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Bastian S, Joerger M, Baertschi D, Holer L, Guckenberger M, Jochum W, Koeberle D, Siebenhüner A, Berger M, Winterhalder R, Largiadèr C, Löffler-Baumann M, Mosna- Firlejczyk K, Wicki A, Fischer Maranta A, von Moos R. 431P Neoadjuvant treatment with regorafenib and capecitabine combined with radiotherapy in locally advanced rectal cancer: A multicenter phase Ib trial (RECAP) SAKK 41/16. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.569] [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: 11/01/2022] Open
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Joerger M, Metaxas Y, Schmitt A, Koeberle D, Zaman K, Betticher D, Mach N, Renner C, Mark M, Petrausch U, Caspar C, Britschgi C, Taverna C, Zenger F, Mingrone W, Schulz J, Kopp C, Hayoz S, Stathis A, von Moos R. LBA80 Outcome and prognostic factors of SARS CoV-2 infection in cancer patients: A cross-sectional study (SAKK 80/20 CaSA). Ann Oncol 2020. [PMCID: PMC7506361 DOI: 10.1016/j.annonc.2020.08.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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McNamara M, Lopes A, Wasan H, Malka D, Goldstein D, Shannon J, Okusaka T, Knox J, Wagner A, Andre T, Cunningham D, Moehler M, Jensen L, Koeberle D, Bekaii-Saab T, Bridgewater J, Valle J. Impact of anatomic site of biliary tract tumour origin and conditional probability of survival (CS): Results from 15 prospective advanced first-line clinical trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.042] [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: 11/14/2022] Open
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Türeci O, Sahin U, Schulze-Bergkamen H, Zvirbule Z, Lordick F, Koeberle D, Thuss-Patience P, Ettrich T, Arnold D, Bassermann F, Al-Batran SE, Wiechen K, Dhaene K, Maurus D, Gold M, Huber C, Krivoshik A, Arozullah A, Park JW, Schuler M. A multicentre, phase IIa study of zolbetuximab as a single agent in patients with recurrent or refractory advanced adenocarcinoma of the stomach or lower oesophagus: the MONO study. Ann Oncol 2019; 30:1487-1495. [PMID: 31240302 PMCID: PMC6771222 DOI: 10.1093/annonc/mdz199] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Claudin 18.2 (CLDN18.2) is physiologically confined to gastric mucosa tight junctions; however, upon malignant transformation, perturbations in cell polarity lead to CLDN18.2 epitopes being exposed on the cancer cell surface. The first-in-class monoclonal antibody, zolbetuximab (formerly known as IMAB362), binds to CLDN18.2 and can induce immune-mediated lysis of CLDN18.2-positive cells. PATIENTS AND METHODS Patients with advanced gastric, gastro-oesophageal junction (GEJ) or oesophageal adenocarcinomas with moderate-to-strong CLDN18.2 expression in ≥50% of tumour cells received zolbetuximab intravenously every 2 weeks for five planned infusions. At least three patients were enrolled in two sequential cohorts (cohort 1300 mg/m2; cohort 2600 mg/m2); additional patients were enrolled into a dose-expansion cohort (cohort 3600 mg/m2). The primary end point was the objective response rate [ORR: complete and partial response (PR)]; secondary end points included clinical benefit [ORR+stable disease (SD)], progression-free survival, safety/tolerability, and zolbetuximab pharmacokinetic profile. RESULTS From September 2010 to September 2012, 54 patients were enrolled (cohort 1, n = 4; cohort 2, n = 6; cohort 3, n = 44). Three patients in cohort 1 and 25 patients in cohorts 2/3 received at least 5 infusions. Antitumour activity data were available for 43 patients, of whom 4 achieved PR (ORR 9%) and 6 (14%) had SD for a clinical benefit rate of 23%. In a subgroup of patients with moderate-to-high CLDN18.2 expression in ≥70% of tumour cells, ORR was 14% (n = 4/29). Treatment-related adverse events occurred in 81.5% (n = 44/54) patients; nausea (61%), vomiting (50%), and fatigue (22%) were the most frequent. CONCLUSIONS Zolbetuximab monotherapy was well tolerated and exhibited antitumour activity in patients with CLDN18.2-positive advanced gastric or GEJ adenocarcinomas, with response rates similar to those reported for single-agent targeted agents in gastric/GEJ cancer trials. CLINICALTRIALS.GOV NUMBER NCT01197885.
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Affiliation(s)
- O Türeci
- Ci3 - Cluster of Individualized Immune Intervention, Mainz.
| | - U Sahin
- TRON - Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - H Schulze-Bergkamen
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Z Zvirbule
- Riga East University Hospital, LLC, Riga, Latvia
| | - F Lordick
- University Cancer Center Leipzig, University Medicine Leipzig, Leipzig, Germany
| | - D Koeberle
- Department of Oncology and Hematology, Kantonsspital, St. Gallen, Switzerland
| | - P Thuss-Patience
- Charite University Medicine Berlin, Medical Clinic of Hematology, Oncology and Tumor Immunology, Berlin
| | - T Ettrich
- Department of Internal Medicine I, Ulm University Hospital, Ulm
| | - D Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg
| | - F Bassermann
- Klinikum rechts der Isar, Technische Universität München, Munich
| | - S E Al-Batran
- Nordwest Hospital, Institute of Clinical Cancer Research, University Cancer Center, Frankfurt
| | - K Wiechen
- Klinikum Worms gGmbH, Institute for Pathology, Worms, Germany
| | - K Dhaene
- MD Dhaene Pathology Lab BVBA, Destelbergen, Belgium
| | - D Maurus
- Formerly of Ganymed GmbH (AG), Mainz, Germany
| | - M Gold
- Formerly of Ganymed GmbH (AG), Mainz, Germany
| | - C Huber
- Ci3 - Cluster of Individualized Immune Intervention, Mainz; TRON - Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | | | | | - J W Park
- Astellas Pharma, Inc., Northbrook, USA
| | - M Schuler
- West German Cancer Center, University Duisburg-Essen, Essen; German Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
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Salvatore L, Bria E, Sperduti I, Hinke A, Hegewisch-Becker S, Aparicio T, Le Malicot K, Boige V, Koeberle D, Baertschi D, Dietrich D, Tortora G, Arnold D. Bevacizumab (BV) maintenance after first-line chemotherapy plus BV for metastatic colorectal cancer patients: a meta-analysis of individual patients data from 3 phase III studies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.020] [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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Koeberle D, Dufour JF, Demeter G, Li Q, Ribi K, Samaras P, Saletti P, Roth AD, Horber D, Buehlmann M, Wagner AD, Montemurro M, Lakatos G, Feilchenfeldt J, Peck-Radosavljevic M, Rauch D, Tschanz B, Bodoky G. Sorafenib with or without everolimus in patients with advanced hepatocellular carcinoma (HCC): a randomized multicenter, multinational phase II trial (SAKK 77/08 and SASL 29). Ann Oncol 2016; 27:856-61. [PMID: 26884590 DOI: 10.1093/annonc/mdw054] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/29/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sorafenib (S), a multitargeted tyrosine kinase inhibitor, is the standard of care for first-line systemic treatment of advanced hepatocellular carcinoma (HCC). Everolimus (E) is a potent inhibitor of mTOR, a pathway frequently activated in HCC. Preclinical data suggest that the combination S + E has additive effects compared with single-agent S. PATIENTS AND METHODS Patients with unresectable or metastatic HCC and Child-Pugh ≤7 liver dysfunction were randomized to receive daily S 800 mg alone or with E 5 mg until progression or unacceptable toxicity. The primary end point was progression-free survival at 12 weeks (PFS12). The secondary end points included response rate, PFS, time to progression (TTP), overall survival (OS), duration of disease stabilization (DDS), safety, and quality-of-life (QoL) assessments. RESULTS A total of 106 patients were randomized: 46 patients received S and 60 patients received S + E. Ninety-three patients were assessable for the primary end point and 105 patients for the safety analysis. The PFS12 rate was 70% [95% confidence interval (CI) 54-83] and 68% (95% CI 53-81) in patients randomized to S and S + E, respectively. The RECIST (mRECIST) response rate was 0% (23%) in the S arm and 10% (35%) in the S + E arm. Median PFS (6.6 versus 5.7 months), TTP (7.6 versus 6.3 months), DDS (6.7 versus 6.7 months), and OS (10 versus 12 months) were similar in the S and S + E arms, respectively. Grade 3/4 adverse events occurred in 72% and 86% of patients in arm S and arm S + E, respectively. Patients had similar QoL scores over time, except for a greater worsening in physical well-being and mood in the arm S + E. CONCLUSIONS No evidence was found that S + E improves the efficacy compared with S alone. Combining 5 mg E with full-dose S is feasible, but more toxic than S alone. Further testing of this drug combination in molecularly unselected HCCs appears unwarranted. CLINICALTRIALSGOV NCT01005199.
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Affiliation(s)
- D Koeberle
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen
| | - J-F Dufour
- Department of Hepatology, University Hospital Bern, Bern, Switzerland
| | - G Demeter
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
| | - Q Li
- SAKK Coordinating Center, Berne
| | - K Ribi
- Quality of life Office, International Breast Cancer Study Group, Bern
| | - P Samaras
- Department of Medical Oncology, University Hospital Zurich, Zürich
| | - P Saletti
- Department of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona
| | - A D Roth
- Department of Medical Oncology, University Hospital of Geneva, Geneva
| | - D Horber
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen
| | - M Buehlmann
- Department of Medical Oncology, University Hospital Bern, Bern
| | - A D Wagner
- Department of Medical Oncology, University Hospital Lausanne, Lausanne
| | - M Montemurro
- Department of Medical Oncology, University Hospital Lausanne, Lausanne
| | - G Lakatos
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
| | - J Feilchenfeldt
- Department of Medical Oncology, Hôpital du Valais (RSV)-CHCVs, Lausanne, Switzerland
| | - M Peck-Radosavljevic
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - D Rauch
- Department of Medical Oncology, Spital STS AG, Bern, Switzerland
| | | | - G Bodoky
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
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Strasser F, Blum D, von Moos R, Cathomas R, Ribi K, Aebi S, Betticher D, Hayoz S, Klingbiel D, Brauchli P, Haefner M, Mauri S, Kaasa S, Koeberle D. The effect of real-time electronic monitoring of patient-reported symptoms and clinical syndromes in outpatient workflow of medical oncologists: E-MOSAIC, a multicenter cluster-randomized phase III study (SAKK 95/06). Ann Oncol 2015; 27:324-32. [PMID: 26646758 DOI: 10.1093/annonc/mdv576] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with advanced, incurable cancer receiving anticancer treatment often experience multidimensional symptoms. We hypothesize that real-time monitoring of both symptoms and clinical syndromes will improve symptom management by oncologists and patient outcomes. PATIENTS AND METHODS In this prospective multicenter cluster-randomized phase-III trial, patients with incurable, symptomatic, solid tumors, who received new outpatient chemotherapy with palliative intention, were eligible. Immediately before the weekly oncologists' visit, patients completed the palm-based E-MOSAIC assessment (Edmonton-Symptom-Assessment-Scale, ≤3 additional symptoms, estimated nutritional intake, body weight change, Karnofsky Performance Status, medications for pain, fatigue, nutrition). A cumulative, longitudinal monitoring sheet (LoMoS) was printed immediately. Eligible experienced oncologists were defined as one cluster each and randomized to receive the immediate print-out LoMoS (intervention) or not (control). Primary analysis limited to patients having uninterrupted (>4/6 visits with same oncologist) patient-oncologist sequences was a mixed model for the difference in patients global quality of life (G-QoL; items 29/30 of EORTC-QlQ-c30) between baseline (BL) and week 6. Intention-to-treat (ITT) analysis included all eligible patients. RESULTS In 8 centers, 82 oncologists treated 264 patients (median 66 years; overall survival intervention 6.3, control 5.4 months) with various tumors. The between-arm difference in G-QoL of 102 uninterrupted patients (intervention: 55; control: 47) was 6.8 (P = 0.11) in favor of the intervention; in a sensitivity analysis (oncologists treating ≥2 patients; 50, 39), it was 9.0 (P = 0.07). ITT analysis revealed improvement in symptoms (difference last study visit-BL: intervention -5.4 versus control 2.1, P = 0.003) and favored the intervention for communication and coping. More patients with high symptom load received immediate symptom management (chart review, nurse-patient interview) by oncologists getting the LoMoS. CONCLUSION Monitoring of patient symptoms, clinical syndromes and their management clearly reduced patients' symptoms, but not QoL. Our results encourage the implementation of real-time monitoring in the routine workflow of oncologist with a computer solution.
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Affiliation(s)
- F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - D Blum
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - R von Moos
- Department of Oncology, Cantonal Hospital Chur, Chur
| | - R Cathomas
- Department of Oncology, Cantonal Hospital Chur, Chur
| | | | - S Aebi
- Department of Oncology, University Hospital Bern, Bern
| | - D Betticher
- Department of Oncology, Cantonal Hospital Fribourg, Fribourg
| | - S Hayoz
- SAKK Coordinating Center, Bern
| | | | | | | | - S Mauri
- Department of Oncology, Cantonal Hospital Lugano, Lugano
| | - S Kaasa
- European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - D Koeberle
- Clinic Oncology/Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Kienle D, Winterhalder R, Koeberle D, Horber D, Kueng M, Saletti P, Helbling D, Bastian S, Dietrich D, Baertschi D, Pilop C, Von Moos R. 1322 Cetuximab monotherapy and cetuximab plus capecitabine as first-line treatment in elderly patients with RAS- and BRAF wild-type metastatic colorectal cancer. Results of the multicenter phase II trial SAKK 41/10. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Koeberle D, Betticher DC, von Moos R, Dietrich D, Brauchli P, Baertschi D, Matter K, Winterhalder R, Borner M, Anchisi S, Moosmann P, Kollar A, Saletti P, Roth A, Frueh M, Kueng M, Popescu RA, Schacher S, Hess V, Herrmann R. Bevacizumab continuation versus no continuation after first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer: a randomized phase III non-inferiority trial (SAKK 41/06). Ann Oncol 2015; 26:709-714. [PMID: 25605741 DOI: 10.1093/annonc/mdv011] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [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: 12/30/2022] Open
Abstract
BACKGROUND Chemotherapy plus bevacizumab is a standard option for first-line treatment in metastatic colorectal cancer (mCRC) patients. We assessed whether no continuation is non-inferior to continuation of bevacizumab after completing first-line chemotherapy. PATIENTS AND METHODS In an open-label, phase III multicentre trial, patients with mCRC without disease progression after 4-6 months of standard first-line chemotherapy plus bevacizumab were randomly assigned to continuing bevacizumab at a standard dose or no treatment. CT scans were done every 6 weeks until disease progression. The primary end point was time to progression (TTP). A non-inferiority limit for hazard ratio (HR) of 0.727 was chosen to detect a difference in TTP of 6 weeks or less, with a one-sided significance level of 10% and a statistical power of 85%. RESULTS The intention-to-treat population comprised 262 patients: median follow-up was 36.7 months. The median TTP was 4.1 [95% confidence interval (CI) 3.1-5.4] months for bevacizumab continuation versus 2.9 (95% CI 2.8-3.8) months for no continuation; HR 0.74 (95% CI 0.58-0.96). Non-inferiority could not be demonstrated. The median overall survival was 25.4 months for bevacizumab continuation versus 23.8 months (HR 0.83; 95% CI 0.63-1.1; P = 0.2) for no continuation. Severe adverse events were uncommon in the bevacizumab continuation arm. Costs for bevacizumab continuation were estimated to be ∼30,000 USD per patient. CONCLUSIONS Non-inferiority could not be demonstrated for treatment holidays versus continuing bevacizumab monotheray, after 4-6 months of standard first-line chemotherapy plus bevacizumab. Based on no impact on overall survival and increased treatment costs, bevacizumab as a single agent is of no meaningful therapeutic value. More efficient treatment approaches are needed to maintain control of stabilized disease following induction therapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, number NCT00544700.
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Affiliation(s)
- D Koeberle
- Department of Oncology, Kantonsspital St Gallen, St Gallen.
| | - D C Betticher
- Department of Oncology, Hôpital Fribourgeois, Fribourg
| | - R von Moos
- Department of Oncology, Kantonsspital Chur, Chur
| | | | | | | | - K Matter
- Institute of Pharmaceutical Medicine/ECPM, Basel
| | | | - M Borner
- Department of Oncology, Spitalzentrum Biel, Biel
| | - S Anchisi
- Department of Oncology, Hôpital de Sion, Sion
| | - P Moosmann
- Department of Oncology, Kantonsspital Aarau, Aarau
| | - A Kollar
- Department of Oncology, Inselspital Bern, Bern
| | - P Saletti
- Department of Oncology, IOSI, Bellinzona
| | - A Roth
- Department of Oncology, HCUG, Geneva
| | - M Frueh
- Department of Oncology, Kantonsspital St Gallen, St Gallen
| | - M Kueng
- Department of Oncology, Hôpital Fribourgeois, Fribourg
| | - R A Popescu
- Department of Oncology, Hirslanden Klinik Aarau, Aarau
| | - S Schacher
- Department of Oncology, Kantonsspital Winterthur, Winterthur
| | - V Hess
- Department of Oncology, Universitätsspital Basel, Basel, Switzerland
| | - R Herrmann
- Department of Oncology, Universitätsspital Basel, Basel, Switzerland
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Montemurro M, Cioffi A, Domont J, Rutkowski P, Roth A, von Moos R, Inauen R, Bui B, Burkhard R, Knuesli C, Bauer S, Cassier P, Schwarb H, Le Cesne A, Koeberle D, Baertschi D, Dietrich D, Biaggi C, Prior J, Leyvraz S. Long-Term Outcome of Dasatinib First-Line Treatment in Gastrointestinal Stromal Tumors: a Multicenter Two Stage Phase Ii Trial Sakk 56/07. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Matter-Walstra K, Schwenkglenks M, Li Q, Cvijetic I, Tschanz B, Samaras P, Saletti P, Roth A, Horber D, Koeberle D. Health Economic Analysis of the Randomized Multicenter Phase Ii Trial Sakk 77/08: Sorafenib with or Without Everolimus in Patients with Unresectable Hepatocellular Carcinoma (Hcc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu341.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Blum D, Koeberle D, Omlin A, Walker J, Von Moos R, Mingrone W, deWolf-Linder S, Hayoz S, Kaasa S, Strasser F, Ribi K. Feasibility and acceptance of electronic monitoring of symptoms and syndromes using a handheld computer in patients with advanced cancer in daily oncology practice. Support Care Cancer 2014; 22:2425-34. [DOI: 10.1007/s00520-014-2201-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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Joerger M, Huitema ADR, Koeberle D, Rosing H, Beijnen JH, Hitz F, Cerny T, Schellens JHM, Gillessen S. Safety and pharmacology of gemcitabine and capecitabine in patients with advanced pancreatico-biliary cancer and hepatic dysfunction. Cancer Chemother Pharmacol 2013; 73:113-24. [PMID: 24166106 DOI: 10.1007/s00280-013-2327-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We assessed the impact of hepatic dysfunction on the safety and pharmacology of gemcitabine/capecitabine in patients with advanced pancreatico-biliary cancer. METHODS We included 12 patients receiving 3 weekly gemcitabine 1,000 mg/m(2) day 1, 8 and oral capecitabine 650 mg/m(2) b.i.d. over 2 weeks until disease progression or intolerable toxicity. Patients were included into one normal hepatic function cohort [total bilirubin (TB) ≤15 μmol/L] and 3 cohorts with increasing TB (16-39, 40-80, >80 μmol/L). Three patients with a creatinine clearance <60 ml/min were also included. Patients were sampled for gemcitabine, difluoro-deoxy uridine, intracellular gemcitabine triphosphates, capecitabine, 5'-deoxy-5-fluorocytidine, 5'-deoxy-5-fluorouridine and 5-fluorouracil up to 4 h after initiation of chemotherapy on day 1, and up to 90 min on day 8. All compounds were analyzed using validated liquid chromatography-tandem mass spectrometry. Nonlinear mixed-effect modeling was used for population analysis. RESULTS Hepatic dysfunction was caused by intrahepatic cholestasis in 4 out of 8 patients (50 %) and extrahepatic cholestasis in another 4 patients (50 %). Dose-limiting toxicity was increasing hyperbilirubinemia and severe neutropenia in 2 patients each. Hepatic dysfunction was not associated with dose-limiting toxicity or severe hematological or non-hematological toxicity. However, hepatic dysfunction was associated with low clearance of both gemcitabine (p = 10(-3)) and capecitabine (p = 10(-5)), and low intracellular gemcitabine triphosphate concentrations (p = 10(-3)). CONCLUSIONS Gemcitabine/capecitabine can be given at the standard dose in patients with severe hyperbilirubinemia, though the present data suggest that gemcitabine's activity may be limited due to poor intracellular activation. In patients with severe hyperbilirubinemia, initial monotherapy with capecitabine should be considered, followed by the addition of gemcitabine with improving hyperbilirubinemia.
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Affiliation(s)
- M Joerger
- Department of Medical Oncology and Hematology, Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland,
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Barone C, Koeberle D, Metselaar H, Parisi G, Sansonno D, Spinzi G. Multidisciplinary approach for HCC patients: hepatology for the oncologists. Ann Oncol 2013; 24 Suppl 2:ii15-23. [PMID: 23715939 DOI: 10.1093/annonc/mdt053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a complex and heterogeneous disease, often associated with underlying conditions, like cirrhosis or other relevant co-morbidities that worsen the prognosis and make the clinical management more challenging. Current recommendations emphasize the importance of a multidisciplinary approach for the management of HCC patients and stress the crucial role of careful prevention and the management of cirrhosis-associated complications. This article discusses the importance of a multidisciplinary approach in the treatment of HCC patients. Current recommendations for the treatment of cirrhotic patients with HCC are also reviewed.
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Affiliation(s)
- C Barone
- Oncologia Medica, Università Cattolica del S. Cuore, Rome, Italy.
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Helbling D, Bodoky G, Gautschi O, Sun H, Bosman F, Gloor B, Burkhard R, Winterhalder R, Madlung A, Rauch D, Saletti P, Widmer L, Borner M, Baertschi D, Yan P, Benhattar J, Leibundgut EO, Bougel S, Koeberle D. Neoadjuvant chemoradiotherapy with or without panitumumab in patients with wild-type KRAS, locally advanced rectal cancer (LARC): a randomized, multicenter, phase II trial SAKK 41/07. Ann Oncol 2012; 24:718-25. [PMID: 23139259 DOI: 10.1093/annonc/mds519] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We conducted a randomized, phase II, multicenter study to evaluate the anti-epidermal growth factor receptor (EGFR) mAb panitumumab (P) in combination with chemoradiotherapy (CRT) with standard-dose capecitabine as neoadjuvant treatment for wild-type KRAS locally advanced rectal cancer (LARC). PATIENTS AND METHODS Patients with wild-type KRAS, T3-4 and/or N+ LARC were randomly assigned to receive CRT with or without P (6 mg/kg). The primary end-point was pathological near-complete or complete tumor response (pNC/CR), defined as grade 3 (pNCR) or 4 (pCR) histological regression by Dworak classification (DC). RESULTS Forty of 68 patients were randomly assigned to P + CRT and 28 to CRT. pNC/CR was achieved in 21 patients (53%) treated with P + CRT [95% confidence interval (CI) 36%-69%] versus 9 patients (32%) treated with CRT alone (95% CI: 16%-52%). pCR was achieved in 4 (10%) and 5 (18%) patients, and pNCR in 17 (43%) and 4 (14%) patients. In immunohistochemical analysis, most DC 3 cells were not apoptotic. The most common grade ≥3 toxic effects in the P + CRT/CRT arm were diarrhea (10%/6%) and anastomotic leakage (15%/4%). CONCLUSIONS The addition of panitumumab to neoadjuvant CRT in patients with KRAS wild-type LARC resulted in a high pNC/CR rate, mostly grade 3 DC. The results of both treatment arms exceeded prespecified thresholds. The addition of panitumumab increased toxicity.
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Affiliation(s)
- D Helbling
- Department of Medical Oncology, Gastrointestinal Tumorcenter Zurich, Zurich 8038, Switzerland.
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Blum D, Koeberle D, von Moos R, Ribi K, Aebi S, Betticher D, Hayoz S, Nadig J, Mauri S, Strasser F. Real-Time Electronic Monitoring of Patient-Reported Symptoms and Syndromes (PRS): E-Mosaic, a Multicenter Phase iii Study (Sakk 95/06). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33977-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Strasser F, deWolf-Linder S, Blum D, Widmer C, Omlin AG, Koeberle D. Early palliative cancer care. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koeberle D, Bougel S, Benhattar J, Bosman F, Gautschi O, Sun H, Bodoky G, von Moos R, Helbling D. Prospective analysis of KRAS, BRAF, and PIK3CA mutational status and EGFR copy number in patients (pts) with locally advanced rectal cancer: A translational substudy of a clinical trial (SAKK 41/07) evaluating the effect of neoadjuvant chemoradiation (CRT) with or without panitumumab. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Helbling D, Bodoky G, Gautschi O, Sun H, Bosman F, Gloor B, Burkhard R, Winterhalder RC, Madlung A, Rauch D, Saletti P, Widmer LA, Borner MM, Baertschi D, Yan P, Koeberle D. Neoadjuvant chemoradiation (CRT) with or without panitumumab (Pan) in patients with K-ras-unmutated, locally advanced rectal cancer (LARC): A randomized multicenter phase II trial (SAKK 41/07). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koeberle D, Ruhstaller T, Jost L, Pagani O, Zaman K, von Moos R, Oehlschlegel C, Crowe S, Pilop C, Thuerlimann B. Combination of trastuzumab and letrozole after resistance to sequential trastuzumab and aromatase inhibitor monotherapies in patients with estrogen receptor-positive, HER-2-positive advanced breast cancer: a proof-of-concept trial (SAKK 23/03). Endocr Relat Cancer 2011; 18:257-64. [PMID: 21317203 DOI: 10.1530/erc-10-0317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 11/08/2022]
Abstract
A sequential treatment design was chosen in this trial to ensure complete resistance to single-agent non-steroidal aromatase inhibitor (AI) and trastuzumab both given as monotherapy before receiving the combination of a non-steroidal AI and trastuzumab. Key eligibility criteria included postmenopausal patients with advanced, measurable, human epidermal growth factor receptor-2 (HER-2)-positive disease (assessed by FISH, ratio (≥2)), hormone receptor (HR)-positive disease, and progression on prior treatment with a non-steroidal AI, e.g. letrozole or anastrozole, either in the adjuvant or in the advanced setting. Patients received standard dose trastuzumab monotherapy in step 1 and upon disease progression continued trastuzumab in combination with letrozole in step 2. The primary endpoint was clinical benefit rate (CBR) in step 2. Totally, 13 patients were enrolled. In step 1, six patients (46%) achieved CBR. Median time to progression (TTP) was 161 days (95% confidence interval (CI): 82-281). In step 2, CBR was observed in eight out of the 11 evaluable patients (73%), including one patient with partial response. Median TTP for all the 11 patients was 188 days (95% CI: 77-not reached). Results of this proof-of-concept trial suggest that complete resistance to both AI and trastuzumab can be overcome in a proportion of patients by combined treatment of AI and trastuzumab, as all patients served as their own control. Our results appear promising for a new treatment strategy that offers a chemotherapy-free option for at least a subset of patients with HR-positive, HER-2-positive breast cancer over a clinically relevant time period.
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Affiliation(s)
- D Koeberle
- Division of Oncology/Hematology, Department of Internal Medicine, Kantonsspital St Gallen, CH-9007 St Gallen, Switzerland.
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Joerger M, Templeton A, Koeberle D, Engler H, Riesen WF, Thurlimann BJ. Predictive value of n-terminal telopeptide of type I collagen in patients with malignant osteolytic bone disease on bisphosphonates. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koeberle D, Montemurro M, Samaras P, Simcock M, Limacher A, Hess V, Inauen R, Borner M, Roth A, Bodoky G. 6515 Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Koeberle D, Montemurro M, Samaras P, Majno P, Simcock M, Kovacs K, Inauen R, Hess V, Saletti P, Bodoky G. Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4591] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4591 Background: Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenetic activity. Evidence for clinical activity in HCC was reported in 2 phase II trials [Zhu et al and Faivre et al, ASCO 2007] using either a 37.5 or a 50 mg daily dose in a 4 weeks on, 2 weeks off regimen. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients (pts) with HCC. Methods: Key eligibility criteria included unresectable or metastatic HCC, no prior systemic anticancer treatment, measurable disease and Child-Pugh A or B liver dysfunction. Pts received 37.5 mg SU daily until progression or unacceptable toxicity. The primary endpoint was progression free survival at 12 weeks (PFS12) defined as ‘success’ if the patient was alive and without tumor progression assessed by 12 weeks (± 7 days) after registration. A PFS12 of ≤ 20% was considered uninteresting and promising if ≥ 40%. Using the Simon-two minimax stage design with 90% power and 5% significance the sample size was 45 pts. Secondary endpoints included safety assessments, measurement of serum cobalamin levels and tumor density. Results: From September 2007 to August 2008 45 pts, mostly male (87%), were enrolled in 10 centers. Median age was 63 years, 89% had Child-Pugh A and 47% had distant metastases. Median largest lesion diameter was 84 mm (range: 18 - 280) and 18% had prior TACE. Reasons for stopping therapy were: PD 60%, symptomatic deterioration 16%, toxicity 11%, death 2% (due to tumor), and other reasons 4%; 7% remain on therapy. PFS12 was rated as success in 15 pts (33%) (95% CI: 20%, 49%) and failure in 27 (60%); 3 were not evaluable (due to refusal). Over the whole trial period 1 CR and 40% SD as best response were achieved. Median PFS, duration of disease stabilization, TTP and OS were 2.8, 3.2, 2.8 and 9.3 months, respectively. Grade 3 and 4 adverse events were infrequent and all deaths due to the tumor. Conclusions: Continuous SU treatment with 37.5 mg/d daily is feasible and demonstrates moderate activity in pts with advanced HCC and mild to moderately impaired liver dysfunction. Under this trial design the therapy is considered promising (> 13 PFS12 successes). No significant financial relationships to disclose.
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Affiliation(s)
- D. Koeberle
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Montemurro
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Samaras
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Majno
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Simcock
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - K. Kovacs
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - R. Inauen
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - V. Hess
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Saletti
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - G. Bodoky
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
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Schuller JC, Balmer-Majno S, Mingrone W, Hess V, von Moos R, Borner M, Schnider A, Koeberle D, Popescu RA, Ruhstaller T. Preoperative induction chemotherapy with docetaxel-cisplatin followed by concurrent docetaxel-cisplatin and radiation therapy (RT) in patients with locally advanced esophageal cancer: Final results of the multicenter phase ll trial SAKK 75/02. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Gerber D, Dietrich D, Koeberle D, Saletti P, Borner M, Caspar CB, Mingrone W, Beretta K, Herrmann R. Clinical benefit and quality of life in patients with advanced biliary tract cancer receiving gemcitabine plus capecitabine (GemCap): Results from a multicenter phase II trial (SAKK 44/02). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Borner M, Koeberle D, Von Moos R, Saletti P, Rauch D, Hess V, Trojan A, Helbling D, Pestalozzi B, Caspar C, Ruhstaller T, Roth A, Kappeler A, Dietrich D, Lanz D, Mingrone W. Adding cetuximab to capecitabine plus oxaliplatin (XELOX) in first-line treatment of metastatic colorectal cancer: a randomized phase II trial of the Swiss Group for Clinical Cancer Research SAKK. Ann Oncol 2008; 19:1288-1292. [PMID: 18349029 DOI: 10.1093/annonc/mdn058] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To determine the activity and tolerability of adding cetuximab to the oxaliplatin and capecitabine (XELOX) combination in first-line treatment of metastatic colorectal cancer (MCC). PATIENTS AND METHODS In a multicenter two-arm phase II trial, patients were randomized to receive oxaliplatin 130 mg/m(2) on day 1 and capecitabine 1000 mg/m(2) twice daily on days 1-14 every 3 weeks alone or in combination with standard dose cetuximab. Treatment was limited to a maximum of six cycles. RESULTS Seventy-four patients with good performance status entered the trial. Objective partial response rates after external review and radiological confirmation were 14% and 41% in the XELOX and in the XELOX + Cetuximab arm, respectively. Stable disease has been observed in 62% and 35% of the patients, with 76% disease control in both arms. Cetuximab led to skin rash in 65% of the patients. The median overall survival was 16.5 months for arm A and 20.5 months for arm B. The median time to progression was 5.8 months for arm A and 7.2 months for arm B. CONCLUSION Differences in response rates between the treatment arms indicate that cetuximab may improve outcome with XELOX. The correct place of the cetuximab, oxaliplatin and fluoropyrimidine combinations in first-line treatment of MCC has to be assessed in phase III trials.
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Affiliation(s)
- M Borner
- Institute of Medical Oncology, Inselspital, Bern, Switzerland.
| | - D Koeberle
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - R Von Moos
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - P Saletti
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Rauch
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - V Hess
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Trojan
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Helbling
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - B Pestalozzi
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - C Caspar
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - T Ruhstaller
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Roth
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Kappeler
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Dietrich
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Lanz
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - W Mingrone
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
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- Institute of Medical Oncology, Inselspital, Bern, Switzerland
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Inauen R, Cathomas R, Boehm T, Koeberle D, Pestalozzi BC, Gillessen S, von Moos R. Feasibility of using cetuximab and bevacizumab in a patient with colorectal cancer and terminal renal failure. Oncology 2007; 72:209-10. [PMID: 18160810 DOI: 10.1159/000112828] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 06/27/2007] [Indexed: 11/19/2022]
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Koeberle D, Peter I, Boggian K, Mackowiak PA. Excruciating Thigh Pain and Hepatic Air Collection. Clin Infect Dis 2007. [DOI: 10.1086/523579] [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: 11/03/2022] Open
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Koeberle D, Saletti P, Borner M, Caspar C, Strasser F, Ruhstaller T, Mora O, Dietrich D, Gerber D, Herrmann R. 3524 POSTER High rate of clinical benefit response in patients with advanced biliary tract cancer receiving gemcitabine plus capecitabine. A prospective, multicenter phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 44/02). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Klaeser B, Wiederkehr O, Koeberle D, Mueller A, Bubeck B, Thuerlimann B. Therapeutic impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose positron emission tomography in the pre- and postoperative staging of patients with clinically intermediate or high-risk breast cancer. Ann Oncol 2007; 18:1329-34. [PMID: 17693646 DOI: 10.1093/annonc/mdm139] [Citation(s) in RCA: 23] [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: 11/13/2022] Open
Abstract
BACKGROUND Positron emission tomography with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG-PET) is an accurate imaging modality for the staging of breast cancer. The aim of this study was to determine the potential therapeutic impact of pre- and postoperative FDG-PET in patients with clinically intermediate or high-risk breast cancer. PATIENTS AND METHODS One hundred and fourteen patients with newly diagnosed breast cancer were examined before (73) or after (41) surgery. Patient data were translated into three scoring sheets corresponding to information available before positron emission tomography (PET), after PET and after further diagnostic tests. Three medical oncologists independently reviewed the retrospectively acquired patient data and prospectively made decisions on the theoretically planed treatment for each time point, according to the recommendations of St Gallen Consensus Guidelines 2005. RESULTS FDG-PET changed the planed treatment in 32% of 114 patients. In 20% of cases, therapeutic intention (curative versus palliative) was modified. Radiation treatment planning was changed in 27%, surgical planning in 9%, chemotherapy in 11% and intended therapy with bisphosphonates in 13% of all patients. CONCLUSION Based on current treatment guidelines, FDG-PET, as a staging procedure in patients with newly diagnosed clinically intermediate or high-risk breast cancer examined pre- and postoperatively, may have a substantial therapeutic impact on treatment planning.
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Affiliation(s)
- B Klaeser
- Department of Nuclear Medicine, Inselspital, Bern, Switzerland.
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Jost C, Schuller JC, Meyenberger C, Bauerfeind P, Moosmann P, Frossard JL, von Moos R, Koeberle D, Metzger U, Ruhstaller T. Response evaluation with endoscopic ultrasound (EUS) measuring maximum tumor thickness to predict pathological response after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced esophageal cancer (EC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15009 Background: EUS does not accurately assess T-stage after neoadjuvant CRT due to inflammation, necrosis and fibrosis. We evaluated whether maximum tumor thickness (MTT) can predict pathological response (tumor regression grade, TRG) after CRT. Methods: Patients (pts) with resectable, locally advanced EC, were treated with 2 cycles of docetaxel/cisplatin (DC) q3w followed by CRT (DC weekly x5 with concomitant 45 Gy radiation therapy) and surgery. Radial scan EUS (7.5MHz) measured MTT at baseline and 3–5 weeks after CRT completion. We prospectively hypothesized that MTT =6mm in the second EUS predicts complete and subtotal pathological response (TRG1 and 2), tested by logistic regression. The effect of >50% reduction of MTT was analysed as well. Results: 66 pts from 11 institutions were treated; median age 61y (35–70y); adenocarcinoma (AC) 53%; squamous cell carcinoma 46%; 40 pts were eligible for the EUS project (10 no surgery, 10 tumor stenosis prohibiting EUS, 5 MTT not measured, 1 intolerant to EUS). Initial EUS staging: 9 uT2N1, 3 uT3N0, 27 uT3N1, 1 uT3Nx; Siewert-type-1 in 13 of 22 AC. Reduction of MTT to =6mm correctly predicted TRG1/2 with sensitivity (sens) 45%, specificity (spec) 90%, negative predictive value (NPV) 62%, and positive predictive value (PPV) 82%, the Iogistic regression model showed a trend predicting response only (OR 0.80; C.I. 0.62–1.03; p=0.082). Reduction of MTT >50% predicted TRG1/2 with sens 40%, spec 75%, NPV 56% and PPV 62%. Conclusions: The absolute value of maximum tumor thickness =6mm in the second EUS correctly predicts a good response to CRT in 82% (spec 90%) - rather than the relative reduction of MTT >50% -, but does not identify all responders. Feasibility in this multicenter setting was limited by exclusions due to tumor stenosis and incomplete measurements. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- C. Jost
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - J. C. Schuller
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - C. Meyenberger
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - P. Bauerfeind
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - P. Moosmann
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - J. L. Frossard
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R. von Moos
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D. Koeberle
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - U. Metzger
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - T. Ruhstaller
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
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Ruhstaller T, Widmer L, Balmer Majno S, Mingrone W, Hess V, von Moos R, Borner M, Schnider A, Koeberle D, Popescu R. Preoperative induction chemotherapy with docetaxel-cisplatin followed by concurrent docetaxel-cisplatin and radiation therapy in patients with locally advanced esophageal cancer: A prospective, multicenter phase ll trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4562 Background: The role of preoperative therapy in patients (pts) with locally advanced esophageal cancer remains unclear. Non-randomized and randomized studies were often performed in single and highly specialized centers. The purpose of this study was to investigate 1) the efficacy and toxicity of preoperative docetaxel-cisplatin together with radiation therapy (RT) 2) the feasibility of a complex preoperative strategy in a community-based multicenter setting. Methods: Eligibility criteria: resectable, locally advanced (uT3 or uN1, T4 if deemed resectable) squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the thoracic esophagus or gastroesophageal junction (Siewert type l); staged by EUS, CT and PET scan; age 18–70y; PS <2; normal organ functions. Treatment: 2 cycles of docetaxel 75mg/m2 and cisplatin 75mg/m2 q3w, followed by weekly x5 docetaxel 20mg/m2 and cisplatin 25mg/m2 with concomitant 45 Gy RT in 25 fractions; surgery 3- 8 weeks after RT. A two stage-design was used with two primary endpoints: 1) efficacy (TRG : tumor regression grade ); 2) feasibility (successful completion of entire therapy and being alive 30 days after surgery). Results: 66 pts, 56 males, were included from 11 institutions; median age 61y (35–70y); AC 53%; SCC 46%; 53 pts (80%) completed the preoperative therapy, underwent resection and were alive 30 days after surgery; 10 pts (15%) had no resection (4 progressive disease, 4 medical reasons, 2 patient’s refusal). Of 56 (85%) pts who had surgery, 51 pts had RO-resection (91%), 5 pts (9%) died due to complications after surgery (3 after > 30 days). Conclusion: Our trimodality treatment shows encouraging antineoplastic activity with 57% histopathological responders (TRG1 and 2) and acceptable feasibility in a community-based multicenter setting. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- T. Ruhstaller
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - L. Widmer
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - S. Balmer Majno
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - W. Mingrone
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - V. Hess
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R. von Moos
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - M. Borner
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - A. Schnider
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D. Koeberle
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R. Popescu
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
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Borner M, Mingrone W, Koeberle D, Von Moos R, Rauch D, Saletti P, Herrmann R, Dietrich D, Lanz D, Roth A. The impact of cetuximab on the capecitabine plus oxaliplatin (XELOX) combination in first-line treatment of metastatic colorectal cancer (MCC): A randomized phase II trial of the Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3551] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3551 Background: XELOX is a valuable alternative to continuous infusion FOLFOX type regimens in the treatment of MCC (Borner et al, JCO 2002, 1759). Cetuximab is an EGFR antibody, which has been shown to improve the efficacy of chemotherapy. A phase II study in first-line treatment of MCC has demonstrated a high response rate combining cetuximab with FOLFOX (Tabernero et al, Proc ASCO 2004, 3512). Methods: Multicenter, randomized two-arm phase II trial: OXA 130 mg/m2 day 1 and oral CAP 1000 mg/m2 bid days 1–14 every 21 days alone or in combination with cetuximab 250 mg/m2 weekly after a loading dose of 400 mg/m2. Treatment was limited to a maximum of 6 cycles. With 37 patients in each arm, the power was 90% to select the truly better arm if the true between-arm difference in response rate (RECIST) is at least 15%. The study was open for accrual until October 2005. Results: We present here the results of 74 patients included in the study. In 67 patients the first response data are available (investigators’ assessment after 3 cycles). The two arms are well balanced for relevant patient, disease and treatment characteristics. The study treatment was well tolerated with grade 3/4 toxicities in < 10% of the cycles in each arm. The frequency of side effects was balanced, but with more frequent skin toxicity in the cetuximab arm (6% versus 0% grade 3/4). Conclusions: Cetuximab seems to positively interact with XELOX in terms of efficacy but not toxicity. The cetuximab/XELOX combination appears to be a valuable option in first-line treatment of MCC especially if high response rates are a primary objective. This trial was supported in part by Merck KGaA and Sanofi-Aventis Switzerland. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Borner
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - W. Mingrone
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Koeberle
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - R. Von Moos
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Rauch
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - P. Saletti
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - R. Herrmann
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Dietrich
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Lanz
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - A. Roth
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
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Borner MM, Bernhard J, Dietrich D, Popescu R, Wernli M, Saletti P, Rauch D, Herrmann R, Koeberle D, Honegger H, Brauchli P, Lanz D, Roth AD. A randomized phase II trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity. Ann Oncol 2005; 16:282-8. [PMID: 15668285 DOI: 10.1093/annonc/mdi047] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To determine the efficacy, impact on quality-of-life (QoL) and tolerability of two different irinotecan administration schedules in combination with capecitabine as first-line treatment of metastatic colorectal cancer. PATIENTS AND METHODS We carried out a randomized phase II trial to select one of the following treatment regimens for further investigation: weekly irinotecan at a dose of 70 mg/m(2) days 1, 8, 15, 22, 29 (arm A) or 3-weekly irinotecan at a dose of 300/240 mg/m(2) day 1 and days 22 (arm B) in combination with capecitabine 1000 mg/m(2) twice daily days 1-14 and days 22-35 every 6 weeks. RESULTS Seventy-five patients with good performance status entered the trial. The two arms were well balanced for relevant patient and disease characteristics. The most frequent toxic effects were grade 3/4 diarrhea (arm A: 34%, B: 19%), grade 3/4 neutropenia (A: 5%, B: 19%) and grade 2/3 alopecia (A: 26%, B: 65%). Other grade 3/4 toxic effects were rare (<5%). Response rates were 34% [95% confidence interval (CI) 20% to 51%] in arm A and 35% (95% CI: 20% to 53%) in arm B. Median time to progression was 6.9 (4.6-10.1) and 9.2 (7.9-11.5) months and median overall survival was 17.4 (12.6-23.0+) and 24.7 (16.3-26.4+) months. Patients with an objective tumor response reported better physical well-being (P < 0.01), mood (P < 0.05), functional performance (P < 0.05) and less effort to cope (P < 0.05) compared with the non-responders and stable disease patients. CONCLUSIONS The primary end point of this study was the objective response rate and based on the statistical design of the trial, the 3-weekly irinotecan schedule was selected over weekly irinotecan administration. The 3-weekly irinotecan schedule also seemed advantageous in terms of grade 3/4 diarrhea, time to progression, overall survival and patient convenience, but the study was not designed to detect differences in these parameters. In addition, tumor response was shown to have a beneficial effect on QoL indicators.
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Affiliation(s)
- M M Borner
- Institute of Medical Oncology, Inselspital, 3101 Berne, Switzerland.
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Gessner U, Koeberle D, Thuerlimann B, Bacchus L, Horisberger B. Economic analysis of terminal care for patients with malignant osteolytic bone disease and pain treated with pamidronate. Support Care Cancer 2000; 8:115-22. [PMID: 10739358 DOI: 10.1007/s005200050025] [Citation(s) in RCA: 14] [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] [Indexed: 11/29/2022]
Abstract
The goals of this study were the assessment (1) of all costs of terminal care of patients with osteolytic bone disease and pain and (2) of the economic consequences of the pamidronate treatment as observed in a prospective clinical trial on the effectiveness of pamidronate. A total of 70 patients were recruited, who were all suffering from advanced tumour diseases (60% breast cancer, 21% multiple myeloma, and 19% other tumours). In a single-institution study the patients were randomly assigned to receive, in a double-blinded setting, pamidronate 60 mg i.v. or 90 mg i.v. every 3 weeks for a maximum of six cycles. Perception of pain intensity was recorded by self-assessment, using a linear analogue scale. Follow-up lasted 6 months after treatment. All elements of direct costs of in-patient and out-patient care were recorded in cooperation with the hospital administration and the health insurance companies [Krankenkassen]. Average monthly direct costs amounted to ECU 1,290 (+/-410) and 1,050 (+/- 430) during the treatment phase and follow-up, respectively. Average in-patient costs were about three times the out-patient costs. Significantly higher costs (by a factor of 2) were observed for terminal care in hospital (last 3 months before death) than for continued care (of patients surviving the study period). The treatment with pamidronate reduced pain significantly but did not add noticeably to the costs. The study showed that it is practicable and quite efficient to combine a pharmaco-economic evaluation with a clinical trial, although it may be difficult (depending on the setting and availability of information) to assess true costs, i.e. total resource usage.
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Affiliation(s)
- U Gessner
- Research Group on Management in the Health System, University of St. Gallen, Switzerland
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Koeberle D, Henz S, Flury D, Mayer R. [Yellow nail syndrome]. Schweiz Med Wochenschr 1999; 129:1342. [PMID: 10515008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- D Koeberle
- Departement für Innere Medizin, Kantonsspital St. Gallen
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Koeberle-Wuehrer R, Haid A, Sprenger-Maehr H, Koeberle D, Meusburger E, Neyer U. [Intraoperative blood sampling for parathyroid hormone measurement during total parathyroidectomy and autotransplantation in patients with renal hyperparathyroidism]. Wien Klin Wochenschr 1999; 111:246-50. [PMID: 10234780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Normalisation of intact parathyroid hormone serum level confirms sufficient resection of parathyroid tissue after total parathyroidectomy in patients with secondary hyperparathyroidism. The short half-life of the intact parathyroid hormone is such that complete resection may even be confirmed by intraoperative monitoring of the hormone, and operative exploration thus reduced. We tested intact parathyroid hormone serum levels in 9 patients during total parathyroidectomy, preoperatively, after the removal of each gland, after autotransplantation and 1 month postoperatively. The serum levels of the intact parathyroid hormone were significantly reduced after removal of each gland. The total percentage decrement after parathyroidectomy with autotransplantation was 77%. However intact parathyroid hormone levels had normalised in all patients one month after the operation. The absence of perioperative normalisation of intact parathyroid hormone serum levels in our patients cannot be defined as a predictor of incomplete resection in total parathyroidectomy. The definition of an intraoperative cut-off-level concerning the decrement of intact parathyroid hormone levels remains to be proven in further studies.
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Koeberle D, Bacchus L, Thuerlimann B, Senn HJ. Pamidronate treatment in patients with malignant osteolytic bone disease and pain: a prospective randomized double-blind trial. Support Care Cancer 1999; 7:21-7. [PMID: 9926970 DOI: 10.1007/s005200050218] [Citation(s) in RCA: 34] [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: 11/26/2022]
Abstract
The aim of this double-blind, randomized study was to compare the effects of two pamidronate dosages, given as repeated infusions in patients with advanced malignant osteolytic bone disease and bone pain. Seventy patients were randomly assigned to receive pamidronate 60 mg or 90 mg i.v. every 3 weeks for a maximum of six cycles. Pain parameters, analgesic consumption and performance status were assessed at baseline and throughout the study. Furthermore, total-body bone mineral density was measured using dual-energy X-ray absorptiometry at baseline, after three and after six infusions. Sixty percent (95% CI 41-77%) of the patients in the 60 mg group and 63% (95% CI 44-79%) of the patients in the 90-mg group had a sustained reduction of pain intensity and were classified as pain responders. Median duration of pain response was 15 versus 12 weeks in the 60-mg and 90-mg groups, respectively (P = 0.32). After two infusions, significant changes in pain intensity, pain frequency, general well-being and WHO pain score were observed (P<0.01). A trend toward improved performance status and reduced consumption of analgesics was also observed. Patients in the 90-mg group had more pronounced bone remineralization as measured by total-body bone mineral density. No significant difference was detectable between the two pamidronate treatments in any of the parameters evaluated. In conclusion, bone pain can be effectively reduced by repeated pamidronate infusions in patients with advanced osteolytic bone disease. Pamidronate 90 mg every 3 weeks results in higher bone remineralization, but this difference did not translate into a further increase of palliative effects.
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Affiliation(s)
- D Koeberle
- Department of Internal Medicine C, Kantonsspital St. Gallen, Switzerland
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Engler H, Koeberle D, Thuerlimann B, Senn HJ, Riesen WF. Diagnostic and prognostic value of biochemical markers in malignant bone disease: a prospective study on the effect of bisphosphonate on pain intensity and progression of malignant bone disease. Clin Chem Lab Med 1998; 36:879-85. [PMID: 9877095 DOI: 10.1515/cclm.1998.154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Seventy cancer patients with malignant osteolytic bone disease received pamidronate every three weeks for a maximum of six cycles. Bone resorption parameters, urinary calcium excretion, and pain parameters were assessed at baseline and throughout the study. At baseline, 80-95% of patients showed elevated urinary pyridinoline, deoxypyridinoline, Osteomark NTx and serum ICTP levels, whereas only 35% of patients had elevated urinary CrossLaps excretion rates. During bisphosphonate therapy, significant decreases in Osteomark NTx, CrossLaps and calcium excretion were observed, which were not related to the clinical outcome. The baseline levels of bone resorption markers were used to predict the probability of non-progressive bone disease or reduction in pain intensity during bisphosphonate therapy. Significant predictors of non-progressive bone disease were urinary pyridinoline and serum ICTP levels; significant predictors of reduction in pain intensity were urinary free deoxypyridinoline and serum ICTP levels. Our data indicate that serum ICTP levels predict significantly the response to bisphosphonate therapy in patients with advanced malignant osteolytic bone disease. CrossLaps did not predict the clinical outcome, but decreased significantly during bisphosphonate therapy. Our data demonstrate that the different bone resorption markers are reflecting different aspects of bone metabolism, and therefore differ in their diagnostic and prognostic properties.
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Affiliation(s)
- H Engler
- Institute of Clinical Chemistry and Hematology, Kantonsspital St. Gallen, Switzerland
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Abstract
Plasma endothelin-1 (ET-1) and cortisol were measured around the clock at hourly intervals on 7 clinically healthy, diurnally active, nocturnally resting subjects 22-27 years of age. The circadian rhythm in cortisol is demonstrated for each subject (p < or = 0.020) as well as on a group basis (p = 0.002), peaking in the morning. By contrast, the circadian variation of ET-1 is statistically significant in only one of the subjects, and it is not detected for the group as a whole (p > 0.20). Instead, ET-1 is characterized by an about 8-h component (p < 0.001) that is not found for cortisol.
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Affiliation(s)
- M Herold
- Universitäts-Klinik für Innere Medizin, Innsbruck, Austria
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