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Doherty MK, Leung Y, Su J, Naik H, Patel D, Eng L, Kong QQ, Mohsin F, Brown MC, Espin-Garcia O, Vennettilli A, Renouf DJ, Faluyi OO, Knox JJ, MacKay H, Wong R, Howell D, Mittmann N, Darling GE, Cella D, Xu W, Liu G. Health utility scores from EQ-5D and health-related quality of life in patients with esophageal cancer: a real-world cross-sectional study. Dis Esophagus 2018; 31:5037798. [PMID: 29905764 DOI: 10.1093/dote/doy058] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer and its treatment can cause serious morbidity/toxicity. These effects on health-related quality of life (HRQOL) can be measured using disease-specific scales such as FACT-E, generic scales such as EQ-5D-3L, or through symptoms. In a two-year cross-sectional study, we compared HRQOL across esophageal cancer patients treated in an ambulatory clinic and across multiple disease states, among patients with all stages of esophageal cancer. Consenting patients completed FACT-E, EQ-5D, a visual analog scale, and patient reported (PR)-ECOG. Symptom complexes were constructed from FACT-E domains. Responses were categorized by disease state: pre-, during, and post-treatment, surveillance, progression, and palliative chemotherapy. Spearman correlation and multivariable linear regression characterized these associations. In total, 199 patients completed 317 questionnaires. Mean FACT-E and subscale scores dropped from baseline through treatment and recovered during post-treatment surveillance (P < 0.001); EQ-5D health utility scores (HUS) displayed a similar pattern but with smaller differences (P = 0.07), and with evidence of ceiling effect. Among patients with stage II/III esophageal cancer, mean EQ-5D HUS varied across disease states (P < 0.001), along with FACT-E and subscales (P < 0.001). Among patients with advanced disease, there was no significant difference between baseline and on-treatment total scores, but improved esophageal cancer-specific scales were noted (P = 0.003). Strong correlation was observed between EQ-5D and FACT-E (R = 0.73), along with physical and functional subscales. In addition, the association between FACT-E and EQ-5D HUS was maintained in a multivariable model (P < 0.001). We interpret these results to suggest that in a real-world clinic setting, FACT-E, EQ-5D HUS, and symptoms were strongly correlated. Most HRQOL and symptom parameters suggested that patients had worse HRQOL and symptoms during curative therapy, but recovered well afterwards. In contrast, palliative chemotherapy had a neutral to positive impact on HRQOL/symptoms when compared to their baseline pre-treatment state.
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Affiliation(s)
- M K Doherty
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Y Leung
- Department of Psychosocial Oncology, Princess Margaret Cancer Centre, British Colombia, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - H Naik
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D Patel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L Eng
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Q Q Kong
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - F Mohsin
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - M C Brown
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - O Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - A Vennettilli
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D J Renouf
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,BC Cancer Agency, University of British Columbia, Vancouver, British Colombia, Canada
| | - O O Faluyi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, UK
| | - J J Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - H MacKay
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - R Wong
- Radiation Medicine Program, University of Toronto, Toronto, Ontario
| | - D Howell
- Department of Psychosocial Oncology, Princess Margaret Cancer Centre, British Colombia, Canada
| | - N Mittmann
- Cancer Care Ontario, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - G E Darling
- Department of Surgery, Princess Margaret Cancer Centre, Chicago, Illinois, USA
| | - D Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, British Colombia, Canada
| | - G Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Knox JJ, Barrios CH, Kim TM, Cosgriff T, Srimuninnimit V, Pittman K, Sabbatini R, Rha SY, Flaig TW, Page RD, Beck JT, Cheung F, Yadav S, Patel P, Geoffrois L, Niolat J, Berkowitz N, Marker M, Chen D, Motzer RJ. Final overall survival analysis for the phase II RECORD-3 study of first-line everolimus followed by sunitinib versus first-line sunitinib followed by everolimus in metastatic RCC. Ann Oncol 2018; 29:2269. [PMID: 29390043 PMCID: PMC6290878 DOI: 10.1093/annonc/mdx807] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Knox JJ, Barrios CH, Kim TM, Cosgriff T, Srimuninnimit V, Pittman K, Sabbatini R, Rha SY, Flaig TW, Page RD, Beck JT, Cheung F, Yadav S, Patel P, Geoffrois L, Niolat J, Berkowitz N, Marker M, Chen D, Motzer RJ. Final overall survival analysis for the phase II RECORD-3 study of first-line everolimus followed by sunitinib versus first-line sunitinib followed by everolimus in metastatic RCC. Ann Oncol 2018; 28:1339-1345. [PMID: 28327953 PMCID: PMC5452072 DOI: 10.1093/annonc/mdx075] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [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] [Indexed: 12/11/2022] Open
Abstract
Background RECORD-3 compared everolimus and sunitinib as first-line therapy, and the sequence of everolimus followed by sunitinib at progression compared with the opposite (standard) sequence in patients with metastatic renal cell carcinoma (mRCC). This final overall survival (OS) analysis evaluated mature data for secondary end points. Patients and methods Patients received either first-line everolimus followed by second-line sunitinib at progression (n = 238) or first-line sunitinib followed by second-line everolimus (n = 233). Secondary end points were combined first- and second-line progression-free survival (PFS), OS, and safety. The impacts of neutrophil lymphocyte ratio (NLR) and baseline levels of soluble biomarkers on OS were explored. Results At final analysis, median duration of exposure was 5.6 months for everolimus and 8.3 months for sunitinib. Median combined PFS was 21.7 months [95% confidence interval (CI) 15.1–26.7] with everolimus-sunitinib and 22.2 months (95% CI 16.0–29.8) with sunitinib-everolimus [hazard ratio (HR)EVE-SUN/SUN-EVE, 1.2; 95% CI 0.9–1.6]. Median OS was 22.4 months (95% CI 18.6–33.3) for everolimus-sunitinib and 29.5 months (95% CI 22.8–33.1) for sunitinib-everolimus (HREVE-SUN/SUN-EVE, 1.1; 95% CI 0.9–1.4). The rates of grade 3 and 4 adverse events suspected to be related to second-line therapy were 47% with everolimus and 57% with sunitinib. Higher NLR and 12 soluble biomarker levels were identified as prognostic markers for poor OS with the association being largely independent of treatment sequences. Conclusions Results of this final OS analysis support the sequence of sunitinib followed by everolimus at progression in patients with mRCC. The safety profiles of everolimus and sunitinib were consistent with those previously reported, and there were no unexpected safety signals. Clinical Trials number ClinicalTrials.gov identifier, NCT00903175
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Affiliation(s)
- J J Knox
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - C H Barrios
- PUCRS School of Medicine, Porto Alegre, Brazil
| | - T M Kim
- Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - T Cosgriff
- Crescent City Research Consortium, Marrero, USA
| | - V Srimuninnimit
- Internal Medicine, Siriraj Hospital, Mahidol University, Mahidol, Thailand
| | - K Pittman
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, Australia
| | | | - S Y Rha
- Yonsei Cancer Center, Seoul, South Korea
| | - T W Flaig
- University of Colorado School of Medicine, Aurora
| | - R D Page
- The Center for Cancer and Blood Disorders, Fort Worth
| | - J T Beck
- Highlands Oncology Group, Fayetteville, USA
| | - F Cheung
- Department of Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - S Yadav
- Saskatoon Cancer Center, University of Saskatchewan, Saskatoon, Canada
| | - P Patel
- Academic Division of Clinical Oncology, University of Nottingham, Nottingham, UK
| | - L Geoffrois
- Department of Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre Lès Nancy
| | - J Niolat
- Novartis Pharma SAS, Rueil-Malmaison, France
| | | | | | - D Chen
- Novartis Oncology, East Hanover
| | - R J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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Horgan AM, Darling G, Wong R, Guindi M, Liu G, Jonker DJ, Lister J, Xu W, MacKay HM, Dinniwell R, Kim J, Pierre A, Shargall Y, Asmis TR, Agboola O, Seely AJ, Ringash J, Wells J, Marginean EC, Haider M, Knox JJ. Adjuvant sunitinib following chemoradiotherapy and surgery for locally advanced esophageal cancer: a phase II trial. Dis Esophagus 2016; 29:1152-1158. [PMID: 26663741 DOI: 10.1111/dote.12444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prognosis for locally advanced esophageal cancer is poor despite the use of trimodality therapy. In this phase II study, we report the feasibility, tolerability and efficacy of adjuvant sunitinib. Included were patients with stage IIa, IIB or III cancer of the thoracic esophagus or gastroesophageal junction. Neoadjuvant therapy involved Irinotecan (65 mg/m2 ) + Cisplatin (30 mg/m2 ) on weeks 1 and 2, 4 and 5, 7 and 8 with concurrent radiation (50Gy/25 fractions) on weeks 4-8. Sunitinib was commenced 4-13 weeks after surgery and continued for one year. Sixty-one patients were included in the final analysis, 36 patients commenced adjuvant sunitinib. Fourteen patients discontinued sunitinib due to disease recurrence (39%) within the 12-month period, 12 (33%) discontinued due to toxicity, and 3 (8%) requested cessation of therapy. In the overall population, median survival was 26 months with a 2 and 3-year survival rate of 52% and 35%, respectively. The median survival for the 36 patients treated with sunitinib was 35 months and 2-year survival probability of 68%. In a historical control, a prior phase II study with the same trimodality therapy (n = 43), median survival was 36 months, with a 2-year survival of 67%. Initiation of adjuvant sunitinib is feasible, but poorly tolerated, with no signal of additional benefit over trimodality therapy for locally advanced esophageal cancer.
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Affiliation(s)
- A M Horgan
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - G Darling
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - R Wong
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - M Guindi
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - G Liu
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - D J Jonker
- Department of Medical Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Lister
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - H M MacKay
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - R Dinniwell
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - A Pierre
- Department of Surgical Oncology, Division of Thoracic Surgery, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - Y Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - T R Asmis
- Department of Medical Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - O Agboola
- Department of Thoracic Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - A J Seely
- Department of Pathology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Ringash
- Department of Radiation Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J Wells
- Department of Radiation Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - E C Marginean
- Department of Pathology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - M Haider
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
| | - J J Knox
- Department of Medical Oncology, Princess Margaret and Toronto General Hospitals, University Health Network, Toronto, Ontario, Canada
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Heng DYC, Choueiri TK, Rini BI, Lee J, Yuasa T, Pal SK, Srinivas S, Bjarnason GA, Knox JJ, Mackenzie M, Vaishampayan UN, Tan MH, Rha SY, Donskov F, Agarwal N, Kollmannsberger C, North S, Wood LA. Outcomes of patients with metastatic renal cell carcinoma that do not meet eligibility criteria for clinical trials. Ann Oncol 2014; 25:149-54. [PMID: 24356626 DOI: 10.1093/annonc/mdt492] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [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: 01/03/2023] Open
Abstract
BACKGROUND Targeted therapies in metastatic renal cell carcinoma (mRCC) have been approved based on registration clinical trials that have strict eligibility criteria. The clinical outcomes of patients treated with targeted agents but are ineligible for trials are unknown. PATIENTS AND METHODS mRCC patients treated with vascular endothelial growth factor-targeted therapy were retrospectively deemed ineligible for clinical trials (according to commonly used inclusion/exclusion criteria) if they had a Karnofsky performance status (KPS) <70%, nonclear-cell histology, brain metastases, hemoglobin ≤9 g/dl, creatinine >2× the upper limit of normal, corrected calcium ≥12 mg/dl, platelet count of <100 × 10(3)/uL, or neutrophil count <1500/mm(3). RESULTS Overall, 768 of 2210 (35%) patients in the International Metastatic RCC Database Consortium (IMDC) were deemed ineligible for clinical trials by the above criteria. Between ineligible versus eligible patients, the response rate, median progression-free survival (PFS) and median overall survival of first-line targeted therapy were 22% versus 29% (P = 0.0005), 5.2 versus 8.6 months, and 12.5 versus 28.4 months (both P < 0.0001), respectively. Second-line PFS (if applicable) was 2.8 months in the trial ineligible versus 4.3 months in the trial eligible patients (P = 0.0039). When adjusted by the IMDC prognostic categories, the HR for death between trial ineligible and trial eligible patients was 1.55 (95% confidence interval 1.378-1.751, P < 0.0001). CONCLUSIONS The number of patients that are ineligible for clinical trials is substantial and their outcomes are inferior. Specific trials addressing the unmet needs of protocol ineligible patients are warranted.
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Affiliation(s)
- D Y C Heng
- Tom Baker Cancer Center, Calgary, AB, Canada
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Ko JJ, Choueiri TK, Rini BI, Lee JL, Kroeger N, Srinivas S, Harshman LC, Knox JJ, Bjarnason GA, MacKenzie MJ, Wood L, Vaishampayan UN, Agarwal N, Pal SK, Tan MH, Rha SY, Yuasa T, Donskov F, Bamias A, Heng DYC. First-, second-, third-line therapy for mRCC: benchmarks for trial design from the IMDC. Br J Cancer 2014; 110:1917-22. [PMID: 24691425 PMCID: PMC3992507 DOI: 10.1038/bjc.2014.25] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/20/2013] [Accepted: 01/08/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Limited data exist on outcomes for metastatic renal cell carcinoma (mRCC) patients treated with multiple lines of therapy. Benchmarks for survival are required for patient counselling and clinical trial design. METHODS Outcomes of mRCC patients from the International mRCC Database Consortium database treated with 1, 2, or 3+ lines of targeted therapy (TT) were compared by proportional hazards regression. Overall survival (OS) and progression-free survival (PFS) were calculated using different population inclusion criteria. RESULTS In total, 2705 patients were treated with TT of which 57% received only first-line TT, 27% received two lines of TT, and 16% received 3+ lines of TT. Overall survival of patients who received 1, 2, or 3+ lines of TT were 14.9, 21.0, and 39.2 months, respectively, from first-line TT (P<0.0001). On multivariable analysis, 2 lines and 3+ lines of therapy were each associated with better OS (HR=0.738 and 0.626, P<0.0001). Survival outcomes for the subgroups were as follows: for all patients, OS 20.9 months and PFS 7.2 months; for those similar to eligible patients in the first-line ADAPT trial, OS 14.7 months and PFS 5.6 months; for those similar to patients in first-line TIVO-1 trial, OS 24.8 months and PFS 8.2 months; for those similar to patients in second-line INTORSECT trial, OS 13.0 months and PFS 3.9 months; and for those similar to patients in the third-line GOLD trial, OS 18.0 months and PFS 4.4 months. CONCLUSIONS Patients who are able to receive more lines of TT live longer. Survival benchmarks provide context and perspective when interpreting and designing clinical trials.
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Affiliation(s)
- J J Ko
- Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | - T K Choueiri
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - B I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - J-L Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - N Kroeger
- 1] Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada [2] Department of Urology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - S Srinivas
- Division of Oncology, Stanford Medical Center, Stanford, California, USA
| | - L C Harshman
- Division of Oncology, Stanford Cancer Institute, Stanford School of Medicine, Stanford, California, USA
| | - J J Knox
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - G A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - M J MacKenzie
- London Health Sciences Center, London, Ontario, Canada
| | - L Wood
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - U N Vaishampayan
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - N Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - S K Pal
- City of Hope Comprehensive Cancer Center, Medical Oncology & Experimental Therapeutics, Duarte, California, USA
| | - M-H Tan
- National Cancer Center, Institute of Bioengineering and Nanotechnology, Singapore, Singapore
| | - S Y Rha
- Yonsei University Hospital, Seoul, South Korea
| | - T Yuasa
- Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - F Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A Bamias
- Alexandra Peripheral General Hospital, Athens, Greece
| | - D Y C Heng
- Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
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McNamara MG, Templeton AJ, Maganti M, Walter T, Horgan AM, McKeever L, Min T, Amir E, Knox JJ. Neutrophil/lymphocyte ratio as a prognostic factor in biliary tract cancer. Eur J Cancer 2014; 50:1581-9. [PMID: 24630393 DOI: 10.1016/j.ejca.2014.02.015] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [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: 12/17/2013] [Revised: 02/12/2014] [Accepted: 02/16/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Biliary tract cancers (BTCs) include intrahepatic (IHC), hilar, distal bile duct (DBD) and gallbladder carcinoma (GBC). Neutrophil/lymphocyte ratio (NLR), a marker of host inflammation, is prognostic in several cancers but has not been reviewed in large BTC series, or advanced BTC (ABTC) at diagnosis. PATIENTS AND METHODS Baseline demographics and NLR at diagnosis were retrospectively evaluated in 864 consecutive patients with BTC treated from January 1987 to December 2012. The association between NLR and overall survival (OS) was determined using a multivariable Cox proportional hazards model. RESULTS Eight hundred and sixty-four patients were included in the analysis, of which 62% had ABTC and 38% had surgery with curative intent. Median age was 65 years, 444 (51%) were male and 727 (84%) had performance status (PS) ⩽ 2. A NLR ⩾ 3.0, PS >2, IHC primary, stage, lack of surgery, haemoglobin <110 g/L and albumin <40 g/L were associated with significantly worse OS on multivariable analysis. A NLR ⩾ 3.0 was an independent prognostic factor for OS for the entire cohort; median OS was 21.6 months versus 12.0 months for patients with NLR <3.0 versus NLR ⩾ 3.0 respectively (adjusted hazard ratio (HR)-1.26, 95% confidence interval (CI); 1.06-1.50, P = 0.01). NLR was also prognostic in patients with ABTC (HR-1.26, 95% CI; 1.02-1.56, P = 0.035) and hilar cancer: overall group (N = 149) (HR-1.70, 95% CI; 1.10-2.50, P = 0.01) and advanced group (N = 111) (HR-1.57, 95% CI; 1.04-2.44, P = 0.048). CONCLUSION Baseline NLR is a readily available and inexpensive prognostic biomarker in patients with BTC and likely warrants validation in large prospective clinical trials.
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Affiliation(s)
- M G McNamara
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - A J Templeton
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - M Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - T Walter
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Department of Gastroenterology, Edouard Herriot Hospital, 5 place d'Arsonval, 69003 Lyon, France
| | - A M Horgan
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Department of Medical Oncology, Waterford Regional Hospital, Waterford, Ireland
| | - L McKeever
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - T Min
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - E Amir
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - J J Knox
- Department of Medical Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
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Leibowitz-Amit R, Templeton AJ, Omlin A, Pezaro C, Atenafu EG, Keizman D, Vera-Badillo F, Seah JA, Attard G, Knox JJ, Sridhar SS, Tannock IF, de Bono JS, Joshua AM. Clinical variables associated with PSA response to abiraterone acetate in patients with metastatic castration-resistant prostate cancer. Ann Oncol 2014; 25:657-662. [PMID: 24458472 PMCID: PMC4433513 DOI: 10.1093/annonc/mdt581] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 11/20/2013] [Accepted: 12/03/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abiraterone acetate (abiraterone) prolongs overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC). This study's objective was to retrospectively identify factors associated with prostate-specific antigen (PSA) response to abiraterone and validate them in an independent cohort. We hypothesized that the neutrophil/lymphocyte ratio (NLR), thought to be an indirect manifestation of tumor-promoting inflammation, may be associated with response to abiraterone. PATIENTS AND METHODS All patients receiving abiraterone at the Princess Margaret (PM) Cancer Centre up to March 2013 were reviewed. The primary end point was confirmed PSA response defined as PSA decline ≥50% below baseline maintained for ≥3 weeks. Potential factors associated with PSA response were analyzed using univariate and multivariable analyses to generate a score, which was then evaluated in an independent cohort from Royal Marsden (RM) NHS foundation. RESULTS A confirmed PSA response was observed in 44 out of 108 assessable patients (41%, 95% confidence interval 31%-50%). In univariate analysis, lower pre-abiraterone baseline levels of lactate dehydrogenase, an NLR ≤ 5 and restricted metastatic spread to either bone or lymph nodes were each associated with PSA response. In multivariable analysis, only low NLR and restricted metastatic spread remained statistically significant. A score derived as the sum of these two categorical variables was associated with response to abiraterone (P = 0.007). Logistic regression analysis on an independent validation cohort of 245 patients verified that this score was associated with response to abiraterone (P = 0.003). It was also associated with OS in an exploratory analysis. CONCLUSIONS A composite score of baseline NLR and extent of metastatic spread is associated with PSA response to abiraterone and OS. Our data may help understand the role of systemic inflammation in mCRPC and warrant further research.
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Affiliation(s)
| | | | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - E G Atenafu
- Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | - D Keizman
- Genitourinary Oncology Service, Meir Medical Center, Kfar-Saba, Israel
| | | | - J-A Seah
- Departments of Medical Oncology and Haematology
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J J Knox
- Departments of Medical Oncology and Haematology
| | - S S Sridhar
- Departments of Medical Oncology and Haematology
| | - I F Tannock
- Departments of Medical Oncology and Haematology
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - A M Joshua
- Departments of Medical Oncology and Haematology.
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9
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Templeton AJ, Vera-Badillo FE, Wang L, Attalla M, De Gouveia P, Leibowitz-Amit R, Knox JJ, Moore M, Sridhar SS, Joshua AM, Pond GR, Amir E, Tannock IF. Translating clinical trials to clinical practice: outcomes of men with metastatic castration resistant prostate cancer treated with docetaxel and prednisone in and out of clinical trials. Ann Oncol 2013; 24:2972-7. [PMID: 24126362 DOI: 10.1093/annonc/mdt397] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple factors can influence outcomes of patients receiving identical interventions in clinical trials and in routine practice. Here, we compare outcomes of men with metastatic castrate-resistant prostate cancer (mCRPC) treated with docetaxel and prednisone in routine practice and in clinical trials. PATIENTS AND METHODS We reviewed patients with mCRPC treated with docetaxel at Princess Margaret Cancer Centre. Primary outcomes were overall survival and PSA response rate. Secondary outcomes were reasons for discontinuation and febrile neutropenia. Outcomes were compared for men treated in routine practice and in clinical trials, and with data from the TAX 327 study. RESULTS From 2001 to 2011, 438 men were treated, of whom 357 received 3-weekly docetaxel as first-line chemotherapy: 314 in routine practice and 43 in clinical trials. Trial patients were younger and had better performance status. Median survival was 13.6 months [95% confidence interval (95% CI) 12.1-15.1 months] in routine practice and 20.4 months (95% CI 17.4-23.4 months, P = 0.007) within clinical trials, compared with 19.3 months (95% CI 17.6-21.3 months, P < 0.001) in the TAX 327 study. PSA response rates were 45%, 54%, and 53%, respectively (P = NS). Reasons for treatment discontinuation were similar although trial patients received more cycles (median: 6 versus 8 versus 9.5, P < 0.001). Rates of febrile neutropenia were 9.6, 0, and 3% (P < 0.001) while rates of death within 30 days of last dose were 4%, 0%, and 3%, respectively (P = NS). CONCLUSIONS Survival of patients with mCRPC treated with docetaxel in routine practice is shorter than for men included in trials and is associated with more toxicity.
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Affiliation(s)
- A J Templeton
- Division of Medical Oncology and Hematology, University of Toronto, Toronto
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10
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Jewett MA, Knox JJ, Kollmannsberger C. Management of kidney cancer: Canadian Kidney Cancer Forum Consensus Statement. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.567] [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: 11/19/2022]
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11
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Sherman M, Burak K, Maroun J, Metrakos P, Knox JJ, Myers RP, Guindi M, Porter G, Kachura JR, Rasuli P, Gill S, Ghali P, Chaudhury P, Siddiqui J, Valenti D, Weiss A, Wong R. Multidisciplinary Canadian consensus recommendations for the management and treatment of hepatocellular carcinoma. ACTA ACUST UNITED AC 2011; 18:228-40. [PMID: 21980250 DOI: 10.3747/co.v18i5.952] [Citation(s) in RCA: 46] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Globally, hepatocellular carcinoma (hcc) is the third most common cause of death from cancer, after lung and stomach cancer. The incidence of hcc in Canada is increasing and is expected to continue to increase over the next decade. Given the high mortality rate associated with hcc, steps are required to mitigate the impact of the disease. To address this challenging situation, a panel of 17 hcc experts, representing gastroenterologists, hepatologists, hepatobiliary surgeons, medical oncologists, pathologists, and radiologists from across Canada, convened to provide a framework that, using an evidence-based approach, will assist clinicians in optimizing the management and treatment of hcc. The recommendations, summarized here, were developed based on a rigorous methodology in a pre-specified process that was overseen by the steering committee. Specific topics were identified by the steering committee and delegated to a group of content experts within the expert panel, who then systematically reviewed the literature on that topic and drafted the related content and recommendations. The set of recommendations for each topic were reviewed and assigned a level of evidence and grade according to the levels of evidence set out by the Centre for Evidence-based Medicine, Oxford, United Kingdom. Agreement on the level of evidence for each recommendation was achieved by consensus. Consensus was defined as agreement by a two-thirds majority of the 17 members of the expert panel. Recommendations were subject to iterative review and modification by the expert panel until consensus could be achieved.
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Affiliation(s)
- M Sherman
- Department of Medicine, University of Toronto; University Health Network; and Canadian Liver Foundation, Toronto, ON
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12
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Heng DY, Mackenzie MJ, Vaishampayan UN, Bjarnason GA, Knox JJ, Tan MH, Wood L, Wang Y, Kollmannsberger C, North S, Donskov F, Rini BI, Choueiri TK. Primary anti-vascular endothelial growth factor (VEGF)-refractory metastatic renal cell carcinoma: clinical characteristics, risk factors, and subsequent therapy. Ann Oncol 2011; 23:1549-55. [PMID: 22056973 DOI: 10.1093/annonc/mdr533] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A subset of patients treated with initial anti-vascular endothelial growth factor (VEGF) therapy exhibit progressive disease (PD) as the best response per RECIST criteria. METHODS Data from patients with metastatic renal cell carcinoma (mRCC) treated with anti-VEGF therapy were collected through the International mRCC Database Consortium from 12 centers. RESULTS One thousand and fifty-six assessable patients received initial VEGF inhibitors and 272 (26%) of these patients had PD as best response. Initial treatment included sunitinib (n = 203), sorafenib (n = 51), or bevacizumab (n = 18). Six percent of patients were at favorable risk, 55% at intermediate risk, and 39% at poor risk. On multivariable analysis, predictors of PD were Karnofsky performance status < 80% [odds ratio (OR) = 2.3, P < 0.0001], diagnosis to treatment < 1 year (OR = 2.1, P < 0.0001), neutrophilia (OR = 1.9, P = 0.0021), thrombocytosis (OR = 1.7, P = 0.0068), and anemia (OR = 1.6, P = 0.0058). Median progression-free survival (PFS) in patients with PD versus without PD was 2.4 versus 11 months (P < 0.0001) and overall survival (OS) was 6.8 versus 29 months (P < 0.0001), respectively. One hundred and eight (40%) VEGF-refractory patients proceeded to receive further systemic therapies. Response rate, PFS, and OS for subsequent therapy were 9%, 2.5 months, and 7.4 months, respectively, with no statistical differences between patients who received VEGF versus mammalian target of rapamycin (mTOR) inhibitors. CONCLUSIONS Primary anti-VEGF-refractory mRCC patients have a dismal prognosis. Second-line anti-mTOR and anti-VEGF agents produce similar outcomes.
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Affiliation(s)
- D Y Heng
- Department of Medical Oncology, University of Calgary, Calgary, Canada.
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13
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Horgan AM, Knox JJ, Liu G, Sahi C, Bradbury PA, Leighl NB. Capecitabine or infusional 5-fluorouracil for gastroesophageal cancer: a cost-consequence analysis. ACTA ACUST UNITED AC 2011; 18:e64-70. [PMID: 21505591 DOI: 10.3747/co.v18i2.730] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In patients with advanced gastroesophageal cancer, the phase iii Randomized ECF for Advanced and Locally Advanced Esophagogastric Cancer 2 (real-2) trial demonstrated equivalent clinical efficacy when capecitabine (x) was substituted for 5-fluorouracil (5fu) in the epirubicin-cisplatin-5fu (ecf) regimen. The present analysis compares the direct medical costs associated with both regimens. METHODS This cost-consequence analysis of direct medical costs took resource utilization data from the real-2 trial where available. Direct medical costs were derived from the perspective of the Canadian public health care system in 2008 Canadian dollars. Mean cost per patient on each treatment arm was calculated. RESULTS Drug costs from start of treatment until first progression, including pre- and post-chemotherapy medications and administration costs, totalled $5,344 for ecx as compared with $3,187 for ecf. Costs for treatment of adverse events were estimated at $2,621 for ecx as compared with $3,397 for ecf. An additional cost of $873 was associated with insertion of an implanted venous access. Total incremental cost of ecx over ecf was $508. CONCLUSIONS In advanced gastroesophageal cancer, capecitabine is an attractive alternative to 5fu. Although the drug cost per se is greater, use of capecitabine is associated with decreased consumption of hospital resources. Not only does capecitabine fit with patient preference for oral therapy, it also avoids the inconvenience and complications of central venous access.
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Affiliation(s)
- A M Horgan
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON
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14
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Kassam Z, Mackay H, Buckley CA, Fung S, Pintile M, Oza A, Brierley J, Swallow C, Cummings B, Knox JJ, Kim J, Wong R, Siu L, Feld R, Ringash J. Adjuvant chemoradiation for gastric cancer with infusional 5-fluorouracil and cisplatin: a phase I study. ACTA ACUST UNITED AC 2011; 17:34-41. [PMID: 20697512 DOI: 10.3747/co.v17i4.521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 12/12/2022]
Abstract
OBJECTIVE This phase I study aimed to determine the maximal tolerated dose of cisplatin administered every 2 weeks with infusional 5-fluorouracil (5FU) and concurrent radiation therapy (RT) in patients after complete resection of gastric adenocarcinoma. METHODS Patients with resected stage IB to IV (M0) gastric adenocarcinoma were treated with 12 weeks of infusional 5FU (200 mg/m(2) daily) and with RT (45 Gy in 25 fractions starting on day 16). Cisplatin was administered in escalating doses (0, 20, 30, and 40 mg/m(2)) in weeks 1, 3, 5, and 7. In the final cohort, patients received an additional dose of cisplatin (40 mg/m(2)) in week 9. RESULTS Among the 34 patients [median age: 56 years (range: 31-77 years)] who were assessable for toxicity, 5 experienced dose-limiting toxicities: 1 sepsis (cohort 1), 1 fatigue (cohort 2), 3 upper gastrointestinal toxicity (1 in cohort 2, 2 in cohort 5). Cohort 5 exceeded the maximal tolerated dose. Median follow-up was 2.5 years (range: 0.3-5 years). The 3-year overall and relapse-free survival rates were 86% and 71% respectively; median survival was not reached. CONCLUSIONS Cisplatin was well tolerated in combination with infusional 5FU and RT, showing promising activity in the adjuvant treatment of gastric cancer. Infusional 5FU 200 mg/m(2) daily for 12 weeks with cisplatin 40 mg/m(2) in weeks 1, 3, 5, and 7 and with concurrent RT 45 Gy in 25 fractions, starting at day 16, is being explored in a phase II study at our institution.
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Affiliation(s)
- Z Kassam
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto ON.
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15
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Groskopf J, Niraula S, Emmeneger U, Adams L, Tannock I, Sridhar SS, Knox JJ, Day JR, Manthe J, Joshua AM. Use of serum and tissue biomarker analysis embedded in a phase II clinical trial of cytarabine in castration-refractory prostate cancer to investigate prostate cancer biology. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15022] [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: 11/20/2022] Open
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16
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Knox JJ, Wong R, Darling GE, Lister J, Guindi M, Liu G, Xu W, Kim JJ, Jonker DJ, Wells J, Kendal W, Mackay H, Visbal A, Dinniwell RE, Pierre A, Feld R, Sundaresan S, Bayley A, Shargall Y, Horgan AM. Adjuvant sunitinib (Su) for locally advanced esophageal cancer (LAEC): Results of a phase II trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4091] [Citation(s) in RCA: 3] [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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17
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Bujold A, Massey C, Kim JJ, Brierley JD, Wong R, Cho C, Kassam Z, Dinniwell RE, Ringash J, Cummings B, Knox JJ, Sherman M, Dawson LA. Outcomes following sequential trials of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4111] [Citation(s) in RCA: 3] [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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18
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Horgan AM, Amir E, Walter T, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer (BTC): A systematic review and meta-analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Grünwald V, Karakiewicz PI, Bavbek SE, Miller K, Machiels JH, Lee S, Larkin JMG, Bono P, Rha SY, Castellano DE, Blank CU, Knox JJ, Hawkins R, Yuan RR, Rosamilia M, Booth JL, Bodrogi I. Final results of the international, expanded-access program of everolimus in patients with advanced renal cell carcinoma who progress after prior vascular endothelial growth factor receptor–tyrosine kinase inhibitor (VEGFr-TKI) therapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4601] [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: 11/20/2022] Open
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20
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Al-Marrawi MY, Rini BI, Harshman LC, Bjarnason GA, Wood L, Vaishampayan UN, MacKenzie MJ, Knox JJ, Agarwal N, Kollmannsberger CK, Tan M, Rha SY, Donskov F, North SA, Choueiri TK, Heng DYC. The association of clinical outcome to front-line VEGF-targeted therapy with clinical outcome to second-line VEGF-targeted therapy in metastatic renal cell carcinoma (mRCC) patients (Pts). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4555] [Citation(s) in RCA: 10] [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: 11/20/2022] Open
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21
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Porta C, Escudier B, Hutson TE, Figlin RA, Calvo E, Grünwald V, Osanto S, Ravaud A, Panneerselvam A, Knox JJ, Motzer RJ. Analysis of the relationship between Karnofsky performance status (KPS) and tumor response in the RECORD-1 phase III trial of everolimus in patients with advanced renal cell carcinoma (RCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4610] [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: 11/20/2022] Open
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22
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Finelli A, Horgan AM, Evans A, Kim TK, Durrant K, Yap S, Cassol CA, Dubinski W, Fleshner N, Jewett MAS, Joshua AM, Sridhar SS, Zlotta A, Knox JJ. Preoperative sorafenib (Sor) and cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Heng DY, MacKenzie MJ, Vaishampayan UN, Knox JJ, Bjarnason GA, Tan M, Wood L, Donskov F, Rini BI, Choueiri TK. Primary anti-VEGF-refractory metastatic renal cell carcinoma (mRCC): Clinical characteristics, risk factors, and subsequent therapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.305] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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
305 Background: A proportion of patients treated with anti-VEGF therapy first line exhibit progressive disease (PD) as best response (per RECIST). The characteristics and outcome of this population are poorly understood. Methods: Data from patients with mRCC treated with anti-VEGF therapy were collected through the International mRCC Database Consortium from 12 centers. Results: One thousand fifty-six evaluable patients were treated with VEGF-inhibitors as their first-line antiangiogenic therapy. Of those, 272 (26%) patients had PD as best response. Their initial treatment was sunitinib (n=203), sorafenib (n=51), or bevacizumab (n=18). Six percent of patients were favorable risk, 55% intermediate risk, and 39% poor risk as per Heng et al JCO 2009 prognostic factors. On multivariable analysis, predictors of PD at first restaging were KPS < 80% (OR 2.3, p < 0.0001), diagnosis to treatment < 1 year (OR 2.1, p < 0.0001), neutrophilia (OR 1.9, p = 0.0021), thrombocytosis (OR 1.7, p = 0.0068), and anemia (OR 1.6, p = 0.0058). The median progression-free survival (PFS) and overall survival (OS) in patients with primary refractory disease vs. patients without (i.e., partial response or stable disease) was 2.4 vs. 11 months (p<0.0001) and 6.8 vs. 29 months (p<0.0001), respectively. Only 108 (40%) VEGF-refractory patients proceeded to receive 2nd line VEGF inhibitors (sunitinib (n=32), sorafenib (n=44), axitinib (n=2), bevacizumab (n=4)), mTOR inhibitors (temsirolimus (n=14), everolimus (n=11)), or interferon (n=1). The response rate, PFS and OS of this second-line therapy was 9%, 2.5 months and 7.4 months, respectively. The response rate, PFS and OS of those receiving second-line VEGF vs. mTOR inhibitors was 10% vs. 6% (p=NS), 2.8 vs. 2.0 months (p=0.069) and 7.9 vs. 4.7 months (p=0.40), respectively. Conclusions: Primary anti-VEGF-refractory mRCC patients have a dismal prognosis. Second-line anti-mTOR agents may not be better than alternate anti-VEGF agents after primary anti-VEGF failure. Investigation into the mechanism of primary resistance and alternative therapeutic strategies are needed. [Table: see text]
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Affiliation(s)
- D. Y. Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - M. J. MacKenzie
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - U. N. Vaishampayan
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - J. J. Knox
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - G. A. Bjarnason
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - M. Tan
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - L. Wood
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - F. Donskov
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - B. I. Rini
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
| | - T. K. Choueiri
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; London Regional Cancer Program, London, ON, Canada; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; National Cancer Centre Singapore, Singapore, Singapore; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Cleveland Clinic Taussig Cancer
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24
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Niraula S, Emmeneger U, Adams L, Tannock I, Sridhar SS, Knox JJ, Day JR, Manthe J, Groskopf J, Joshua AM. Use of serum and tissue biomarker analysis embedded in a phase II clinical trial of cytarabine in castration-refractory prostate cancer to investigate prostate cancer biology. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
59 Background: Other than the androgen receptor, the TMPRSS2-ERG genomic aberrations in prostate cancer provide the first recent opportunity to target therapy in castration refractory prostate cancer (CRPC). We initiated a phase II clinical trial of cytarabine in docetaxel refractory CRPC on the basis of microarray, in vitro and case report evidence that cytarabine may be particularly effective in men harbouring abnormalities of the ERG oncogenes. Embedded in this clinical trial was the first use of blood mRNA levels of prostate cancer related genes as biomarkers of response and prognosis. Methods: Patients with docetaxel refractory progressive CRPC received intravenous cytarabine at doses between 1g/m2-0.25 g/m2 q3 weekly. Responses were defined according to PCWG2C. 10 patients were enrolled between June 2007 and January 2010. TMPRSS2:ERG, PSA and PCA3 mRNA copies in whole blood collected with PAXgene tubes at the beginning of each cycle and at trial termination were quantified using transcription-mediated amplification assays. The prototype TMPRSS2:ERG assay detects the gene fusion isoform TMPRSS2 exon1 to ERG exon4. Results: No patients demonstrated a serum PSA response (PCWG2C). The average number of cycles administered was 2.6. Significant toxicities including grade 3-4 thrombocytopenia (2) and grade 3-4 neutropenia (3). These toxicities necessitated several dose reductions in the protocol, however most patients were removed from trial for serum PSA progression alone. PCA3 and PSA mRNAs were detectable in 8/10 and 9/10 cases, respectively; there was no correlation between serum PSA and PCA3 or PSA mRNA copy levels in blood. Testing for TMPRSS2:ERG in blood was able to predict the presence or absence of the TMPRSS2-ERG rearrangement in 9/10 cases when compared to 3 colour FISH carried out on baseline biopsies/ prostatectomies (2/10 positive for Exon 4:Exon 1 deletion). Conclusions: Cytarabine administation is ineffective in docetaxel refractory CRPC. Blood mRNA levels of prostate cancer genes reveal novel aspects of prostate cancer biology and have implications for the understanding of circulating tumour cells. [Table: see text]
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Affiliation(s)
- S. Niraula
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - U. Emmeneger
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - L. Adams
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - I. Tannock
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - S. S. Sridhar
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - J. R. Day
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - J. Manthe
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - J. Groskopf
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
| | - A. M. Joshua
- Princess Margaret Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Gen-Probe, San Diego, CA
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Alharbi H, Choueiri TK, Kollmannsberger CK, North S, MacKenzie MJ, Knox JJ, Rini BI, Heng DY. Brain metastases in patients treated with targeted therapy for metastatic renal cell carcinoma (mRCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
326 Background: Patients with brain metastases from advanced RCC treated in the targeted therapy era are not well characterized. Methods: Data from patients with mRCC treated with targeted therapy were collected through the International mRCC Database Consortium from 6 centers. Results: One hundred six out of 705 (15%) patients with mRCC had brain metastases. Forty-seven patients had brain metastases at the start of first-line anti-VEGF therapy and the rest developed metastases during follow-up. Of the patients with brain metastases, 6%, 68%, and 26% were in the favorable, intermediate and poor prognosis groups, respectively, per the Heng et al JCO 2009 criteria. Ninety percent had cerebral metastases, 17% had cerebellar metastases, 40% had a Karnofsky performance status (KPS) <80%, and 81% had symptoms of brain metastases. The median largest size and number of brain metastases was 1.8 cm (range 0.2–6.6) and 1 (range 1–20), respectively. Patients were treated with first-line sunitinib (n=77), sorafenib (n=23), bevacizumab (n=5), and temsirolimus (n=1). Local disease treatment included whole brain radiotherapy (81%), stereotactic radiosurgery (25%), and neurosurgery (25%). The brain metastases of 59 patients were evaluable and based on the local treatment and/or targeted therapy achieved 7 (12%) complete responses, 23 (39%) partial responses, 14 (24%) patients with stable disease, and 15 (25%) patients with progressive disease in the brain metastases. Patients with more than 4 brain metastases vs. those with no more than 4 have an overall survival time from diagnosis of brain metastasis of 3.9 vs. 15.4 months (p=0.0051). Previous nephrectomy, sarcomatoid, and non-clear cell histology are not associated with development of brain metastases. On multivariable analysis, KPS<80% (p=0.0139), diagnosis to treatment with targeted therapy <1 year (p=0.0012), and higher number of brain metastases (p=0.0311) were associated with worse survival from diagnosis of brain metastases. Conclusions: In patients with brain metastases from RCC, KPS at start of therapy, diagnosis to treatment time and number of brain metastases may be prognostic factors for overall survival. [Table: see text]
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Affiliation(s)
- H. Alharbi
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - T. K. Choueiri
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - C. K. Kollmannsberger
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - S. North
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - M. J. MacKenzie
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - J. J. Knox
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - B. I. Rini
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
| | - D. Y. Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Vancouver Cancer Center, British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Institute, Edmonton, AB, Canada; London Regional Cancer Program, London, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Cleveland Clinic Taussig Cancer Center, Cleveland, OH
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Horgan AM, McKeever E, Knox JJ. Biliary tract cancer (BTC) in the older adult: Complex decisions for complex patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
295 Background: BTC is an uncommon malignancy. Complex patient (pt) factors potentially determine treatment choices in older pts and may independently impact outcomes. Methods: Between 2000 and 2010, 133 pts aged ≥ 75 years with BTC were evaluated at Princess Margaret Hospital. Clinical and histopathological characteristics, geriatric-specific factors, and survival outcomes were studied in a retrospective analysis. Results: Median age was 79 years (range 75-93). Predominant histology was adenocarcinoma (95%). 31 pts (23%) had curative surgery, 4 (13%) had additional (neo)adjuvant chemotherapy (CT) ± radiation therapy (RT). Pathological staging included: I/II: 20 (65%); III: 6 (19%); IV: 5 (16%). 25 pts (19%) received CT ± RT alone, 4 (15%) had stage I/II and 21(84%) stage III/IV disease. 77 pts (58%) received best supportive care (BSC) alone. Radiological complete or partial response was noted for 33% of pts treated with CT [gemcitabine (gem) alone 48%; gem doublet 52%]. 24% pts discontinued CT with toxicity. Untreated pts had greater degrees of functional dependence and poorer social supports. Of those untreated, the risk of treatment was felt to outweigh potential benefit given age ± comorbidities in 17%. In 22%, the pt opted not to receive treatment. Median overall survival was 19.7 months for the surgical group, 12.3 mths for the CT ± RT group and 4.37 mths for the BSC group. Conclusions: Untreated BTC has a poor prognosis. Factors other than clinicopathological features may impact treatment decisions. Integrating geriatric assessements into the evaluation of this vulnerable patient group may help better guide treatment choices. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
| | - E. McKeever
- Princess Margaret Hospital, Toronto, ON, Canada
| | - J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada
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Horgan AM, Wang YV, Shepherd FA, Brenner D, Knox JJ, McLaughlin J, Liu G, Hung RJ. The interaction between smoking status and disease stage on non-small cell lung cancer (NSCLC) survival. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18021] [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: 11/20/2022] Open
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28
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Heng DY, Xie W, Bjarnason GA, Vaishampayan UN, Donskov F, Wood L, Knox JJ, Tan M, Kollmannsberger CK, Rini BI, Choueiri TK. A unified prognostic model for first- and second-line targeted therapy in metastatic renal cell carcinoma (mRCC): Results from a large international study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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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Toh H, Chen P, Carr BI, Knox JJ, Gill S, Qian J, Qin Q, Ricker JL, Carlson DM, Yong W. Linifanib phase II trial in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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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Hutson TE, Procopio G, Escudier B, Negrier S, Knox JJ, Keilholz U, Szczylik C, Brueckner A, Kalmus J, Bokemeyer C. Long-term sorafenib (SOR) safety profile in more than 700 patients (pts) with renal-cell carcinoma (RCC) treated for 12 to 42 months (mos). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4614] [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: 11/20/2022] Open
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31
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Gore ME, Beck J, Knox JJ, Eisen T, Szczylik C, Negrier S, Hutson TE, Brueckner A, Kalmus J, Escudier B. Sorafenib (SOR) safety profile in more than 4,600 patients (pts) with renal cell carcinoma (RCC): Assessment at 3-month (mo) intervals using an integrated database of eight company-sponsored studies. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Choueiri TK, Xie W, Kollmannsberger CK, Rini BI, McDermott DF, Knox JJ, Heng DY. The impact of body mass index (BMI) and body surface area (BSA) on treatment outcome to vascular endothelial growth factor (VEGF)-targeted therapy in metastatic renal cell carcinoma: Results from a large international collaboration. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4524] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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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33
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Knox JJ, Kay AC, Schiff E, Hollaender N, Rouyrre N, Ravaud A, Motzer RJ. First-line everolimus followed by second-line sunitinib versus the opposite treatment sequence in patients with metastatic renal cell carcinoma (mRCC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps232] [Citation(s) in RCA: 3] [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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34
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Toh H, Chen P, Carr BI, Knox JJ, Gill S, Steinberg J, Carlson DM, Qian J, Qin Q, Yong W. A phase II study of ABT-869 in hepatocellular carcinoma (HCC): Interim analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4581] [Citation(s) in RCA: 19] [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: 11/20/2022] Open
Abstract
4581 Background: ABT-869 is a novel orally active, potent and selective inhibitor of the vascular endothelial growth factor and platelet derived growth factor families of receptor tyrosine kinases. Results of an interim analysis of a phase 2 trial of ABT-869 in HCC are presented. Methods: An open-label, multicenter phase II trial (M06–879) of oral ABT-869 at 0.25 mg/kg daily in Child-Pugh A (C-PA) or QOD in Child-Pugh B (C-PB) patients (pts) until progressive disease (PD) or intolerable toxicity, is ongoing. Key eligibility criteria included unresectable or metastatic HCC; up to one prior line of systemic treatment; and at least one measurable lesion by computed tomography (CT) scan. The primary endpoint was the progression free (PF) rate at 16 weeks. Secondary endpoints included objective response rate (ORR), time to progression (TTP), progression free survival (PFS) and overall survival (OS). CT scans were assessed centrally and by the investigators; presented results are from central assessment. Results: 44 pts were enrolled from 09/07 to 08/08 at 6 centers internationally, with interim data available for 34 pts. There were 28 C-PA pts (median age, 63.5 y [range, 20- 81]) and 6 C-PB pts (median age, 64.5 y [range, 36–69]) and 73.5% received no prior systemic therapy. For the 19 evaluable C-PA pts included in the per-protocol interim analysis, 8 (42.1%) were progression free at 16 weeks [95% CI 20.3, 66.5]. The estimated ORR was 8.7% [95% CI, 1.1, 28] for the 23 C-PA pts and 0% for the 2 C-PB pts who had at least one post-baseline CT scan reviewed by central imaging. For all 34 pts, median TTP was 112 d [95% CI, 110, -], median PFS was 112 d [95% CI, 61, 168] and median OS was 295 d [95% CI, 182, 333]. The most common adverse events (AEs) for all pts were hypertension (41%), fatigue (47%), diarrhea (38%), rash (35%), proteinuria (24%), vomiting (24%), cough (24%) and oedema peripheral (24%). The most common grade 3/4 AEs for all pts were hypertension (20.6%) and fatigue (11.8%). Most AEs were mild/moderate and reversible with interruption/dose reductions/or discontinuation of ABT-869. Conclusions: ABT-869 appears to benefit HCC patients, with an estimated TTP of 112 days and an acceptable safety profile. Updated results from this ongoing study will be presented. [Table: see text]
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Affiliation(s)
- H. Toh
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - P. Chen
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - B. I. Carr
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - J. J. Knox
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - S. Gill
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - J. Steinberg
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - D. M. Carlson
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - J. Qian
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - Q. Qin
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
| | - W. Yong
- National Cancer Centre, Singapore; National Taiwan University Hospital, Taipei, Taiwan; Thomas Jefferson University, Philadelphia, PA; University of Toronto, Toronto, ON, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Abbott Laboratories, Abbott Park, IL; National University Hospital, Singapore
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Horgan AM, Darling G, Wong R, Visbal A, Guindi M, Jonker D, Liu G, Hornby J, Xu W, Knox JJ. Adjuvant sunitinib following chemoradiotherapy (CRT) and surgery for esophageal cancer: A phase II trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15550 Background: Locally advanced esophageal cancer (LAEC) has a 5-year survival of < 30 %. Most patients (pts) fail after curative intent tri-modality treatment with distant metastatic disease. This phase II trial aims to determine if adjuvant targeted therapy, after neoadjuvant CRT plus surgery for resectable LAEC, may impact on systemic disease without significant toxicity. Methods: Pts with LAEC of the thoracic esophagus or gastroesophageal junction, ECOG PS 0,1 and surgical candidates treated with: preoperative Irinotecan (65mg/m2 initially, ammended to 50mg/m2) + Cisplatin (30mg/m2) on weeks 1,2,4,5,7,8 + concurrent conformal radiotherapy (50Gy/25 fractions) on weeks 4–8. Esophagectomy during weeks 15–18. Sunitinib 37.5mg daily (escalating to 50mg daily if tolerated) commenced 4–12 weeks post surgery, for 1 year. Primary endpoint is feasibility and efficacy of adjuvant sunitinib. Planned sample size 36pts. Results: 30pts enrolled from 11/06 to 12/08. Median age 64 yr (43–71), male: 22, adenocarcinoma: squamous 22:6; 10 pts stage IIA, 5 IIB and 13 III. 2 pts excluded with positive PET scan. 28 pts completed CRT - 18 pts (64%) received ≥80% of planned chemotherapy dose, 23 pts (82%) received full radiation dose. Grade 3/4 toxicity included: neutropenia (17/28), diarrhea (7/28), dehydration (4/28), febrile neutropenia (FN) (3/28) and nausea (2/28). 2 deaths on chemotherapy (1 bacterial meningitis, 1 FN) leading to irinotecan dose- reduction. Dysphagia improved in 14/23 pts during CRT. 18 pts have undergone esophagectomy. Complete pathological response in 4 (22%), downstaging in 3 (17%), stable disease in 11 (61%). 2 pts unresectable (metastases at laparotomy). 1 post-operative death due to pulmonary embolus. 9 pts have commenced sunitinib, 6 maintained at starting dose of 37.5mg; 2 dose reductions; 1 discontinued with poor wound healing. Grade 3 toxicity included: leukopenia (2/9), hand-foot reaction (1/9) and depression (1/9). Conclusions: In LAEC, induction Irinotecan/Cisplatin and radiotherapy followed by esophagectomy is associated with a significant but manageable toxicity profile. Early initiation of sunitinib is feasible and well-tolerated. Updated results to be presented. No significant financial relationships to disclose.
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Affiliation(s)
- A. M. Horgan
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - G. Darling
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - R. Wong
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - A. Visbal
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - M. Guindi
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - D. Jonker
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - G. Liu
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - J. Hornby
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - W. Xu
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
| | - J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada; The Ottawa Hospital, Toronto, ON, Canada
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Sridhar SS, Canil CM, Eisen A, Tannock IF, Knox JJ, Reaume N, Mukherjee SD, Winquist E, Chung A, Ko YJ. A phase II study of single agent abraxane as second-line therapy in patients with advanced urothelial carcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16058] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16058 Background: Metastatic urothelial cancer progressing on or after first-line platinum-based chemotherapy is incurable and has a very poor prognosis. There is no standard second-line therapy, but the taxanes including paclitaxel, have previously shown activity. Abraxane (ABI-007) is a novel well tolerated albumin-bound nanoparticle formulation of paclitaxel. The goal of this study was to determine the efficacy and tolerability of single agent Abraxane in the second-line metastatic urothelial cancer setting. Methods: Patients with measureable metastatic urothelial cancer, who progressed on or after first-line cisplatin based chemotherapy were enrolled onto this phase II, two-stage multicenter trial. Patients received Abraxane 260 mg/m2 intravenously every 3 weeks. Clinical evaluation, CBC and blood chemistries were performed every cycle and restaging CT scans every 2 cycles. Results: Fourteen patients have been enrolled to date. Patient demographics: M: F 12:2; mean age 64 (range 45–80); ECOG 0:1:2 4:5:5. A total of 57 cycles, avg 4 cycles/ patient (range 1–9) have been administered. There were three dose delays due to neuropathy, pain, and low neutrophil count respectively. There were two dose reductions due to fatigue and neuropathy. Most frequent adverse events (AE) were fatigue, alopecia, anorexia, cough and joint pain; the most frequent grade 3+ AE were fatigue, joint pain, hypertension, joint stiffness and back pain. Fourteen patients are currently evaluable for best response using RECIST criteria. There have been 5 partial responses (PR), 5 stable disease (SD) and 4 progressive disease (PD). Conclusions: Single agent Abraxane was well tolerated in the 2nd line, cisplatin refractory/resistant metastatic urothelial cancer setting. Preliminary efficacy results are encouraging with a clinical benefit rate of 71% (10 out of 14 evaluable pts having either SD or PR). Stage 1 response criteria have been met and accrual is ongoing to a total of 48 patients. No significant financial relationships to disclose.
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Affiliation(s)
- S. S. Sridhar
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - C. M. Canil
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - A. Eisen
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - I. F. Tannock
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - N. Reaume
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - S. D. Mukherjee
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - E. Winquist
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - A. Chung
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
| | - Y. J. Ko
- Princess Margaret Hospital, Toronto, ON, Canada; Ottawa Regional Cancer Center, Ottawa, ON, Canada; Odette Cancer Center, Toronto, ON, Canada; Juravinski Cancer Center, Hamilton, ON, Canada; London Regional Cancer Center, London, ON, Canada
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Vickers MM, Choueiri TK, Zama I, Cheng T, North S, Knox JJ, Kollmannsberger C, McDermott DF, Rini BI, Heng DY. Failure of initial VEGF-targeted therapy in metastatic renal cell carcinoma (mRCC): What next? J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5098] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5098 Background: The characterization and efficacy of second-line targeted therapy in patients with metastatic RCC who failed first-line VEGF-targeted therapy in a population-based setting is of clinical relevance but remains to be assessed. Methods: Provincial registries and clinical databases from seven cancer centers (3 in US and 4 in Canada) identified patients with mRCC who received first-line anti-VEGF targeted therapy between 2005–2007. Patient characteristics, data on second-line therapy and outcomes were analyzed. Results: 645 patients with mRCC who received initial VEGF-targeted therapy were identified (sunitinib, sorafenib or bevacizumab) and had a median follow-up of 25 mos. Of these, 218 patients (34%) received second-line targeted therapy: the median age was 62 yrs (range, 41–87), median KPS was 90%, 90% had prior nephrectomy, 3.8% had non-clear cell histology, 5.8% had brain metastases and 79% had > 1 metastatic site. Second-line therapy included anti-VEGF agents (sunitinib n = 93, sorafenib n = 80, bevacizumab n = 11, axitinib n = 8) and mTOR-inhibiting agents (temsirolimus n = 21, everolimus n = 3). Patient characteristics were similar aside from more non-clear cell histology in patients receiving second-line mTOR-inhibiting agents (14% vs 3% p = 0.045). On multivariable analysis, only a higher baseline KPS score prior to first-line therapy predicted which patients were more likely to receive second-line therapy (p < 0.0001). The median time to treatment failure (TTF) of second-line therapy was 4.9 mos for anti-VEGF therapy and 2.5 mos for mTOR inhibitors (p = 0.014). After adjusting for MSKCC prognostic profile (favorable, intermediate, poor), the hazard ratio for TTF was 0.52 (95%CI:0.29–0.91) in pts receiving anti-VEGF therapy. Overall survival from start of second-line therapy was not different between anti-VEGF or anti-mTOR drugs (14.2 vs 10.6 respectively; p = 0.38). 70 patients (10%) received third-line therapy. Conclusions: Baseline KPS is an independent predictor of receiving second-line targeted therapy. Patients who receive a second-line anti-VEGF drug appear to have a longer TTF than those who receive a second-line anti-mTOR drug. However, patient selection may account for this finding and overall survival was not significantly different. Results of ongoing randomized trials are awaited. [Table: see text]
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Affiliation(s)
- M. M. Vickers
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - T. K. Choueiri
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - I. Zama
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - T. Cheng
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - S. North
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - J. J. Knox
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - C. Kollmannsberger
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - D. F. McDermott
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - B. I. Rini
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
| | - D. Y. Heng
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA
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Sahi C, Knox JJ, Hinder V, Deva S, Cole D, Clemons M, Broom RJ. The effects of sorafenib and sunitinib on bone turnover markers in patients with bone metastases from renal cell carcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16145] [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: 11/20/2022] Open
Abstract
e16145 Background: Bone metastases (BM) from renal cell carcinoma (RCC) are common and associated with poor outcomes. While the multi-tyrosine kinase inhibitors (TKI's) sunitinib and sorafenib have advanced the treatment of metastatic RCC, their efficacy on BM is unknown. Urinary N-telopeptide (uNTX) is a marker of bone turnover measured in nmol/mmol creatinine. Elevated uNTX levels correlate with an increased risk of skeletal related events and mortality in patients receiving bisphosphonates for BM from a range of primaries. In this pilot biomarker study we sought to prospectively evaluate the effects on BM of these multi-TKI's in RCC patients. Methods: Eligible patients had advanced RCC, at least one BM evident on imaging and no bisphosphonate exposure within 4 weeks. UNTX levels (OsteoMark) were measured at; baseline and weeks-1, 4, 8 and 12 after commencing either sunitinib or sorafenib. The primary endpoint was the percentage change (Ch) in uNTX levels from baseline. Serum samples were also collected for KIT and VEGFR-2 (Quantikine). Patients also completed pain (including bone pain) and quality of life questionnaires. Results: The uNTX results on the first 9 patients are presented in the table below (7 received sunitinib and 2 sorafenib). In this group, sVEGFR-2 and sKIT levels fell by week-1 and 4 respectively and at week-12 the mean % changes (95% CI) were -34% (-0.53,-0.14) and -38% (-0.58,-0.18). Conclusions: In patients with BM from RCC and at least moderately elevated uNTX levels at baseline, these multi-TKI's show a significant trend to decrease uNTX levels, but perhaps not as effectively as bone-specific therapies (e.g. bisphosphonates) do in other malignancies. SVEGFR-2 and sKIT levels also fell across the patient group over the same period. This pilot data raises questions about the activity of the multi-TKI's in BM from RCC and further research is needed. [Table: see text] [Table: see text]
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Affiliation(s)
- C. Sahi
- Princess Margaret Hospital, Toronto, ON, Canada; Auckland University, Grafton, New Zealand; Auckland City Hospital, Grafton, New Zealand; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada; Auckland University, Grafton, New Zealand; Auckland City Hospital, Grafton, New Zealand; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - V. Hinder
- Princess Margaret Hospital, Toronto, ON, Canada; Auckland University, Grafton, New Zealand; Auckland City Hospital, Grafton, New Zealand; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S. Deva
- Princess Margaret Hospital, Toronto, ON, Canada; Auckland University, Grafton, New Zealand; Auckland City Hospital, Grafton, New Zealand; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D. Cole
- Princess Margaret Hospital, Toronto, ON, Canada; Auckland University, Grafton, New Zealand; Auckland City Hospital, Grafton, New Zealand; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M. Clemons
- Princess Margaret Hospital, Toronto, ON, Canada; Auckland University, Grafton, New Zealand; Auckland City Hospital, Grafton, New Zealand; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R. J. Broom
- Princess Margaret Hospital, Toronto, ON, Canada; Auckland University, Grafton, New Zealand; Auckland City Hospital, Grafton, New Zealand; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Heng DY, Xie W, Regan MM, Cheng T, North S, Knox JJ, Kollmannsberger C, McDermott D, Rini BI, Choueiri TK. Prognostic factors for overall survival (OS) in patients with metastatic renal cell carcinoma (RCC) treated with vascular endothelial growth factor (VEGF)-targeted agents: Results from a large multicenter study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5041 Background: Prognostic factors (PF) for OS have yet to be fully defined for patients with metastatic RCC in the era of VEGF-targeted therapy. This study identifies PFs in this population and updated survival and validation results are presented. Methods: Baseline characteristics and outcomes on anti-VEGF-naïve metastatic RCC patients were collected from three US and four Canadian centers. Using a Cox proportional hazards model, 3 risk categories for predicting survival were identified on the basis of 6 pretreatment clinical features. Results: Six-hundred forty-five patients were included. The median (m) OS was 22 months (95% CI: 20.0–24.8) with a median follow-up of 25 months. Patients were treated with sunitinib (n = 396), sorafenib (n = 200) or bevacizumab (n = 49); 33% had prior immunotherapy. Four of the five PFs previously identified by MSKCC were independent predictors of short survival, including hemoglobin below the lower limit of normal (LLN) (p < 0.0001), corrected calcium above the upper limit of normal (ULN) (p = 0.0006), Karnofsky performance status <80% (p < 0.0001) and time from initial diagnosis to initiation of therapy ULN (pULN (p = 0.012) were independent adverse PFs. Patients were assigned one point for each poor PF and were segregated into three risk categories: favorable-risk (0 PFs, n = 133) median OS (mOS) 37.0 months; intermediate-risk (1 - 2 PFs, n = 292) mOS 28.5 months; and poor-risk (3–6 PFs, n = 139) mOS 9.4 months (log rank p < 0.0001). This model produced a c-index of 0.74 and the bootstrap procedure confirmed good internal validity. The discriminatory ability of the model and its parameter estimates were not affected after adjusting for prior use of immunotherapy or the type of anti-VEGF drug used. Conclusions: These data validate components of the MSKCC model with the addition of platelet and neutrophil counts. This model derived from a large population can be incorporated into patient care and clinical trials of VEGF-targeted agents. [Table: see text]
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Affiliation(s)
- D. Y. Heng
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - W. Xie
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - M. M. Regan
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - T. Cheng
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - S. North
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - J. J. Knox
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - C. Kollmannsberger
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - D. McDermott
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - B. I. Rini
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - T. K. Choueiri
- Tom Baker Cancer Centre, Calgary, AB, Canada; Dana-Farber Cancer Institute, Boston, MA; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; Beth Israel Deaconess Medical Center, Boston, MA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
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Bukowski RM, Stadler WM, Figlin RA, Knox JJ, Gabrail N, McDermott DF, Cupit L, Miller WH, Hainsworth JD, Ryan CW. Safety and efficacy of sorafenib in elderly patients (pts) ≥65 years: A subset analysis from the Advanced Renal Cell Carcinoma Sorafenib (ARCCS) Expanded Access Program in North America. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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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Joshua AM, Broom R, Milosevic M, Jewett M, Evans A, Asa S, Tannock IF, Knox JJ. Rationale and evidence for the use of sunitnib to treat patients with malignant paraganglioma/pheochromocytoma (MPP). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.14681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ryan CW, Bukowski RM, Figlin RA, Knox JJ, Hutson TE, Dutcher JP, George J, Kirshner J, Humphrey J, Stadler WM. The Advanced Renal Cell Carcinoma Sorafenib (ARCCS) expanded access trial: Long-term outcomes in first-line patients (pts). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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
5096 Background: Sorafenib (SOR) doubled median progression-free survival (PFS) versus placebo in a phase III study (TARGETs) for previously treated pts with clear cell renal cell carcinoma (RCC). We report on pts who had not received any prior systemic anti- cancer therapy (1st line) for advanced RCC from the ARCCS program in the US and Canada, which enrolled a broad range of pts. Methods: Pts received SOR 400 mg bid in the ARCCS open-label, nonrandomized treatment protocol if they were =15 years old with advanced (unresectable, recurrent or metastatic) RCC and had ECOG PS 0–2. In the US, ARCCS enrollment ended with SOR approval in 12/05, and pts were transitioned to commercial drug with 1st line pts being eligible for an additional 6-mo follow-up in an extension protocol (EP); Canadian enrollment completed in 8/06. Response evaluation (baseline and =1 post-baseline radiologic assessment) was conducted every 4 wks in the main study and every 8 wks during the EP. Pts without a confirmatory scan were classified as unconfirmed PR. The primary efficacy analysis on PFS was pre-specified to be performed only on the EP-enrolled pts. Results: Of the 2,488 pts valid for safety in ARCCS, nearly 50% were 1st line (n=1239) of which 69% were male with median age 65 yrs; 77% had prior nephrectomy and 29% had prior radiotherapy. Time from diagnoses to treatment was <1 yr for 52% and =1 yr 36% in these 1st line pts. Grade 3 and 4 adverse events with >2% incidence included hand-foot skin reaction 7.7%, fatigue 4.7%, hypertension 3.8%, rash/desquamation 5.2%, dehydration 2.9, diarrhea and dyspnea 2.6%. Confirmed responses are reported in the table ; 15% had unconfirmed PRs. For the 224 1st line pts enrolled in the EP, median PFS was 35.1 wks (95% CI; 32.7, 41.9). Conclusions: SOR toxicity in 1st line pts appeared similar to that in both overall and 2nd line populations previously reported in the phase III study. The PFS among patients enrolled in the EP is encouraging, but may be biased by low enrollment and selection for non-progressors. [Table: see text] [Table: see text]
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Affiliation(s)
- C. W. Ryan
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - R. M. Bukowski
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - R. A. Figlin
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - J. J. Knox
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - T. E. Hutson
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - J. P. Dutcher
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - J. George
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - J. Kirshner
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - J. Humphrey
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
| | - W. M. Stadler
- Oregon Health & Science University, Portland, OR; Cleveland Clinic Foundation, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Princess Margaret Hospital, Toronto, ON, Canada; Baylor Charles A. Sammons Cancer Center, Dallas, TX; Our Lady of Mercy Medical Center, Bronx, NY; The Cancer Center, Mobile, AL; Hematology/Oncology Associates of Central NY, East Syracuse, NY; Bayer HealthCare, West Haven, CT; University of Chicago Medical Center, Chicago, IL
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Knox JJ, Figlin RA, Stadler WM, McDermott DF, Gabrail N, Miller WH, Hainsworth J, Ryan CW, Cupit L, Bukowski RM. The Advanced Renal Cell Carcinoma Sorafenib (ARCCS) expanded access trial in North America: Safety and efficacy. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [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
5011 Background: A prior phase III trial (TARGETs) demonstrated that sorafenib (SOR) doubled median progression-free survival versus placebo in previously treated clear cell renal cell cancer (RCC) patients (pts). The ARCCS trial made SOR available to a broader range of RCC pts through an expanded access program. Methods: This open-label, nonrandomized trial enrolled pts with advanced RCC not eligible for, or without access to, other SOR clinical trials; ECOG PS 0–2 with waivers granted for pts with ECOG PS 3–4; age =15 yrs; and adequate prior treatment of brain metastases. Major exclusion criteria included treatment <4 wks prior, life expectancy <2 mos, uncontrolled hypertension, and severe renal impairment requiring dialysis. Objectives were to analyze the safety and efficacy (response by RECIST) of 400 mg bid SOR in a community-based setting. Enrollment ceased on 12/20/05 when SOR became commercially available in the US, and those with no prior therapy or non-clear cell RCC continued in an extension protocol. Enrollment completed in Canada in 8/06. Results: A total of 2488 pts were valid for safety: 69% male with median age 63 yrs and most (83%) had prior nephrectomy; histologies included 78% clear-cell, 7% papillary, 1% chromophobe, and <1% collecting duct and oncocytoma. Median time from diagnosis for all pts was 1.4 yrs (range <1–34). Of those pts receiving prior therapy (n=1249), treatments included interferon alfa (54%), interleukin 2 (43%), bevacizumab (23%), thalidomide (12%), and sunitinib (2%). Grade 3 and 4 adverse events occurring in > 2% pts were hand- foot skin reaction 7.2%, fatigue 5.3%, hypertension 4.4%, rash/desquamation 4%, dehydration and dyspnea 2.7%, and diarrhea 2.5%. Efficacy assessment, mainly PFS, was limited by the short median time (14 wks) on study due to many pts enrolling during the last 2 months of the study. Of 1,850 pts evaluable for response, 17.5% had unconfirmed PR. One (0.1%), 67 (3.6%), 1479 (79.9%) and 303 (16.4%) had CR, PR, SD, and PD, respectively. Conclusions: ARCCS pts were representative of the broader range of RCC pts in the community including those excluded from previous SOR trials. Toxicity and response rates were similar to those reported previously, supporting the generalizability of the phase III trial data. [Table: see text]
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Affiliation(s)
- J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - R. A. Figlin
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - W. M. Stadler
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - D. F. McDermott
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - N. Gabrail
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - W. H. Miller
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - J. Hainsworth
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - C. W. Ryan
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - L. Cupit
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
| | - R. M. Bukowski
- Princess Margaret Hospital, Toronto, ON, Canada; City of Hope Comprehensive Cancer Center, Los Angeles, CA; University of Chicago Medical Center, Chicago, IL; Beth Israel Deaconess Medical Center, Boston, MA; Gabrail Cancer Center, Canton, OH; Jewish General Hospital, McGill University, Montreal, PQ, Canada; Sarah Cannon Research Institute, Nashville, TN; Oregon Health and Science University, Portland, OR; Bayer HealthCare, West Haven, CT; Cleveland Clinic Foundation, Cleveland, OH
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Dawson LA, Tse R, Kim J, Dinniwell R, Lockwood G, Sherman M, Knox JJ, Gallinger S. Phase I study of stereotactic radiotherapy for unresectable hepatobiliary cancer and liver metastases. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4590 Background: Safety of stereotactic radiotherapy (SRT) for unresectable hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CC) and liver metastases (LM) has not been well established. Results from a phase I study of 6 fraction SRT are reported. Methods: Eligible patients had unresectable or medically inoperable HCC, CC or LM, liver enzymes < 6 fold higher than normal, platelets > 80,000 bil/L, Child score A, > 800 cc uninvolved liver, KPS = 60 and unsuitability for standard therapies. Patients were treated with breath hold and image guided 6 fraction SRT. Dose was individualized to maintain the same risk of liver toxicity at three risk levels (I-5%, II-10%, III-20%). Escalation to level II and III occurred once at least 3 patients had been followed for >3 months without dose limiting toxicity (grade 4/5 < 1 month or grade 4/5 liver < 3 months) for each stratum. Stratification was based on diagnosis and liver volume irradiated (low <20%, mid 20–50%, high 50–80%). Results: From Aug. 2003 to Dec. 2006, 82 patients initiated SRT. Two patients discontinued SRT after 1 fraction for progressive disease (LM) and a variceal bleed (HCC). 80 patients completed SRT (38 LM, 32 HCC, 10 CC). Median age was 64 years (38–92 years). Median tumor volume was 293 cc (3–3088 cc). 24 patients (30%) had extra-hepatic disease. 17 HCC patients had portal vein thrombosis (53%), 14 HBV, 12 HCV and 4 alcoholic cirrhosis. The median prescribed dose was 40 Gy (24 Gy - 60 Gy) in 6 fractions. Within 3 months post SRT, no dose-limiting grade 4/5 toxicity or classic radiation liver toxicity was observed. Grade 3 liver enzymes (2 new, 9 pre-existing), thrombocytopenia (3), nausea (3) and fatigue (1) was observed. Child score declined in 8 patients (5 HCC, 2 CC, 1 LM), 6 with progressive disease. Late toxicity included 1 tumor-duodenal fistula, 1 bowel obstruction and 2 GI bleeds. The in-field response rate was 60% (LM 57%, CC 50%, HCC 67%): CR 14%, PR 46%, SD 23%, PD 17%. Actuarial 12 month local control was 78% (95% CI: 58- 90%). The median survival for LM, CC and HCC was 16.6 months (7.9–25.6), 13.1 months (6.0–28.4) and 11.0 months (8.6–20.8) respectively. Conclusions: Individualized SRT is a safe, promising treatment for unresectable liver cancer. No significant financial relationships to disclose.
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Affiliation(s)
- L. A. Dawson
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - R. Tse
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - J. Kim
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - R. Dinniwell
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - G. Lockwood
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - M. Sherman
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - J. J. Knox
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
| | - S. Gallinger
- Princess Margaret Hosp, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada
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Chin S, Riechelmann RP, Wang L, Tannock IF, Berthold DR, Moore M, Knox JJ. Sorafenib for the treatment of metastatic renal cancer (MRC) in the real world: The Princess Margaret Hospital (PMH) experience. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15568 Background: Sorafenib, an oral multi-kinase inhibitor, prolonged progression free survival (PFS) of MRC patients (pts) in second line when compared to placebo in a phase III trial (Escudier at al ECCO 2005). Grade 3/4 adverse events (AE) were reported in 12% of pts. Here we present sorafenib’s efficacy and safety in a less selected cohort of pts enrolled in the Bayer Expanded Access Program at PMH. Methods: Pts with MRC received Sorafenib 400 mg bid continuously until disease progression (PD) and/or clinical deterioration..Tumor response was measured by RECIST criteria. AE were graded by NCI common toxicity criteria. Summary statistics and logistic regression were used to describe the results. Results: From Nov 2005 to Aug 2006, 58 pts were enrolled: median age was 59 years (range 14–86), 47 (81%) were male, 48 (83%) had clear cell histology and 46 (79%) received Sorafenib in first line. None received prior kinase-inhibitors. Using the Motzer Prognostic Index, 29 pts (50%) were low risk, 21 (36%) intermediate and 8 (14%) poor risk. Grade 3/4 AE occurred in 37 pts (64%, 95% CI 50–76%): 15 (26%) pts had skin rash, 10 (17%) hand-foot syndrome, 4 (7%) hypertension, 4 (7%) fatigue, and 4 (7%) diarrhea. Thirty-six (62%) pts required dose reductions and/or treatment interruptions, most due to skin reactions and hand-foot syndrome. Median follow-up was 9 months (IQR range 2–11), the median PFS was 7.5 months (IQR range 5.4–11.3), and the best responses among 56 evaluable pts were: 10 (17%) confirmed partial responses (median duration: 6 months, range 4–11), 14 (24%) stable diseases for = 6 months and 10 (18%) early progression. Pts with bony mets progressed earlier than pts without bony mets. Abnormal creatinine clearance, age, performance status, line of treatment and presence of significant comorbid conditions were not associated with grade 3/4 AE in univariate analysis. Conclusions: Sorafenib is effective in a ”real world”, less selected patient population with MRC but leads to more toxicity than described previously. [Table: see text]
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Affiliation(s)
- S. Chin
- Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - R. P. Riechelmann
- Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - L. Wang
- Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - I. F. Tannock
- Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - D. R. Berthold
- Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - M. Moore
- Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
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46
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Molinari M, Kachura JR, Dixon E, Rajan DK, Hayeems EB, Asch MR, Benjamin MS, Sherman M, Gallinger S, Burnett B, Feld R, Chen E, Greig PD, Grant DR, Knox JJ. Transarterial chemoembolisation for advanced hepatocellular carcinoma: results from a North American cancer centre. Clin Oncol (R Coll Radiol) 2007; 18:684-92. [PMID: 17100154 DOI: 10.1016/j.clon.2006.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS In Asian countries, transarterial chemoembolisation (TACE) has long been used for palliation of unresectable hepatocellular carcinoma (HCC) without strong evidence of improved survival or quality of life. In 2002, a survival benefi of TACE was shown in two randomised controlled trials in Europe and Hong Kong. The effectiveness of interventions fo HCC is influenced by geographical factors related to diverse patient characteristics and protocols. Therefore, the validation of TACE as palliative modality for unresectable HCC requires confirmation in diverse patient populations. The aim of the present study was to assess the effectiveness of TACE for HCC in a North American population. MATERIALS AND METHODS This was a single centre prospective cohort study. Child-Pugh A cirrhosis or better patients wit unresectable HCC and without radiological evidence of metastatic disease or segmental portal vein thrombosis wer assessed between November 2001 and May 2004. Of 54 patients who satisfied the inclusion criteria, 47 underwent 80 TACE sessions. Chemoembolisation was carried out using selective hepatic artery injection of 75 mg/m(2) doxorubicin and lipiodol followed by an injection of embolic particles when necessary. Repeat treatments were carried out at 2-3 month intervals for recurrent disease. The primary outcome was overall survival; secondary outcomes were morbidity and tumour response. RESULTS The survival probabilities at 1, 2 and 3 years were 76.6, 55.5 and 50%, respectively. At 6 months after the first intervention, 31% of patients had a partial response and 60% had stable disease by RECIST criteria. Minor adverse events occurred after 39% of TACEs and major adverse events after 20% of sessions, including two treatment-related deaths (4% of patients). One patient had complete cancer remission after undergoing three TACE treatments. Further progression of tumour growth was prevented in 91% of tumours at the 6 month point after the first TACE. At 3 months, serum levels of the tumour marker alpha-feto protein were significantly reduced in patients with elevated levels before TACE. CONCLUSIONS The survival probabilities at 1 and 2 years after TACE were comparable with results in randomised studies from Europe and Asia. Most patients tolerated TACE well, but clinicians need to be aware that moderately severe sideeffects require close monitoring and prompt intervention.
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Affiliation(s)
- M Molinari
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Knox JJ, Chen E, Feld R, Nematollahi M, Pond GR, Cheiken R, Gill S, Zwiebel J, Moore M. A phase II trial of oblimersen sodium (G3139) in combination with doxorubicin (DOX) in advanced hepatocellular carcinoma (HCC). NCI protocol # 5798. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14072 Background: Advanced HCC is refractory to most standard forms of chemotherapy, however responses to DOX are seen. The bcl-2 protein confers resistance to apoptosis in cancer cells and is important in tumor progression and resistance to chemotherapy. The bcl-2 antisense oligonucleotide, G3139 (G), has been shown to enhance the activity of DOX in tumor models by blocking bcl-2 synthesis. This argues for evaluating G + DOX in combination in HCC. By decreasing tumor bcl-2 protein levels, HCC may be sensitized to the apoptotic effects of DOX. Methods: We completed a phase II trial evaluating treatment with G at 7 mg/ kg for 7 days cont. i.v. infusion (d1–8) plus DOX at 45 mg/m2 i.v. bolus d5, every 28 d (as determined from our phase I HCC study). Eligible patients (pts) had path-confirmed, measurable, advanced HCC. Minimal eligibility included Childs-Pugh A cirrhosis, adequate hematological (hem) parameters and ECOG PS <2. Tumor biopsies for correlative studies were obtained at baseline and cycle 1 d 4 in consenting pts. Results: 19 patients were accrued, 1 was ineligible, 18 evaluable for toxicity, 17 evaluable for response; receiving a median (med) of 2 cycles (range 1,10). Risk for HCC was 39% HBV, 22% HCV, 17% alcohol, 22% other. Most common toxicities were hem and could be attributed to both G+DOX and to G alone. Overall grade 3–4 toxicities seen were: ANC- 67% (med nadir d 24–25), lymphopenia - 44%, thrombocytopenia - 6%, transaminitis - 33% and grade 1–2 G-fever - 67%. No responses were seen and the trial was stopped at stage 1. Six patients (35%) had stable disease, with one pt completing 10 cycles as per protocol (pt # 22). Med TTP is 1.8 months (1.7-NA) and 6-month PFS is 17.2% (5.3–56.4). 18 of 19 pts have died with med OS of only 5.4 months (2.7–11.6). Correlative studies on 3 available pts’ paired tumor biopsies showed absent baseline bcl-2 expression but moderate expression of both bcl-xl and BAX protein and with no change after exposure to G (includes pt #22). Conclusions: G + DOX is inactive in HCC at this dose and schedule. The overlap of hem toxicity may have resulted in suboptimal DOX dosing in HCC. Low baseline bcl-2 tumor expression relative to bcl-xl seen may suggest a relative insensitivity to the effects of bcl-2 inhibition in these HCC tumors. [Table: see text]
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Affiliation(s)
- J. J. Knox
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - E. Chen
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - R. Feld
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - M. Nematollahi
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - G. R. Pond
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - R. Cheiken
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - S. Gill
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - J. Zwiebel
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
| | - M. Moore
- Princess Margaret Hospital, Toronto, ON, Canada; BC Cancer Agency, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD
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48
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Knox JJ, Ornstein D, Rathmell KW, Wong MKK, Jewett M, Corcos J, Finke LH, Miesowicz F, Nicolette CA, Batist G. A phase I/II study of vaccination with autologous dendritic cells (DCs) transfected with autologous amplified tumor-derived mRNA in patients with stage IV renal cell carcinoma (RCC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4710] [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)
- J. J. Knox
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - D. Ornstein
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - K. W. Rathmell
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - M. K. K. Wong
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - M. Jewett
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - J. Corcos
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - L. H. Finke
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - F. Miesowicz
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - C. A. Nicolette
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
| | - G. Batist
- Princess Margaret Hospital- Univ Health Netw, Toronto, ON, Canada; The Univ of CA, Irvine, Orange, CA; Lineberger Cancer Ctr, Univ of N Carolina, Chapel Hill, NC; Roswell Park Cancer Institute, Buffalo, NY; Jewish Gen Hosp, McGill Univ, Montreal, PQ, Canada; Argos Therapeutics, Inc, Durham, NC
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Hawkins MA, Eccles C, Lockwood G, Cummings B, Ringash J, Knox JJ, Sherman M, Greig P, Gallinger S, Dawson LA. Preliminary results of a phase I study of stereotactic radiotherapy for unresectable primary and metastatic liver cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. A. Hawkins
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - C. Eccles
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - G. Lockwood
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - B. Cummings
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - J. Ringash
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - J. J. Knox
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - M. Sherman
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - P. Greig
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - S. Gallinger
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - L. A. Dawson
- The Princess Margaret Hosp, Toronto, ON, Canada; Toronto Gen Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
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50
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Kassam Z, Ringash J, Brierley J, Swallow C, Moore M, Knox JJ, Siu L, Wong R, Cummings B, Oza A. Toxicity and outcomes of adjuvant chemoradiotherapy in patients with resected gastric adenocarcinoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4157] [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)
- Z. Kassam
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - J. Ringash
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - J. Brierley
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - C. Swallow
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - M. Moore
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - J. J. Knox
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - L. Siu
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - R. Wong
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - B. Cummings
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
| | - A. Oza
- Princess Margaret Hosp, Toronto, ON, Canada; Mount Sinai Hosp, Toronto, ON, Canada
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