as their primary lung resection (P=0.006). In all patients R0 resection was achieved according to histological reports. The overall 5-year survival was 60%, while the median overall survival was 22.5 months. Analysis revealed that patient age (P=0.027), preoperative chronic obstructive pulmonary disease (COPD) (P=0.001), tumor size (4.0 vs. 6.0 cm) (P=0.001), postoperative respiratory dysfunction (P=0.001) and postoperative atelectasis (P=0.036) are possible independent variables that are significantly correlated with patient outcome. Conclusions We suggest that in patients with stage IIIA/T4 NSCLC, complete resection of the T4 tumor, although challenging, can be performed in highly selected patients. Such an approach seems to result in improved long-term survival. More specific studies on this area of NSCLC probably will further enlighten this field, and may result in even better outcomes, as advanced systemic perioperative approaches such as modern chemotherapy, immunotherapy and improvements in radiation therapy have been incorporated in daily practice.
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Affiliation(s)
- Dimitrios Filippou
- Cardiothoracic Department of European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Kleontas
- Cardiothoracic Department of European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | | | - Christos Emmanouilides
- Oncology Department of European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Stavros Tryfon
- Pulmonology Department of "Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Sofia Baka
- Oncology Department of European Interbalkan Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Filippou
- Pulmonology Department of "Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, Greece
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Zafrakas M, Papasozomenou P, Emmanouilides C. Sorafenib in breast cancer treatment: A systematic review and overview of clinical trials. World J Clin Oncol 2016; 7:331-336. [PMID: 27579253 PMCID: PMC4974240 DOI: 10.5306/wjco.v7.i4.331] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/15/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the current role of sorafenib, an oral multikinase inhibitor in the treatment of breast cancer.
METHODS: An extensive search of the literature until March 2016 was carried out in Medline and clinicaltrials.gov, by using the search terms “sorafenib” and “breast cancer”. Papers found were checked for further relevant publications. Overall, 21 relevant studies were found, 18 in advanced breast cancer (16 in stage IV and two in stages III-IV) and three in early breast cancer.
RESULTS: Among studies in advanced breast cancer, there were two trials with sorafenib as monotherapy, four trials of sorafenib in combination with taxanes, two in combination with capecitabine, one with gemcitabine and/or capecitabine, one with vinorelbine, one with bevacizumab, one with pemetrexed and one with ixabepilone, three trials of sorafenib in combination with endocrine therapy and two trials in women with brain metastases undergoing whole brain radiotherapy. In addition, there was one trial of sorafenib added to standard chemotherapy in the adjuvant setting, and two trials in the neoadjuvant setting. In general, sorafenib was well tolerated in breast cancer patients, though its dosage had to be adjusted in some trials, and discontinuation rates were high, particularly for the combination of sorafenib with anastrozole. Sorafenib monotherapy and combinations with taxanes, bevacizumab and ixabepilone showed inadequate efficacy, while efficacy results from combinations with gemcitabine and/or capecitabine and possibly tamoxifen were more promising.
CONCLUSION: At present, sorafenib should not be used for the treatment of breast cancer outside of clinical trials and more clinical data are needed in order to support its standard use in breast cancer therapy.
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Emmanouilides C. Reorganisation of Oncologic Care in Greece: A Proposal. Forum of Clinical Oncology 2016. [DOI: 10.1515/fco-2015-0018] [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: 11/15/2022] Open
Abstract
Abstract
Cancer is becoming a major public health issue as patients enjoy longer survivals than ever before due to the introduction innovative but expensive drugs in the clinic. In addition, the ageing of the population in Greece is expected to increase the absolute incidence of cancer. The National Health System should rapidly and efficiently adapt to the new challenges, including increased pharmaceutical costs. Resources ought to be allocated rationally and efficiently while maintaining adequate coverage for the insured population. Economising due to large-scale operations should be pursued by the governmental single payor (EOPYY), so that affordable coverage remains feasible. Establishment of mechanisms to deal with new and very costly drugs should be put in place. The major changes in anchor oncologic hospitals are needed in order to play a role as regional leaders in oncologic care, including merging of similar divisions, subspecialisation of services and promotion of clinical research. These major centres could coordinate a host of satellite oncology services in other urban hospitals and in the provinces. In addition, joint operations in training and patient care should be pursued with major private centres, without mutual mistrust or obsolete inflexibilities. The current financial crisis represents an excellent opportunity for revisioning and restructuring oncologic care in Greece, taking into account the societal needs and based on flexibility and efficiency.
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Tryfon S, Zarogoulidis P, Tsavlis D, Tsirgogianni K, Zissimopoulos A, Kioumis I, Emmanouilides C, Baka S, Titopoulos H, Dager A, Filippou D. Ex situ reimplantation technique, in central lung tumors. Ann Transl Med 2015; 3:178. [PMID: 26366395 DOI: 10.3978/j.issn.2305-5839.2015.08.03] [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] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/04/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The parenchyma-sparing resection is most often performed in patients with impaired preoperative lung or cardiovascular function who would not be able to tolerate a pneumonectomy. METHODS Our experience on the ex situ reimplantation procedure and the outcome of patients with lung malignancies, who underwent upper or upper-middle lobectomy, with reimplantation of the lower lobe was reported. RESULTS We present 9 patients mean age 62.6+16.2 years (7 males/2 females) underwent ex situ reimplantation due to extensive lung tumor of upper lobes. The surgical technique precludes IV heparinization and then radical pneumonectomy. The entire lung was immersed in Ringer's solution (temperature 4 degrees centigrade) and bench surgery was performed. The involved upper (or upper-middle) lobes with involved lymph nodes were resected, thus leaving the healthy lower lobe of the lung. Pneumoplegia solution, named "Papworth pneumoplegia", was administered (1,473 mL) through catheterization of the pulmonary artery and vein stumps (ante grade and retrograde) along with 250 mL of prostaglandin E1. Re-implantation of the lower lobe was performed (I) on the right side, implantation involved the anastomosis of lower pulmonary vein in the site of the cuff of left atrium, followed by suturing the stump of the intermedius pulmonary artery to the right main pulmonary artery and finally the bronchial stumps-intermedius bronchus to the right main bronchus; (II) on the left side the pulmonary vein was anastomosed first, followed by the bronchial stumps and finally by the pulmonary artery. The graft ischemia time was 70.2+8.4 minutes ranged between 55 and 80 minutes. CONCLUSIONS Re-implantation or auto-transplantation should be considered as a safe option for the appropriate patient with lung cancer. The ex situ separation of the cancerous lobes is technically feasible and allows extensive pulmonary resection while minimizing the loss of pulmonary reserve. Based on our work, the major factors that play a role for the survival of initially resected and then re-implanted lung graft, are: (I) the ischemia time of the re-implanted lobe; (II) the proper use of pneumoplegia solutions, along with prostaglandin E1 and heparin; (III) the occurrence of pulmonary vein thrombosis; and (IV) the bronchial anastomosis.
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Affiliation(s)
- Stavros Tryfon
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Drosos Tsavlis
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Katerina Tsirgogianni
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Athanasios Zissimopoulos
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Christos Emmanouilides
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Sofia Baka
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Hercules Titopoulos
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Albert Dager
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Dimitrios Filippou
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
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Thiery-Vuillemin A, Theodore C, Jacobasch L, Schmitz J, Papandreou C, Guillot A, Emmanouilides C, Slimane K, Kelkouli N, Kim S, Nguyen Tan Hon T. Efficacy and Safety of Sequential Use of Everolimus in Patients With Metastatic Renal Cell Carcinoma Previously Treated With Bevacizumab With or Without Interferon Therapy: Results From the European AVATOR Study. Clin Genitourin Cancer 2015; 13:231-8. [DOI: 10.1016/j.clgc.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 01/11/2023]
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Emmanouilides C, Tryfon S, Baka S, Titopoulos H, Dager A, Filippou D. Operation for preservation of lung parenchyma in central lung cancer--in vivo and ex situ reimplantation techniques. Anticancer Res 2015; 35:1675-1681. [PMID: 25750327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Lobar reimplantation techniques enable the safe resection of lung cancer when pneumonectomy is not desirable or not feasible. We report our experience with this procedure. PATIENTS AND METHODS Patients with difficult to resect upper/middle lobe non-small cell lung cancer were included. In situ reimplantation technique requires the reanastomosis of the pulmonary vein of the healthy lower lobe to the upper lobe stump; bench surgery reimplantation involves the ex vivo surgical treatment of the whole excised lung and subsequent reimplantation of the healthy remnant. RESULTS Nine patients with upper-middle lobe lung cancer underwent in situ reimplantation, mean age=70.7±4.2 years; 6 patients underwent ex situ resection, mean age=64.3±18.4 years. One obese patient succumbed due to thrombosis of the anastomosed pulmonary vein. One patient developed a stroke. CONCLUSION The procedure was in general well-tolerated and enables for curative resection of otherwise unresectable lung cancer.
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Affiliation(s)
| | - Stavros Tryfon
- Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - Sofia Baka
- Department of Oncology, Thessaloniki, Greece
| | | | - Albert Dager
- Cardiothoracic Surgery at Interbalkan European Medical Center, Thessaloniki, Greece
| | - Dimitrios Filippou
- Cardiothoracic Surgery at Interbalkan European Medical Center, Thessaloniki, Greece
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Boukovinas I, Kentepozidis N, Vamvakas L, Karampeazis A, Varthalitis I, Emmanouilides C, Kalbakis K, Athanasiadis A, Georgoulias V, Souglakos J. Phase I Trial of Panitumumab in Combination with Cisplatin, Fluourouracil and Docetaxel (Mdcf) in Advanced/Metastatic Gastric Cancer. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt203.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Emmanouilides C, Yermetaki T, Serpanou A, Sapountzi E, Mantziari P, Titopoulos I, Filippou D. Feasibility study of dose-dense biweekly administered pemetrexed in patients with non-small cell lung cancer. Hematol Oncol Stem Cell Ther 2010; 3:34-8. [PMID: 20231811 DOI: 10.1016/s1658-3876(10)50054-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pemetrexed is a multitargeted folate pathway inhibitor with documented activity in non-small cell lung cancer (NSCLC). The presumed maximum tolerated dose is 500 mg/m2 every 3 weeks, but pemetrexed-related toxicity is ameliorated when folate and B12 supplementation is provided and therefore a higher dose intensity may be tolerated. The current exploratory study assessed the feasibility of administration of pemetrexed at a fixed dose of 1000 mg every 2 weeks in patients with relapsed or refractory NSCLC. PATIENTS AND METHODS The first cohort of 12 patients received pemetrexed monotherapy. No dose-limiting grade 4 toxicity was noted after 4 cycles, so the subsequent cohort of 14 patients received additional anticancer agents (bevacizumab, erlotinib, carboplatin, docetaxel, vinorelbine) given along with dose-dense pemetrexed. RESULTS Toxicity overall was reversible and manageable. Among 19 patients who received pemetrexed either alone or with non-myelosuppressive targeted agents, there were only 2 instances of grade 4 neutropenia after prolonged treatment. Grade 3-4 hematologic toxicity was eventually noted in 11 of the 26 patients (42%; 95% confidence interval, 23% to 61%) after a median of 4 cycles (range, 2-14 cycles). There was no significant additional toxicity nor any treatment-related deaths. CONCLUSION Our preliminary observations indicate that dose-dense pemetrexed every 2 weeks is feasible and this regimen can be used as monotherapy. These data may serve as a scaffold for combination studies.
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Emmanouilides C. Review of Y-ibritumomab tiuxetan as first-line consolidation radio-immunotherapy for B-cell follicular non-Hodgkin's lymphoma. Cancer Manag Res 2009; 1:131-6. [PMID: 21188131 PMCID: PMC3004670 DOI: 10.2147/cmr.s6765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Indexed: 11/23/2022] Open
Abstract
Several studies have indicated that radioimmunotherapy is an effective and clinically relevant complementary therapeutic approach for patients with B-cell non-Hodgkin's lymphoma (NHL) and may convert partial to complete response when given as consolidation after induction chemotherapy. Yttrium-90((90)Y)-ibritumomab tiuxetan ((90)Y-IT, Zevalin(®), Y2B8) has documented efficacy for both indolent and aggressive NHL. Patients considered eligible for (90)Y-IT treatment should satisfy several screening criteria. A recently completed randomized study for patients with follicular lymphoma has demonstrated that (90)Y-ibritumomab consolidation also produced a marked prolongation of the median time to progression from 13.5 to 37 months, while partial responders seem to derive relatively more benefit. Other published and ongoing studies explore a similar use for patients with aggressive lymphoma. Studies are comparing the use of (90)Y-IT consolidation with the anti-CD20 antibody rituximab maintenance, which is also gaining acceptance. In conclusion, the documented benefit of radioimmunotherapy should be viewed in the context of the goals of treatment and the changing standards of care for lymphoma.
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Emmanouilides C. Review of (90)Y-ibritumomab tiuxetan as first-line consolidation radio-immunotherapy for B-cell follicular non-Hodgkin’s lymphoma. Cancer Manag Res 2009. [DOI: 10.2147/cmar.s6765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Emmanouilides C, Witzig TE, Gordon LI, Vo K, Wiseman GA, Flinn IW, Darif M, Schilder RJ, Molina A. Treatment with yttrium 90 ibritumomab tiuxetan at early relapse is safe and effective in patients with previously treated B-cell non-Hodgkin's lymphoma. Leuk Lymphoma 2009; 47:629-36. [PMID: 16690521 DOI: 10.1080/10428190500376076] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [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: 10/24/2022]
Abstract
Yttrium 90 ((90)Y) ibritumomab tiuxetan (Zevalin), a radiolabeled monoclonal antibody against the CD20 antigen, is indicated for the treatment of patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma (NHL), including patients with rituximab-refractory follicular NHL. Data on 211 patients treated in four clinical trials were analysed to compare the efficacy and safety of (90)Y ibritumomab tiuxetan when it was used after the first relapse of NHL and when it was used after two or more prior therapies. Sixty-three patients (30%) were treated with (90)Y ibritumomab tiuxetan after their first relapse and 148 (70%) after two or more prior therapies. Demographics, disease characteristics and the frequency of adverse events were similar in all groups, with the exception of a higher rate of marrow involvement in first-relapse patients than in patients with two or more prior therapies (57% vs. 39%; P < 0.05). The complete response rate [confirmed (CR) and unconfirmed (Cru)] was higher in first-relapse patients (49% vs. 28%; P < 0.01), and the median time to progression (TTP) was longer (12.6 vs. 7.9 months; P < 0.05). In patients with follicular NHL, the differences were even more pronounced (CR/CRu: 51% vs. 28%; P < 0.01; TTP: 15.4 vs. 9.2 months; P < 0.05). (90)Y ibritumomab tiuxetan has substantial clinical benefits as a second-line therapy, especially in patients with follicular NHL. The quality of disease remissions obtained when (90)Y ibritumomab tiuxetan is administered after first relapse appears to be comparable with that observed with most chemotherapy regimens in first-relapse patients.
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Affiliation(s)
- Christos Emmanouilides
- Division of Hematology and Oncology, University of California Los Angeles, Los Angeles, CA 90095-1678, USA.
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Treon SP, Branagan AR, Ioakimidis L, Soumerai JD, Patterson CJ, Turnbull B, Wasi P, Emmanouilides C, Frankel SR, Lister A, Morel P, Matous J, Gregory SA, Kimby E. Long-term outcomes to fludarabine and rituximab in Waldenström macroglobulinemia. Blood 2009; 113:3673-8. [PMID: 19015393 PMCID: PMC2670786 DOI: 10.1182/blood-2008-09-177329] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 10/27/2008] [Indexed: 11/20/2022] Open
Abstract
We report the long-term outcome of a multicenter, prospective study examining fludarabine and rituximab in Waldenström macroglobulinemia (WM). WM patients with less than 2 prior therapies were eligible. Intended therapy consisted of 6 cycles (25 mg/m(2) per day for 5 days) of fludarabine and 8 infusions (375 mg/m(2) per week) of rituximab. A total of 43 patients were enrolled. Responses were: complete response (n = 2), very good partial response (n = 14), partial response (n = 21), and minor response (n = 4), for overall and major response rates of 95.3% and 86.0%, respectively. Median time to progression for all patients was 51.2 months and was longer for untreated patients (P = .017) and those achieving at least a very good partial response (P = .049). Grade 3 or higher toxicities included neutropenia (n = 27), thrombocytopenia (n = 7), and pneumonia (n = 6), including 2 patients who died of non-Pneumocystis carinii pneumonia. With a median follow-up of 40.3 months, we observed 3 cases of transformation to aggressive lymphoma and 3 cases of myelodysplastic syndrome/acute myeloid leukemia. The results of this study demonstrate that fludarabine and rituximab are highly active in WM, although short- and long-term toxicities need to be carefully weighed against other available treatment options. This study is registered at clinicaltrials.gov as NCT00020800.
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MESH Headings
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Myelodysplastic Syndromes/chemically induced
- Myelodysplastic Syndromes/mortality
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/mortality
- Neutropenia/chemically induced
- Neutropenia/mortality
- Pneumonia/chemically induced
- Pneumonia/mortality
- Prospective Studies
- Rituximab
- Survival Rate
- Thrombocytopenia/chemically induced
- Thrombocytopenia/mortality
- Time Factors
- Vidarabine/administration & dosage
- Vidarabine/adverse effects
- Vidarabine/analogs & derivatives
- Waldenstrom Macroglobulinemia/diet therapy
- Waldenstrom Macroglobulinemia/mortality
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Affiliation(s)
- Steven P Treon
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
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Leonard JP, Schuster SJ, Emmanouilides C, Couture F, Teoh N, Wegener WA, Coleman M, Goldenberg DM. Durable complete responses from therapy with combined epratuzumab and rituximab: final results from an international multicenter, phase 2 study in recurrent, indolent, non-Hodgkin lymphoma. Cancer 2008; 113:2714-23. [PMID: 18853418 DOI: 10.1002/cncr.23890] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In this international, multicenter trial, the authors evaluated rituximab (anti-CD20) plus epratuzumab (anti-CD22) in patients with postchemotherapy relapsed/refractory, indolent non-Hodgkin lymphoma (NHL), including long-term efficacy. METHODS Forty-nine patients with follicular NHL (FL) (N = 41) or small lymphocytic lymphoma (SLL) (N = 7) received intravenous epratuzumab 360 mg/m2 and then intravenous rituximab 375 mg/m2 weekly x4. The regimen was tolerated well. RESULTS Twenty-two of 41 patients with FL (54%) had an objective response (OR), including 10 (24%) complete responses (CR) (CR/unconfirmed CR [CRu]), whereas 4 of 7 patients with SLL (57%) had ORs, including 3 (43%) with CR/CRu. Rituximab-naive patients (N = 34) had an OR rate of 50% (26% CR/CRu rate), whereas patients who previously responded to rituximab (N = 14) had an OR rate of 64% (29% CR/CRu rate). An OR rate of 85% was observed in patients with FL who had Follicular Lymphoma International Prognostic Index (FLIPI) risk scores of 0 or 1 (N = 13), whereas 28 patients with intermediate or high-risk FLIPI scores (> or =2) had an OR rate of 39% (18% CR/CRu rate). In patients with FL, the median response duration was 13.4 months, and that duration increased to 29.1 months for 10 patients who had a CR/CRu, including 4 patients who had durable responses with remissions that continued for >4 years. In patients with SLL, the median response duration was 20 months, including 1 patient who had a response that continued for >3 years. CONCLUSIONS The combination of epratuzumab and rituximab induced durable responses in patients with recurrent, indolent NHL.
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Affiliation(s)
- John P Leonard
- Center for Lymphoma and Myeloma, Division of Hematology/Oncology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York, USA.
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20
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Kagiava A, Tsingotjidou A, Emmanouilides C, Theophilidis G. The effects of oxaliplatin, an anticancer drug, on potassium channels of the peripheral myelinated nerve fibres of the adult rat. Neurotoxicology 2008; 29:1100-6. [PMID: 18845186 DOI: 10.1016/j.neuro.2008.09.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 09/04/2008] [Accepted: 09/09/2008] [Indexed: 12/27/2022]
Abstract
Oxaliplatin is a novel chemotherapeutic agent which is effective against advanced colorectal cancer, but at the same time causes severe neuropathy in the peripheral nerve fibres, affecting mainly the voltage-gated sodium (Na(+)) channels (VGNaCs), according to literature. In this study the effects of oxaliplatin on the peripheral myelinated nerve fibres (PMNFs) were investigated in vitro using the isolated sciatic nerve of the adult rat. The advantage of this nerve-preparation was that stable in amplitude evoked compound action potentials (CAP) were recorded for over 1000min. Incubation of the sciatic nerve fibres in 25, 100 and 500microM oxaliplatin, for 300-700min caused dramatic distortion of the waveform of the CAP, namely broadening the repolarization phase, repetitive firing and afterhyperpolarization (AHP), related to the malfunction of voltage-gated potassium (K(+)) channels (VGKCs). At a concentration of 5microM, oxaliplatin caused broadening of the repolarization phase of the CAP only, while the no observed effect concentration was estimated to be 1microM. These findings are indicative of severe effects of oxaliplatin on the VGKCs. In contrast, the amplitude and the rise-time of the depolarization of the CAP did not change significantly, a clear indication that the VGNaCs of the particular nerve preparation were not affected by oxaliplatin. The effects of oxaliplatin on the PMNFs were similar to those of 4-aminopyridine (4-AP), a classical antagonist of VGKCs. These similarities in the pattern of action between oxaliplatin and 4-AP combined with the fact that the effects of oxaliplatin were more pronounced and developed at lower concentrations suggest that oxaliplatin acts as a potent VGKCs antagonist.
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Affiliation(s)
- Alexia Kagiava
- Laboratory of Animal Physiology, Department of Zoology, School of Biology, Aristotle University of Thessaloniki, University Campus, Thessaloniki 54 124, Greece
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Kosmidis C, Efthimiadis C, Anthimidis G, Levva S, Ioannidou G, Zaramboukas T, Emmanouilides C, Baka S, Kosmidou M, Basdanis G, Fachantidis E. Adrenalectomy for solitary adrenal metastasis from colorectal cancer: A case report. Cases J 2008; 1:49. [PMID: 18638404 PMCID: PMC2503966 DOI: 10.1186/1757-1626-1-49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 07/18/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with adrenal metastasis from various primary tumours are regarded as cases of diffuse systemic spread and considered unsuitable for surgical resection. We herein report an operable case of heterochronic adrenal metastasis from colorectal carcinoma in a 63-year-old woman. CASE PRESENTATION Sixteen months after low anterior resection for the primary tumour, left lower pneumonectomy was performed for a solitary lung metastasis. Four months later a right adrenal metastasis was detected by magnetic resonance imaging (MRI), as sole evidence of metastatic disease. A right adrenalectomy was performed. The histopathological examination revealed adenocarcinoma compatible with the colorectal carcinoma resected 19 months earlier. The patient received adjuvant chemotherapy after each operation and is alive and free of disease 21 months after the adrenalectomy. CONCLUSION The possibility of adrenal metastasis should be considered in the follow-up of patients after primary surgery for colorectal cancer, even though other sites are the main metastatic sites. Although the prognosis of adrenal metastasis from colorectal cancer is poor, we suggest that patients with solitary adrenal metastasis may benefit from complete removal of it.
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Affiliation(s)
- Christopher Kosmidis
- Departments of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - George Anthimidis
- Departments of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Sofia Levva
- Departments of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Georgia Ioannidou
- Departments of Radiology, "Panagia" General Hospital, Thessaloniki, Greece
| | - Thomas Zaramboukas
- Departments of Pathology, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Sofia Baka
- Departments of Oncology, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Maria Kosmidou
- Departments of Internal Medicine, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Georgios Basdanis
- Departments of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece
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Emmanouilides C. Anticancer effects on leiomyosarcoma-bearing Wistar rats after electromagnetic radiation of resonant radiofrequencies. Hell J Nucl Med 2008; 11:122-124. [PMID: 18815672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Wiseman GA, Conti PS, Vo K, Schilder RJ, Gordon LI, Emmanouilides C, Silverman DH, Witzig TE, Darif M, Molina A. Weight-based dosing of Yttrium 90 ibritumomab tiuxetan in patients with relapsed or refractory B-cell non-Hodgkin lymphoma. ACTA ACUST UNITED AC 2008; 7:514-7. [PMID: 18021468 DOI: 10.3816/clm.2007.n.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ibritumomab tiuxetan radioimmunotherapy produces durable remissions in patients with relapsed/refractory indolent non-Hodgkin lymphoma. The dosing of Yttrium 90 (90Y)-ibritumomab tiuxetan is based on patient weight and platelet count: 0.4 mCi/kg in patients with a count >or= 150 x 10(9)/L, to a maximum dose of 32 mCi. Patients weighing > 80 kg with platelet counts of >or= 150 x 10(9)/L receive a lower dose per unit of body weight. We evaluated whether this influences the safety or efficacy of treatment. PATIENTS AND METHODS Data on efficacy and safety in patients in 3 registration trials who were treated with 90Y ibritumomab tiuxetan at 0.4 mCi/kg (patients weighing <or= 80 kg) or 32 mCi (patients weighing > 80 kg) were collected. RESULTS Clinical responses were evaluated in 103 patients weighing <or= 80 kg (median, 70 kg) and 67 patients weighing > 80 kg (median, 95 kg). Sex (41% female vs. 73% male) was the only significantly different characteristic between the patients weighing <or= 80 kg and > 80 kg, respectively. The overall response rates were 79% (<or= 80 kg) and 70% (> 80 kg), and the complete response rates were 28% and 34%, respectively. Median times to progression were 8.9 months (<or= 80 kg) and 9.5 months (> 80 kg). There were no significant differences in efficacy measures or in the incidences of grade 3/4 nonhematologic adverse events, neutropenia, thrombocytopenia, or anemia. CONCLUSION The dose of 90Y ibritumomab tiuxetan was < 0.4 mCi/kg in 39% of patients, owing to the 32-mCi dose cap, but the efficacy or safety of 90Y ibritumomab tiuxetan in patients > 80 kg was not affected.
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Leonard JP, Link BK, Emmanouilides C, Gregory SA, Weisdorf D, Andrey J, Hainsworth J, Sparano JA, Tsai DE, Horning S, Krieg AM, Weiner GJ. Phase I trial of toll-like receptor 9 agonist PF-3512676 with and following rituximab in patients with recurrent indolent and aggressive non Hodgkin's lymphoma. Clin Cancer Res 2007; 13:6168-74. [PMID: 17947483 DOI: 10.1158/1078-0432.ccr-07-0815] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE PF-3512676 (formerly CpG 7909) is a novel Toll-like receptor 9-activating oligonucleotide with single-agent antitumor activity that augments preclinical rituximab efficacy. This Phase I trial was designed to investigate the safety, tolerability, and preliminary antitumor activity of PF-3512676 in combination with rituximab. EXPERIMENTAL DESIGN Patients with relapsed/refractory CD20+ B cell non-Hodgkin's lymphoma received i.v. rituximab (375 mg/m2/week for 4 weeks) and PF-3512676 weekly for 4 weeks either i.v. (0.04, 0.16, 0.32, or 0.48 mg/kg) or s.c. (0.01, 0.04, 0.08, or 0.16 mg/kg). An additional extended-treatment cohort received 4 weeks of 0.24 mg/kg s.c. PF-3512676 in combination with rituximab followed by s.c. PF-3512676 alone weekly for 20 weeks. RESULTS Patients (N = 50) had received a median of three prior therapies (range, 1-11) including rituximab in 80% of patients. Treatment-related adverse events occurred in 11 of 19 (58%) i.v. patients, 15 of 19 (79%) s.c. patients, and all 12 patients in the extended-treatment cohort. Most common adverse events were mild to moderate systemic flu-like symptoms and injection-site reactions (s.c. cohorts only). Grade 3/4 neutropenia occurred in four patients. Objective responses occurred in 12 of 50 (24%) patients overall and in 6 of 12 (50%) patients in the extended-treatment cohort, including 2 patients with rituximab-refractory disease. CONCLUSION Brief or extended-duration PF-3512676 can be safely administered in combination with rituximab in patients with relapsed/refractory non-Hodgkin's lymphoma.
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Affiliation(s)
- John P Leonard
- Weill Medical College of Cornell University, New York, New York, USA
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25
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Emmanouilides C, Witzig TE, Wiseman GA, Gordon LI, Wang H, Schilder R, Saville MW, Flinn I, Molina A. Safety and Efficacy of Yttrium-90 Ibritumomab Tiuxetan in Older Patients With Non-Hodgkin's Lymphoma. Cancer Biother Radiopharm 2007; 22:684-91. [DOI: 10.1089/cbr.2007.359] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Leo I. Gordon
- Division of Hematology/Oncology, Northwestern University Medical School, Chicago, IL
| | - Hua Wang
- Global Medical Affairs, Biogen Idec Inc., San Diego, CA
| | - Russell Schilder
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Ian Flinn
- Hematologic Malignancies Research, Sarah Cannon Research Institute, Nashville, TN
| | - Arturo Molina
- Global Medical Affairs, Biogen Idec Inc., San Diego, CA
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Czuczman MS, Emmanouilides C, Darif M, Witzig TE, Gordon LI, Revell S, Vo K, Molina A. Treatment-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Patients Treated With Ibritumomab Tiuxetan Radioimmunotherapy. J Clin Oncol 2007; 25:4285-92. [PMID: 17709799 DOI: 10.1200/jco.2006.09.2882] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo investigate the incidence of treatment-related myelodysplastic syndrome (t-MDS) and treatment-related acute myelogenous leukemia (t-AML) after treatment with ibritumomab tiuxetan radioimmunotherapy.Patients and MethodsAnalysis of the incidence of t-MDS and t-AML in 746 patients with non-Hodgkin's lymphoma (NHL) treated with the ibritumomab tiuxetan regimen in registration and compassionate-use trials between 1996 and 2002.ResultsNineteen patients (2.5%) developed t-MDS or t-AML at a median follow-up of 4.4 years (range, 0 to 9.3). These malignancies were diagnosed at a median of 5.6 years (range, 1.4 to 13.9) after the diagnosis of NHL and 1.9 years (range, 0.4 to 6.3) after radioimmunotherapy. The annualized rates were 0.3% per year after the diagnosis of NHL and 0.7% per year after treatment. Most patients with t-MDS or t-AML had multiple cytogenetic aberrations, commonly on chromosomes 5 and 7, suggesting an association with previous exposure to chemotherapy.ConclusionAnalysis of data from patients in registration and compassionate-use trials suggests that the annualized incidences of t-MDS and t-AML are consistent with that expected in patients with NHL who have had extensive previous chemotherapy treatment and do not appear to be increased after treatment with the ibritumomab tiuxetan regimen. Cytogenetic testing before treatment with radioimmunotherapy may identify existing chromosomal abnormalities in previously treated patients, particularly those who have been treated with alkylating agents and purine nucleoside analogs and would be at higher risk for t-MDS or t-AML.
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Witzig TE, Molina A, Gordon LI, Emmanouilides C, Schilder RJ, Flinn IW, Darif M, Macklis R, Vo K, Wiseman GA. Long-term responses in patients with recurring or refractory B-cell non-Hodgkin lymphoma treated with yttrium 90 ibritumomab tiuxetan. Cancer 2007; 109:1804-10. [PMID: 17380530 DOI: 10.1002/cncr.22617] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [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: 11/10/2022]
Abstract
BACKGROUND Radioimmunotherapy with radiolabeled monoclonal antibodies to CD20 produces a high response rate in patients with recurring non-Hodgkin lymphoma (NHL), but the durability of those remissions is not well defined. METHODS Data on patients with recurring NHL treated with yttrium Y 90 ibritumomab tiuxetan in 4 clinical trials were reviewed to identify patients with a long-term response, defined as a time to progression of 12 months or longer. RESULTS Long-term responses were seen in 37% (78/211) of patients. At a median follow-up of 53.5 months (range, 12.7-88.9) the median duration of response was 28.1 months and the median time to progression was 29.3 months. A third of these patients had been treated with at least 3 previous therapies, and 37% of them had not responded to their last therapy. The findings in patients with follicular lymphoma (n=59) were similar to those in the overall population of long-term responders. The estimated overall survival at 5 years was 53% for all patients treated with 90Y ibritumomab tiuxetan and 81% for long-term responders. CONCLUSIONS A single dose of 90Y ibritumomab tiuxetan can produce durable responses and prolonged overall survival in a substantial number of patients in whom previous therapies have failed.
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Affiliation(s)
- Thomas E Witzig
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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29
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Khan KD, Emmanouilides C, Benson DM, Hurst D, Garcia P, Michelson G, Milan S, Ferketich AK, Piro L, Leonard JP, Porcu P, Eisenbeis CF, Banks AL, Chen L, Byrd JC, Caligiuri MA. A phase 2 study of rituximab in combination with recombinant interleukin-2 for rituximab-refractory indolent non-Hodgkin's lymphoma. Clin Cancer Res 2006; 12:7046-53. [PMID: 17145827 DOI: 10.1158/1078-0432.ccr-06-1571] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The incidence of non-Hodgkin's lymphoma (NHL), the fifth most common malignancy in the United States, has increased over 70% in the last 30 years. Fifty percent to 75% of patients with low-grade or follicular NHL respond to rituximab therapy. However, responses are generally of limited duration, and complete responses are rare. Preclinical work suggests that human recombinant interleukin-2 (rIL-2; aldesleukin, Proleukin) enhances rituximab efficacy. Antibody-dependent cellular cytotoxicity (ADCC) is an important mechanism of action of rituximab. rIL-2 induces expansion and activation of Fc receptor (FcR)-bearing cells, thereby enhancing ADCC. Therefore, a large, multicenter phase 2 trial to assess the effects of rIL-2 on rituximab therapy in patients with rituxumab-refractory low-grade NHL was conducted. EXPERIMENTAL DESIGN The combination of rituximab and rIL-2 was studied in 57 patients with rituximab-refractory low-grade NHL (i.e., patients must have received a single-agent course of rituximab and showed no tumor response, or had a response lasting <6 months). I.V. rituximab was given at 375 mg/m(2) (weeks 1-4). S.C. rIL-2 was given thrice a week at 14 MIU (weeks 2-5) and at 10 MIU (weeks 6-9). RESULTS Rituximab plus rIL-2 combination therapy was safe and generally well tolerated, but responses were low. Fifty-seven patients were enrolled with 54 evaluable for response; however, only five responses (one complete and four partial) were observed. Correlative data indicate that rIL-2 expanded FcR-bearing cells and enhanced ADCC. However, other factors, such as FcgammaR polymorphisms in patients refractory to single-agent rituxumab and heterogeneous tumor biology, may have influenced the lack of clinical efficacy seen with this combination therapy. CONCLUSIONS rIL-2 expands FcR-bearing cellular subsets in vivo and enhances in vitro ADCC of rituxumab. However, these findings do not directly translate into meaningful clinical benefit for patients with rituxumab-refractory NHL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD/genetics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Disease-Free Survival
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drug-Related Side Effects and Adverse Reactions
- Female
- Follow-Up Studies
- Humans
- Injections, Intravenous
- Injections, Subcutaneous
- Interleukin-2/administration & dosage
- Interleukin-2/adverse effects
- Kaplan-Meier Estimate
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/genetics
- Male
- Maximum Tolerated Dose
- Middle Aged
- Neoplasm Staging
- Polymorphism, Genetic/genetics
- Receptors, IgG/genetics
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/adverse effects
- Rituximab
- Treatment Outcome
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Affiliation(s)
- Khuda D Khan
- American Health Network Oncology/Hematology, Indianapolis, Indiana, USA
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Stiff PJ, Emmanouilides C, Bensinger WI, Gentile T, Blazar B, Shea TC, Lu J, Isitt J, Cesano A, Spielberger R. Palifermin Reduces Patient-Reported Mouth and Throat Soreness and Improves Patient Functioning in the Hematopoietic Stem-Cell Transplantation Setting. J Clin Oncol 2006; 24:5186-93. [PMID: 16391299 DOI: 10.1200/jco.2005.02.8340] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo describe patient-reported outcomes of mouth and throat soreness (MTS) and related sequelae on daily activities from a phase III study of palifermin in the autologous hematopoietic stem-cell transplantation (HSCT) setting and to compare patient self-evaluations with clinicians' assessments of oral mucositis using objective scales.Patients and MethodsPatients (n = 212) received palifermin (60 μg/kg/d) or placebo for 3 days before total-body irradiation (12 Gy), etoposide 60 mg/kg, and cyclophosphamide 100 mg/kg, and 3 days after HSCT. Patients completed a daily questionnaire (Oral Mucositis Daily Questionnaire [OMDQ]) evaluating MTS severity and its effects on daily functional activities. Patients' self-assessment data were compared with clinicians' assessments of oral mucositis using the objective scales.ResultsPalifermin reduced the incidence and duration of severe oral mucositis, as assessed by both clinicians and patients. Comparisons between patient and clinician assessments demonstrated that the average daily scores between mucositis grade and subjective (MTS) instruments were similar, although patients reported MTS onset, peak, and resolution earlier (1 to 3 days) than clinicians' assessments. Patients receiving palifermin reported statistically significant improvements (P < .001) in daily functioning activities (swallowing, drinking, eating, talking, sleeping) and required significantly less narcotic opioids (P < .001); improvement in the patient's overall physical and functional well-being was also reported. This was confirmed by the results of the Functional Assessment of Cancer Treatment questionnaire.ConclusionThese results support the clinical benefit of palifermin in the HSCT setting, providing evidence that a patient's self-assessment instrument (OMDQ) may serve as an alternative tool to assess oral mucositis severity in clinical trials.
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Winston DJ, Baden LR, Gabriel DA, Emmanouilides C, Shaw LM, Lange WR, Ratanatharathorn V. Pharmacokinetics of ganciclovir after oral valganciclovir versus intravenous ganciclovir in allogeneic stem cell transplant patients with graft-versus-host disease of the gastrointestinal tract. Biol Blood Marrow Transplant 2006; 12:635-40. [PMID: 16737936 DOI: 10.1016/j.bbmt.2005.12.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 12/22/2005] [Indexed: 11/16/2022]
Abstract
The pharmacokinetics of ganciclovir after oral valganciclovir versus intravenous ganciclovir were compared in allogeneic stem cell transplant recipients with stable graft-versus-host disease of the gastrointestinal tract. Twenty-two evaluable adult patients were randomized to receive a single dose of open-label study drug (900 mg of oral valganciclovir or 5 mg/kg of intravenous ganciclovir). After a washout period of 2 to 7 days, patients were crossed over to receive the alternate study drug. Ganciclovir and valganciclovir concentrations in plasma were measured over 24 hours after dosing. Noninferiority of 900 mg of valganciclovir relative to intravenous ganciclovir was concluded if the lower limit of the 1-sided 95% confidence interval of the ratio of least-square means of the ganciclovir area under the curve (AUC) for the 2 study drugs was >80%. Valganciclovir was found to be rapidly absorbed and converted into ganciclovir. The ganciclovir exposure after 900 mg of valganciclovir noninferior to that of intravenous ganciclovir (AUC0-infinity, 52.1 and 53.8 microg.h/mL, respectively; 95% confidence interval of the ratio of least square means of AUC0-infinity, 82.48%-118.02%). Oral valganciclovir could be a useful alternative to intravenous ganciclovir in certain stable stem cell transplant patients who require prophylaxis or preemptive therapy for cytomegalovirus infection.
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Affiliation(s)
- Drew J Winston
- Department of Medicine, University of California-Los Angeles Medical Center, Los Angeles, California 90095, and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, USA.
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Pangalis GA, Kyrtsonis MC, Vassilakopoulos TP, Dimopoulou MN, Siakantaris MP, Emmanouilides C, Doufexis D, Sahanas S, Kontopidou FN, Kalpadakis C, Angelopoulou MK, Dimitriadou EM, Kokoris SI, Panayiotidis P. Immunotherapeutic and Immunoregulatory Drugs in Haematologic Malignancies. Curr Top Med Chem 2006; 6:1657-86. [PMID: 17017950 DOI: 10.2174/156802606778194235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/22/2022]
Abstract
A better understanding of the biology and pathogenesis of hematological malignancies has led to the development of immunotherapeutic and immunoregulatory drugs. Many of these agents have revolutionized the current treatment modalities, while others are under investigation. Rituximab (anti-CD20 antibody) has been established as the gold standard of treatment for aggressive B-cell lymphomas in combination with CHOP and has shown significant activity as monotherapy in the treatment of indolent B-cell lymphomas. In follicular lymphomas the combination of Rituximab with chemotherapy improves the outcome compared to chemotherapy alone. CD 20-based radioimmunotherapy, with the advantage of the bystander effect, represents an additional therapeutic alternative in B-cell lymphomas and may produce tumor regression in Rituximab resistant patients. The anti-CD52 monoclonal antibody, alemtuzumab, further expands the armamentarium against lymphoid malignancies producing high response rates in these entities. Antibody-targeted chemotherapy such as gemtuzumab ozogamicin, consisting of an anti-CD33 antibody combined to calicheamicin, has shown efficacy in the treatment of refractory acute myeloid leukemia; exact indications, timing and dosing schedule for optimized efficacy remain to be determined. Interferons have proven significant activity in cutaneous lymphomas, hairy cell leukemia and chronic myelogenous leukemia by mechanisms that are not fully elucidated. Thalidomide, by acting as an immunomodulatory and antiangiogenic agent can modulate neoplastic cells microenvironment and lead to disease control in multiple myeloma as well as in numerous other hematological malignancies. Bortezomib, a proteasome inhibitor, displays significant anti-tumor activity, especially in multiple myeloma and lymphoproliferative disorders. The addition of these agents in therapeutic regimens has improved considerably the treatment of hematological malignancies.
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Affiliation(s)
- Gerassimos A Pangalis
- First Department of Internal Medicine, First Department of Propedeutic Internal Medicine & Department of Hematology, National and Kapodistrian University of Athens Medical School, Laikon General Hospital, Athens, Greece.
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Stiff PJ, Erder H, Bensinger WI, Emmanouilides C, Gentile T, Isitt J, Lu ZJ, Spielberger R. Reliability and validity of a patient self-administered daily questionnaire to assess impact of oral mucositis (OM) on pain and daily functioning in patients undergoing autologous hematopoietic stem cell transplantation (HSCT). Bone Marrow Transplant 2006; 37:393-401. [PMID: 16415901 DOI: 10.1038/sj.bmt.1705250] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Oral mucositis (OM) is a frequent complication of myeloablative therapy and HSCT. We evaluated the feasibility, reliability, and validity of a new patient self-reported daily questionnaire on OM and its impact on daily functions. This OM Daily Questionnaire (OMDQ), containing 10 items, was developed for use in palifermin clinical trials. In a phase 3 study, 212 patients received palifermin or placebo for three consecutive days before conditioning and three consecutive days after HSCT. Compliance rates were consistently >80% for most patients. Mouth and throat soreness (MTS) and MTS-Activity Limitations (MTS-AL) (swallowing, drinking, eating, talking, and sleeping) scores on consecutive days were highly correlated (days 7,8 = 0.70-0.86; test-retest reliability). Correlations among items measuring the same construct ranged between 0.5 and 0.8 (internal consistency reliability). The WHO Oral Toxicity scale was the clinical comparator to assess the criterion, discriminative, and evaluative validities of MTS-related questions. Most correlation coefficients between the WHO and MTS ranged between 0.45 and 0.55. Patients with more severe WHO OM grades had higher MTS mean scores. Changes in MTS scores were similar, but patients detected changes 1-3 days earlier than clinicians. In conclusion, the OMDQ is a feasible, reliable, valid, and responsive patient-reported measure of OM severity.
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Affiliation(s)
- P J Stiff
- Cardinal Bernardin Cancer Center, Loyola University, Maywood, IL 60153, USA.
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Lashkari A, Lowe T, Collisson E, Paquette R, Emmanouilides C, Territo M, Schiller G. Long-term Outcome of Autologous Transplantation of Peripheral Blood Progenitor Cells as Postremission Management of Patients ≥60 Years with Acute Myelogenous Leukemia. Biol Blood Marrow Transplant 2006; 12:466-71. [PMID: 16545730 DOI: 10.1016/j.bbmt.2005.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Accepted: 12/07/2005] [Indexed: 11/24/2022]
Abstract
The optimal postremission treatment for elderly patients with acute myelogenous leukemia (AML) is presently unknown, but recent studies report the feasibility of autologous stem cell transplantation in this population. To better understand the long-term outcome of autologous transplantation in AML patients > or =60 years of age, we evaluated high-dose chemoradiotherapy preparative conditioning followed by transplantation of peripheral blood progenitor cells procured after a single cycle of cytarabine-based consolidation chemotherapy as postremission therapy in 27 patients aged 60 to 71 years (median age, 65 years) with newly diagnosed AML in first complete remission (CR). The median follow-up from CR for all patients was 13.6 months (range, 6.0-123.1 months). The median follow-up from remission for surviving patients was 81 months (range, 41.4-123.1 months). Seven patients are alive in continuous CR, 19 died from relapse, and 1 died as a result of treatment-related infection. Leukemia-free survival and overall survival are 10.3 and 13.4 months, respectively. Actuarial leukemia-free and overall survival at 3 years are 25% +/- 9% and 28% +/- 9%, respectively. Our results demonstrate that autologous transplantation of peripheral blood progenitor cells is well tolerated and feasible for patients > or =60 years of age with AML in first CR. Future investigation should focus on a randomized study evaluating a larger group of elderly patients in first CR comparing autologous stem cell transplantation with conventional cytarabine-based consolidation chemotherapy to identify the optimal postremission therapy.
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Affiliation(s)
- Ashkan Lashkari
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Abstract
Radioimmunotherapy treatment for lymphoma is a novel targeted therapeutic approach. Several years of development of radioimmunotherapeutic compounds came to fruition in February of 2002 when 90Y-ibritumomab tiuxetan (Zevalin, Y2B8) was approved in the USA and later in Europe, for the treatment of relapsed or refractory, low grade or transformed B-cell lymphoma in the USA. 90Y-ibritumomab tiuxetan utilizes a monoclonal anti-CD20 antibody to deliver beta-emitting yttrium-90 to the malignant B-cells. Clinical trials have demonstrated its efficacy, with observed clinical responses in the 80 % range. This product has become available in Europe, with simplified administration, for the treatment of relapsed follicular lymphoma. A similar anti-CD20 radiotherapeutic compound, 131I-tositumomab, was subsequently approved in the USA. Promising studies exploring expanded applications of radioimmunotherapy as consolidation, as part of transplant, or in other histologic types have been recently completed or are under way. Radioimmunotherapy has been shown to be an effective and clinically relevant complementary therapeutic approach for patients with lymphoma, bringing the Nuclear Medicine into lymphoma therapeutics.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antibody Specificity
- Antigens, CD/immunology
- Antigens, CD20/immunology
- Antigens, Neoplasm/immunology
- Clinical Trials as Topic
- Contraindications
- Drug Resistance, Neoplasm
- European Union
- Forecasting
- Humans
- Immunoconjugates/administration & dosage
- Immunoconjugates/adverse effects
- Immunoconjugates/therapeutic use
- Iodine Radioisotopes/administration & dosage
- Iodine Radioisotopes/adverse effects
- Iodine Radioisotopes/therapeutic use
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/radiotherapy
- Patient Selection
- Radioimmunotherapy/adverse effects
- Radioimmunotherapy/methods
- Rituximab
- Salvage Therapy
- Tetraspanins
- Treatment Outcome
- United States
- Yttrium Radioisotopes/administration & dosage
- Yttrium Radioisotopes/adverse effects
- Yttrium Radioisotopes/therapeutic use
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Meredith R, Schilder R, Emmanouilides C, Vo K, Witzig T, Flinn I, Darif M, Gordon L, Molina A. Radioimmunotherapy with Yttrium 90 Ibritumomab Tiuxetan (Zevalin®) Is a Safe and Effective Treatment Option for Older Patients with Relapsed or Refractory Low-Grade Non-Hodgkin’s Lymphoma (NHL). Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.715] [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: 11/28/2022]
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Czuczman MS, Thall A, Witzig TE, Vose JM, Younes A, Emmanouilides C, Miller TP, Moore JO, Leonard JP, Gordon LI, Sweetenham J, Alkuzweny B, Finucane DM, Leigh BR. Phase I/II Study of Galiximab, an Anti-CD80 Antibody, for Relapsed or Refractory Follicular Lymphoma. J Clin Oncol 2005; 23:4390-8. [PMID: 15994148 DOI: 10.1200/jco.2005.09.018] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [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: 11/20/2022] Open
Abstract
Purpose This multicenter, dose-escalation study evaluates the safety, pharmacokinetics, and efficacy of galiximab (anti-CD80 monoclonal antibody) in patients with relapsed or refractory follicular lymphoma. Patients and Methods Patients had follicular lymphoma that had relapsed or failed to respond to primary therapy; the majority (90%) presented with stage III or IV disease. Four weekly intravenous infusions of galiximab were administered at doses of 125, 250, 375, or 500 mg/m2. Results Thirty-seven patients received galiximab treatment and were evaluated for safety; 35 were assessable for response. Antibody infusions were safe and well tolerated with no dose-limiting toxicities. A total of 22 (60%) of 37 patients experienced adverse events related to galiximab. All but one of the events were grade 1 or 2; the most common were fatigue, nausea, and headache. Cytopenias were rare; only one patient experienced anemia and febrile neutropenia, which were unrelated to galiximab and resolved after treatment. No patient developed antigaliximab antibody formation. The mean serum half-life ranged from 13 to 24 days. The overall response rate was 11% (two complete responses and two partial responses). Time to best response was delayed (months 3, 6, 9, and 12). Twelve patients (34%) maintained stable disease. Nearly half of all patients (49%) had a decrease in indicator lesions. Two responders remain on study without progression (22 and 24.4 months). Conclusion The favorable safety profile of galiximab and evidence of single-agent biologic activity and dose-dependent pharmacokinetics support further evaluation of galiximab as a treatment for follicular lymphoma, possibly in combination with other lymphoma therapies.
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Affiliation(s)
- Myron S Czuczman
- Roswell Park Cancer Institute, Elm and Carlton St, Buffalo, NY 14263-0001, USA.
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Schilder RJ, Emmanouilides C, Vo K, Witzig TE, Flinn I, Darif M, Gordon L, Molina A. Yttrium 90 ibritumomab tiuxetan is safe and effective in older patients with relapsed or refractory NHL. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. J. Schilder
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
| | - C. Emmanouilides
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
| | - K. Vo
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
| | - T. E. Witzig
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
| | - I. Flinn
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
| | - M. Darif
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
| | - L. Gordon
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
| | - A. Molina
- Fox Chase Cancer Ctr, Philadelphia, PA; UCLA Medcl Ctr, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Mayo Clinic, Rochester, MN; John Hopkins Univ, Baltimore, MD; Northwestern Univ Medcl Sch, Chicago, IL
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Emmanouilides C, Pegram M, Robinson R, Hecht R, Kabbinavar F, Isacoff W. Anti-VEGF antibody bevacizumab (Avastin) with 5FU/LV as third line treatment for colorectal cancer. Tech Coloproctol 2005; 8 Suppl 1:s50-2. [PMID: 15655642 DOI: 10.1007/s10151-004-0110-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To evaluate the activity and safety of bevacizumab when given with standard 5FU/leukovorin (LV) regimens in patients with metastatic colorectal cancer who have failed irinotecan and oxaliplatin-based treatments. METHODS Bevacizumab was given at 5 mg/kg as an IV infusion every 2 weeks. Patients received 5FU according to Roswell Park or the de Gramont regimen. RESULTS Nineteen patients enrolled, median age 60, median PS: 1. Most common toxicity attributable to bevacizumab was mild hypertension, epistaxis and mild proteinuria; 1 patient had a CNS haemorrhage. The median number of cycles was 1 (8 weeks). Clinical benefit as disease stabilisation lasting 2-6 months was noted in 9 patients, whereas 10 progressed (median f/u: 5 months). TTP was 16 weeks, and the overall survival has not been reached (24+ weeks). CONCLUSIONS Bevacizumab may result in growth arrest and clinical benefit in a substantial proportion of patients with colorectal cancer and no alternative treatment.
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Affiliation(s)
- C Emmanouilides
- Division of Hematology/Oncology, UCLA Medical Center, Los Angeles, CA 90095, USA.
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Stiff P, Bensinger W, Emmanouilides C, Gentile T, Okano G, Lu J, Erder M, Spielberger R. Evaluation of oral mucositis using a self-reported questionnaire in patients with hematologic malignancies undergoing high-dose chemoradiotherapy followed by peripheral blood progenitor cell transplantation. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.213] [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: 11/16/2022]
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Treon SP, Hansen M, Branagan AR, Verselis S, Emmanouilides C, Kimby E, Frankel SR, Touroutoglou N, Turnbull B, Anderson KC, Maloney DG, Fox EA. Polymorphisms in FcγRIIIA (CD16) Receptor Expression Are Associated With Clinical Response to Rituximab in Waldenström’s Macroglobulinemia. J Clin Oncol 2005; 23:474-81. [PMID: 15659493 DOI: 10.1200/jco.2005.06.059] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Rituximab is an important therapeutic for Waldenström’s macroglobulinemia (WM). Polymorphisms in FcγRIIIA (CD16) receptor expression modulate human immunoglobulin G1 binding and antibody-dependent cell-mediated cytotoxicity, and may therefore influence responses to rituximab. Patients and Methods Sequence analysis of the entire coding region of FcγRIIIA was undertaken in 58 patients with WM whose outcomes after rituximab were known. Results Variations in five codons of FcγRIIIA were identified. Two were commonly observed (FcγRIIIA-48 and FcγRIIIA-158) and predicted for amino acid polymorphisms at FcγRIIIA-48: leucine/leucine (L/L), leucine/arginine (L/R), and leucine/histidine (L/H). Polymorphisms at FcγRIIIA-158 were phenylalanine/phenylalanine (F/F), phenylalanine/valine (F/V), and valine/valine (V/V). A clear linkage between these polymorphisms was detected and all patients with FcγRIIIA-158F/F were always FcγRIIIA-48L/L, and patients with either FcγRIIIA-L/R or -L/H always expressed at least one valine at FcγRIIIA-158 (P ≤ .001). The response trend was higher for patients with FcγRIIIA-48L/H (38.5%) versus -48L/R (25.0%) and LL (22.0%), and was significantly higher for patients with FcγRIIIA-158V/V (40.0%) and -V/F (35%) versus -158F/F (9.0%; P = .030). Responses for patients with FcγRIIIA-48L/L were higher when at least one valine was present at FcγRIIIA-158 (P = .057), thereby supporting a primary role for FcγRIIIA-158 polymorphisms in predicting rituximab responses. With a median follow-up of 13 months, no significant differences in the median time to progression and progression-free survival were observed when patients were grouped according to their FcγRIIIA-48 and -158 polymorphisms. Conclusion The results of these studies therefore support a predictive role for FcγRIIIA-158 polymorphisms and responses to rituximab in WM.
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Affiliation(s)
- Steven P Treon
- Bing Program for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, LG102, 44 Binney St, Boston, MA 02115, USA.
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Treon SP, Emmanouilides C, Kimby E, Kelliher A, Preffer F, Branagan AR, Anderson KC, Frankel SR. Extended rituximab therapy in Waldenström's macroglobulinemia. Ann Oncol 2005; 16:132-8. [PMID: 15598950 DOI: 10.1093/annonc/mdi022] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Waldenström's macroglobulinemia (WM) is a CD20 expressing B-cell malignancy represented by the pathological diagnosis of IgM secreting lymphoplasmacytic lymphoma. Major response rates of 30% have been reported in most studies with standard dose rituximab, i.e. 4 weekly infusions at 375 mg/m(2)/week. METHODS In an effort to increase rituximab activity in WM, an extended dose schedule employing two sets of four (375 mg/m(2)/week) infusions at weeks 1-4 and 12-16 was evaluated. Expression of the complement resistance antigens CD46, CD55 and CD59 was also evaluated on tumor cells pre- and post-therapy to determine impact on response. RESULTS Twenty-nine patients were enrolled and 26 patients completed the intended therapy. On an intent to treat analysis, 14 (48.3%) patients achieved a partial response, and 5 (17.2%) patients achieved a minor response. Responses were observed in 18/24 (75%) patients with a serum IgM level of <6000 mg/dl, and only 1 of 5 (20%) patients with a level of >6000 mg/dl (P=0.03). The median time to best response was 17 months, and only 2 of 19 responding patients progressed with a median follow-up of 29 months. No differences in baseline expression of the complement resistance antigens CD46, CD55 and CD59 were observed among responding and non-responding patients, although post-therapy CD55 expression was higher in non-responding patients (P=0.002). CONCLUSIONS These data show that extended rituximab therapy is active and may lead to more major responses over standard dose rituximab in WM. WM patients with serum IgM levels of <6000 mg/dl are more likely to benefit from extended rituximab therapy.
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Affiliation(s)
- S P Treon
- Bing Program for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
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Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, Shea T, Yanovich S, Hansen K, Noga S, McCarty J, LeMaistre CF, Sung EC, Blazar BR, Elhardt D, Chen MG, Emmanouilides C. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med 2004; 351:2590-8. [PMID: 15602019 DOI: 10.1056/nejmoa040125] [Citation(s) in RCA: 562] [Impact Index Per Article: 28.1] [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: 11/19/2022]
Abstract
BACKGROUND Oral mucositis is a complication of intensive chemotherapy and radiotherapy with no effective treatment. We tested the ability of palifermin (recombinant human keratinocyte growth factor) to decrease oral mucosal injury induced by cytotoxic therapy. METHODS This double-blind study compared the effect of palifermin with that of a placebo on the development of oral mucositis in 212 patients with hematologic cancers; 106 patients received palifermin (60 microg per kilogram of body weight per day) and 106 received a placebo intravenously for three consecutive days immediately before the initiation of conditioning therapy (fractionated total-body irradiation plus high-dose chemotherapy) and after autologous hematopoietic stem-cell transplantation. Oral mucositis was evaluated daily for 28 days after transplantation. RESULTS The incidence of oral mucositis of World Health Organization (WHO) grade 3 or 4 was 63 percent in the palifermin group and 98 percent in the placebo group (P<0.001). Among patients with this degree of mucositis, the median duration of mucositis was 6 days (range, 1 to 22) in the palifermin group and 9 days (range, 1 to 27) in the placebo group. Among all patients, regardless of the occurrence of mucositis, the median duration of oral mucositis of WHO grade 3 or 4 was 3 days (range, 0 to 22) in the palifermin group and 9 days (range, 0 to 27) in the placebo group (P<0.001). As compared with placebo, palifermin was associated with significant reductions in the incidence of grade 4 oral mucositis (20 percent vs. 62 percent, P<0.001), patient-reported soreness of the mouth and throat (area-under-the-curve score, 29.0 [range, 0 to 98] vs. 46.8 [range, 0 to 110]; P<0.001), the use of opioid analgesics (median, 212 mg of morphine equivalents [range, 0 to 9418] vs. 535 mg of morphine equivalents [range, 0 to 9418], P<0.001), and the incidence of use of total parenteral nutrition (31 percent vs. 55 percent, P<0.001). Adverse events, mainly rash, pruritus, erythema, mouth and tongue disorders, and taste alteration, were mild to moderate in severity and were transient. CONCLUSIONS Palifermin reduced the duration and severity of oral mucositis after intensive chemotherapy and radiotherapy for hematologic cancers.
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Affiliation(s)
- Ricardo Spielberger
- City of Hope National Medical Center, Department of Hematology and Hematopoietic Cell Transplantation and Kaiser Permanente BMT Program, Duarte, Calif 91010, USA.
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Ansell SM, Schilder RJ, Pieslor PC, Gordon LI, Emmanouilides C, Vo K, Czuczman MS, Witzig TE, Theuer C, Molina A. Antilymphoma Treatments Given Subsequent to Yttrium 90 Ibritumomab Tiuxetan Are Feasible in Patients with Progressive Non-Hodgkin's Lymphoma: A Review of the Literature. ACTA ACUST UNITED AC 2004; 5:202-4. [PMID: 15636698 DOI: 10.3816/clm.2004.n.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Yttrium 90-labeled ibritumomab tiuxetan is approved for the treatment of patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma (NHL). To date, the efficacy of repeated courses of radioimmunoconjugate treatment in patients whose disease has progressed has not been studied as a formal endpoint in a clinical trial setting. However, several clinical studies have been conducted in patients with progressive NHL who had previously received 90Y ibritumomab tiuxetan. A retrospective review of these studies has shown that clinical responses have been achieved with all types of subsequent treatment with no apparent impact on their efficacy. In addition, no significant differences in toxicities with subsequent therapies have been observed between patients who had previously received 90Y ibritumomab tiuxetan therapy and those who had not. These findings suggest that patients previously treated with 90Y ibritumomab tiuxetan can feasibly undergo other forms of treatment for progressive NHL, and that a clinical response to further treatment options is not precluded by administration of 90Y ibritumomab tiuxetan.
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Affiliation(s)
- Stephen M Ansell
- Division of Hematology Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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Gordon LI, Witzig T, Molina A, Czuczman M, Emmanouilides C, Joyce R, Vo K, Theuer C, Pohlman B, Bartlett N, Wiseman G, Darif M, White C. Yttrium 90–Labeled Ibritumomab Tiuxetan Radioimmunotherapy Produces High Response Rates and Durable Remissions in Patients with Previously Treated B-Cell Lymphoma. ACTA ACUST UNITED AC 2004; 5:98-101. [PMID: 15453924 DOI: 10.3816/clm.2004.n.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [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: 11/20/2022]
Abstract
We report updated time-to-event variables of a phase III randomized study comparing yttrium 90-labeled ibritumomab with rituximab standard therapy in 143 rituximab-naive patients with relapsed or refractory low-grade, follicular, or transformed CD20+ non-Hodgkin's lymphoma (NHL). Most patients (79%) had follicular lymphoma. Patients were randomized to receive a single intravenous (I.V.) dose of 90Y ibritumomab tiuxetan 0.4 mCi/kg (n = 73) or rituximab 375 mg/m2 I.V. weekly for 4 doses (n = 70). The radioimmunotherapy group was pretreated with 2 rituximab doses (250 mg/m2) to improve biodistribution and one dose of Indium 111-labeled ibritumomab tiuxetan for imaging. The overall response rate was 80% versus 56% (P = 0.002) and complete response (CR)/CR unconfirmed (CRu) rates were 34% for 90Y ibritumomab tiuxetan versus 20% for rituximab. With a median follow-up of 44 months, the data are mature as all ongoing patients in both groups exceeded the median Kaplan-Meier estimated time to progression (TTP), duration of response (DR), and time to next therapy. Although this study was not powered to detect differences in time-to-event variables, the results from this randomized trial demonstrate trends toward longer median TTP (15 vs. 10.2 months; P = 0.07), DR (16.7 vs. 11.2 months; P = 0.44) and time to next therapy (21.1 vs. 13.8 months; P = 0.27) in follicular NHL patients treated with 90Y ibritumomab tiuxetan compared with the rituximab control arm. In patients achieving a CR/CRu, the median TTP was 24.7 months for patients treated with 90Y ibritumomab tiuxetan compared with 13.2 months for rituximab-treated patients (P = 0.41), and ongoing responses of > 5 years have been observed. These results confirm that 90Y ibritumomab tiuxetan produces high response rates and durable remissions in patients with previously treated low-grade, follicular, and transformed NHL.
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Affiliation(s)
- Leo I Gordon
- Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA.
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Schilder R, Molina A, Gordon L, Emmanouilides C, Czuczman M, Wang H, Witzig T, Ansell S, White C. Radioimmunotherapy with 90Y ibritumomab tiuxetan (Zevalin) does not preclude subsequent radiotherapy or other antilymphoma therapies: Updated safety and efficacy data. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.513] [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: 11/25/2022]
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Winston DJ, Emmanouilides C, Bartoni K, Schiller GJ, Paquette R, Territo MC. Elimination of Aspergillus infection in allogeneic stem cell transplant recipients with long-term itraconazole prophylaxis: prevention is better than treatment. Blood 2004; 104:1581; author reply 1582. [PMID: 15317732 DOI: 10.1182/blood-2004-03-1025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Treon SP, Hansen M, Branagan A, Emmanouilides C, Kimby E, Frankel S, Touroutoglou N, Maloney D, Anderson KC, Fox EA. Polymorphisms in FcγRIIIA (CD16) receptor expression are associated with clinical response to rituximab in Waldenstrom's macroglobulinemia. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. P. Treon
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - M. Hansen
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - A. Branagan
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - C. Emmanouilides
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - E. Kimby
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - S. Frankel
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - N. Touroutoglou
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - D. Maloney
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - K. C. Anderson
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - E. A. Fox
- Dana Farber Cancer Institute, Boston, MA; UCLA Medical Center, Los Angeles, CA; Karolinska Institutet, Stockholm, Sweden; University of Maryland, Baltimore, MD; Nevada Cancer Center, Las Vegas, NV; Fred Hutchinson Cancer Research Center, Seattle, WA
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Wiseman GA, Emmanouilides C, Vo K, Schilder RJ, Foster P, Gordon LI, Witzig TE, Molina A. Analysis of relationship between baseline body weight and efficacy/safety of yttrium 90 ( 90Y) ibritumomab tiuxetan radioimmunotherapy in patients (pts) with non-Hodgkin's lymphoma (NHL). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G. A. Wiseman
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
| | - C. Emmanouilides
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
| | - K. Vo
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
| | - R. J. Schilder
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
| | - P. Foster
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
| | - L. I. Gordon
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
| | - T. E. Witzig
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
| | - A. Molina
- Mayo Clinic & Mayo Foundation, Rochester, MN; UCLA, Los Angeles, CA; Biogen Idec Inc, San Diego, CA; Fox Chase Cancer Center, Philadelphia, PA; Northwestern University, Chicago, IL
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50
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Weiner GJ, Link BK, Leonard J, Emmanouilides C, Albert G, Schmalbach T. Combination of CpG7909 and rituximab in patients with relapsed or refractory B-cell non-Hodgkin's lymphoma (NHL): A phase I, open label dose-escalation study of safety and tolerability. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G. J. Weiner
- University of Iowa, Iowa City, IA; New York Presbyterian, New York, NY; UCLA Medical Center, Los Angeles, CA; Coley Pharmaceutical Group, Wellesley, MA
| | - B. K. Link
- University of Iowa, Iowa City, IA; New York Presbyterian, New York, NY; UCLA Medical Center, Los Angeles, CA; Coley Pharmaceutical Group, Wellesley, MA
| | - J. Leonard
- University of Iowa, Iowa City, IA; New York Presbyterian, New York, NY; UCLA Medical Center, Los Angeles, CA; Coley Pharmaceutical Group, Wellesley, MA
| | - C. Emmanouilides
- University of Iowa, Iowa City, IA; New York Presbyterian, New York, NY; UCLA Medical Center, Los Angeles, CA; Coley Pharmaceutical Group, Wellesley, MA
| | - G. Albert
- University of Iowa, Iowa City, IA; New York Presbyterian, New York, NY; UCLA Medical Center, Los Angeles, CA; Coley Pharmaceutical Group, Wellesley, MA
| | - T. Schmalbach
- University of Iowa, Iowa City, IA; New York Presbyterian, New York, NY; UCLA Medical Center, Los Angeles, CA; Coley Pharmaceutical Group, Wellesley, MA
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