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von Heymann A, Finsted E, Guldin MB, Andersen EAW, Dammeyer J, Sjøgren P, von der Maase H, Benthien KS, Kjellberg J, Johansen C, Bidstrup P. Effects of home-based specialized palliative care and dyadic psychological intervention on caregiver burden: results from a randomized controlled trial. Acta Oncol 2023; 62:803-807. [PMID: 37010505 DOI: 10.1080/0284186x.2023.2194491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
Background The Domus study, a randomized controlled trial (RCT), evaluated the effect of home-based specialized palliative care (SPC) reinforced with a psychological intervention for the patient-caregiver dyad on increasing advanced cancer patients' time spent at home, as opposed to hospitalized, and the number of home deaths. As palliative care extends to include support for patients' families and may thus assist caregivers and decrease demands on them, in this study we evaluated a secondary outcome, caregiver burden.Material and Methods Patients with incurable cancer and their caregivers were randomized (1:1) to care as usual or home-based SPC. Caregiver burden was assessed using the Zarit Burden Interview (ZBI) at baseline and 2, 4, 8 weeks and 6 months after randomization. Intervention effects were assessed in mixed effects models.Results A total of 258 caregivers were enrolled. Eleven per cent of informal caregivers experienced severe caregiver burden at baseline. Caregiver burden increased significantly over time in both groups (p = 0.0003), but no significant effect of the intervention was seen on overall caregiver burden (p = 0.5046) or burden subscales measuring role and personal strain.Conclusion In line with the majority of previous RCTs, the Domus intervention was not able to significantly reduce caregiver burden. Future interventions should consider targeting only caregivers reporting the greatest caregiver burden.
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Affiliation(s)
- Annika von Heymann
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Finsted
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Public Health, Aarhus University, Aarhus, Denmark
| | | | - Jesper Dammeyer
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjøgren
- Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans von der Maase
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine S Benthien
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE, The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Dohn LH, Thind P, Salling L, Lindberg H, Oersted S, Christensen IJ, Laerum OD, Illemann M, von der Maase H, Høyer-Hansen G, Pappot H. Circulating Forms of Urokinase-Type Plasminogen Activator Receptor in Plasma Can Predict Recurrence and Survival in Patients with Urothelial Carcinoma of the Bladder. Cancers (Basel) 2021; 13:cancers13102377. [PMID: 34069121 PMCID: PMC8156453 DOI: 10.3390/cancers13102377] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Bladder cancer is an aggressive disease and after operation many patients are at risk of recurrence and shortened survival. Specific proteins are known to be of importance in the development of cancers. One of these proteins is the urokinase-type plasminogen activator receptor (uPAR) which exists in different forms. We here investigate the presence of the different uPAR forms in plasma from patients with bladder cancer, and we associate the elevated amount of uPAR forms with survival. We find that high levels of all uPAR forms is associated with short survival in patients with bladder cancer and suggest that this in the future might help improve handling of the disease. Abstract Urothelial carcinoma of the bladder is a highly aggressive disease characterised by a very heterogeneous clinical outcome. Despite cystectomy, patients still have a high recurrence risk and shortened survival. Urokinase-type plasminogen activator receptor (uPAR) is present in tumour tissue specimens from patients with urothelial carcinoma. The different uPAR forms in blood are strong prognostic markers in other cancer types. We investigate the presence of different uPAR forms in tumour tissue and test the hypothesis that preoperative plasma levels of the uPAR forms predict recurrence free survival, cancer specific survival, and overall survival in patients treated with cystectomy for urothelial carcinoma. Using Western blotting we analyse neoplasia and adjacent benign-appearing urothelium from randomly selected patients for the presence of intact and cleaved uPAR forms. Prospectively collected preoperative plasma samples from 107 patients who underwent radical cystectomy for urothelial carcinoma are analysed. The different uPAR forms are measured by time-resolved fluorescence immunoassays. uPAR in tumour tissue from patients with urothelial carcinoma is demonstrated in both an intact and cleaved form. The different uPAR forms in plasma are all significantly associated with both recurrence free survival, cancer specific survival, and overall survival, high concentrations predicting short survival. uPAR (I) has the strongest association with a HR of 2.56 for overall survival. In the multivariable survival analysis uPAR (I) is significantly associated with cancer specific survival and overall survival.
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Affiliation(s)
- Line H. Dohn
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (S.O.); (H.v.d.M.); (H.P.)
- The Finsen Laboratory, Rigshospitalet, Copenhagen Biocenter, Ole Maaloes Vej 5, Building 3, 3rd Floor, 2200 Copenhagen, Denmark; (I.J.C.); (O.D.L.); (M.I.); (G.H.-H.)
- Correspondence: ; Tel.: +45-40783032
| | - Peter Thind
- Department of Urology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (P.T.); (L.S.)
| | - Lisbeth Salling
- Department of Urology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (P.T.); (L.S.)
| | - Henriette Lindberg
- Department of Oncology, Herlev and Gentofte Hospital, Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark;
| | - Sofie Oersted
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (S.O.); (H.v.d.M.); (H.P.)
| | - Ib J. Christensen
- The Finsen Laboratory, Rigshospitalet, Copenhagen Biocenter, Ole Maaloes Vej 5, Building 3, 3rd Floor, 2200 Copenhagen, Denmark; (I.J.C.); (O.D.L.); (M.I.); (G.H.-H.)
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Ole Maaloes Vej 5, 2200 Copenhagen, Denmark
- Department of Surgical Gastroenterology, Hvidovre Hospital, 2650 Hvidovre, Denmark
| | - Ole D. Laerum
- The Finsen Laboratory, Rigshospitalet, Copenhagen Biocenter, Ole Maaloes Vej 5, Building 3, 3rd Floor, 2200 Copenhagen, Denmark; (I.J.C.); (O.D.L.); (M.I.); (G.H.-H.)
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Ole Maaloes Vej 5, 2200 Copenhagen, Denmark
| | - Martin Illemann
- The Finsen Laboratory, Rigshospitalet, Copenhagen Biocenter, Ole Maaloes Vej 5, Building 3, 3rd Floor, 2200 Copenhagen, Denmark; (I.J.C.); (O.D.L.); (M.I.); (G.H.-H.)
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Ole Maaloes Vej 5, 2200 Copenhagen, Denmark
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (S.O.); (H.v.d.M.); (H.P.)
| | - Gunilla Høyer-Hansen
- The Finsen Laboratory, Rigshospitalet, Copenhagen Biocenter, Ole Maaloes Vej 5, Building 3, 3rd Floor, 2200 Copenhagen, Denmark; (I.J.C.); (O.D.L.); (M.I.); (G.H.-H.)
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Ole Maaloes Vej 5, 2200 Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (S.O.); (H.v.d.M.); (H.P.)
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Benthien K, Diasso P, von Heymann A, Nordly M, Kurita G, Timm H, Johansen C, Kjellberg J, von der Maase H, Sjøgren P. Oncology to specialised palliative home care systematic transition: the Domus randomised trial. BMJ Support Palliat Care 2020; 10:350-357. [PMID: 32680894 DOI: 10.1136/bmjspcare-2020-002325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/30/2020] [Accepted: 06/10/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the effect of a systematic, fast-track transition from oncological treatment to specialised palliative care at home on symptom burden, to explore intervention mechanisms through patient and intervention provider characteristics and to assess long-term survival and place of death. MEASURES The effect of a systematic, fast-track transition from oncological treatment to specialised palliative care at home on patient symptom burden was studied in the Domus randomised clinical trial. Participants had incurable cancer and limited treatment options. The intervention was provided by specialised palliative home teams (SPT) based in hospice or hospital and was enriched with a psychological intervention for patient and caregiver dyad. Symptom burden was measured with Edmonton Symptom Assessment System (ESAS-r) at baseline, 8 weeks and 6 months follow-up and analysed with mixed models. Survival and place of death was analysed with Kaplan-Meier and Fisher's exact tests. RESULTS The study included 322 patients. Tiredness was significantly improved for the Domus intervention group at 6 months while the other nine symptom outcomes were not significantly different from the control group. Exploring the efficacy of intervention provider demonstrated significant differences in favour of the hospice SPT on four symptoms and total symptom score. Patients with children responded more favourably to the intervention. The long-term follow-up demonstrated no differences between the intervention and the control groups regarding survival or home deaths. CONCLUSIONS The Domus intervention may reduce tiredness. Moreover, the intervention provider and having children might play a role concerning intervention efficacy. The intervention did not affect survival or home deaths. TRIAL REGISTRATION NUMBER NCT01885637.
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Affiliation(s)
- Kirstine Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Pernille Diasso
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mie Nordly
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Geana Kurita
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Timm
- REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE Health, VIVE-The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Holmsten K, Jensen NV, Mouritsen LS, Jonsson E, Mellnert C, Agerbæk M, Nilsson C, Moe M, Carus A, Öfverholm E, Lahdenperä O, Brandberg Y, Johansson H, Hellström M, Maase HVD, Pappot H, Ullén A. Vinflunine/gemcitabine versus carboplatin/gemcitabine as first-line treatment in cisplatin-ineligible patients with advanced urothelial carcinoma: A randomised phase II trial (VINGEM). Eur J Cancer 2019; 127:173-182. [PMID: 31648851 DOI: 10.1016/j.ejca.2019.08.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/06/2019] [Revised: 08/06/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The present study (VINGEM) is the first randomised trial comparing vinflunine/gemcitabine (VG) to standard carboplatin/gemcitabine (CG) in patients with advanced urothelial carcinoma (aUC) ineligible for treatment with cisplatin. PATIENTS AND METHODS Patients with aUC, creatinine clearance 30-60 ml/min, performance status ≤1 and no prior chemotherapy for metastatic disease were randomised to the experimental arm (vinflunine 280 or 250 mg/m2 day 1, gemcitabine 1000 mg/m2 days 1 and 8, q21 days) or the control arm (carboplatin AUC 4.5 day 1, gemcitabine 1000 mg/m2 days 1 and 8, q21 days). Primary end-point was progression-free survival (PFS). RESULTS Sixty-two patients were randomised; a total of 59 patients were treated (29 VG, 30 CG). There was no significant difference in PFS between the treatment arms: median 6.2 months for VG versus 6.3 months for CG (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.44-1.28; P = 0.293). Median overall survival was 12.5 months for VG versus 10.6 months for CG. The overall response rate (ORR) was higher in the VG arm than in the CG arm (63% versus 40%) but was not statistically significant in the intention-to-treat analysis. Furthermore, VG showed a high complete response (CR) rate, 22% versus 3% in CG. In the per-protocol group, both ORR and CR were significantly higher for VG than for CG. The most common adverse events (AEs) were fatigue, haematological toxicities, gastrointestinal disorders and nausea/vomiting. Common grade III/IV AEs were neutropenia (VG 62%, CG 43%), thrombocytopenia (VG 7%, CG 37%) and febrile neutropenia (VG 31%, CG 7%). CONCLUSIONS The combination of VG did not improve PFS compared with standard treatment with CG in patients unfit for cisplatin due to renal impairment. The response rate of VG indicates, however, an active regimen and warrants further studies. CLINICALTRIALS. GOV NUMBER NCT02665039.
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Affiliation(s)
- Karin Holmsten
- PO Bäckencancer, Tema Cancer, Karolinska Universitetssjukhuset and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | | | | | - Erika Jonsson
- Department of Oncology, Norrlands Universitetssjukhus, Umeå, Sweden
| | - Camilla Mellnert
- Department of Oncology, Skånes Universitetssjukhus, Lund, Sweden
| | - Mads Agerbæk
- Department of Oncology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Cecilia Nilsson
- Department of Oncology, Västmanlands Sjukhus, Västerås, Sweden
| | - Mette Moe
- Department of Oncology, Aalborg Universitetshospital, Aalborg, Denmark
| | - Andreas Carus
- Department of Oncology, Aalborg Universitetshospital, Aalborg, Denmark
| | | | - Outi Lahdenperä
- Department of Oncology, Åbo Universitetscentralsjukhus, Åbo, Finland
| | - Yvonne Brandberg
- PO Bäckencancer, Tema Cancer, Karolinska Universitetssjukhuset and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hemming Johansson
- PO Bäckencancer, Tema Cancer, Karolinska Universitetssjukhuset and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Hellström
- PO Bäckencancer, Tema Cancer, Karolinska Universitetssjukhuset and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Anders Ullén
- PO Bäckencancer, Tema Cancer, Karolinska Universitetssjukhuset and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Nordly M, Skov Benthien K, Vadstrup ES, Kurita GP, von Heymann-Horan AB, von der Maase H, Johansen C, Timm H, Kjellberg J, Sjøgren P. Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS - a randomized clinical trial. Palliat Med 2019; 33:135-149. [PMID: 30415608 DOI: 10.1177/0269216318811269] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death. Aim: To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival. Design: A prospective, single-centre, randomized controlled trial ( Clinicaltrials.gov : NCT01885637). Setting/participants: In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options. Results: No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups ( p = 0.605). No adverse effects were seen as consequence of the intervention. Conclusions: The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.
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Affiliation(s)
- Mie Nordly
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Skov Benthien
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva S Vadstrup
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Geana P Kurita
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 3 Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Hans von der Maase
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- 4 Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Helle Timm
- 5 REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Copenhagen, Denmark
| | - Jakob Kjellberg
- 6 The Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Per Sjøgren
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Shah CH, Pappot H, Agerbæk M, Holmsten K, Jäderling F, Yachnin J, Grybäck P, von der Maase H, Ullén A. Safety and Activity of Sorafenib in Addition to Vinflunine in Post-Platinum Metastatic Urothelial Carcinoma (Vinsor): Phase I Trial. Oncologist 2018; 24:745-e213. [PMID: 30552156 PMCID: PMC6656519 DOI: 10.1634/theoncologist.2018-0795] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. First trial to report safety and activity of the microtubule inhibitor vinflunine plus the tyrosine kinase inhibitor sorafenib in post‐platinum metastatic urothelial cancer (mUC) patients. A recommended phase II dose was identified for the treatment combination of vinflunine plus sorafenib, with main adverse events including fatigue, febrile neutropenia, neutropenia, hypertension, and hyponatremia. An overall response rate of 41% to second‐line vinflunine plus sorafenib treatment in patients with platinum‐resistant mUC was confirmed.
Background. Platinum‐progressive metastatic urothelial carcinoma (mUC) is a clinical challenge. The tyrosine kinase inhibitor sorafenib has demonstrated varied activity in mUC. This trial was designed to examine safety and activity of vinflunine plus sorafenib in mUC. Methods. In addition to standard dose of vinflunine (320 or 280 mg/m2), patients received sorafenib (400, 600, or 800 mg/day), in a 3 + 3 dose‐escalation phase I design. Results. Twenty‐two patients (median age 62.5 years) were included. Five patients received vinflunine 320 mg/m2 and 17 received 280 mg/m2. The maximum tolerated dose (MTD) of sorafenib with vinflunine 280 mg/m2 was 600 mg, and with vinflunine 320 mg/m2 it was not determined, owing to toxicity. Adverse events (AEs) grades 3 + 4 consisted of neutropenia (6 patients), febrile neutropenia (5), and hyponatremia (5). The overall response rate (ORR) in the efficacy‐evaluable patients was 41% (7 of 17), all partial responses evaluated by RECIST version 1.1. Median overall survival (OS) was 7.0 months (1.8–41.7). Conclusion. The defined recommended phase II dose (RPTD) was vinflunine 280 mg/m2 plus sorafenib 400 mg. Sorafenib was too toxic in combination with vinflunine 320 mg/m2. The ORR of 41% to this second‐line combination treatment of mUC is noteworthy and supports further trials.
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Affiliation(s)
- Carl-Henrik Shah
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
- Theme Cancer, Karolinska University Hospital, Solna, Sweden
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Karin Holmsten
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
| | - Fredrik Jäderling
- Department of Radiology, Karolinska University Hospital, Solna, Sweden
| | - Jeffrey Yachnin
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
- Theme Cancer, Karolinska University Hospital, Solna, Sweden
| | - Per Grybäck
- Department of Radiology, Karolinska University Hospital, Solna, Sweden
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden
- Theme Cancer, Karolinska University Hospital, Solna, Sweden
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von Heymann-Horan A, Bidstrup PE, Johansen C, Rottmann N, Andersen EAW, Sjøgren P, von der Maase H, Timm H, Kjellberg J, Guldin MB. Dyadic coping in specialized palliative care intervention for patients with advanced cancer and their caregivers: Effects and mediation in a randomized controlled trial. Psychooncology 2018; 28:264-270. [PMID: 30353600 DOI: 10.1002/pon.4932] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/28/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Specialized palliative care (SPC) interventions increasingly include patient-caregiver dyads, but their effects on dyadic coping are unknown. We investigated whether an SPC and dyadic psychological intervention increased aspects of dyadic coping in patients with advanced cancer and their caregivers, whether dyad characteristics moderated effects and whether aspects of dyadic coping mediated significant intervention effects on caregivers' anxiety and depression. METHODS We randomized 258 patients with incurable cancer and their caregivers to care as usual or accelerated transition from oncological treatment to home-based SPC and dyadic psychological support. In secondary outcome analyses, using mixed-effects models, we estimated intervention effects and 95% confidence intervals (CIs) for communication of stress and common coping, and moderation by dyad type and demographics. In path analyses, we investigated whether stress communication and common coping mediated intervention effects on caregivers' symptoms of anxiety and depression. (Clinicaltrials.gov NCT01885637). RESULTS The intervention significantly increased common coping in patients and caregivers in couples (estimated difference, 0.68; 95% CI, 0.11 to 1.24) and stress communication by partner caregivers (0.97; 0.24 to 1.24). We found some support for different intervention effects for spouses and other dyads, but no evidence of mediation. CONCLUSIONS Specialized palliative care and dyadic psychological intervention may affect aspects of dyadic coping. Common coping and stress communication did not mediate the previously found significant intervention effects on caregiver anxiety and depression, indicating that other mechanisms may have been central in the intervention.
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Affiliation(s)
- Annika von Heymann-Horan
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Per Sjøgren
- Palliative Research Group, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Timm
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Jakob Kjellberg
- KORA, The Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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von Heymann-Horan A, Bidstrup P, Guldin MB, Sjøgren P, Andersen EAW, von der Maase H, Kjellberg J, Timm H, Johansen C. Effect of home-based specialised palliative care and dyadic psychological intervention on caregiver anxiety and depression: a randomised controlled trial. Br J Cancer 2018; 119:1307-1315. [PMID: 30425351 PMCID: PMC6265292 DOI: 10.1038/s41416-018-0193-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 02/08/2018] [Revised: 06/29/2018] [Accepted: 07/04/2018] [Indexed: 12/25/2022] Open
Abstract
Background Specialised palliative care trials often fail to address intervention effects on caregiver anxiety and depression, particularly in bereavement. We evaluate effects of specialised palliative care and dyadic psychological intervention on caregiver anxiety and depression in a randomised controlled trial (RCT). Methods Patients with incurable cancer and limited antineoplastic treatment options and their caregivers, recruited from a university hospital oncology department, were randomised (1:1) to care as usual or accelerated transition from oncological treatment to home-based specialised palliative care. We assessed caregivers’ symptoms of anxiety and depression with the Symptom Checklist-92 up to six months after randomisation and 19 months into bereavement, and estimated intervention effects in mixed effects models. Results The ‘Domus’ trial enrolled 258 caregivers. The intervention significantly attenuated increases in caregivers’ symptoms of anxiety overall (estimated difference, −0.12; 95% confidence interval, −0.22 to −0.01, p = 0.0266), and symptoms of depression at eight weeks (−0.17; −0.33 to −0.02; p = 0.0314), six months (−0.27; −0.49 to −0.05; p = 0.0165), and in bereavement at two weeks (−0.28; −0.52 to −0.03; p = 0.0295) and two months (−0.24; −0.48 to −0.01; p = 0.0448). Conclusions This first RCT evaluating specialised palliative care with dyadic psychological support significantly attenuated caregiver anxiety and depression before and during bereavement. (Clinicaltrials.gov: NCT01885637)
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Affiliation(s)
| | | | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Per Sjøgren
- Department of Oncology, Palliative Research Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob Kjellberg
- KORA, The Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Helle Timm
- Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Skov Benthien K, Nordly M, von Heymann-Horan A, Rosengaard Holmenlund K, Timm H, Kurita GP, Johansen C, Kjellberg J, von der Maase H, Sjøgren P. Causes of Hospital Admissions in Domus: A Randomized Controlled Trial of Specialized Palliative Cancer Care at Home. J Pain Symptom Manage 2018; 55:728-736. [PMID: 29056562 DOI: 10.1016/j.jpainsymman.2017.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/25/2022]
Abstract
CONTEXT Avoidable hospital admissions are important negative indicators of quality of end-of-life care. Specialized palliative care (SPC) may support patients remaining at home. OBJECTIVES Therefore, the purpose of this study was to investigate if SPC at home could prevent hospital admissions in patients with incurable cancer. METHODS These are secondary results of Domus: a randomized controlled trial of accelerated transition to SPC with psychological intervention at home (Clinicaltrials.gov: NCT01885637). Participants were patients with incurable cancer and limited antineoplastic treatment options and their caregivers. They were included from the Department of Oncology, Rigshospitalet, Denmark, between 2013 and 2016. The control group received usual care. Outcomes were hospital admissions, causes thereof, and patient and caregiver perceptions of place of care (home, hospital, etc.) at baseline, four weeks, eight weeks, and six months. RESULTS During the study, 340 patients were randomized and 322 were included in modified intention-to-treat analyses. Overall, there were no significant differences in hospital admissions between the groups. The intervention group had more admissions triggered by worsened general health (22% vs. 16%, P = 0.0436) or unmanageable home situation (8% vs. 4%, P = 0.0119). After diagnostics, admissions were more often caused by clinical symptoms of cancer without progression in the intervention group (11% vs. 7%, P = 0.0493). The two groups did not differ significantly in overall potentially avoidable admissions. Both groups felt mostly safe about their place of care. CONCLUSION The intervention did not prevent hospital admissions. Likely, any intervention effects were outweighed by increased identification of problems in the intervention group leading to hospital admissions. Overall, patients and caregivers felt safe in their current place of care.
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Affiliation(s)
- Kirstine Skov Benthien
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Mie Nordly
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Annika von Heymann-Horan
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark; The Danish Cancer Society, Copenhagen, Denmark
| | | | - Helle Timm
- The Danish Knowledge Center for Rehabilitation and Palliative Care, Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; The Danish Cancer Society, Copenhagen, Denmark
| | - Jakob Kjellberg
- The Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Mortensen MS, Bandak M, Kier MGG, Lauritsen J, Agerbaek M, Holm NV, von der Maase H, Daugaard G. Surveillance versus adjuvant radiotherapy for patients with high-risk stage I seminoma. Cancer 2016; 123:1212-1218. [DOI: 10.1002/cncr.30458] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Mette S. Mortensen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mikkel Bandak
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Maria G. G. Kier
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
- Unit of Survivorship; Danish Cancer Society Research Center, Danish Cancer Society; Copenhagen Denmark
| | - Jakob Lauritsen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mads Agerbaek
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Niels V. Holm
- Department of Oncology; Odense University Hospital; Odense Denmark
| | - Hans von der Maase
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Gedske Daugaard
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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Dohn LH, Pappot H, Iversen BR, Illemann M, Høyer-Hansen G, Christensen IJ, Thind P, Salling L, von der Maase H, Laerum OD. uPAR Expression Pattern in Patients with Urothelial Carcinoma of the Bladder--Possible Clinical Implications. PLoS One 2015; 10:e0135824. [PMID: 26292086 PMCID: PMC4546385 DOI: 10.1371/journal.pone.0135824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 06/03/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022] Open
Abstract
The objective of the present study was to confirm the expression and localisation pattern of the urokinase-type plasminogen activator receptor (uPAR) focusing on its possible clinical relevance in patients with urothelial neoplasia of the bladder. uPAR is a central molecule in tissue remodelling during cancer invasion and metastasis and is an established prognostic marker in various cancer diseases other than bladder cancer. Formalin-fixed and paraffin-embedded tumour-tissue blocks from 186 patients treated with radical cystectomy were analysed. uPAR expression was scored as either negative or positive as well as by the actual score. Separate scores were obtained for cancer cells, macrophages and myofibroblasts at the invasive front and in tumour core. We were able to confirm, in an independent patient cohort, the tissue expression and localisation pattern of uPAR as investigated by Immunohistochemistry as well as a significant association between uPAR positivity and increasing tumour stage and tumour grade. This demonstrates the robustness of our previous and current findings. In addition the association between uPAR positive myofibroblasts and poor survival was reproduced. The highest hazard ratios for survival were seen for uPAR positive myofibroblasts both at the invasive front and in tumour core. Evaluating uPAR expression by the actual score showed a significant association between uPAR positive myofibroblasts in tumour core and an increased risk of cancer specific mortality. Our investigations have generated new and valuable biological information about the cell types being involved in tumour invasion and progression through the plasminogen activation system.
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Affiliation(s)
- Line Hammer Dohn
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | - Martin Illemann
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Gunilla Høyer-Hansen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Ib Jarle Christensen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Peter Thind
- Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Ole Didrik Laerum
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
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Daugaard G, Kier MG, Mortensen MS, Agerbæk M, Holm NV, Rørth M, von der Maase H, Jarle Christensen I, Lauritsen J. Reply to C. Rusner et al, L.C. Pagliaro et al, and K. Lu. J Clin Oncol 2015; 33:2326-7. [PMID: 26033816 DOI: 10.1200/jco.2015.60.9313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gedske Daugaard
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Gry Kier
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Mikael Rørth
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Ib Jarle Christensen
- The Finsen Laboratory, Rigshospitalet; and Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lauritsen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Daugaard G, Gundgaard MG, Mortensen MS, Agerbæk M, Holm NV, Rørth MR, von der Maase H, Jarle Christensen I, Lauritsen J. Surgery After Relapse in Stage I Nonseminomatous Testicular Cancer. J Clin Oncol 2015; 33:2322. [DOI: 10.1200/jco.2014.60.2177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gedske Daugaard
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | | | | | - Ib Jarle Christensen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark and Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lauritsen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Dohn LH, Illemann M, Høyer-Hansen G, Christensen IJ, Hostmark J, Litlekalsoy J, von der Maase H, Pappot H, Laerum OD. Urokinase-type plasminogen activator receptor (uPAR) expression is associated with T-stage and survival in urothelial carcinoma of the bladder. Urol Oncol 2015; 33:165.e15-24. [PMID: 25575713 DOI: 10.1016/j.urolonc.2014.12.001] [Citation(s) in RCA: 19] [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] [Received: 10/08/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the expression-and localization pattern of the urokinase-type plasminogen activator receptor (uPAR), focusing on its clinical implications in patients with urothelial neoplasia of the bladder treated with radical cystectomy. uPAR is a central molecule in tissue remodeling during cancer invasion and metastasis and is an established prognostic marker in cancer. The expression and localization of uPAR and its prognostic significance is only limitedly investigated in urothelial bladder neoplasia. MATERIALS AND METHODS The expression-and localization pattern of uPAR was investigated in formalin-fixed paraffin-embedded tumor tissue from 149 patients treated with radical cystectomy between 1988 and 2005. uPAR expression was determined by immunohistochemistry and scored as either negative or positive. Separate values were obtained for cancer cells, macrophages, and myofibroblasts at the invasive front and tumor core, respectively. Statistical analyses were performed to evaluate the association of uPAR localization and score with clinicopathologic covariates and survival. RESULTS uPAR positivity was seen in 122/137 (89%) and 118/149 (74%) of the neoplasias at the invasive front and tumor core, respectively. uPAR was primarily expressed by myofibroblasts and macrophages in the surrounding stroma as well as some cancer cells. A significant association between uPAR positivity and T-stage as well as grade was found for all 3 cell types in tumor core (P ≤ 0.04 for all comparisons). In univariate analysis, the uPAR positive group had a shorter survival than the uPAR negative group (hazard ratio = 2.39; 95% CI: 1.15-5.01; P = 0.020). CONCLUSIONS The expression of uPAR is a possible prognostic marker that could be useful in identification of patients with aggressive, highly invasive tumors that could benefit from additional chemotherapy or more intensive follow-up after cystectomy.
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Affiliation(s)
- Line Hammer Dohn
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark; The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.
| | - Martin Illemann
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark; Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Gunilla Høyer-Hansen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark; Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Ib J Christensen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark; Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Jens Hostmark
- Department of Clinical Medicine, Section of Urology, University of Bergen, Bergen, Norway
| | - Jorunn Litlekalsoy
- Department of Clinical Medicine, The Gade Laboratory of Pathology, University of Bergen and Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | | | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Ole D Laerum
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark; Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, The Gade Laboratory of Pathology, University of Bergen and Department of Pathology, Haukeland University Hospital, Bergen, Norway
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Mortensen MS, von der Maase H, Daugaard G. Reply to Jorge Aparicio, Pablo Maroto, Javier Sastre and José R. Germà's Letter to the Editor Re: Mette Saksø Mortensen, Jakob Lauritsen, Maria Gry Gundgaard, et al. A nationwide cohort study of stage I seminoma patients followed on a surveillance program. Eur Urol 2014;66:1172-8. Eur Urol 2014; 67:e95. [PMID: 25465338 DOI: 10.1016/j.eururo.2014.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Mette Saksø Mortensen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Daugaard G, Gundgaard MG, Mortensen MS, Agerbæk M, Holm NV, Rørth M, von der Maase H, Christensen IJ, Lauritsen J. Surveillance for Stage I Nonseminoma Testicular Cancer: Outcomes and Long-Term Follow-Up in a Population-Based Cohort. J Clin Oncol 2014; 32:3817-23. [DOI: 10.1200/jco.2013.53.5831] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose To describe treatment results in a large cohort with stage I nonseminoma germ cell cancer (NSGCC) treated in a surveillance program. Patients and Methods From January 1, 1984, to December 31, 2007, 1,226 patients with stage I NSGCC, including high-risk patients with vascular invasion, were observed in a surveillance program. Results The relapse rate after orchiectomy alone was 30.6% at 5 years. Presence of vascular invasion together with embryonal carcinoma and rete testis invasion in the testicular primary identified a group with a relapse risk of 50%. Without risk factors, the relapse risk was 12%. Eighty percent of relapses were diagnosed within the first year after orchiectomy. The median time to relapse was 5 months (range, 1 to 308 months). Early relapses were mainly detected by increase in tumor markers, and late relapses were detected by computed tomography scans. Relapses after 5 years were seen in 0.5% of the whole cohort or in 1.6% of relapsing patients. The majority of relapses (94.4%) belonged to the good prognostic group according to the International Germ Cell Cancer Collaborative Group classification. The disease-specific survival at 15 years was 99.1%. Conclusion A surveillance policy for patients with stage I NSGCC is a safe approach associated with an excellent cure rate and an overall low treatment burden despite a high relapse rate in a small group of patients. We recommend surveillance for patients with stage I NSGCC with immediate systemic treatment at relapse. Clearly defined risk factors for relapse are presented if an option of risk-adapted treatment is preferred.
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Affiliation(s)
- Gedske Daugaard
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Maria Gry Gundgaard
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Mette Saksø Mortensen
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Mads Agerbæk
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Niels Vilstrup Holm
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Mikael Rørth
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Hans von der Maase
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Ib Jarle Christensen
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
| | - Jakob Lauritsen
- Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark
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Gundgaard MG, Almstrup K, Toft BG, Rajpert-De Meyts E, Roerth M, von der Maase H, Mortensen MS, Lauritsen J, Andersen KK, Agerbaek M, Holm NV, Dalton SO, Johansen C, Daugaard G. Screening for carcinoma in situ (CIS) testis and occurrence of metachronous germ cell cancer (mGCC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Mikael Roerth
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Jakob Lauritsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | | | | | - Gedske Daugaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Robinson P, Maase HVD, Bhalla S, Kielhorn A, Aristides M, Brown A, Tilden D. Cost–utility analysis of the GC versus MVAC regimens for the treatment of locally advanced or metastatic bladder cancer. Expert Rev Pharmacoecon Outcomes Res 2014; 4:27-38. [DOI: 10.1586/14737167.4.1.27] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Carus A, Gurney H, Gebski V, Harnett P, Hui R, Kefford R, Wilcken N, Ladekarl M, von der Maase H, Donskov F. Impact of baseline and nadir neutrophil index in non-small cell lung cancer and ovarian cancer patients: Assessment of chemotherapy for resolution of unfavourable neutrophilia. J Transl Med 2013; 11:189. [PMID: 23945200 PMCID: PMC3751486 DOI: 10.1186/1479-5876-11-189] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 08/12/2013] [Indexed: 12/26/2022] Open
Abstract
Background Chronic inflammation has been recognized to foster tumour development. Whether chemotherapy can be used to neutralize chronic inflammation is unclear. Methods We evaluated baseline and nadir neutrophils in 111 patients (pts.) with non-small cell lung cancer (NSCLC) and 118 pts. with ovarian cancer (OC) treated with chemotherapy administered with dose-individualization to achieve nadir neutropenia of 1.5. We used predefined baseline neutrophil cut-offs 4.5 × 109/L (NSCLC) and 3.9 × 109/L (OC). Results Absence of chemotherapy-induced nadir neutropenia (CTCAE grade 0, neutrophils ≥ LLN) was seen in 23% of OC and 25% of NSCLC pts. Absence of nadir neutropenia was associated with decreased overall survival (OS) compared with presence (>grade 0) of neutropenia (9 vs. 14 months, P = 0.004 for NSCLC and 23 vs. 56 months; P = 0.01 for OC). Obtaining grade 3/4 neutropenia did not improve survival compared with grade 1/2 neutropenia. In multivariate analyses, baseline neutrophils ≥4.5 × 109/L (HR: 2.0; 95% CI: 1.11-3.44;P = 0.02) and absence of nadir neutropenia (HR: 1.6; 95% CI: 1.02-2.65;P = 0.04) for NSCLC and absence of nadir neutropenia (HR: 1.7; 95% CI: 1.04;2.93;P = 0.04) for OC were independently associated with short OS. Three prognostic neutrophil index (NI) groups were defined. Favourable NI: low baseline neutrophils and presence of nadir neutropenia (>grade 0), Intermediate NI: elevated baseline neutrophils and presence of nadir neutropenia (>grade 0), and Poor NI: elevated baseline neutrophils and absence of nadir neutropenia (grade 0). For NSCLC patients, the median OS was 18.0, 13.4, and 8.8 months for favourable, intermediate and poor NI, respectively (fav vs. poor P = 0.002; fav vs. intermed P = 0.04; and intermed vs. poor P = 0.03). For OC patients, median OS was 69, 52 and 23 months for favourable, intermediate and poor NI, respectively (fav vs. poor P = 0.03; fav vs. intermed P = 0.3; and intermed vs. poor P = 0.02). Interestingly, survival rates in the intermediate NI groups indicated that individualised dose of chemotherapy to induce neutropenia may partly overcome the negative impact of elevated baseline neutrophils. Conclusions A neutrophil index comprising elevated baseline neutrophils and absence of neutropenia identified a high risk group of NSCLC and ovarian cancer patients with only modest effect of chemotherapy. New treatment options for this subset of patients are required.
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Brandberg Y, Johansson H, Aamdal S, Bastholt L, Hernberg M, Stierner U, von der Maase H, Hansson J. Role functioning before start of adjuvant treatment was an independent prognostic factor for survival and time to failure. A report from the Nordic adjuvant interferon trial for patients with high-risk melanoma. Acta Oncol 2013; 52:1086-93. [PMID: 23621752 DOI: 10.3109/0284186x.2013.789140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the role of health-related quality of life (HRQoL) at randomization as independent prognostic factors for survival and time to failure, and to explore associations between HRQoL and treatment effects. MATERIAL AND METHODS In the Nordic adjuvant interferon trial, a randomized trial evaluating if adjuvant therapy with intermediate-dose IFN had the same beneficial effects on overall and disease-free survival in high-risk melanoma as high-dose IFN, 855 patients in Denmark, Finland, Norway, and Sweden were included. The EORTC QLQ-C30 questionnaire was used to assess HRQoL before randomization. RESULTS A total of 785 (92%) agreed to participate in the HRQoL-study and provided baseline HRQoL data. Prognostic variables included in the multivariate model were age, sex, performance status, tumor thickness, stage, and number of positive lymph nodes. Univariate analyses revealed an association between prolonged survival and age, stage/ number of metastatic lymph nodes and the HRQoL variable role functioning (p ≤ 0.01). After controlling for other prognostic factors, these variables remained independently statistically significant for survival. The univariate analyses of time to failure showed significant associations with the clinical variable stage/nodes and with the HRQoL variables physical functioning and role functioning. Adjusted multivariate analyses including the same clinical conditions as above showed statistically significant relationships between time to failure and global quality of life, physical functioning, role functioning, social functioning and fatigue (p ≤ 0.01). No interactions between HRQoL variables and treatment were found, with the exception for cognitive functioning. CONCLUSION Role functioning was found to be an independent prognostic factor for time to failure and survival in patients with high-risk melanoma. Thus, also in this early stage of melanoma, HRQoL variables might be useful as important prognostic factors for time to failure and overall survival.
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Affiliation(s)
- Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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Mortensen MS, Gundgaard MG, Lauritsen J, Agerbaek M, Holm NV, von der Maase H, Daugaard G. A nationwide cohort study of surveillance for stage I seminoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4502] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4502 Background: The standard treatment for stage I seminoma remains a topic for discussion. Survival rates are excellent irrespective of treatment modality (radiotherapy, carboplatin or surveillance). However, late effects might differ between treatment options. Only smaller surveillance studies with limited follow-up have previously been published. We present data from a large nationwide cohort study on surveillance in stage I seminoma patients. Methods: A nationwide and population based clinical database covering germ cell cancer patients diagnosed 1984-2007 was constructed. The database included 4,683 cases. All stage I seminoma patients followed by surveillance were identified. Possible prognostic factors for relapse were collected from patient files and pathology reports. By merging our data with the national patient registry we were able to collect data on late relapses, vital status and cause of death on all patients up to December 2012. Results: 1,822 patients with stage I seminoma were followed on a surveillance program. The median follow-up time was 15.4 years. Ten year cancer specific survival (CSS) was 99.6%. A total of 355 (19.5%) patients had a relapse after a median time of 13.7 months (range 1.2-173.7 months). Within 2-5 years after orchiectomy, 72 patients (4.0 %) had a relapse and 26 patients (1.4 %) had a relapse more than 5 years after orchiectomy. Invasion of blood or lymphatic vessels, tumor size > 4 cm and serum human chorionic gonadotropin > 200 IU/L were all predictive factors for relapse in both univariate and multivariate analyses (p<0.01). Invasion of rete testis was significant in the univariate analysis but not in the multivariate analyses (p=0.53). Conclusions: We present the largest cohort ever published of stage I seminoma patients followed on a surveillance program. The prognosis was excellent with a 10 year CSS of 99.6%. Prognostic factors for relapse were identified. The relapse rate after 5-years of follow-up was 1.4%. Surveillance should be the preferred option of management in stage I seminoma patients. Several international guidelines are now in agreement with this statement.
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Affiliation(s)
| | | | - Jakob Lauritsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Gedske Daugaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Dohn LH, Illemann M, Høyer-Hansen G, Maase HVD, Christensen IJ, Litlekalsoey J, Hoestmark JG, Pappot H, Laerum OD. Abstract B14: uPAR expression in the microenvironment of human urothelial neoplasia of the bladder is associated with invasive behavior and increases significantly with T-stage and grade. Cancer Res 2013. [DOI: 10.1158/1538-7445.tim2013-b14] [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: 11/16/2022]
Abstract
Abstract
Introduction and objectives: More than 90% of bladder tumors are urothelial neoplasias, characterised as heterogeneous cell populations consisting of tumor cells, macrophages and stromal cells. At time of diagnosis, most neoplasias are non-invasive (stage Ta) or with invasion of lamina propria (stage T1). Despite advances in surgical techniques and intra-vesical therapy, patients with stage Ta and T1 have high recurrence and progression rates. Pathologic stage and grade, have limited ability to predict the invasive and metastatic potential, probably due to tumors of similar stage and grade having a significantly different biology. Biomarkers discriminating the microenvironment in non-invasive from invasive neoplasia are needed in order to improve curability. For this reason we have investigated one of the key players in proteolytic activity of invasive neoplasias, the plasminogen activation system. Components of this system: urokinase plasminogen activator (uPA), its cellular receptor (uPAR) and inhibitor (PAI-1), have prognostic, diagnostic and/or predictive value in several human cancers, but are poorly investigated in urothelial cancer.
Materials and methods: Retrospectively collected, formalin fixed and paraffin embedded tissue samples (Haukeland University Hospital, Bergen) from 107 patients who underwent cystectomy for urothelial neoplasias in the period 1988-2005 were investigated. The material consists of 10 Ta, 24 T1, 73 T2-4 tumors, including 39 low-grade (LG) and 68 high-grade (HG) tumors.
uPAR expression was investigated by immunohistochemistry using a polyclonal antibody against uPAR. uPAR expression was evaluated as either negative or positive. All cases were re-diagnosed by the same pathologist. Cancer cells were identified by staining for cytokeratin (CK-pan and CK7 combined), macrophages by CD68 and tumour associated myofibroblasts by α-smooth muscle actin (α-SMA).
Results: 7/10 (70%) of the non-invasive neoplasias (stage Ta) showed no uPAR-immunoreactivity. The uPAR positive cells were only found in the surrounding stroma and not in cancer cells.
In the neoplasias showing stromal- (stage T1) or muscular invasion (stage T2-T4), uPAR-positivity was found in 14/24 (58%) and 63/73 (86%) respectively.
uPAR-positivity was found in 58/68 (85%) of HG tumors and in 17/39 (44%) LG tumors (p<0.001). uPAR-immunoreactivity was primarily seen in fibroblast-like cells (presumably myofibroblasts) and to a lesser extent in macrophages in the surrounding stroma as well as in some scattered cancer cells.
There was a significant trend between uPAR-positivity and T-stage for cancer cells, macrophages and myofibroblasts (p<0.001). High correlations have been shown between uPAR-expression in tumor core and the invasive front for all three cell types (rs>0.57).
Conclusions: This study demonstrated that uPAR-positivity in the complex microenvironment of human urothelial neoplasia of the bladder significantly increases with T-stage and grade.
Myofibroblasts and macrophage expression of uPAR may be an early marker for invasive potential in urothelial neoplasia of the bladder. This may help in the identification of T1 neoplasias with high invasive potential.
The expression of uPAR, as well as PAI-1 and uPA, will be investigated in a larger material and correlated with survival/clinical data. Our aim is to establish predictive and prognostic tools for use in clinical setting based on semi-quantitative immunohistochemical methodology.
Citation Format: Line Hammer Dohn, Martin Illemann, Gunilla Høyer-Hansen, Hans von der Maase, Ib Jarle Christensen, Jorunn Litlekalsoey, Jens G. Hoestmark, Helle Pappot, Ole Didrik Laerum. uPAR expression in the microenvironment of human urothelial neoplasia of the bladder is associated with invasive behavior and increases significantly with T-stage and grade. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr B14.
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Affiliation(s)
- Line Hammer Dohn
- 1Department of Oncology, Finsen Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,
| | - Martin Illemann
- 2The Finsen Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
| | - Gunilla Høyer-Hansen
- 2The Finsen Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
| | - Hans von der Maase
- 1Department of Oncology, Finsen Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,
| | - Ib Jarle Christensen
- 2The Finsen Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
| | - Jorunn Litlekalsoey
- 3The Gade Institute, Section for Pathology, Haukeland University Hospital, Bergen, Norway,
| | - Jens G. Hoestmark
- 4Surgical Clinic, Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Helle Pappot
- 1Department of Oncology, Finsen Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,
| | - Ole Didrik Laerum
- 3The Gade Institute, Section for Pathology, Haukeland University Hospital, Bergen, Norway,
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Poulsen HS, von der Maase H. [MiRNA in glioblastomas--potentials and limitations]. Ugeskr Laeger 2012; 174:628. [PMID: 22395009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Bellmunt J, von der Maase H, Mead GM, Skoneczna I, De Santis M, Daugaard G, Boehle A, Chevreau C, Paz-Ares L, Laufman LR, Winquist E, Raghavan D, Marreaud S, Collette S, Sylvester R, de Wit R. Randomized phase III study comparing paclitaxel/cisplatin/gemcitabine and gemcitabine/cisplatin in patients with locally advanced or metastatic urothelial cancer without prior systemic therapy: EORTC Intergroup Study 30987. J Clin Oncol 2012; 30:1107-13. [PMID: 22370319 DOI: 10.1200/jco.2011.38.6979] [Citation(s) in RCA: 317] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The combination of gemcitabine plus cisplatin (GC) is a standard regimen in patients with locally advanced or metastatic urothelial cancer. A phase I/II study suggested that a three-drug regimen that included paclitaxel had greater antitumor activity and might improve survival. PATIENTS AND METHODS We conducted a randomized phase III study to compare paclitaxel/cisplatin/gemcitabine (PCG) with GC in patients with locally advanced or metastatic urothelial carcinoma. Primary outcome was overall survival (OS). Secondary outcomes were progression-free survival (PFS), overall response rate, and toxicity. RESULTS From 2001 to 2004, 626 patients were randomly assigned; 312 patients were assigned to PCG, and 314 patients were assigned to GC. After a median follow-up of 4.6 years, the median OS was 15.8 months on PCG versus 12.7 months on GC (hazard ratio [HR], 0.85; P = .075). OS in the subgroup of all eligible patients was significantly longer on PCG (3.2 months; HR, 0.82; P = .03), as was the case in patients with bladder primary tumors. PFS was not significantly longer on PCG (HR, 0.87; P = .11). Overall response rate was 55.5% on PCG and 43.6% on GC (P = .0031). Both treatments were well tolerated, with more thrombocytopenia and bleeding on GC than PCG (11.4% v 6.8%, respectively; P = .05) and more febrile neutropenia on PCG than GC (13.2% v 4.3%, respectively; P < .001). CONCLUSION The addition of paclitaxel to GC provides a higher response rate and a 3.1-month survival benefit that did not reach statistical significance. Novel approaches will be required to obtain major improvements in survival of incurable urothelial cancer.
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Pedersen AF, Rossen P, Olesen F, von der Maase H, Vedsted P. Fear of recurrence and causal attributions in long-term survivors of testicular cancer. Psychooncology 2011; 21:1222-8. [DOI: 10.1002/pon.2030] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 06/08/2011] [Accepted: 06/08/2011] [Indexed: 11/06/2022]
Affiliation(s)
- Anette Fischer Pedersen
- The Research Unit for General Practice, Research Center for Cancer Diagnosis in Primary Care; Aarhus University; Aarhus C Denmark
| | - Philip Rossen
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Frede Olesen
- The Research Unit for General Practice, Research Center for Cancer Diagnosis in Primary Care; Aarhus University; Aarhus C Denmark
| | | | - Peter Vedsted
- The Research Unit for General Practice, Research Center for Cancer Diagnosis in Primary Care; Aarhus University; Aarhus C Denmark
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Hansson J, Aamdal S, Bastholt L, Brandberg Y, Hernberg M, Nilsson B, Stierner U, von der Maase H. Two different durations of adjuvant therapy with intermediate-dose interferon alfa-2b in patients with high-risk melanoma (Nordic IFN trial): a randomised phase 3 trial. Lancet Oncol 2011; 12:144-52. [DOI: 10.1016/s1470-2045(10)70288-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bellmunt J, Choueiri TK, Fougeray R, Schutz FAB, Salhi Y, Winquist E, Culine S, von der Maase H, Vaughn DJ, Rosenberg JE. Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol 2010; 28:1850-5. [PMID: 20231682 DOI: 10.1200/jco.2009.25.4599] [Citation(s) in RCA: 303] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The present study sought to identify pretreatment prognostic factors for overall survival (OS) in patients with metastatic transitional cell carcinoma of the urothelial tract (TCCU) who experienced treatment failure with the first-line, platinum-based regimen included in the phase III vinflunine trial. PATIENTS AND METHODS In total, 370 patients with platinum-refractory TCCU were included in this analysis. Potential prognostic factors were recorded prospectively. Univariate analysis was used to identify clinical and laboratory factors that significantly impact survival. Multivariate analysis was used to identify independent prognostic factors, and bootstrap analysis was performed for internal validation, forming a prognostic model. External validation was performed on the phase II vinflunine study CA183001. RESULTS Multivariate analysis and the internal validation identified Eastern Cooperative Oncology Group performance status (PS) more than 0, hemoglobin level less than 10 g/dL, and the presence of liver metastasis as the main adverse prognostic factors for OS. External validation confirmed these prognostic factors. Four subgroups were formed based on the presence of zero, one, two, or three prognostic factors; the median OS times for these groups were 14.2, 7.3, 3.8, and 1.7 months (P < .001), respectively. CONCLUSION We identified and both internally and externally validated three adverse risk factors (PS, hemoglobin level, and liver metastasis) that predict for OS and developed a scoring system that classifies patients with platinum-refractory disease on second-line chemotherapy into four risk groups with different outcome. Similar to the first-line setting, the presence of visceral metastases and poor PS predict a worse prognosis. These factors, together with low hemoglobin, can be used for prognostication and future patient stratification in clinical trials.
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Affiliation(s)
- Joaquim Bellmunt
- Department of Medical Oncology, University Hospital Del Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain.
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El-Hariry I, Powles T, Lau MR, Sternberg CN, Ravaud A, von der Maase H, Zantl N, Harper P, Rolland F, Audhuy B, Barthel F, Machiels JP, Patel P, Kreuser ED, Hawkins RE. Amplification of epidermal growth factor receptor gene in renal cell carcinoma. Eur J Cancer 2010; 46:859-62. [PMID: 20167476 DOI: 10.1016/j.ejca.2010.01.011] [Citation(s) in RCA: 10] [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] [Received: 08/23/2009] [Revised: 01/11/2010] [Accepted: 01/14/2010] [Indexed: 11/20/2022]
Abstract
Expression of epidermal growth factor receptor (EGFR) may be of prognostic value in renal cell cancer (RCC). Gene amplification of EGFR was investigated in a cohort of 315 patients with advanced RCC from a previously reported randomised study. Using fluorescent in situ hybridisation, only 2 patients (0.6%) had gene amplification; therefore gene amplification is of no prognostic value in RCC.
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Affiliation(s)
- Iman El-Hariry
- Oncology Business Unit, GlaxoSmithKline, London UB11 1BT, United Kingdom
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Abstract
Purpose A growing number of patients with testicular cancer (TC) become long-term survivors. As a consequence, quality-of-life (QOL) issues become increasingly important. The objective of this study was to investigate QOL among Danish TC survivors. Methods A long-term follow-up assessment of all patients with TC treated at Aarhus University Hospital in Denmark between 1990 and 2000 was conducted. A total of 401 survivors (response rate, 66%) completed questionnaires concerning QOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30), depression (Beck Depression Inventory-II), fatigue (Multidimensional Fatigue Inventory-20), and health-related issues such as neurotoxic symptoms and Raynaud-like phenomena. On the basis of their treatment, participants were categorized as having received surveillance, radiotherapy, or chemotherapy. Results QOL among patients with TC was equal to that of men from the general population. Although patients who received chemotherapy reported higher levels of peripheral sensory neuropathy, ototoxicity, and Raynaud-like phenomena, treatment strategies were generally unrelated to QOL and depressive symptoms. Conclusion Overall, the patients in this study reported high levels of QOL. The results suggest that patients treated for TC should be informed about the anticipated good post-therapeutic QOL and the low risk of psychosocial and physical long-term effects.
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Affiliation(s)
- Philip Blach Rossen
- From the Department of Oncology, Aarhus University Hospital; Psychooncology Research Unit, University of Aarhus, Aarhus; and Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anette Fischer Pedersen
- From the Department of Oncology, Aarhus University Hospital; Psychooncology Research Unit, University of Aarhus, Aarhus; and Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robert Zachariae
- From the Department of Oncology, Aarhus University Hospital; Psychooncology Research Unit, University of Aarhus, Aarhus; and Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans von der Maase
- From the Department of Oncology, Aarhus University Hospital; Psychooncology Research Unit, University of Aarhus, Aarhus; and Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Køllgaard T, Duval L, Schmidt H, Kaltoft K, Seremet T, Andersen MH, Maase HVD, Straten PT, Hadrup SR. Longitudinal immune monitoring of patients receiving intratumoral injection of a MART-1 T-cell receptor-transduced cell line (C-Cure 709). Cytotherapy 2009; 11:631-41. [PMID: 19530030 DOI: 10.1080/14653240902923146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AIMS Adoptive transfer of tumor-specific lymphocytes is a promising strategy in the treatment of cancer. We conducted intratumoral administration of an allogeneic irradiated continuous T-cell line (C-Cure 709) expressing an HLA-A2-restricted MART-1-specific T-cell receptor (TCR) into HLA-A2(+) melanoma patients. The C-Cure 709 cell line is cytotoxic against MART-1(+) HLA-A2(+) melanoma cell lines and secretes several immune stimulatory cytokines upon stimulation. METHODS Anti-tumor immune responses against the commonly expressed tumor antigen (Ag) MART-1 were longitudinally analyzed in peripheral blood by fluorescence-activated cell sorting (FACS) before and after intratumoral injection of C-Cure 709. RESULTS No treatment-induced increase in Ag-specific T-cell frequencies was observed in peripheral blood, and the phenotype of MART-1-specific T cells was very stable during the treatment. Interestingly, despite a very stable frequency of MART-1-specific T cells over the course of treatment, clonotype mapping revealed that the response was in fact highly diverse and dynamic, with new clonotypes emerging during treatment. Only a few clonotypes were recurrently detected in consecutive samples. One MART-1-specific T-cell clone disappearing from peripheral blood was later detected in a metastatic lesion. CONCLUSIONS Sequence analyzes of the CDR3 region revealed conserved structural characteristics in the MART-1-specific TCR used by T-cell clones.
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Affiliation(s)
- Tania Køllgaard
- Center for Cancer Immune Therapy (CCIT), University Hospital Herlev, Herlev, Denmark
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Jensen HK, Donskov F, Marcussen N, Nordsmark M, Lundbeck F, von der Maase H. Presence of intratumoral neutrophils is an independent prognostic factor in localized renal cell carcinoma. J Clin Oncol 2009; 27:4709-17. [PMID: 19720929 DOI: 10.1200/jco.2008.18.9498] [Citation(s) in RCA: 334] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We have previously demonstrated a significant negative impact of intratumoral neutrophils in metastatic renal cell carcinoma. This study assessed intratumoral neutrophils in localized clear cell renal cell carcinoma (RCC). PATIENTS AND METHODS The study comprised 121 consecutive patients who had a nephrectomy for localized RCC. Biomarkers (intratumoral CD8+, CD57+ immune cells, CD66b+ neutrophils, and carbonic anhydrase IX [CA IX]) were assessed by immunohistochemistry, and the relationship with clinical and histopathologic features and patient outcome was evaluated. RESULTS The intratumoral neutrophils ranged from zero to 289 cells/mm(2) tumor tissue. The presence of intratumoral neutrophils was statistically significantly associated with increasing tumor size, low hemoglobin, high creatinine, and CA IX < or = 85%. In multivariate analysis, the presence of intratumoral neutrophils (hazard ratio [HR], 3.0; 95% CI, 1.7 to 5.4; P < .0001), pT stage T3b/T4 (HR, 2.1; 95% CI, 1.2 to 3.6; P = .007), and low hemoglobin (HR, 1.8; 95% CI, 1.0 to 3.1; P = .03) were independent prognostic factors significantly associated with short recurrence-free survival. The presence of intratumoral neutrophils was also an independent prognostic factor for cancer-specific survival (HR, 3.5; 95% CI, 1.9 to 6.4; P < .0001) and overall survival (HR, 3.1; 95% CI, 1.9 to 5.0; P < .0001). Applying the prognostic value of intratumoral neutrophils to the Leibovich low-/intermediate-risk group (n = 78) showed a 5-year recurrence-free survival of 53% (95% CI, 34.6% to 71.8%; presence of intratumoral neutrophils) versus 87% (95% CI, 77.8% to 96.8%; absence of intratumoral neutrophils). The estimated concordance index was 0.74 using the Leibovich risk score and 0.80 when intratumoral neutrophils were added. CONCLUSION The presence of intratumoral neutrophils is a new, strong, independent prognostic factor for short recurrence-free, cancer-specific, and overall survival in localized clear cell RCC.
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Affiliation(s)
- Hanne Krogh Jensen
- Department of Oncology, Aarhus University Hospital, 8000 Aarhus C, Denmark.
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Pedersen AF, Zachariae R, Jensen AB, Bovbjerg DH, Andersen O, von der Maase H. Psychological stress predicts the risk of febrile episodes in cancer patients during chemotherapy. Psychother Psychosom 2009; 78:258-60. [PMID: 19468261 DOI: 10.1159/000219526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bellmunt J, Théodore C, Demkov T, Komyakov B, Sengelov L, Daugaard G, Caty A, Carles J, Jagiello-Gruszfeld A, Karyakin O, Delgado FM, Hurteloup P, Winquist E, Morsli N, Salhi Y, Culine S, von der Maase H. Phase III trial of vinflunine plus best supportive care compared with best supportive care alone after a platinum-containing regimen in patients with advanced transitional cell carcinoma of the urothelial tract. J Clin Oncol 2009; 27:4454-61. [PMID: 19687335 DOI: 10.1200/jco.2008.20.5534] [Citation(s) in RCA: 544] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Vinflunine (VFL) is a new microtubule inhibitor that has activity against transitional cell carcinoma of urothelial tract (TCCU). We conducted a randomized phase III study of VFL and best supportive care (BSC) versus BSC alone in the treatment of patients with advanced TCCU who had experienced progression after a first-line platinum-containing regimen. PATIENTS AND METHODS The study was designed to compare overall survival (OS) between patients receiving VFL + BSC (performance status [PS] = 0: 320 mg/m(2), every 3 weeks; PS = 0 with previous pelvic radiation and PS = 1: 280 mg/m(2) subsequently escalated to 320 mg/m(2)) or BSC. RESULTS Three hundred seventy patients were randomly assigned (VFL + BSC, n =253; BSC, n = 117). Both arms were well balanced except there were more patients with PS more than 1 (10% difference) in the BSC arm. Main grade 3 or 4 toxicities for VFL + BSC were neutropenia (50%), febrile neutropenia (6%), anemia (19%), fatigue (19%), and constipation (16%). In the intent-to-treat population, the objective of a median 2-month survival advantage (6.9 months for VFL + BSC v 4.6 months for BSC) was achieved (hazard ratio [HR] = 0.88; 95% CI, 0.69 to 1.12) but was not statistically significant (P = .287). Multivariate Cox analysis adjusting for prognostic factors showed statistically significant effect of VFL on OS (P = .036), reducing the death risk by 23% (HR = 0.77; 95% CI, 0.61 to 0.98). In the eligible population (n = 357), the median OS was significantly longer for VFL + BSC than BSC (6.9 v 4.3 months, respectively), with the difference being statistically significant (P = .040). Overall response rate, disease control, and progression-free survival were all statistically significant favoring VFL + BSC (P = .006, P = .002, and P = .001, respectively). CONCLUSION VFL demonstrates a survival advantage in second-line treatment for advanced TCCU. Consistency of results exists with significant and meaningful benefit over all efficacy parameters. Safety profile is acceptable, and therefore, VFL seems to be a reasonable option for TCCU progressing after first-line platinum-based therapy.
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Affiliation(s)
- Joaquim Bellmunt
- Department of Medical Oncology, University Hospital Del Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain.
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von der Maase H. Is a contralateral testicular biopsy in patients with unilateral germ cell testicular cancer indicated as a routine procedure? Acta Oncol 2009; 44:523-5. [PMID: 16165909 DOI: 10.1080/02841860500251562] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hansen BD, Schmidt H, von der Maase H, Sjoegren P, Agger R, Hokland M. Tumour-associated macrophages are related to progression in patients with metastatic melanoma following interleukin-2 based immunotherapy. Acta Oncol 2009; 45:400-5. [PMID: 16760175 DOI: 10.1080/02841860500471798] [Citation(s) in RCA: 10] [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: 10/25/2022]
Abstract
The aim of the present study was to analyze whether leukocyte subsets in peripheral blood and tumour biopsies obtained before treatment were able to predict response or survival in patients with metastatic melanoma following Interleukin-2 (IL-2) based immunotherapy. Flow cytometry was performed on peripheral blood for CD4(+) T cells, CD8(+) T cells and CD56(+) natural killer (NK) cells. Immunohistochemical analyses were used to identify CD4(+) T cells, CD8(+) T cells, CD57(+) NK cells and CD64(+) (macrophages) cells in tumour biopsies. High numbers of tumour-associated CD64(+) macrophages in tumour biopsies were statistically significantly associated with poor response to treatment. Our data suggest that tumour-associated macrophages may correlate negatively with response, which may be of biological importance for IL-2 based immunotherapy of malignant melanoma.
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Galvis OL, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Ares LP, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. Corrigendum to: “European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I” [Eur Urol 2008;53:478–96] and to: “European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part II” [Eur Urol 2008;53:497–513]. Eur Urol 2008. [DOI: 10.1016/j.eururo.2008.03.017] [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: 11/16/2022]
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Jensen HK, Nordsmark M, Donskov F, Marcussen N, von der Maase H. Immunohistochemical expression of carbonic anhydrase IX assessed over time and during treatment in renal cell carcinoma. BJU Int 2008; 101 Suppl 4:41-4. [DOI: 10.1111/j.1464-410x.2008.07649.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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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Ravaud A, Hawkins R, Gardner JP, von der Maase H, Zantl N, Harper P, Rolland F, Audhuy B, Machiels JP, Pétavy F, Gore M, Schöffski P, El-Hariry I. Lapatinib versus hormone therapy in patients with advanced renal cell carcinoma: a randomized phase III clinical trial. J Clin Oncol 2008; 26:2285-91. [PMID: 18467719 DOI: 10.1200/jco.2007.14.5029] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lapatinib is an orally reversible inhibitor of epidermal growth factor receptor (EGFR)/human epidermal growth factor receptor 2 (HER-2) tyrosine kinases with demonstrated activity in patients with HER-2-positive breast cancer. In the current phase III open-label trial, lapatinib was compared with hormone therapy (HT) in patients with advanced renal cell carcinoma (RCC) that express EGFR and/or HER-2. PATIENTS AND METHODS Patients with advanced RCC who had experienced disease progression through first-line cytokine therapy--stratified by Karnofsky performance status and number of metastatic sites--were randomly assigned to lapatinib 1,250 mg daily or HT. The primary end point was time to progression (TTP); secondary end points included overall survival (OS), safety, and biomarker analyses. RESULTS Four hundred sixteen patients were enrolled onto the study. Median TTP was 15.3 weeks for lapatinib versus 15.4 weeks for HT (hazard ratio [HR] = 0.94; P = .60), and median OS was 46.9 weeks for lapatinib versus 43.1 weeks for HT (HR = 0.88; P = .29). In a biomarker analysis of patients with EGFR-overexpressed tumors (3+ by immunohistochemistry [IHC]; n = 241) median TTP was 15.1 weeks for lapatinib versus 10.9 weeks for HT (HR = 0.76; P = .06), and median OS was 46.0 weeks for lapatinib versus 37.9 weeks for HT (HR = 0.69; P = .02). These results were confirmed by Cox regression analysis. No unexpected toxicities were observed; the most commonly reported drug-related adverse events (all grades) for lapatinib were rash (44%) and diarrhea (40%). CONCLUSION Lapatinib was well tolerated with equivalent overall efficacy to HT in advanced RCC patients who had experienced disease progression while receiving cytokines, and the study supports that lapatinib prolonged OS relative to HT in patients with 3+ EGFR status determined by IHC.
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Affiliation(s)
- Alain Ravaud
- Department of Medical Oncology, Hôpital Saint André, CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux cedex, France.
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Jensen HK, Donskov F, Nordsmark M, Marcussen N, von der Maase H. 5IL-2 therapy increases intratumoral FOXP3
+ regulatory immune cells in patients with metastatic renal cell carcinoma. APMIS 2008. [DOI: 10.1111/j.1600-0463.2008.001165_17.x] [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: 11/30/2022]
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Jensen HK, Donskov F, Nordsmark M, Marcussen N, von der Maase H. 5 IL-2 therapy increases intratumoral FOXP3 + regulatory immune cells in patients with metastatic renal cell carcinoma. APMIS 2008. [DOI: 10.1111/j.1600-0463.2008.00abs1165_17.x] [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: 11/30/2022]
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz-Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. Eur Urol 2008; 53:497-513. [PMID: 18191015 DOI: 10.1016/j.eururo.2007.12.025] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I. Eur Urol 2008; 53:478-96. [PMID: 18191324 DOI: 10.1016/j.eururo.2007.12.024] [Citation(s) in RCA: 330] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Christensen S, Zachariae R, Jensen AB, Vaeth M, Møller S, Ravnsbaek J, von der Maase H. Prevalence and risk of depressive symptoms 3-4 months post-surgery in a nationwide cohort study of Danish women treated for early stage breast-cancer. Breast Cancer Res Treat 2008; 113:339-55. [PMID: 18278553 DOI: 10.1007/s10549-008-9920-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 01/28/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elevated levels of depressive symptoms are generally found among cancer patients, but results from existing studies vary considerably with respect to prevalence and proposed risk factors. PURPOSE To study the prevalence of depressive symptoms and major depression 3-4 months following surgery for breast cancer, and to identify clinical risk factors while adjusting for pre-cancer sociodemographic factors, comorbidity, and psychiatric history. PATIENTS AND METHODS The study cohort consists of 4917 Danish women, aged 18-70 years, receiving standardized treatment for early stage invasive breast cancer during the 2 1/2 year study period. Of these, 3343 women (68%) participated in a questionnaire study 12-16 weeks following surgery. Depressive symptoms (Beck's Depression Inventory II) and health-related behaviors were assessed by questionnaire. The Danish Breast Cancer Cooperative Group (DBCG) and the surgical departments provided disease-, treatment-, and comorbidity data for the study cohort. Information concerning sociodemographics and psychiatric history were obtained from national longitudinal registries. RESULTS The results indicated an increased prevalence of depressive symptoms and major depression (13.7%) compared to population-based samples. The pre-cancer variables: Social status, net-wealth, ethnicity, comorbidity, psychiatric history, and age were all independent risk factors for depressive symptoms. Of the clinical variables, only nodal status carried additional prognostic information. Physical functioning, smoking, alcohol use, and BMI were also independently associated with depressive symptoms. CONCLUSION Risk factors for depressive symptoms were primarily restricted to pre-cancer conditions rather than disease-specific conditions. Special attention should be given to socio-economically deprived women with a history of somatic- and psychiatric disease and poor health behaviors.
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Affiliation(s)
- Søren Christensen
- Psychooncology Reseach Unit, Aarhus University Hospital, Nobelparken, Bygn. 1483, 8000, Aarhus C, Denmark.
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Hernberg M, Mattila PS, Rissanen M, Hansson J, Aamdal S, Bastholt L, von der Maase H, Schmidt H, Stierner U, Tarkkanen J. The prognostic role of blood lymphocyte subset distribution in patients with resected high-risk primary or regionally metastatic melanoma. J Immunother 2007; 30:773-9. [PMID: 17893569 DOI: 10.1097/cji.0b013e31814e0898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this study was to investigate whether the profile of peripheral blood lymphocyte subsets of patients with high-risk malignant melanoma is associated with prognosis. Blood samples were systematically obtained from 31 patients with high-risk melanoma eligible for the Nordic Melanoma Cooperative Group adjuvant interferon study. The frequencies of peripheral blood lymphocyte subsets were monitored by flow cytometry using CD3, CD4, CD8, CD56, and CD69 monoclonal antibodies. Patients with low proportions of CD3+CD4+CD69+ cells and of CD3+CD56+ cells before treatment had an improved disease-free survival compared to those with high proportions [77.7 vs. 16.8 mo, hazard ratio (HR) 0.25, confidence interval (CI) 0.09-0.71, P=0.005 and 77.2 vs. 16.0 mo, HR: 0.25, CI 0.086-0.73, P=0.001, respectively]. Low pretreatment levels of these cell populations also correlated with a better overall survival (79.2 vs. 22.6 mo, HR: 0.17, CI 0.05-0.52, P=0.0005 and 78.2 vs. 21.4 mo, HR: 0.2, CI 0.07-0.59, P=0.001, respectively). In the multivariate analysis both the pretreatment proportion of CD3+CD4+CD69+ cells (P=0.01, HR: 0.21, CI 0.07-0.67) and CD3+CD56+ cells (P=0.01, HR: 0.22, CI 0.062-0.65) were independent prognostic factors for overall survival. Our data show that both the proportions of CD3+CD4+CD69+ cells and of CD3+CD56+ cells seem to have a prognostic potential in the natural course of melanoma. These results need to be confirmed in larger studies.
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Affiliation(s)
- Micaela Hernberg
- Department of Oncology, HUSLAB, Helsinki University Central Hospital, Finland.
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Als AB, Dyrskjøt L, von der Maase H, Koed K, Mansilla F, Toldbod HE, Jensen JL, Ulhøi BP, Sengeløv L, Jensen KME, Orntoft TF. Emmprin and survivin predict response and survival following cisplatin-containing chemotherapy in patients with advanced bladder cancer. Clin Cancer Res 2007; 13:4407-14. [PMID: 17671123 DOI: 10.1158/1078-0432.ccr-07-0109] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [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: 11/16/2022]
Abstract
PURPOSE Cisplatin-containing chemotherapy is the standard of care for patients with locally advanced and metastatic transitional cell carcinoma of the urothelium. The response rate is approximately 50% and tumor-derived molecular prognostic markers are desirable for improved estimation of response and survival. EXPERIMENTAL DESIGN Affymetrix GeneChip expression profiling was carried out using tumor material from 30 patients. A set of genes with an expression highly correlated to survival time after chemotherapy was identified. Two genes were selected for validation by immunohistochemistry in an independent material of 124 patients receiving cisplatin-containing therapy. RESULTS Fifty-five differentially expressed genes correlated significantly to survival time. Two of the protein products (emmprin and survivin) were validated using immunohistochemistry. Multivariate analysis identified emmprin expression (hazard ratio, 2.23; P < 0.0001) and survivin expression (hazard ratio, 2.46; P < 0.0001) as independent prognostic markers for poor outcome, together with the presence of visceral metastases (hazard ratio, 2.62; P < 0.0001). In the clinical good prognostic group of patients without visceral metastases, both markers showed significant discriminating power as supplemental risk factors (P < 0.0001). Within this group of patients, the subgroups of patients with no positive, one positive, or two positive immunohistochemistry scores (emmprin and survivin) had estimated 5-year survival rates of 44.0%, 21.1%, and 0%, respectively. Response to chemotherapy could also be predicted with an odds ratio of 4.41 (95% confidence interval, 1.91-10.1) and 2.48 (95% confidence interval, 1.1-5.5) for emmprin and survivin, respectively. CONCLUSIONS Emmprin and survivin proteins were identified as strong independent prognostic factors for response and survival after cisplatin-containing chemotherapy in patients with advanced bladder cancer.
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Affiliation(s)
- Anne B Als
- Department of Oncology, Aarhus University Hospital, Denmark
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von der Maase H. Editorial Comment on: Weekly Paclitaxel and Carboplatin against Advanced Transitional Cell Cancer after Failure of a Platinum-Based Regimen. Eur Urol 2007; 52:1122. [PMID: 17433856 DOI: 10.1016/j.eururo.2007.03.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hans von der Maase
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Als AB, Sengelov L, von der Maase H. Long-Term Survival after Gemcitabine and Cisplatin in Patients with Locally Advanced Transitional Cell Carcinoma of the Bladder: Focus on Supplementary Treatment Strategies. Eur Urol 2007; 52:478-86. [PMID: 17383078 DOI: 10.1016/j.eururo.2007.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 03/07/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to evaluate response and survival, as well as efficacy of subsequent supplementary treatment and follow-up strategy in patients with locally advanced transitional cell carcinoma of the bladder following combination chemotherapy with gemcitabine and cisplatin (GC). METHODS A total of 84 patients with locally advanced (T4b, Nx, M0 or Tx, N2-3, M0) received GC. After chemotherapy, the strategy was close surveillance in patients with complete response, and supplementary radical cystectomy or radiotherapy whenever possible in patients with partial response. RESULTS A total of 25 patients (29.8%) with complete response to chemotherapy were followed by close surveillance. This group achieved a median overall survival of 47.6 mo. Another 25 patients had partial response to chemotherapy. Of these patients, 16 had supplementary treatment, with 10 achieving "no evidence of disease" (NED). Thus, a total of 35 patients achieved NED with a median overall survival of 48.7 mo versus 10.2 mo in patients not achieving NED (hazard ratio=0.10; 95%CI, 0.05-0.20; p<0.0001). The rate of NED was higher in the group of patients who had a cystectomy compared with the group who received radiotherapy as supplementary treatment. CONCLUSIONS In patients with locally advanced bladder cancer, NED following chemotherapy alone or chemotherapy plus supplementary cystectomy or radiotherapy is essential to achieve long-term survival. Patients with a partial response should be offered radical cystectomy whenever possible, which seems to be superior to radiotherapy. Close surveillance may be an alternative to immediate cystectomy in patients with complete response following chemotherapy.
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Affiliation(s)
- Anne Birgitte Als
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
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Schmidt H, Suciu S, Punt CJA, Gore M, Kruit W, Patel P, Lienard D, von der Maase H, Eggermont AMM, Keilholz U. Pretreatment levels of peripheral neutrophils and leukocytes as independent predictors of overall survival in patients with American Joint Committee on Cancer Stage IV Melanoma: results of the EORTC 18951 Biochemotherapy Trial. J Clin Oncol 2007; 25:1562-9. [PMID: 17443000 DOI: 10.1200/jco.2006.09.0274] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE An elevated count of blood neutrophils and monocytes recently was shown independently to predict short survival in patients with stage IV melanoma undergoing interleukin-2-based immunotherapy. In this study, we aimed to validate this finding in a large cohort of stage IV melanoma patients. PATIENTS AND METHODS For this retrospective prognostic study, the data from the European Organisation for the Research and Treatment of Cancer 18951 study were used. Patients were randomly assigned between treatment with dacarbazine, cisplatin, and interferon alfa with or without interleukin-2. Counts of neutrophils and leukocytes were analyzed together with other known prognostic factors: serum lactate dehydrogenase, performance status, metastatic site, and sex. Two multivariate prognostic factor analyses were carried out in the model: one with leukocyte counts and one with neutrophil counts. RESULTS A total of 363 patients were randomly assigned and baseline blood neutrophil and leukocyte counts were available from 316 and 350 patients, respectively. A high neutrophil count (> 7.5 x 10(9)/L) was an independent prognostic factor for short overall survival (hazard ratio [HR], 1.5; 95% CI, 1.1 to 2.1; P = 0.02), and a high leukocyte count (> 10 x 10(9)/L) was an independent prognostic factor of both short overall survival (HR, 1.7; 95% CI, 1.3 to 2.4; P = 0.0005) and short progression-free survival (HR, 1.5; 95% CI, 1.1 to 2.1; P = 0.008). CONCLUSION A high pretreatment count of neutrophils in blood was confirmed as an independent prognostic factor for short overall survival in stage IV melanoma patients undergoing interleukin-2-based immunotherapy. Furthermore, a high count of leukocytes was an independent prognostic factor for short overall survival and progression-free survival. Both parameters should be useful as stratification factors in clinical trials.
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Affiliation(s)
- Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark.
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Sternberg CN, Donat SM, Bellmunt J, Millikan RE, Stadler W, De Mulder P, Sherif A, von der Maase H, Tsukamoto T, Soloway MS. Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer. Urology 2007; 69:62-79. [PMID: 17280909 DOI: 10.1016/j.urology.2006.10.041] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 10/24/2006] [Accepted: 10/27/2006] [Indexed: 11/28/2022]
Abstract
To determine the optimal use of chemotherapy in the neoadjuvant, adjuvant, and metastatic setting in patients with advanced urothelial cell carcinoma, a consensus conference was convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) to critically review the published literature on chemotherapy for patients with locally advanced bladder cancer. This article reports the development of international guidelines for the treatment of patients with locally advanced bladder cancer with neoadjuvant and adjuvant chemotherapy. Bladder preservation is also discussed, as is chemotherapy for patients with metastatic urothelial cancer. The conference panel consisted of 10 medical oncologists and urologists from 3 continents who are experts in this field and who reviewed the English-language literature through October 2004. Relevant English-language literature was identified with the use of Medline; additional cited works not detected on the initial search regarding neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and chemotherapy for patients with metastatic urothelial cancer were reviewed. Evidence-based recommendations for diagnosis and management of the disease were made with reference to a 4-point scale. Results of the authors' deliberations are presented as a consensus document. Meta-analysis of randomized trials on cisplatin-containing combination neoadjuvant chemotherapy revealed a 5% difference in favor of neoadjuvant chemotherapy. No randomized trials have yet compared survival with transurethral resection of bladder tumor alone versus cystectomy for the management of patients with muscle-invasive disease. Collaborative international adjuvant chemotherapy trials are needed to assist researchers in assessing the true value of adjuvant chemotherapy. Systemic cisplatin-based combination chemotherapy is the only current modality that has been shown in phase 3 trials to improve survival in responsive patients with advanced urothelial cancer. A panel of international experts has formulated grade A through D recommendations for the management of patients with locally advanced and metastatic urothelial cancer on the basis of level 1 to 3 evidence and the findings of phase 2 trials, prospective randomized clinical trials, and meta-analyses.
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Affiliation(s)
- Cora N Sternberg
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy.
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Hoyer M, Roed H, Hansen AT, Ohlhuis L, Petersen J, Nellemann H, Berthelsen AK, Grau C, Engelholm SA, von der Maase H. Prospective study on stereotactic radiotherapy of limited-stage non–small-cell lung cancer. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.01.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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