1
|
Schnitzer T, Pueyo M, Deckx H, van der Aar E, Bernard K, Hatch S, van der Stoep M, Grankov S, Phung D, Imbert O, Chimits D, Muller K, Hochberg MC, Bliddal H, Wirth W, Eckstein F, Conaghan PG. Evaluation of S201086/GLPG1972, an ADAMTS-5 inhibitor, for the treatment of knee osteoarthritis in ROCCELLA: a phase 2 randomized clinical trial. Osteoarthritis Cartilage 2023:S1063-4584(23)00737-9. [PMID: 37059327 DOI: 10.1016/j.joca.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the anti-catabolic ADAMTS-5 inhibitor S201086/GLPG1972 for the treatment of symptomatic knee osteoarthritis. DESIGN ROCCELLA (NCT03595618) was a randomized, double-blind, placebo-controlled, dose-ranging, phase 2 trial in adults (aged 40-75 years) with knee osteoarthritis. Participants had moderate-to-severe pain in the target knee, Kellgren-Lawrence grade 2 or 3 and Osteoarthritis Research Society International joint space narrowing (grade 1 or 2). Participants were randomized 1:1:1:1 to once-daily oral S201086/GLPG1972 75, 150 or 300 mg, or placebo for 52 weeks. The primary endpoint was change from baseline to week 52 in central medial femorotibial compartment cartilage thickness (cMFTC) assessed quantitatively by magnetic resonance imaging. Secondary endpoints included change from baseline to week 52 in radiographic joint space width, Western Ontario and McMaster Universities Osteoarthritis Index total and subscores, and pain (visual analogue scale). Treatment-emergent adverse events (TEAEs) were also recorded. RESULTS Overall, 932 participants were enrolled. No significant differences in cMFTC cartilage loss were observed between placebo and S201086/GLPG1972 therapeutic groups: placebo vs 75 mg, P = 0.165; vs 150 mg, P = 0.939; vs 300 mg, P = 0.682. No significant differences in any of the secondary endpoints were observed between placebo and treatment groups. Similar proportions of participants across treatment groups experienced TEAEs. CONCLUSIONS Despite enrolment of participants who experienced substantial cartilage loss over 52 weeks, during the same time period, S201086/GLPG1972 did not significantly reduce rates of cartilage loss or modify symptoms in adults with symptomatic knee osteoarthritis.
Collapse
Affiliation(s)
- T Schnitzer
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - M Pueyo
- Institut de Recherches Internationales Servier (IRIS), Suresnes, France
| | - H Deckx
- Galapagos NV, Mechelen, Belgium.
| | | | - K Bernard
- Institut de Recherches Internationales Servier (IRIS), Suresnes, France.
| | - S Hatch
- Galapagos Inc., Waltham, Massachusetts, USA.
| | | | - S Grankov
- Institut de Recherches Internationales Servier (IRIS), Suresnes, France.
| | - D Phung
- Galapagos NV, Mechelen, Belgium.
| | - O Imbert
- Institut de Recherches Internationales Servier (IRIS), Suresnes, France.
| | - D Chimits
- Institut de Recherches Internationales Servier (IRIS), Suresnes, France.
| | - K Muller
- Galapagos NV, Mechelen, Belgium.
| | - M C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - H Bliddal
- The Parker Institute, Copenhagen, Denmark.
| | - W Wirth
- Chondrometrics GmbH, Ainring, Germany; Institute of Anatomy and Cell Biology and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria.
| | - F Eckstein
- Chondrometrics GmbH, Ainring, Germany; Institute of Anatomy and Cell Biology and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria.
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.
| |
Collapse
|
2
|
Le HTCH, Dang TN, Ware R, Phung D, Thai PK, Sly PD, Le An P. Using the health beliefs model to explore children's attitudes and beliefs on air pollution. Public Health 2021; 196:4-9. [PMID: 34126559 DOI: 10.1016/j.puhe.2021.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/16/2020] [Revised: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Traffic-related air pollution (TRAP) negatively impacts children's health. Self-protective measures are available, but population uptake is variable. It is essential to understand human beliefs and behaviours related to air pollution in order to understand the lack of self-protection in communities. As a prelude to undertaking a comprehensive assessment of children's attitudes and beliefs on the health effects of TRAP exposure, we sought to develop and validate an appropriate instrument. STUDY DESIGN This study used exploratory sequential mixed methods. METHODS This instrument, based on the constructs of the health belief model (HBM), aimed to determine factors predicting wearing a mask to protect against TRAP exposure. An initial literature-based questionnaire was modified using in-depth interviews, focus group discussions, and a quantitative survey pilot. This study included 121 school students and nine professional experts in Vietnam. The questionnaire was tested for content validity, agreement, test-retest reliability, and internal consistency. RESULTS The concordance of questionnaire items between two repeated assessments ranged from 47.2% to 78.3%, intraclass correlation coefficients ranged from 0.16 to 0.87 and Cronbach's internal reliability coefficient for the instrument was 0.60. CONCLUSION The self-administered instrument, based on the HBM, is suitable to understand health attitudes and beliefs related to self-protective behaviours to reduce TRAP exposure.
Collapse
Affiliation(s)
- H T C H Le
- Faculty of Medicine, The University of Queensland, Australia; Children's Health and Environment Program, Centre for Children's Health Research, Queensland, Australia
| | - T N Dang
- Department of Environmental Health, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - R Ware
- Menzies Health Institute Queensland, Griffith University, Australia
| | - D Phung
- Centre for Environment and Population Health, Griffith University, Australia
| | - P K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Australia
| | - P D Sly
- Children's Health and Environment Program, Centre for Children's Health Research, Queensland, Australia
| | - P Le An
- Centre for the Training of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
| |
Collapse
|
3
|
Bernard K, Grankov S, Van der Stoep M, Lalande A, Imbert O, Phung D, Chimits D, Muller K, Van der Aar E, Deckx H, Pueyo M, Eckstein F. FRI0393 BASELINE CHARACTERISTICS OF THE STUDY POPULATION IN ROCCELLA, A PHASE 2 CLINICAL TRIAL EVALUATING THE EFFICACY AND THE SAFETY OF S201086/GLPG1972 IN PATIENTS WITH KNEE OSTEOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Osteoarthritis (OA) is a degenerative joint disease involving structural pathology of all joint tissues, and most commonly affecting the knee, hip and hand. Degradation of the cartilage extracellular matrix represents a central feature of OA and is widely thought to be mediated by proteinases that degrade primarily aggrecan and collagen. ADAMTS-5, a Disintegrin And Metalloproteinase with ThromboSpondin-motif-5, is a key aggrecan-cleaving enzyme involved in cartilage degradation. S201086/GLPG1972, a potent and highly selective inhibitor of ADAMTS-5, is an oral Disease-Modifying OsteoArthritis Drug (DMOAD) candidate.Objectives:The primary objective of the ROCCELLA phase 2 clinical trial (NCT03595618) is to evaluate the effect of S201086/GLPG1972 over 52 weeks of treatment (3 dose groups compared to placebo) in reducing cartilage loss. Cartilage thickness of the knee is being measured quantitatively by Magnetic Resonance Imaging. Here, we describe the baseline characteristics of patients included in the ROCCELLA clinical trial.Methods:The main inclusion criteria were: male or female, aged 40 to 75, with a diagnosis of knee OA according to the clinical and radiological criteria of the American College of Rheumatology. The target knee had to meet a pain score between 40 and 90 mm on a 100 mm Visual Analog Scale (VAS), and the following radiographic feature upon central radiographic readings: Kellgren/Lawrence (KL) 2 or 3 and OARSI medial joint space narrowing (JSN) 1 or 2 (for more details see Deckxet al. OARSI 2020). The rationale for these specific radiographic inclusion criteria was to ensure sufficient cartilage loss over 12 months to assess the efficacy of S201086/GLPG1972.Results:Across 12 countries, 3319 patients were screened and 932 were finally included in the study. The screen failure of 72% is mainly due to the radiological criteria. The age of the patients was 62.9 ± 7.3 years (mean ± SD) with a majority of women (69.3%). The BMI was 30.5 ± 4.7 kg/m2. The duration of knee OA was 7.2 ± 6.9 years. Five hundred and one (53.8%) patients reported a medical history of musculoskeletal and connective tissue disorders, mainly osteoarthritis in other sites (20.2%), back pain (13.6%), and arthralgia (9.8%). At inclusion, 97.2% of the patients were taking different types of drug treatments, mainly anti-inflammatory and anti-rheumatic products (69.4%) and analgesics (42%). At baseline, 11% of the target knees were KL2 and 89% were KL3; 32% were OARSI medial JSN grade 1 and 68% grade 2. Target knees at inclusion had a pain score on the VAS of 63.5 ± 11.4 mm (range 0-100, with 0 for no and 100 for extreme pain) and a total WOMAC (Likert 3.1) score of 48.0 ± 15.0 (range 0-96). The WOMAC subscores for pain, stiffness and physical function were 10.0 ± 3.2 (range 0-20), 4.2 ± 1.6 (range 0-8) and 33.8 ± 11.2 (range 0-68, indicating functional limitation), respectively.Conclusion:For this clinical trial, patients were selected to present radiological criteria (i.e.OARSI JSN 1 and 2) to ensure sufficient structural progression (cartilage loss) over 12 months, as well as clinical symptoms. These stringent selection criteria were the main cause for the high screen failure rate. These baseline characteristics should warrant the ability to evaluate the efficacy of S201086/GLPG1972 as a DMOAD candidate. The search for an effective pharmacological treatment that can prevent or cure OA remains a major challenge and unmet medical need.Disclosure of Interests:Katy Bernard Employee of: Institut de Recherches Internationales Servier, Sergey GRANKOV Employee of: Institut de Recherches Internationales Servier, Marjolijne van der Stoep Employee of: Galapagos, Agnès Lalande Employee of: Institut de Recherches Internationales Servier, Olivier Imbert Employee of: Institut de Recherches Internationales Servier, De Phung Employee of: Galapagos, Damien Chimits Employee of: Institut de Recherches Internationales Servier, Karine Muller Employee of: Galapagos, Ellen van der Aar Employee of: Galapagos, Henri Deckx Employee of: Galapagos, Maria Pueyo Employee of: Institut de Recherches Internationales Servier, Felix Eckstein Grant/research support from: Merck, Orthotrphix, Servier, Galapagos, Kolon Tissuegene, Samumed, Novartis, Consultant of: Merck, Bioclinica, Servier, Samumed, Roche, Kolon Tissuegene, Galapagos and Novartis, Employee of: co-owner and employment with Chondrometrics
Collapse
|
4
|
Armstrong AJ, Lin P, Higano CS, Sternberg CN, Sonpavde G, Tombal B, Templeton AJ, Fizazi K, Phung D, Wong EK, Krivoshik A, Beer TM. Development and validation of a prognostic model for overall survival in chemotherapy-naïve men with metastatic castration-resistant prostate cancer. Ann Oncol 2019; 29:2200-2207. [PMID: 30202945 DOI: 10.1093/annonc/mdy406] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Prognostic models are needed that reflect contemporary practice for men with metastatic castration-resistant prostate cancer (mCRPC). We sought to identify predictive and prognostic variables for overall survival (OS) in chemotherapy-naïve men with mCRPC treated with enzalutamide. Patients and methods Patients from the PREVAIL trial database (enzalutamide versus placebo) were randomly split 2 : 1 into training (n = 1159) and testing (n = 550) sets. Using the training set, 23 predefined variables were analyzed and a multivariable model predicting OS was developed and validated in an independent testing set. Results Patient characteristics and outcomes were well balanced between training and testing sets; median OS was 32.7 months in each. The final validated multivariable model included 11 independent prognostic variables. Median OS for low-, intermediate-, and high-risk groups (testing set) defined by prognostic risk tertiles were not yet reached (NYR) (95% CI NYR-NYR), 34.2 months (31.5-NYR), and 21.1 months (17.5-25.0), respectively. Hazard ratios (95% CI) for OS in the low- and intermediate-risk groups versus high-risk group were 0.20 (0.14-0.29) and 0.40 (0.30-0.53), respectively. Secondary outcomes of response and progression differed widely in model-defined risk groups. Enzalutamide improved outcomes in all prognostic risk groups. Conclusions Our validated prognostic model incorporates variables routinely collected in chemotherapy-naïve men with mCRPC treated with enzalutamide, identifying subsets of patients with widely differing survival outcomes that provide useful information for external validation, patient care, and clinical trial design. Trial registration ClinicalTrials.gov: NCT01212991.
Collapse
Affiliation(s)
- A J Armstrong
- Division of Medical Oncology and Urology, Duke Prostate and Urologic Cancer Center, Duke Cancer Institute Duke University, Durham.
| | - P Lin
- Biostatistics (Lin) and Medical Affairs (Wong), Pfizer Inc, San Francisco
| | - C S Higano
- Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, USA
| | - C N Sternberg
- Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - G Sonpavde
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, USA
| | - B Tombal
- Urology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - A J Templeton
- Department of Oncology, St. Claraspital and University of Basel, Basel, Switzerland
| | - K Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy University of Paris Sud, Villejuif, France
| | - D Phung
- Biostatistics, Astellas Pharma Europe BV, Leiden, The Netherlands
| | - E K Wong
- Biostatistics (Lin) and Medical Affairs (Wong), Pfizer Inc, San Francisco
| | - A Krivoshik
- Medical Sciences, Astellas Pharma US, Inc, Northbrook
| | - T M Beer
- Hematology/Medical Oncology, OHSU Knight Cancer Institute Oregon Health & Science University, Portland, USA
| |
Collapse
|
5
|
Cartledge S, Rogerson M, Singh TKR, Huynh Huu V, Phung D, Gurrin C, Neil C, Ball K, Maddison R. 297Seeing is believing: the feasibility and acceptability of using wearable cameras to enhance self-management of heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0094] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
For people with heart failure (HF), self-management (e.g., adhering to prescribed medication, management of fluid restrictions and daily weighing) and dietary management is critical for disease management. The rise of technologies (mobile phones, wearable cameras) for healthcare use offers potential support for people to better manage their disease. We aimed to test the feasibility and utility of wearable cameras for identifying self-management practices and to determine if these images can be used to enhance self-management in people with HF.
Methods
Participants wore the “narrative clip”, a small wearable camera for one month during waking hours; still images were taken every 30 seconds. Using state-of-the-art artificial intelligence techniques, we investigated automated image analysis of daily life activities to determine the potential of these systems to identify four categories of human activities: medication management, dietary intake, meal preparation and physical activity. Participants also completed a semi-structured questionnaire about acceptability and feasibility.
Results
30 participants (mean age 73.6 years, 60% male) with HF NYHA Class II-III were recruited. A total of 629,603 images were available for analysis. Higher order analyses were conducted to determine precision of identifying correct images for the pre-defined self-management categories. Precision of identifying the correct images was highest in dietary intake (average 49%, range 13–94%) followed by meal preparation (average 40%, range 1–99%) and physical activity (average 31%, range 0–95%). Medication management had the lowest precision (average 6%, range 6–22%). Manual review of images revealed substantial periods of sedentary time, typically paired with screen time (watching television, playing cards on a computer). All participants agreed the camera was easy to use and felt they had privacy when using the camera. The majority of participants felt comfortable wearing the camera (93%) and thought this technique will help people with HF in the future (93%).
Conclusions
Images from wearable cameras provided rich contextual data to better understand the lived experiences of people with HF and the device was acceptable to participants. Automated machine learning tools require more annotated data for training to enhance precision, which will be achieved via further annotation, fine-tuning and retraining the data analysis model. Despite these challenges, the data collected can be used as an adjunct to traditional data collection methods such as self-report. Once data analysis techniques are refined, objective data from wearable cameras may also prove useful for nurses to provide tailored education for self-management.
Acknowledgement/Funding
Heart Foundation Vanguard Grant, Australia (101348)
Collapse
Affiliation(s)
- S Cartledge
- Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia
| | - M Rogerson
- Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia
| | - T K R Singh
- Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia
| | - V Huynh Huu
- Deakin University, Department of Pattern Recogntion & Data Analytics, Geelong, Australia
| | - D Phung
- Deakin University, Department of Pattern Recogntion & Data Analytics, Geelong, Australia
| | - C Gurrin
- Dublin City University (DCU), School of Computing, Dublin, Ireland
| | - C Neil
- Western Health, Melbourne, Australia
| | - K Ball
- Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia
| | - R Maddison
- Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia
| |
Collapse
|
6
|
Villers A, Attard G, Saad F, Tombal B, Hussein M, Sternberg C, Phung D, Morlock R, Modelska K, Reisman A, Ivanescu C, Penson D. Association entre la qualité de vie liée à la santé (qdv) et les signes cliniques du cancer de prostate résistant à la castration non métastatique (cprcnm) : résultats de l’étude prosper. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.016] [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: 10/27/2022]
|
7
|
Tombal B, Hussain M, Penson D, Attard G, Sternberg C, Phung D, Morlock R, Modelska K, Ramaswamy K, Ivanescu C, Saad F. Prolonged urinary and bowel symptom control in men with non-metastatic castration-resistant prostate cancer (nmCRPC) treated with enzalutamide: Results from the PROSPER study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.016] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
|
8
|
Fizazi K, Hussain M, Saad F, Shore N, De Giorgi U, Efstathiou E, Ferreira U, Ivashchenko P, Madziarska K, Al-Adhami M, Modelska K, Phung D, Steinberg J, Sternberg C. A phase III, randomized, double-blind, placebo (PBO)-controlled study of enzalutamide (ENZA) in men with nonmetastatic (M0) castration-resistant prostate cancer (CRPC): Results of PROSPER by age and region. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.014] [Citation(s) in RCA: 1] [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
|
9
|
Armstrong A, Lin P, Higano C, Iversen P, Sternberg C, Tombal B, Phung D, Parli T, Krivoshik A, Beer T. Prognostic associations of prostate-specific antigen (PSA) decline with survival, radiographic response and progression in chemotherapy-naïve men with metastatic castration-resistant prostate cancer (mCRPC) treated with enzalutamide. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370.004] [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
|
10
|
Bryce AH, Alumkal JJ, Armstrong A, Higano CS, Iversen P, Sternberg CN, Rathkopf D, Loriot Y, de Bono J, Tombal B, Abhyankar S, Lin P, Krivoshik A, Phung D, Beer TM. Radiographic progression with nonrising PSA in metastatic castration-resistant prostate cancer: post hoc analysis of PREVAIL. Prostate Cancer Prostatic Dis 2017; 20:221-227. [PMID: 28117385 PMCID: PMC5435962 DOI: 10.1038/pcan.2016.71] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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: 09/14/2016] [Revised: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Advanced prostate cancer is a phenotypically diverse disease that evolves through multiple clinical courses. PSA level is the most widely used parameter for disease monitoring, but it has well-recognized limitations. Unlike in clinical trials, in practice, clinicians may rely on PSA monitoring alone to determine disease status on therapy. This approach has not been adequately tested. METHODS Chemotherapy-naive asymptomatic or mildly symptomatic men (n=872) with metastatic castration-resistant prostate cancer (mCRPC) who were treated with the androgen receptor inhibitor enzalutamide in the PREVAIL study were analyzed post hoc for rising versus nonrising PSA (empirically defined as >1.05 vs ⩽1.05 times the PSA level from 3 months earlier) at the time of radiographic progression. Clinical characteristics and disease outcomes were compared between the rising and nonrising PSA groups. RESULTS Of 265 PREVAIL patients with radiographic progression and evaluable PSA levels on the enzalutamide arm, nearly one-quarter had a nonrising PSA. Median progression-free survival in this cohort was 8.3 months versus 11.1 months in the rising PSA cohort (hazard ratio 1.68; 95% confidence interval 1.26-2.23); overall survival was similar between the two groups, although less than half of patients in either group were still at risk at 24 months. Baseline clinical characteristics of the two groups were similar. CONCLUSIONS Non-rising PSA at radiographic progression is a common phenomenon in mCRPC patients treated with enzalutamide. As restaging in advanced prostate cancer patients is often guided by increases in PSA levels, our results demonstrate that disease progression on enzalutamide can occur without rising PSA levels. Therefore, a disease monitoring strategy that includes imaging not entirely reliant on serial serum PSA measurement may more accurately identify disease progression.
Collapse
Affiliation(s)
- A H Bryce
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - J J Alumkal
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - A Armstrong
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - C S Higano
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - P Iversen
- Department of Clinical Medicine, Rigshospitalet, Copenhagen, Denmark
| | - C N Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - D Rathkopf
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Y Loriot
- Department of Cancer Medicine, Institut Gustave-Roussy, Villejuif, France
| | - J de Bono
- Division of Clinical Studies, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - B Tombal
- Division of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - S Abhyankar
- Medical Affairs, Medivation, Inc., San Francisco, CA, USA
| | - P Lin
- Biostatistics, Medivation, Inc., San Francisco, CA, USA
| | - A Krivoshik
- Medical Oncology, Astellas Pharma, Inc., Northbrook, IL, USA
| | - D Phung
- Biostatistics, Astellas Pharma, Inc., Northbrook, IL, USA
| | - T M Beer
- OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
11
|
Dwipayanti N, Rutherford S, Phung D, Chu C. How Important is Culture to Sanitation Uptake? The Influence of Local Values in Rural Bali. ACTA ACUST UNITED AC 2017. [DOI: 10.1166/asl.2017.9160] [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: 11/23/2022]
Affiliation(s)
- N Dwipayanti
- Center for Environment and Population Health, Griffith University, Nathan, Queensland, 4111, Australia
| | - S Rutherford
- Center for Environment and Population Health, Griffith University, Nathan, Queensland, 4111, Australia
| | - D Phung
- Center for Environment and Population Health, Griffith University, Nathan, Queensland, 4111, Australia
| | - C Chu
- Center for Environment and Population Health, Griffith University, Nathan, Queensland, 4111, Australia
| |
Collapse
|
12
|
Krauwinkel W, Noukens J, van Dijk J, Popa S, Ouatas T, de Vries M, Phung D, Gibbons J, Mordenti J, Mateva L. A comparison of the pharmacokinetics and safety of enzalutamide in subjects with hepatic impairment and matched healthy subjects. J Clin Pharm Ther 2017; 42:268-275. [PMID: 28251667 DOI: 10.1111/jcpt.12503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/17/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Enzalutamide is an androgen receptor inhibitor approved for treatment of metastatic castration-resistant prostate cancer. Enzalutamide is highly protein bound and eliminated primarily by hepatic metabolism; therefore, it is important to understand whether enzalutamide pharmacokinetics is altered by hepatic impairment. METHODS Pharmacokinetic data were obtained from two non-randomized, open-label, single-dose, phase 1 studies conducted in patients with mild (Child-Pugh class A, n = 6) or moderate (Child-Pugh class B, n = 8) hepatic impairment (NCT01901133) or severe (Child-Pugh class C, n = 8) hepatic impairment (NCT02138162) and their corresponding matched healthy controls; data from both studies are presented here. Subjects with hepatic impairment had liver cirrhosis (n = 19) or chronic hepatitis (n = 3). All subjects received a single oral dose of 160 mg enzalutamide under fasting conditions, with blood samples collected predose and up to 49 days post-dose. RESULTS AND DISCUSSION Exposure to enzalutamide active moieties, based on the area under the curve of the sum of enzalutamide and N-desmethyl enzalutamide (an active metabolite with similar potency to enzalutamide), increased by 13%, 18% and 4% in subjects with mild, moderate and severe hepatic impairment, respectively, relative to matched controls. Compared with healthy controls, the mean maximum plasma concentration for enzalutamide active moieties was 24% higher in subjects with mild hepatic impairment and 11% and 41% lower in subjects with moderate and severe hepatic impairment, respectively. Enzalutamide was generally well tolerated, with no clinically significant trends in abnormal laboratory findings, vital signs or electrocardiograms. WHAT IS NEW AND CONCLUSIONS No major differences in single-dose pharmacokinetics were observed in subjects with hepatic impairment vs. matched healthy controls. Therefore, these studies indicate that no initial dose adjustment is necessary when administering enzalutamide to patients with hepatic impairment.
Collapse
Affiliation(s)
| | - J Noukens
- Kinesis Pharma BV, Breda, The Netherlands
| | - J van Dijk
- Astellas Pharma Europe, Leiden, The Netherlands
| | - S Popa
- ARENSIA Exploratory Medicine, Republican Clinical Hospital, Chisinau, Moldova
| | - T Ouatas
- Astellas Pharma Europe, Leiden, The Netherlands
| | - M de Vries
- Astellas Pharma Europe, Leiden, The Netherlands
| | - D Phung
- Astellas Pharma Europe, Leiden, The Netherlands
| | - J Gibbons
- Medivation, Inc., (Medivation was acquired by Pfizer, Inc. in September 2016), San Francisco, CA, USA
| | - J Mordenti
- Medivation, Inc., (Medivation was acquired by Pfizer, Inc. in September 2016), San Francisco, CA, USA
| | - L Mateva
- Gastroenterology Clinic, University Hospital St. Ivan Rilski, Medical University Sofia, COMAC Medical Ltd, Sofia, Bulgaria
| |
Collapse
|
13
|
Miller K, Mulders P, Freedland S, Scher H, Shore N, Park E, Krivoshik A, Phung D, Modelska K, Scardino P. EMBARK: A phase 3, randomized, efficacy and safety study of enzalutamide plus leuprolide, enzalutamide monotherapy and placebo plus leuprolide in men with high-risk nonmetastatic prostate cancer progressing after definitive therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.53] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
|
14
|
Chowdhury S, Shore N, Saad F, Higano C, Fizazi K, Iversen P, Miller K, Heidenreich A, Ueda T, Kim C, Phung D, Krivoshik A, Wang F, Wu K, Tombal B. Fatigue in men with metastatic castration-resistant prostate cancer treated with enzalutamide: data from randomised clinical trials. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.23] [Citation(s) in RCA: 2] [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: 11/12/2022] Open
|
15
|
Bryce A, Alumkal J, Armstrong A, Higano C, Iversen P, Sternberg C, Rathkopf D, Loriot Y, de Bono J, Tombal B, Abhyankar S, Lin P, Krivoshik A, Phung D, Beer T. A post hoc analysis of radiographic progression with nonrising prostate-specific antigen in patients with metastatic castration-resistant prostate cancer (mCRPC) in the PREVAIL study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
16
|
Graff J, Baciarello G, Armstrong A, Higano C, Iversen P, Flaig T, Forer D, Parli T, Phung D, Tombal B, Beer T, Sternberg C. Efficacy and safety of enzalutamide in patients 75 years or older with chemotherapy-naive metastatic castration-resistant prostate cancer: results from PREVAIL. Ann Oncol 2016; 27:286-94. [DOI: 10.1093/annonc/mdv542] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023] Open
|
17
|
Ivanescu C, Phung D, Loriot Y, Saad F, Mansbach H, Beer TM, Tombal B, Holmstrom S. Skeletal-Related Events (SRES) Impact Significantly the Health-Related Quality of Life (HRQOL) of Chemo-Naive Men With Metastatic Castration Resistant Prostate Cancer (MCRPC). Value Health 2014; 17:A650-A651. [PMID: 27202342 DOI: 10.1016/j.jval.2014.08.2365] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Ivanescu
- Quintiles Consulting, Hoofddorp, The Netherlands
| | - D Phung
- Astellas Pharma Global Development, Leiden, The Netherlands
| | - Y Loriot
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - F Saad
- CHUM, Montreal, QC, Canada
| | | | - T M Beer
- Oregon Health & Science University, Portland, OR, USA
| | - B Tombal
- Cliniques Universitaires Saint-Luc, Brussel, Belgium
| | - S Holmstrom
- HEOR, Astellas Pharma Global Development, Leiden, The Netherlands
| |
Collapse
|
18
|
Loriot Y, Miller K, Sternberg C, Fizazi K, de Bono J, Chowdhury S, Higano C, Noonberg S, Holmstrom S, Mansbach H, Perabo F, Phung D, Ivanescu C, Skaltsa K, Beer T, Tombal B. Impact of Enzalutamide on Skeletal Related Events (Sres), Pain and Quality of Life (Qol) in the Prevail Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.10] [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: 11/12/2022] Open
|
19
|
Tombal B, Borre M, Rathenborg P, Werbrouck P, van Poppel H, Heidenreich A, Iversen P, Braeckman J, Heracek J, Baskin-Bey E, Ouatas T, Perabo F, Phung D, Baron B, Hirmand M, Smith M. Long-Term Efficacy and Safety of Enzalutamide Monotherapy in Hormone-Naive Prostate Cancer: 2-Year Follow-Up. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
20
|
Baskin-Bey ES, Holtkamp GM, Smith MR, Ouatas T, Phung D, Tombal B. A phase II, open-label, single-arm, efficacy, and safety study of MDV3100 in patients with hormone-naïve prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.177] [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
177 Background: MDV3100 is a novel androgen receptor (AR) antagonist in clinical development for the treatment of prostate cancer (PCa). Compared to bicalutamide, MDV3100 has higher in vitro AR binding affinity and no evidence of partial agonism. Preliminary phase I-II data show antitumor activity with MDV3100 in men with advanced PCa who were concurrently using androgen deprivation therapy (ADT; Scher HI, et al. Lancet. 2010;375:1437-46). Phase II and III studies in men with progressive and earlier-stage PCa are ongoing. This abstract describes the design of a phase II study of MDV3100 in men with hormone-naïve PCa (HNPCa) who are candidates for ADT. Methods: This 25-week, open-label, single-arm, efficacy and safety study of MDV3100 (160 mg/d orally) will be initiated at ∼20 investigational sites in late 2010 (planned countries: Austria, Belgium, Czech Republic, Denmark, Germany). Inclusion criteria include histologically confirmed, locally advanced PCa (all stages), noncastrate testosterone (T; ≥230 ng/dL), prostate-specific antigen (PSA) ≥2 ng/mL (screening), Eastern Cooperative Oncology Group score of 0, and life expectancy ≥1 year. Exclusion criteria include, among others, previous/current hormonal therapy or chemotherapy for PCa. The primary endpoint is PSA response, defined as an ≥80% decrease from baseline to wk 25. A binary PSA response per patient (wk 25) will be determined, allowing for generation of a PSA response rate (95% CI) from all patients for the study. Secondary endpoints include: PSA dynamics; pharmacokinetics; change in gonadotropin, T, dihydrotestosterone, estradiol, sex-hormone binding globulin, and prolactin levels; and safety/tolerability. Exploratory endpoints include changes in bone mineral density, bone turnover markers, metabolic parameters, and quality of life. Results: The planned enrollment is 60 patients. With a 20% dropout rate, the study will have 80% power to reject the unwanted PSA response rate of ≤50% (5% significance). Efficacy and safety data will be published later. Conclusions: Previous data were in men with castrate levels of T (≤50 ng/dL). This trial will be the first to investigate the use of MDV3100 monotherapy in HNPCa. [Table: see text]
Collapse
Affiliation(s)
- E. S. Baskin-Bey
- Astellas Pharma Europe, Ltd., Staines, United Kingdom; Astellas Pharma Europe BV, Leiderdorp, Netherlands; Massachusetts General Hospital Cancer Center, Boston, MA; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - G. M. Holtkamp
- Astellas Pharma Europe, Ltd., Staines, United Kingdom; Astellas Pharma Europe BV, Leiderdorp, Netherlands; Massachusetts General Hospital Cancer Center, Boston, MA; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - M. R. Smith
- Astellas Pharma Europe, Ltd., Staines, United Kingdom; Astellas Pharma Europe BV, Leiderdorp, Netherlands; Massachusetts General Hospital Cancer Center, Boston, MA; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - T. Ouatas
- Astellas Pharma Europe, Ltd., Staines, United Kingdom; Astellas Pharma Europe BV, Leiderdorp, Netherlands; Massachusetts General Hospital Cancer Center, Boston, MA; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - D. Phung
- Astellas Pharma Europe, Ltd., Staines, United Kingdom; Astellas Pharma Europe BV, Leiderdorp, Netherlands; Massachusetts General Hospital Cancer Center, Boston, MA; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - B. Tombal
- Astellas Pharma Europe, Ltd., Staines, United Kingdom; Astellas Pharma Europe BV, Leiderdorp, Netherlands; Massachusetts General Hospital Cancer Center, Boston, MA; Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
21
|
Dworkin RH, Boon RJ, Griffin DR, Phung D. Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. J Infect Dis 1998; 178 Suppl 1:S76-80. [PMID: 9852980 DOI: 10.1086/514260] [Citation(s) in RCA: 96] [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: 11/03/2022] Open
Abstract
New and previously reported analyses of the data from a placebo-controlled trial of famciclovir are reviewed in light of recently proposed recommendations for the analysis of pain in herpes zoster trials. The analyses examined the effect of famciclovir treatment on the duration of postherpetic neuralgia (PHN), which was defined as pain persisting after rash healing, pain persisting > 30 days after study enrollment, or pain persisting > 3 months after study enrollment; the baseline characteristics of patients in the famciclovir and placebo groups who developed PHN; the impact of famciclovir treatment on the duration of PHN, while controlling for significant covariates; and the prevalence of PHN at monthly intervals from 30 to 180 days after enrollment. The results of these analyses indicated that greater age, rash severity, and acute pain severity are risk factors for prolonged PHN. In addition, they demonstrated that treatment of acute herpes zoster patients with famciclovir significantly reduces both the duration and prevalence of PHN.
Collapse
Affiliation(s)
- R H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, New York 14642, USA.
| | | | | | | |
Collapse
|
22
|
Towler MA, McGregor W, Rodeheaver GT, Cutler PV, Bond RF, Phung D, Morgan RG, Thacker JG, Edlich RF. Influence of cutting edge configuration on surgical needle penetration forces. J Emerg Med 1988; 6:475-81. [PMID: 3221065 DOI: 10.1016/0736-4679(88)90403-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A standardized test for measuring the needle penetration forces has been developed that can be easily replicated in any laboratory. Using this test, conventional cutting edge needles utilized in the test produced lower penetration forces than reverse cutting edge needles. The lower penetration forces encountered by the conventional cutting edge needles imply that the physician should be able to handle these needles with more dexterity and precision than the reverse cutting edge needle.
Collapse
Affiliation(s)
- M A Towler
- Department of Aerospace Engineering, University of Virginia, Charlottesville
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Edlich RF, Becker DG, Phung D, McClelland WA, Day SG. Water treatment of hydrotherapy exercise pools. J Burn Care Rehabil 1988; 9:510-5. [PMID: 3056952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The major objectives of water treatment of hydrotherapy pools are to disinfect the water and to balance the water appropriately. A variety of disinfectant systems utilizing either halogens, ozone, or metals have been implemented in hydrotherapy pools. Regardless of the disinfectant system employed, continual and appropriate monitoring of the system is mandatory to prevent infection. Water balancing refers to the control of the water mineral concentration so that the water does not damage the pool. Five major factors that influence water balance are pH, total alkalinity, calcium hardness, total dissolved solids, and temperature. The extent to which these five factors affect water balance can be computed by the Langelier saturation index.
Collapse
Affiliation(s)
- R F Edlich
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908
| | | | | | | | | |
Collapse
|
24
|
Phung D, Abidin MR, Thacker JG, Rodeheaver GT, Westwater JJ, Doctor A, Edlich RF. Evaluation of automatic disposable rotating cartridge skin staplers. J Burn Care Rehabil 1988; 9:538-46. [PMID: 3192614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Burn surgeons commonly employ skin staples for the application of skin grafts and to secure dressings on donor site dressings and over skin grafts. Disposable skin staplers with rotating cartridges are ideally suited for wound closure because the position of their cartridges can be manually adjusted to facilitate placement of their staples. In response to the burgeoning interest in disposable automatic skin staplers with rotating cartridges, three different models are now commercially available. This report describes the design configuration and mechanical performance of these disposable automatic staplers and their staples. Mechanical performance of these staplers and staples has been assessed by standardized tests that can be replicated in any research laboratory. On the basis of these objective design and performance parameters, the Premium stapler is recommended for wound closure. This stapler provides maximal visualization of the wound as well as the staple during its formation. It delivers the staple into the skin or wound in a manner that the cross member of the staple is above the skin or wound surface. In addition, the Premium stapler has a prepositioning mechanism that can be controlled by the surgeon with minimal force. This mechanism allows the stapler to hold its staple securely, even when its pointed legs extend beyond the delivery end of the stapler. Force required to form its staples is so low that the surgeon can staple repetitively without fatigue. Finally, the Premium stapler delivers a staple that has a uniform geometry and sharp points that can easily penetrate tissue.
Collapse
Affiliation(s)
- D Phung
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908
| | | | | | | | | | | | | |
Collapse
|
25
|
Becker DG, Abidin MR, Lombardi SA, Phung D, Shotwell RE, Edlich RF. Evaluation of flotation devices for deep-water exercise. J Burn Care Rehabil 1988; 9:407-12. [PMID: 3220857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Jogging and running in deep water (greater than or equal to 7 feet) appears to be a more efficient and safer means of aerobic exercise than jogging and running on land. Consequently, a variety of flotation devices have been developed to facilitate this deep-water exercise. A comprehensive evaluation of these devices revealed distinct performance limitations that interfered with this exercise. On the basis of the results of these studies, a new, improved flotation device has been conceptualized for individuals participating in deep-water exercise.
Collapse
Affiliation(s)
- D G Becker
- University of Virginia School of Medicine, Charlottesville 22908
| | | | | | | | | | | |
Collapse
|