2
|
Braess J, Amler S, Kreuzer KA, Spiekermann K, Lindemann HW, Lengfelder E, Graeven U, Staib P, Ludwig WD, Biersack H, Ko YD, Uppenkamp MJ, De Wit M, Korsten S, Peceny R, Gaska T, Schiel X, Behringer DM, Kiehl MG, Zinngrebe B, Meckenstock G, Roemer E, Medgenberg D, Spaeth-Schwalbe E, Massenkeil G, Hindahl H, Schwerdtfeger R, Trenn G, Sauerland C, Koch R, Lablans M, Faldum A, Görlich D, Bohlander SK, Schneider S, Dufour A, Buske C, Fiegl M, Subklewe M, Braess B, Unterhalt M, Baumgartner A, Wörmann B, Beelen D, Hiddemann W. Sequential high-dose cytarabine and mitoxantrone (S-HAM) versus standard double induction in acute myeloid leukemia-a phase 3 study. Leukemia 2018; 32:2558-2571. [PMID: 30275528 PMCID: PMC6286323 DOI: 10.1038/s41375-018-0268-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/17/2023]
Abstract
Dose-dense induction with the S-HAM regimen was compared to standard double induction therapy in adult patients with newly diagnosed acute myeloid leukemia. Patients were centrally randomized (1:1) between S-HAM (2nd chemotherapy cycle starting on day 8 = “dose-dense”) and double induction with TAD-HAM or HAM(-HAM) (2nd cycle starting on day 21 = “standard”). 387 evaluable patients were randomly assigned to S-HAM (N = 203) and to standard double induction (N = 184). The primary endpoint overall response rate (ORR) consisting of complete remission (CR) and incomplete remission (CRi) was not significantly different (P = 0.202) between S-HAM (77%) and double induction (72%). The median overall survival was 35 months after S-HAM and 25 months after double induction (P = 0.323). Duration of critical leukopenia was significantly reduced after S-HAM (median 29 days) versus double induction (median 44 days)—P < 0.001. This translated into a significantly shortened duration of hospitalization after S-HAM (median 37 days) as compared to standard induction (median 49 days)—P < 0.001. In conclusion, dose-dense induction therapy with the S-HAM regimen shows favorable trends but no significant differences in ORR and OS compared to standard double induction. S-HAM significantly shortens critical leukopenia and the duration of hospitalization by 2 weeks.
Collapse
Affiliation(s)
- Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany. .,Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.
| | - Susanne Amler
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany.,Friedrich Löffler Institute, Federal Research Centre, Greifswald-Insel Riems, Germany
| | - Karl-Anton Kreuzer
- Department of Internal Medicine I, University Hospital, Cologne, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | | | - Eva Lengfelder
- Department of Medicine III, University Hospital, Mannheim, Germany
| | - Ullrich Graeven
- Department of Medicine I, Hospital Maria Hilf, Mönchengladbach, Germany
| | - Peter Staib
- Department of Hematology and Medical Oncology, St. Antonius Hospital, Eschweiler, Germany
| | - Wolf-Dieter Ludwig
- Department of Hematology and Oncology and Tumor Immunology, Helios Hospital, Berlin-Buch, Germany
| | - Harald Biersack
- Department of Medicine I, University Hospital, Lübeck, Germany
| | - Yon-Dschun Ko
- Department of Medicine I, Johanniter Hospital, Bonn, Germany
| | | | - Maike De Wit
- Department of Hematology, Oncology and Palliative Care, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Stefan Korsten
- Department of Medicine, Vinzenz Pallotti Hospital, Bergisch-Gladbach, Germany
| | - Rudolf Peceny
- Department of Hematology and Oncology, Klinikum Osnabrück, Osnabrück, Germany
| | - Tobias Gaska
- Department of Hematology and Oncology, St. Josef Hospital, Paderborn, Germany
| | - Xaver Schiel
- Department of Hematology and Oncology, Klinikum Harlaching, Munich, Germany
| | - Dirk M Behringer
- Department of Hematology, Oncology and Palliative Care, Augusta Hospital, Bochum, Germany
| | - Michael G Kiehl
- Department of Medicine I, Klinikum Frankfurt/Oder, Frankfurt/Oder, Germany
| | - Bettina Zinngrebe
- Department of Hematology, Oncology and Palliative Care, Evangelisches Krankenhaus, Bielefeld, Germany
| | - Gerald Meckenstock
- Department of Medical Oncology, Radiooncology, Hematology and Palliative Care, St. Josef Hospital, Gelsenkirchen, Germany
| | - Eva Roemer
- Department of Hematology and Oncology, Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Dirk Medgenberg
- Department of Medicine III, Klinikum Leverkusen, Leverkusen, Germany
| | | | - Gero Massenkeil
- Department of Medicine II, Klinikum Gütersloh, Gütersloh, Germany
| | - Heidrun Hindahl
- Department of Medicine I, St. Johannes Hospital, Dortmund, Germany
| | - Rainer Schwerdtfeger
- Department for Bone Marrow and Blood Stem Cell Transplantation, DKD Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Guido Trenn
- Department of Medicine I, Knappschaftskrankenhaus, Bottrop, Germany
| | - Cristina Sauerland
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Raphael Koch
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Martin Lablans
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany.,Division of Medical Informatics in Translational Oncology, DKFZ German Cancer Research Center, Heidelberg, Germany
| | - Andreas Faldum
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Dennis Görlich
- Insitute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Stefan K Bohlander
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Stephanie Schneider
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Annika Dufour
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Christian Buske
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany.,Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
| | - Michael Fiegl
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Birgit Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany.,Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Michael Unterhalt
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | - Anja Baumgartner
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | | | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital LMU Campus Grosshadern, Munich, Germany
| | | |
Collapse
|
4
|
Giessen CA, Modest DP, Stintzing S, Fischer von Weikersthal L, Vehling-Kaiser U, Spaeth-Schwalbe E, Freiberg-Richter J, Mayerle J, Bangerter M, Denzlinger C, Sieber M, Teschendorf C, Peuser B, Heinemann V. Sequential first-line treatment for metastatic colorectal cancer with capecitabine, irinotecan, and bevacizumab: Capecitabine plus bevacizumab (Cape-Bev) versus capecitabine, irinotecan plus bevacizumab (CAPIRI-Bev): The AIO KRK 0110/ML22011 randomized, phase III trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps3639] [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
TPS3639 Background: Several randomized trials have indicated that combination chemotherapy applied in metastatic colorectal cancer (mCRC) does not significantly improve overall survival when compared to the sequential use of cytotoxic agents (CAIRO, MRC Focus, FFCD 2000-05). The present study investigates the question in bevacizumab-based first-line treatment including escalation- and de-escalation strategies. Methods: The AIO KRK 0110/ML22011 trial (ClinicalTrials.gov NCT01249638) is a two-arm, multicenter, open-label randomized phase III trial comparing the efficacy and safety of Cape-Bev versus CAPIRI-Bev in the first-line treatment of metastatic colorectal cancer. Patients with unresectable metastatic colorectal cancer, ECOG PS 0-1, will be assigned in a 1:1 ratio to receive either capecitabine 1250 mg/m2 bid for 14d (d1-14) plus bevacizumab 7.5 mg/kg (d1) q3w (Arm A) or capecitabine 800 mg/m2 BID for 14d (d1-14), irinotecan 200 mg/m2 (d1) and bevacizumab 7.5 mg/kg (d1) q3w (Arm B). Patients included into this trial are required to consent to the analysis of tumor tissue and blood for translational investigations. In Arm A, treatment escalation from Cape-Bev to CAPIRI-Bev is recommended in case of progressive disease (PD). In Arm B, de-escalation from CAPIRI-Bev to Cape-Bev is possible after 6 months of treatment or in case of irinotecan-associated toxicity. Re-escalation to CAPIRI-Bev after PD is possible. The primary endpoint is time to failure of strategy (TFS). Secondary endpoints are ORR, OS, PFS, safety and quality of life. Conclusion: The AIO KRK 0110 trial is designed for patients with disseminated, but asymptomatic mCRC who are not potential candidates for surgical resection of metastasis. Two bevacizumab-based strategies are compared: one starting as single-agent chemotherapy (Cape-Bev) allowing escalation to CAPIRI-Bev and another starting with CAPIRI-Bev and allowing de-escalation to Cape-Bev and subsequent re-escalation if necessary. By January 2012, 79 of planned 516 patients have been enrolled.
Collapse
Affiliation(s)
- Clemens Albrecht Giessen
- Department of Hematology and Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, LMU Munich, Munich, Germany
| | - Dominik Paul Modest
- Department of Hematology and Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, LMU Munich, Munich, Germany
| | - Sebastian Stintzing
- Department of Hematology and Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, LMU Munich, Munich, Germany
| | | | | | | | | | - Julia Mayerle
- Department of Medicine, University Hospital Greifswald, Greifswald, Germany
| | | | | | - Markus Sieber
- Department of Medicine II, Gummersbach Hospital, Gummersbach, Germany
| | | | | | - Volker Heinemann
- Department of Hematology and Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, LMU Munich, Munich, Germany
| |
Collapse
|