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Kinos S, Hagman H, Halonen P, Soveri LM, O'Reilly M, Pfeiffer P, Frödin JE, Sorbye H, Heervä E, Liposits G, Kallio R, Ålgars A, Ristamäki R, Salminen T, Bärlund M, Shah CH, McDermott R, Röckert R, Flygare P, Kwakman J, Teske A, Punt C, Glimelius B, Österlund P. Detailed analysis of metastatic colorectal cancer patients who developed cardiotoxicity on another fluoropyrimidine and switched to S-1 treatment (subgroup analysis of the CardioSwitch-study). Acta Oncol 2024; 63:248-258. [PMID: 38698698 DOI: 10.2340/1651-226x.2024.24023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE The CardioSwitch-study demonstrated that patients with solid tumors who develop cardiotoxicity on capecitabine or 5-fluorouracil (5-FU) treatment can be safely switched to S-1, an alternative fluoropyrimidine (FP). In light of the European Medicines Agency approval of S-1 in metastatic colorectal cancer (mCRC), this analysis provides more detailed safety and efficacy information, and data regarding metastasectomy and/or local ablative therapy (LAT), on the mCRC patients from the original study. MATERIALS AND METHODS This retrospective cohort study was conducted at 12 European centers. The primary endpoint was recurrence of cardiotoxicity after switch. For this analysis, safety data are reported for 78 mCRC patients from the CardioSwitch cohort (N = 200). Detailed efficacy and outcomes data were available for 66 mCRC patients. RESULTS Data for the safety of S-1 in mCRC patients were similar to the original CardioSwitch cohort and that expected for FP-based treatment, with no new concerns. Recurrent cardiotoxicity (all grade 1) with S-1-based treatment occurred in 4/78 (5%) mCRC patients; all were able to complete FP treatment. Median progression-free survival from initiation of S-1-based treatment was 9.0 months and median overall survival 26.7 months. Metastasectomy and/or LAT was performed in 33/66 (50%) patients, and S-1 was successfully used in recommended neoadjuvant/conversion or adjuvant-like combination regimens and schedules as for standard FPs. INTERPRETATION S-1 is a safe and effective FP alternative when mCRC patients are forced to discontinue 5-FU or capecitabine due to cardiotoxicity and can be safely used in the standard recommended regimens, settings, and schedules.
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Affiliation(s)
- Sampsa Kinos
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Helga Hagman
- Department of Oncology, Skåne University Hospital, Malmö, Sweden
| | - Päivi Halonen
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leena-Maija Soveri
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mary O'Reilly
- Department of Oncology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jan-Erik Frödin
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Halfdan Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Eetu Heervä
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - Gabor Liposits
- Department of Oncology, Regional Hospital West Jutland, Hjørring, Denmark
| | - Raija Kallio
- Department of Oncology, Oulu University and University Hospital, Oulu, Finland
| | - Annika Ålgars
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - Raija Ristamäki
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - Tapio Salminen
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Maarit Bärlund
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Carl-Henrik Shah
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Ray McDermott
- Department of Oncology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | | | - Petra Flygare
- Department of Oncology, Sundsvall Hospital, Sundsvall, Sweden
| | - Johannes Kwakman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arco Teske
- Department of Cardiology, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Cornelis Punt
- Depatment of Epidemiology, Jules Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherland
| | | | - Pia Österlund
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; rTema Cancer, Department of GI-cancer, Karolinska University Hospital, Stockholm, Sweden.
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Reivell V, Hagman H, Haux J, Jorns C, Lindnér P, Taflin H. SOULMATE: the Swedish study of liver transplantation for isolated colorectal cancer liver metastases not suitable for operation or ablation, compared to best established treatment-a randomized controlled multicenter trial. Trials 2022; 23:831. [PMID: 36180944 PMCID: PMC9524109 DOI: 10.1186/s13063-022-06778-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/06/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Around one fourth of patients with colorectal cancer present themselves with distant metastases at the time of diagnosis, and one additional one fifth of the patients will develop distant metastases during the disease, most commonly in the liver. Surgical treatment such as liver resection or ablation, often combined with chemotherapy and targeted therapy, is the only treatment option with curative potential, but only about 20% of the patients with liver metastases are candidates for surgical intervention. Standard treatment for unresectable patients is palliative oncological therapy; however, less than 10% of these patients will achieve a 5-year survival. Non-randomized studies indicate that liver transplantation could be an option for selected patients with colorectal liver metastases (CRLM), which are not suitable for operation or ablation due to surgical technical reasons such as massive tumor burden and small future liver remnant, or oncological reasons, for example, early relapse after liver surgery. Since there is a shortage of donated liver grafts, it is important to select the patient group that benefit most from the treatment. Although some studies present positive results from liver transplantation of CRLM, the results must be validated in a randomized controlled trial before this new indication for liver transplantation can be introduced as a clinical routine. Methods The SOULMATE study is a randomized study evaluating if liver transplantation with liver grafts, primarily from extended criteria donors, increases overall survival in patients with CRLM, not suitable for resection or ablation, in comparison with best established treatment. Patients will be randomized to liver transplantation (LT)+ best established treatment (BET) or to best established treatment only. In the SOULMATE trial, we will evaluate the use of livers from extended criteria donors to decrease the risk of prolonging waiting time for patients on the waiting list for LT. Discussion The SOULMATE study has the possibility to confirm the positive results of previous studies in a randomized setting. The use of extended criteria donors will make the results transferable globally, as most countries are struggling with organ shortage. Trial registration Clinical Trial number: NCT04161092 registered 13 November 2019.
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Affiliation(s)
- Veronica Reivell
- Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helga Hagman
- Department of Oncology, Skanes University Hospital, Lund, Sweden
| | - Johan Haux
- Department of Oncology, Skaraborgs Hospital, Skovde, Sweden
| | - Carl Jorns
- Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Per Lindnér
- Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Taflin
- Transplant Institute, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. .,Sahlgrenska University Hospital, Gothenburg, Sweden.
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Osterlund P, Kinos S, Pfeiffer P, Salminen T, Kwakman J, Frödin JE, Shah C, Sorbye H, Ristamäki R, Halonen P, Soveri L, Heervä E, Ålgars A, Bärlund M, Hagman H, McDermott R, O’Reilly M, Röckert R, Liposits G, Kallio R, Flygare P, Teske A, van Werkhoven E, Punt C, Glimelius B. Continuation of fluoropyrimidine treatment with S-1 after cardiotoxicity on capecitabine- or 5-fluorouracil-based therapy in patients with solid tumours: a multicentre retrospective observational cohort study. ESMO Open 2022; 7:100427. [PMID: 35798468 PMCID: PMC9291631 DOI: 10.1016/j.esmoop.2022.100427] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/23/2021] [Accepted: 12/18/2021] [Indexed: 12/14/2022] Open
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Osterlund PJ, Kinos S, Halonen P, Soveri LM, Kwakman JJ, Salminen T, McDermott RS, Pfeiffer P, Heervä E, Liposits G, Röckert R, Ålgars A, Kallio RS, Sorbye H, Flygare P, Hagman H, Shah CHA, van Werkhoven ED, Glimelius B, Punt CJA. Feasibility of switching to S-1 after other fluoropyrimidine-related cardiotoxicity during chemotherapy for solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7037 Background: Fluoropyrimidines (FP) are the cornerstone of chemotherapy in many solid tumors and linked to cardiotoxicity (CarTx) in about 5% (Polk, Cancer Treat Rev 2013), often leading to FP discontinuation. CarTx may be less common with S-1 and successful switch from other FP has been reported (Kwakman, EJC 2017). Methods: This 6-country, 12-center, cohort study included patients with solid tumors (ICD10 C15-C21, C24-25, C50, C80) who experienced FP-related CarTx. Primary endpoint was recurrent (R) CarTx during S-1 therapy after switch from any other FP. Results: CarTx during capecitabine (n = 124), continuous (n = 13) or bolus 5-fluorouracil (n = 4) was reported for 141 patients who switched to S-1 therapy. CarTx was chest pain including vasospasm without cardiac findings (55%), acute coronary syndrome or myocardial infarction (32%), atrial fibrillation (4%), heart failure/cardiomyopathy (4%), tachy-/bradycardia (3%), and/or other (15%). CarTx was grade 3-4 in 55%, appeared on cycle 1-2 in 89%, and at median 4 days (range 0-466) from FP initiation (Table). Causality was judged related in 26%, probable in 60%, and possible in 14%. Action with FP causing CarTx was permanent discontinuation in 91%. Treatment intent was curative in 70%. Cumulative incidence of RCarTx with S-1 was 3.5% (CI95%, 1.2-8.4%) and median time to R-CarTx was 11 (range 6-195) days. Four (out of 141) had grade 1 and one grade 2 R-CarTx. Three were judged possibly related to S-1 and 2 not related. S-1 was discontinued in one patient and continued in 4 (for 63-252 days) without action (n = 2), with dose reduction (n = 1), or delay (n = 1). There were no differences in demographic or risk factors regarding R-CarTx on S-1 (Table). Conclusions: FP-related CarTx is often severe, occurs early, and leads to permanent FP discontinuation. Switching to S-1-based therapy is safe, with, at the most, grade 1-2 R-CarTx in only 3.5%, and rarely leads to treatment discontinuation (0.7%), allowing patients to continue on an FP-based regimen. Clinical trial information: NCT04260269 . [Table: see text]
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Affiliation(s)
| | - Sampsa Kinos
- Tampere university hospital and Tampere university, Tampere, Finland
| | | | - Leena-Maija Soveri
- Helsinki University Central Hospital and Hyvinkää home care, Helsinki, Finland
| | | | | | | | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Eetu Heervä
- Turku University Hospital and University of Turku, Turku, Finland
| | - Gabor Liposits
- Regional Hospital West Jutland (Herning), Herning, Denmark
| | - Rebecka Röckert
- Department of Oncology, Uppsala Academic Hospital, Uppsala, Sweden
| | - Annika Ålgars
- Turku University Hospital, Department of Oncology and Radiotherapy, Turku, Finland
| | | | | | | | - Helga Hagman
- Department of Oncology and Haematology, Skane University Hospital Lund, Lund, Sweden
| | | | | | - Bengt Glimelius
- Uppsala University, Department of Immunology, Genetics and Pathology, Uppsala, Sweden
| | - Cornelis J. A. Punt
- Department of Medical Oncology, Academic Medical Center, Amsterdam, Netherlands
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Lindnér P, Hagman H, Söderdahl G. [Liver transplantation optional treatment of liver metastases from colorectal cancer]. Lakartidningen 2020; 117:FZWP. [PMID: 32314327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Surgical treatment of liver metastases from colorectal cancer (CLM) is the only treatment option with curative potential; however, only about 15% to 20% of the patients seen at major hospitals are candidates for surgical resection. In a prospective study of liver transplantation (Ltx) for non-resectable CLM a 5-year overall survival rate of 60 % has been shown. We now plan to evaluate if the addition of Ltx to conventional treatment of non-resectable, non-ablatable CLM increases overall survival compared to best established treatment. This will be done in a randomized study, primarily utilizing liver grafts from extended criteria donors not utilized for approved indications.
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Affiliation(s)
| | - Helga Hagman
- med dr, överläkare, , Skånes onkologiska klinik, Skånes universitetssjukhus Lund/Malmö
| | - Gunnar Söderdahl
- med dr, verksamhetschef, , Karolinska institutet; PO transplantation, Karolinska universitetssjukhuset, Huddinge
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Taxbro K, Hammarskjöld F, Juhlin D, Hagman H, Bernfort L, Berg S. Cost analysis comparison between peripherally inserted central catheters and implanted chest ports in patients with cancer-A health economic evaluation of the PICCPORT trial. Acta Anaesthesiol Scand 2020; 64:385-393. [PMID: 31721153 DOI: 10.1111/aas.13505] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/15/2019] [Revised: 09/22/2019] [Accepted: 10/29/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND A reliable central venous access device is a cornerstone in the treatment of cancer. Both peripherally inserted central catheters (PICC) and totally implanted chest ports (PORT) are commonly used for the delivery of chemotherapy. Both types of catheter can cause adverse events such as catheter-related deep venous thrombosis (CR-DVT), infection and mechanical complications. METHOD We conducted a randomized controlled trial including 399 patients with cancer and performed a health economic evaluation investigating the cost related to PICCs and PORTs using several clinically relevant dimensions from a healthcare perspective. The cost was determined using process and cost estimate models. RESULT PICCs are associated with a higher total cost when compared with PORTs. Combining the costs of all categories, the prize per inserted device was 824.58 EUR for PICC and 662.34 EUR for PORT. When adjusting for total catheter dwell time the price was 6.58 EUR/day for PICC and 3.01 EUR/day for PORT. The difference in CR-DVT was the main contributor to the difference in cost. The daily cost of PICC is approximately twice to that of PORT. CONCLUSION We have demonstrated that the cost from a healthcare perspective is higher in cancer patients receiving a PICC than to those with a PORT. The difference is driven mainly by the cost related to the management of adverse events. Our findings are relevant to anaesthetists, oncologists and vascular access clinicians and should be considered when choosing vascular access device prior to chemotherapy.
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Affiliation(s)
- Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Department of Medical and Health Sciences Cardiovascular Medicine Linköping University Linköping Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - David Juhlin
- Department of Anaesthesia and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Helga Hagman
- Department of Oncology Skåne University Hospital Lund Sweden
| | - Lars Bernfort
- Division of Health Care Analysis Linköping University Linköping Sweden
| | - Sören Berg
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care Department of Medical and Health Sciences Linköping University Linköping Sweden
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Taxbro K, Hammarskjöld F, Thelin B, Lewin F, Hagman H, Hanberger H, Berg S. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth 2019; 122:734-741. [PMID: 31005243 DOI: 10.1016/j.bja.2019.01.038] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [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: 11/05/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Centrally inserted totally implanted vascular access ports (PORTs) and peripherally inserted central catheters (PICCs) are widely used for the administration of chemotherapy. Our aim was to study the incidence of catheter-related deep venous thrombosis in patients with cancer receiving chemotherapy through either a PICC or a PORT. METHODS Adults with non-haematological cancer (mainly breast and colorectal) from two Swedish oncology centres were included and followed for up to 1 yr. Patients were randomly assigned to receive a single-lumen PICC or PORT. The primary end point was the occurrence of a clinically significant catheter-related deep venous thrombosis, and the secondary end point was a composite of adverse events related to the catheter: insertion complication, thrombosis, occlusion, infection, and mechanical problems. RESULTS The trial recruited 399 participants (PICC, n=201; PORT, n=198) between March 2013 and February 2017. The PICCs were associated with 16 (8%) deep venous thromboses compared with two (1%) in the PORT group (HR=10.2; 95% confidence interval, 2.3-44.6; P=0.002). The overall incidence of composite adverse events was higher for patients with a PICC compared with those with a PORT (HR=2.7; 95% confidence interval, 1.6-4.6; P<0.001). CONCLUSIONS PICCs are associated with higher risk for catheter-related deep venous thrombosis and other adverse events when compared with PORTs. This increased risk should be considered when choosing a vascular access device for chemotherapy, especially in patients with solid malignancy. CLINICAL TRIAL REGISTRATION NCT01971021.
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Affiliation(s)
- Knut Taxbro
- University of Linköping, Linköping, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
| | - Fredrik Hammarskjöld
- University of Linköping, Linköping, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Bo Thelin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Freddi Lewin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Helga Hagman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Håkan Hanberger
- University of Linköping, Linköping, Sweden; Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Sören Berg
- University of Linköping, Linköping, Sweden; Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Linköping University Hospital, Linköping, Sweden
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Hagman H, Bendahl PO, Lidfeldt J, Belting M, Johnsson A. Protein array profiling of circulating angiogenesis-related factors during bevacizumab containing treatment in metastatic colorectal cancer. PLoS One 2018; 13:e0209838. [PMID: 30592740 PMCID: PMC6310295 DOI: 10.1371/journal.pone.0209838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prolonged angiogenesis inhibition may improve treatment outcome in metastatic colorectal cancer (mCRC) patients. However, due to the complexity of the angiogenic pathways there is a lack of valid predictive biomarkers for anti-angiogenic agents. Here, we describe and optimize a procedure for simultaneous dynamic profiling of multiple angiogenesis related proteins in patient serum to explore associations with the response and acquired resistance to anti-angiogenic therapy. MATERIALS AND METHODS Patients (n=22) were selected from a clinical trial investigating maintenance treatment with bevacizumab alone after response to induction chemotherapy + bevacizumab in mCRC. Serum samples were analysed for 55 unique angiogenesis related proteins using a commercial proteome profiler array and a publicly available image analysis program for quantification. Samples were collected at baseline before induction treatment start, at start of maintenance treatment, and at end of treatment after tumour progression. MAIN RESULTS AND CONCLUSION For eight proteins, the antibody array signals were below detection range in all patient samples. None of the proteins showed levels at baseline or at start of maintenance with strong evidence for correlation to time to progression (lowest nominal p-value 0.03). The dynamic ranges of protein levels measured during the induction treatment period and during the maintenance period were analysed separately for time trends. Evidence for changing trends (up/down) in the levels of MMP-8, TIMP-4 and EGF was observed both during response to induction treatment and at progressive disease, respectively. For three of the proteins (IL-8, Activin A and IGFBP-2), weak evidence for correlation between increasing protein levels during induction with chemotherapy and bevacizumab and time to progression was observed. In conclusion, semi-quantitative profiling of angiogenesis related proteins in patient serum may be a versatile tool to screen for protein patterns aiming at identifying resistance mechanisms of anti-angiogenic treatment in patients with mCRC.
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Affiliation(s)
- Helga Hagman
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
| | - Jon Lidfeldt
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
| | - Mattias Belting
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Anders Johnsson
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
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Hagman H, Bendahl PO, Melander O, Sundberg J, Johnsson A, Belting M. Vasoactive peptides associate with treatment outcome ofbevacizumab-containing therapy in metastatic colorectal cancer. Acta Oncol 2017; 56:653-660. [PMID: 28303751 DOI: 10.1080/0284186x.2017.1302098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hypertension is a common early adverse event of anti-angiogenic treatment of cancer and may associate with treatment response. However, blood pressure measurement as a surrogate response biomarker has methodological limitations, and predictive biomarkers of angiogenesis inhibitors are lacking. In disease associated with hypertension, vasoactive peptides have been linked to cardiovascular pressure load. Here, we have explored potential associations between circulating levels of vasoactive peptides and tumor response during bevacizumab-containing treatment of colorectal cancer. MATERIAL AND METHODS Metastatic colorectal cancer (mCRC) patients with available best objective response (ORR) and time to tumor progression (TTP) data were included from a randomized clinical trial investigating maintenance therapy after first line chemotherapy plus bevacizumab. Midregional-pro-adrenomedullin (MR-proADM), midregional-pro-atrial-natriuretic-peptide (MR-proANP), and C-terminal-prepro-vasopressin (Copeptin) vasoactive peptide concentrations were measured in plasma at baseline and after 6 weeks of chemotherapy and bevacizumab treatment (n = 97). We determined associations among clinical outcome (ORR and TTP), peptide levels, and hypertension (NCI-CTCAE 4.0 criteria), using Spearman's test, multiple linear regression, and Mann-Whitney's test. RESULTS Increasing levels of vasoactive peptides from baseline and after six weeks of treatment were associated with improved treatment outcome (MR-proADM: ORR, p = .0003; TTP, p = .05; MR-proANP: ORR, p = .05; TTP, p = .03; Copeptin: ORR, p = .10; TTP, p = .02). Patients with increasing levels of all three peptides (n = 28) versus increasing levels of one or two peptides (n = 59) showed a median TTP of 284 and 225 d, respectively (p = .02). CONCLUSIONS Our results suggest that increasing systemic levels of vasoactive peptides associate with improved tumor response and TTP in mCRC patients treated with a bevacizumab-containing regimen. These findings support the proposed link between the tumor vasculature and the cardiovascular system of the host. This should motivate further studies that investigate the potential role of vasoactive peptides as a novel class of dynamic biomarkers in the treatment of cancer.
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Affiliation(s)
- Helga Hagman
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, County Hospital Ryhov, Jönköping, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Section of Hypertension and Cardiovascular Disease, Lund University, Malmö, Sweden
- Department of Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - Jan Sundberg
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Anders Johnsson
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Mattias Belting
- Department of Clinical Sciences Lund, Section of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
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Hagman H, Frödin JE, Berglund Å, Sundberg J, Vestermark LW, Albertsson M, Fernebro E, Johnsson A. A randomized study of KRAS-guided maintenance therapy with bevacizumab, erlotinib or metronomic capecitabine after first-line induction treatment of metastatic colorectal cancer: the Nordic ACT2 trial. Ann Oncol 2015; 27:140-7. [PMID: 26483047 DOI: 10.1093/annonc/mdv490] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/06/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maintenance treatment (mt) with bevacizumab (bev) ± erlotinib (erlo) has modest effect after induction chemotherapy in metastatic colorectal cancer (mCRC). We hypothesized the efficacy of erlo to be dependent on KRAS mutational status and investigated this by exploring mt strategies with bev ± erlo and low-dose capecitabine (cap). PATIENTS AND METHODS Included patients had mCRC scheduled for first-line therapy, Eastern Cooperative Oncology Group (ECOG) 0-1 and no major comorbidities. Treatment with XELOX/FOLFOX or XELIRI/FOLFIRI + bev was given for 18 weeks. After induction, patients without progression were eligible for randomization to mt; KRAS wild-type (wt) patients were randomized to bev ± erlo (arms wt-BE, N = 36 versus wt-B, N = 35), KRAS mutated (mut) patients were randomized to bev or metronomic cap (arms mut-B, N = 34 versus mut-C, N = 33). Primary end point was progression-free survival (PFS) rate (PFSr) at 3 months after start of mt. A pooled analysis of KRAS wt patients from the previous ACT study was performed. RESULTS We included 233 patients. Median age was 64 years, 62% male, 68% ECOG 0, 52% with primary tumor in situ. A total of 138 patients started mt after randomization. PFSr was 64.7% versus 63.6% in wt-B versus wt-BE, P = 1.000; and 75% versus 66.7% in mut-B versus mut-C, P = 0.579, with no significant difference in median PFS and overall survival (OS). In the pooled cohort, median PFS was 3.7 months in wt-B (N = 64) and 5.7 months in wt-BE (N = 62) (hazard ratios 1.03, 95% confidence interval 0.70-1.50, P = 0.867). The frequency of any grade 3/4 toxicities during mt was: 28%/58%/18%/15% (wt-B/wt-BE/mut-B/mut-C). CONCLUSIONS Addition of erlo to bev as mt in KRAS wt mCRC did not significantly improve PFS or OS, but it did increase toxicity. KRAS status does not seem to influence the outcome of treatment with erlotinib. Metronomic cap warrants further investigation in mt strategies, given our explorative results. CLINICALTRIALSGOV NCT01229813.
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Affiliation(s)
- H Hagman
- Department of Oncology, County Hospital Ryhov, Jönköping
| | - J-E Frödin
- Department of Oncology, Karolinska University Hospital, Stockholm
| | - Å Berglund
- Department of Oncology, Uppsala University Hospital, Uppsala
| | - J Sundberg
- Department of Oncology, Skåne University Hospital, Lund/Malmö, Sweden
| | - L W Vestermark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - M Albertsson
- Department of Oncology, Linköping University Hospital, Linköping
| | - E Fernebro
- Department of Oncology, Växjö Hospital, Växjö, Sweden
| | - A Johnsson
- Department of Oncology, Skåne University Hospital, Lund/Malmö, Sweden
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Hagman H, Frödin J, Berglund A, Sundberg J, Vestermark L, Albertsson M, Fernebro E, Johnsson A. A Randomized Study of Kras-Stratified Maintenance Therapy with Bevacizumab, Erlotinib or Metronomic Capecitabine After First Line Induction Treatment of Metastatic Colorectal Cancer: the Nordic Act2 Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Johnsson A, Hagman H, Frödin JE, Berglund A, Keldsen N, Fernebro E, Sundberg J, De Pont Christensen R, Garm Spindler KL, Bergström D, Jakobsen A. A randomized phase III trial on maintenance treatment with bevacizumab alone or in combination with erlotinib after chemotherapy and bevacizumab in metastatic colorectal cancer: the Nordic ACT Trial. Ann Oncol 2013; 24:2335-41. [PMID: 23788755 DOI: 10.1093/annonc/mdt236] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The main objective was to study the effect on progression-free survival (PFS) of adding erlotinib to bevacizumab as maintenance treatment following chemotherapy and bevacizumab as first-line treatment of metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Patients with untreated mCRC received doublet chemotherapy + bevacizumab during 18 weeks and those without tumor progression were eligible for randomization to bevacizumab + erlotinib (arm A) or bevacizumab alone (arm B), until progression or unacceptable toxic effect. RESULTS Of the 249 patients enrolled, 80 started maintenance treatment in arm A and 79 in arm B. The rate of any grade 3/4 toxic effect was 53% in arm A and 13% in arm B. Median PFS was 5.7 months in arm A and 4.2 months in arm B (HR = 0.79; 95% confidence interval 0.55-1.12; P = 0.19). Overall survival (OS) from start of induction chemotherapy was 26.7 months in the randomized population, with no difference between the two arms. CONCLUSIONS The addition of erlotinib to bevacizumab as maintenance treatment after first-line chemotherapy in mCRC did not improve PFS significantly. On-going clinical and translational studies focus on identifying subgroups of patients that may benefit from erlotinib in the maintenance setting. CLINICAL TRIALS NUMBER NCT00598156.
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Affiliation(s)
- A Johnsson
- Department of Oncology, Skåne University Hospital, Lund, Sweden.
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Johnsson A, Frodin J, Berglund A, Hagman H, Sundberg J, Bergstrom D, Christensen RD, Keldsen N, Spindler KG, Jakobsen AKM. A randomized phase III trial on maintenance treatment with bevacizumab (bev) alone or in combination with erlotinib (erlo) after chemotherapy and bev in metastatic colorectal cancer (mCRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zelan M, Hagman H, Labaigt G, Jonsell S, Dion CM. Experimental measurement of efficiency and transport coherence of a cold-atom Brownian motor in optical lattices. Phys Rev E Stat Nonlin Soft Matter Phys 2011; 83:020102. [PMID: 21405800 DOI: 10.1103/physreve.83.020102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Indexed: 05/30/2023]
Abstract
The rectification of noise into directed movement or useful energy is utilized by many different systems. The peculiar nature of the energy source and conceptual differences between such Brownian motor systems makes a characterization of the performance far from straightforward. In this work, where the Brownian motor consists of atoms interacting with dissipative optical lattices, we adopt existing theory and present experimental measurements for both the efficiency and the transport coherence. We achieve up to 0.3% for the efficiency and 0.01 for the Péclet number.
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Affiliation(s)
- M Zelan
- Department of Physics, Umeå University, SE-90187 Umeå, Sweden.
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Hagman H, Zelan M, Dion CM, Kastberg A. Directed transport with real-time steering and drifts along predesigned paths using a Brownian motor. Phys Rev E Stat Nonlin Soft Matter Phys 2011; 83:020101. [PMID: 21405799 DOI: 10.1103/physreve.83.020101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Indexed: 05/30/2023]
Abstract
We have realized real-time steering of the directed transport in a Brownian motor based on cold atoms in optical lattices and demonstrate drifts along predesigned paths. The transport is induced by spatiotemporal asymmetries in the system, where we can control the spatial part, and we show that the response to changes in asymmetry is very fast. In addition to directional steering, a real-time control of the magnitude of the average drift velocity and an on-off switching of the motor are also demonstrated. We use a noninvasive real-time detection of the transport, enabling feedback control of the system.
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Affiliation(s)
- H Hagman
- Department of Physics, Umeå University, SE-901 87 Umeå, Sweden.
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Zelan M, Hagman H, Karlsson K, Dion CM, Kastberg A. Fluctuation-induced drift in a gravitationally tilted optical lattice. Phys Rev E Stat Nonlin Soft Matter Phys 2010; 82:031136. [PMID: 21230054 DOI: 10.1103/physreve.82.031136] [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] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 07/05/2010] [Indexed: 05/30/2023]
Abstract
Experimental and theoretical studies are made of Brownian particles trapped in a periodic potential, which is very slightly tilted due to gravity. In the presence of fluctuations, these will trigger a measurable average drift along the direction of the tilt. The magnitude of the drift varies with the ratio between the bias force and the trapping potential. This can be closely compared to a theoretical model system, based on a Fokker-Planck-equation formalism. We show that the level of control and measurement precision we have in our system, which is based on cold atoms trapped in a three-dimensional dissipative optical lattice, makes the experimental setup suitable as a testbed for fundamental statistical physics. We simulate the system with a very simplified and general classical model, as well as with an elaborate semiclassical Monte Carlo simulation. In both cases, we achieve good qualitative agreement with experimental data.
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Affiliation(s)
- M Zelan
- Department of Physics, Umeå University, SE-901 87 Umeå, Sweden.
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Jakobson T, Blumenthal M, Hagman H, Heikkinen E. The diurnal variation of urinary and plasma 17-hydroxy-corticosteroid (17-OHCS) levels and the plasma 17-OHCS response to lysine-8-vasopressin in depressive patients. J Psychosom Res 1969; 13:363-75. [PMID: 4391347 DOI: 10.1016/0022-3999(69)90006-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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