1
|
Tao Y, Sun XS, Pointreau Y, Le Tourneau C, Sire C, Kaminsky MC, Coutte A, Alfonsi M, Calderon B, Boisselier P, Martin L, Miroir J, Ramee JF, Delord JP, Clatot F, Rolland F, Villa J, Magne N, Elicin O, Gherga E, Nguyen F, Lafond C, Bera G, Calugaru V, Geoffrois L, Chauffert B, Damstrup L, Crompton P, Ennaji A, Gollmer K, Nauwelaerts H, Bourhis J. Extended follow-up of a phase 2 trial of xevinapant plus chemoradiotherapy in high-risk locally advanced squamous cell carcinoma of the head and neck: a randomised clinical trial. Eur J Cancer 2023; 183:24-37. [PMID: 36796234 DOI: 10.1016/j.ejca.2022.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/10/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION We report long-term efficacy and overall survival (OS) results from a randomised, double-blind, phase 2 study (NCT02022098) investigating xevinapant plus standard-of-care chemoradiotherapy (CRT) vs. placebo plus CRT in 96 patients with unresected locally advanced squamous cell carcinoma of the head and neck (LA SCCHN). METHODS Patients were randomised 1:1 to xevinapant 200 mg/day (days 1-14 of a 21-day cycle for 3 cycles), or matched placebo, plus CRT (cisplatin 100 mg/m2 every 3 weeks for 3 cycles plus conventional fractionated high-dose intensity-modulated radiotherapy [70 Gy/35 F, 2 Gy/F, 5 days/week for 7 weeks]). Locoregional control, progression-free survival, and duration of response after 3 years, long-term safety, and 5-year OS were assessed. RESULTS The risk of locoregional failure was reduced by 54% for xevinapant plus CRT vs. placebo plus CRT but did not reach statistical significance (adjusted hazard ratio [HR] 0.46; 95% CI, 0.19-1.13; P = .0893). The risk of death or disease progression was reduced by 67% for xevinapant plus CRT (adjusted HR 0.33; 95% CI, 0.17-0.67; P = .0019). The risk of death was approximately halved in the xevinapant arm compared with placebo (adjusted HR 0.47; 95% CI, 0.27-0.84; P = .0101). OS was prolonged with xevinapant plus CRT vs. placebo plus CRT; median OS not reached (95% CI, 40.3-not evaluable) vs. 36.1 months (95% CI, 21.8-46.7). Incidence of late-onset grade ≥3 toxicities was similar across arms. CONCLUSIONS In this randomised phase 2 study of 96 patients, xevinapant plus CRT demonstrated superior efficacy benefits, including markedly improved 5-year survival in patients with unresected LA SCCHN.
Collapse
Affiliation(s)
- Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Xu-Shan Sun
- Department of Radiation Oncology, Nord Franche-Comté de Montbéliard and CHRU de Besançon, Besançon, France
| | - Yoann Pointreau
- Oncologie-Radiothérapie, Institut Inter-Régional de Cancérologie, Centre Jean Bernard, Le Mans, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris-Saclay University, Paris, France
| | - Christian Sire
- South Brittany Hospital Center, Hôpital du Scorff Radiothérapie, Lorient, France
| | - Marie-Christine Kaminsky
- Institut Cancérologie de Lorraine - Alexis Vautrin, Oncologie Médicale, Vandoeuvre-lès-Nancy, France
| | | | - Marc Alfonsi
- Institut Sainte Catherine, Radiothérapie, Avignon, France
| | | | - Pierre Boisselier
- Institut du Cancer de Montpellier, Val d'Aurelle, Oncologie-Radiothérapie, Montpellier, France
| | - Laurent Martin
- Centre de Radiothérapie Guillaume le Conquérant, Le Havre, France
| | - Jessica Miroir
- Jean Perrin Center, Radiothérapie, Clermont-Ferrand, France
| | | | - Jean-Pierre Delord
- Medical Oncology Dept, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Florian Clatot
- Henri Becquerel Centre, Service Oncologie Médicale rue d'Amiens, Rouen, France
| | - Frederic Rolland
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Julie Villa
- CHU Grenoble, Radiothérapie, Pôle de Cancérologie, Grenoble, France
| | - Nicolas Magne
- Institut de Cancérologie Lucien Neuwirth, Radiothérapie, Saint-Priest-en-Jarez, France
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elisabeta Gherga
- Department of Radiation Oncology, Nord Franche-Comté de Montbéliard and CHRU de Besançon, Besançon, France
| | - France Nguyen
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Cédrik Lafond
- Oncologie-Radiothérapie, Institut Inter-Régional de Cancérologie, Centre Jean Bernard, Le Mans, France
| | - Guillaume Bera
- South Brittany Hospital Center, Hôpital du Scorff Radiothérapie, Lorient, France
| | - Valentin Calugaru
- Radiotherapy Oncology Department, Institut Curie, Paris-Saclay University, Paris, France
| | - Lionnel Geoffrois
- Institut Cancérologie de Lorraine - Alexis Vautrin, Oncologie Médicale, Vandoeuvre-lès-Nancy, France
| | - Bruno Chauffert
- CHU Amiens Picardie, Oncologie-Radiothérapie, Amiens, France
| | | | | | | | | | | | - Jean Bourhis
- CHUV, Radiation Oncology Department, Bâtiment Hospitalier, Lausanne, Switzerland.
| |
Collapse
|
2
|
Benhmida S, Sun R, Gherga E, Hammoud Y, Rouvier J, Mauvais O, Bockel S, Louvrier A, Lebbad A, Bontemps P, Ortholan C, Bourhis J, Lestrade L, Sun XS. Split-course hypofractionated radiotherapy for aged and frail patients with head and neck cancers. A retrospective study of 75 cases. Cancer Radiother 2020; 24:812-819. [PMID: 33144061 DOI: 10.1016/j.canrad.2020.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy and the tolerance of a split course hypofractionated (SCH) radiotherapy (RT) protocol in head and neck cancer (HNC) for eldery and/or unfit patients (pts). PATIENTS AND METHODS Pts with HNC treated by SCH-RT in two institutions were included retrospectively. The main SCH RT regimen was two courses of 30 grays (Gy)/10 fractions separated by 2-4 weeks, without any systemic therapy. RESULTS Between February 2012 and January 2019, 75 consecutive patients were analyzed. The median age was 80 years (range: 45.7-98.2) and 53 (70.7%) were men. Sixty-one (81.3%) pts had stage III/IV disease and 54 (72%) had at least two comorbidities. All of them were treated with intensity-modulated radiotherapy. Median follow-up was 10.6 months (range: 3.1-58.3). Local control at 12 and 24 months was 72.8% IC95%[62-85.5] and 51.7% IC95%[38.1-70.1] respectively. Progression free survival (PFS) at 12 and 24 months were 47.7% IC95%[37.4-60.8] and 41% IC95%[15-36.4] respectively, with a median of 11.5 months IC95%[8.9-17]. OS at 12 and 24 months were 60.4% IC95%[50-73.1] and 41% IC95%[30.6-54.9] respectively, with a median of 19.3 months IC95%[11.9-25.8]. Acute and late grade 3 or higher toxicities occurred for 6 (8%) and 3 (4%) pts. CONCLUSION The present SCH-RT regimen seems effective, well-tolerated and could represent an alternative to palliative strategies for pts deemed unfit for standard exclusive RT.
Collapse
Affiliation(s)
- S Benhmida
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France.
| | - R Sun
- Department of radiotherapy, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - E Gherga
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - Y Hammoud
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - J Rouvier
- Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - O Mauvais
- Department of head and neck surgery, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - S Bockel
- Department of radiotherapy, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Louvrier
- Department of Maxillofacial Surgery and Stomatology, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France
| | - A Lebbad
- Department of head and neck surgery, Hôpital Nord Franche-Comté, 100, route de Moval, Trevenans, France
| | - P Bontemps
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - C Ortholan
- Department of radiotherapy, Centre hospitalier Princesse-Grace, 98000 Monaco, Monaco
| | - J Bourhis
- Centre Hospitalier Universitaire Vaudois, Service de Radio-oncologie, 1005 Lausanne, Switzerland
| | - L Lestrade
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| | - X S Sun
- Department of radiotherapy, CHU de Besancon, 2, boulevard Fleming, 25030 Besançon, France; Department of radiotherapy, Hopital Nord Franche-Comté de Montbéliard, site du Mittan, 1 rue Henri Becquerel, 25220 Montbéliard, France
| |
Collapse
|
3
|
Vienot A, Chevalier H, Bolognini C, Gherga E, Klajer E, Meurisse A, Jary M, Kim S, d’Engremont C, Nguyen T, Calcagno F, Almotlak H, Fein F, Nasri M, Abdeljaoued S, Turpin A, Borg C, Vernerey D. FOLFOXIRI vs FOLFIRINOX as first-line chemotherapy in patients with advanced pancreatic cancer: A population-based cohort study. World J Gastrointest Oncol 2020; 12:332-346. [PMID: 32206183 PMCID: PMC7081111 DOI: 10.4251/wjgo.v12.i3.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/26/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy (L1) in advanced pancreatic ductal adenocarcinoma (aPDAC). FOLFOXIRI, a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil, has demonstrated efficacy and feasibility in colorectal cancer.
AIM To investigate the potential clinical value of FOLFOXIRI in patients with aPDAC in routine clinical practice.
METHODS Analyses were derived from all consecutive aPDAC patients treated in L1 between January 2011 and December 2017 in two French institutions, with either FOLFOXIRI (n = 165) or FOLFIRINOX (n = 124) regimens. FOLFOXIRI consisted of irinotecan (165 mg/m2), oxaliplatin (85 mg/m2), leucovorin (200 mg/m2) and 5-fluorouracil (3200 mg/m2 as a 48-h continuous infusion) every 2 wk. Ninety-six pairs of patients were selected through propensity score matching, and clinical outcomes of the two treatment regimens were compared.
RESULTS Median overall survival was 11.1 mo in the FOLFOXIRI and 11.6 mo in the FOLFIRINOX cohorts, respectively. After propensity score matching, survival rates remained similar between the two regimens in terms of overall survival (hazard ratio = 1.22; P = 0.219) and progression-free survival (hazard ratio = 1.27; P = 0.120). The objective response rate was 37.1% in the FOLFOXIRI group vs 47.8% in the FOLFIRINOX group (P = 0.187). Grade 3/4 toxicities occurred in 28.7% of patients in the FOLFOXIRI cohort vs 19.5% in the FOLFIRINOX cohort (P = 0.079). FOLFOXIRI was associated with a higher incidence of grade 3/4 digestive adverse events. Hematopoietic growth factors were used after each chemotherapy cycle and the low hematological toxicity rates were below 5% with both regimens.
CONCLUSION FOLFOXIRI is feasible in L1 in patients with aPDAC but does not confer any therapeutic benefit as compared with FOLFIRINOX. The low hematological toxicity rates strengthened the relevance of primary prophylaxis with hematopoietic growth factors.
Collapse
Affiliation(s)
- Angélique Vienot
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | - Hortense Chevalier
- Department of Medical Oncology, Lille University Hospital, Lille F-59000, France
| | - Clément Bolognini
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Elisabeta Gherga
- Department of Medical Oncology, Nord Franche-Comté Hospital, Montbéliard F-25020, France
| | - Elodie Klajer
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Aurélia Meurisse
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- Methodological and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon F-25030, France
| | - Marine Jary
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | - Stefano Kim
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | | | - Thierry Nguyen
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Fabien Calcagno
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Hamadi Almotlak
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
| | - Francine Fein
- Department of Gastroenterology, Besançon University Hospital, Besançon F-25030, France
| | - Meher Nasri
- Department of Medical Oncology, Nord Franche-Comté Hospital, Montbéliard F-25020, France
| | - Syrine Abdeljaoued
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
| | - Anthony Turpin
- Department of Medical Oncology, Lille University Hospital, Lille F-59000, France
| | - Christophe Borg
- Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France
| | - Dewi Vernerey
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France
- Methodological and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon F-25030, France
| |
Collapse
|
4
|
Vienot A, Chevalier H, Bolognini C, Gherga E, Meurisse A, Vernerey D, Borg C, Turpin A. FOLFOXIRI versus FOLFIRINOX in first-line chemotherapy in patients with advanced pancreatic cancer: A propensity score analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.043] [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
|
5
|
Benhmida S, Sun R, Gherga E, Hammoud Y, Lestrade L, Boulbair F, Mauvais O, Bontemps P, Thariat J, Bourhis J, Sun X. Radiothérapie hypofractionnée en split course de patients âgés et fragiles atteints d’un cancer de la tête et du cou localement évolué : étude de 58 cas. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Sun XS, Michel C, Babin E, De Raucourt D, Péchery A, Gherga E, Géry B, Florescu C, Bourhis J, Thariat J. Approach to oligometastatic disease in head and neck cancer, on behalf of the GORTEC. Future Oncol 2018; 14:877-889. [DOI: 10.2217/fon-2017-0468] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Median survival for recurrent/metastatic head and neck squamous cell cancer (HNSCC) patients is about 10 months after first-line best systemic treatment. We aimed to assess current approaches of oligometastatic HNSCC patients by the analysis of current concept and published data (1995–2017) in this population. Five-year survival rates are over 20% in selected patients who undergo metastasis-directed therapy by either surgery or stereotactic irradiation. Human papillomavirus(+) HNSCC patients have more disseminated metastases but respond more favorably and also benefit from ablative treatments. Treatments of oligometastases are expanding rapidly. Unmet needs include revised imaging follow-up strategies to detect metastases earlier, identification of predictive noninvasive biomarkers for treatment guidance, assessment and corrections of biases in current studies and randomized clinical trials.
Collapse
Affiliation(s)
- Xu Shan Sun
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Cécile Michel
- GORTEC, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Emmanuel Babin
- CHU – Normandie Université, Department of Head & Neck Surgery, 14000 Caen, France
| | - Dominique De Raucourt
- Center François Baclesse – Normandie Université, Department of Head & Neck Surgery, 3 Avenue Général Harris, 14000 Caen, France
| | - Adeline Péchery
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Elisabeta Gherga
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Bernard Géry
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
| | - Carmen Florescu
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
| | - Jean Bourhis
- CHUV. Lausanne, Department of Radio-oncology, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Juliette Thariat
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
| |
Collapse
|