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Moik F, Riedl JM, Ay C. Correspondence to: Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study. Ann Oncol 2024; 35:327. [PMID: 38092622 DOI: 10.1016/j.annonc.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 02/25/2024] Open
Affiliation(s)
- F Moik
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - J M Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - C Ay
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna.
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Barth DA, Moik F, Steinlechner S, Posch F, Mayer MC, Sandner AM, Berton F, Schlintl V, Koch L, John N, Wurm R, Pichler M, Bauernhofer T, Reimann P, Wohlkönig C, Richtig E, Winder T, Preusser M, Jost PJ, Ay C, Gerger A, Terbuch A, Riedl JM. Early kinetics of C reactive protein for cancer-agnostic prediction of therapy response and mortality in patients treated with immune checkpoint inhibitors: a multicenter cohort study. J Immunother Cancer 2023; 11:e007765. [PMID: 38097343 PMCID: PMC10729183 DOI: 10.1136/jitc-2023-007765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND C reactive protein (CRP) kinetics have recently been suggested as predictive biomarkers for the efficacy of immune checkpoint inhibitor (ICI) therapy in selected cancer types. The aim of this study was to characterize early CRP kinetics as a tumor-agnostic biomarker for ICI treatment outcomes. METHODS In this multicenter retrospective cohort study, two independent cohorts of patients with various cancer types undergoing palliative ICI treatment at Austrian academic centers served as the discovery (n=562) and validation cohort (n=474). Four different patterns of CRP kinetics in the first 3 months of ICI therapy were defined (CRP-flare responders, CRP-responders, CRP non-responders, patients with all-normal CRP). Objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were defined as coprimary endpoints. Univariable and multivariable logistic regression, landmark analysis and Cox regression including CRP kinetics as time-dependent variable were performed. RESULTS The ORR in patients with all-normal CRP, CRP responders, CRP flare-responders and CRP non-responders was 41%, 38%, 31% and 12%, respectively. The median OS and PFS estimates were 24.5 months (95% CI 18.5 to not reached) and 8.2 months (95% CI 5.9 to 12.0) in patients with all-normal CRP, 16.1 months (95% CI 12.6 to 19-8) and 6.1 months (95% CI 4.9 to 7.2) in CRP-responders, 14.0 months (95% CI 8.5 to 19.4) and 5.7 months (95% CI 4.1 to 8.5) in CRP flare-responders and 8.1 months (95% CI 5.8 to 9.9) and 2.3 months (95% CI 2.2 to 2.8) in CRP non-responders (log-rank p for PFS and OS<0.001). These findings prevailed in multivariable analysis and could be fully confirmed in our validation cohort. Pooled subgroup analysis suggested a consistent predictive significance of early CRP kinetics for treatment efficacy and outcome independent of cancer type. CONCLUSION Early CRP kinetics represent a tumor-agnostic predictor for treatment response, progression risk and mortality in patients with cancer undergoing ICI therapy.
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Affiliation(s)
- Dominik A Barth
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Moik
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sarah Steinlechner
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Hematology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marie-Christina Mayer
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Amelie M Sandner
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franziska Berton
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Verena Schlintl
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lukas Koch
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Nikolaus John
- Division of Pulmonology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Wurm
- Division of Pulmonology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Translational Oncology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas Bauernhofer
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Patrick Reimann
- Internal Medicine II, Department of Hematology, Oncology, Gastroenterology and Infectiology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Christoph Wohlkönig
- Division of Pulmonology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Erika Richtig
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Thomas Winder
- Internal Medicine II, Department of Hematology, Oncology, Gastroenterology and Infectiology, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine 1, Medizinische Universitat Wien, Wien, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Philipp J Jost
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Cihan Ay
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Armin Gerger
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Angelika Terbuch
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jakob Michael Riedl
- Division of Oncology; Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Doleschal B, Taghizadeh H, Lentner T, Riedl JM, Granitzer J, Morariu D, Decker J, Aichberger KJ, Webersinke G, Kirchweger P, Petzer A, Rumpold H. Bevacizumab mitigates codon-specific effects of trifluridine/tipiracil on efficacy outcome parameters in metastatic colorectal cancer. ESMO Open 2023; 8:102064. [PMID: 37977001 PMCID: PMC10774958 DOI: 10.1016/j.esmoop.2023.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Molecular informed therapy changed treatment patterns of metastatic colorectal cancer (mCRC). Recently KRAS G12, the most prevalent RAS mutation in mCRC, was investigated to be a negative predictive marker for the efficacy of trifluridine/tipiracil (FTD/TPI). Whether this proposed selectivity remains when FTD/TPI is combined with bevacizumab remains elusive. We aimed to describe the efficacy of FTD/TPI + bevacizumab depending on the RAS mutational status in a real-world population. PATIENTS AND METHODS Patients from five different cancer centers in Austria who received FTD/TPI + bevacizumab in any treatment line having available information on their molecular profile were eligible. Data were retrospectively collected by chart review. Survival data were compared using log-rank test. Multivariate Cox regression models included several established covariates. RESULTS One hundred and twenty-three patients with mCRC were included in this study. Median overall survival (OS) was highly similar in the RAS wild type (WT) [9.63 months (95% confidence interval [CI] 8.055-13.775 months)] and the RAS mutant cohorts [8.78 months (95% CI 8.055-11.014 months)], which was confirmed in a multivariable model adjusting for potential confounders; hazard ratio (HR): 1.05 (95% CI 0.618-1.785; P = 0.857). In addition, no effect of KRAS G12 status on patient outcome was observed. In detail, OS was 8.88 months (95% CI 7.332-12.921 months) in patients with KRAS G12 mutation, compared to 9.47 months (95% CI 8.088-11.375 months) in patients with RAS WT/no-KRAS G12 disease [HR: 0.822 (95% CI 0.527-1.282; P = 0.387)]. CONCLUSION This real-world study indicates that the efficacy of FTD/TPI + bevacizumab is independent of RAS mutational status and that bevacizumab may therefore mitigate the potentially limited efficacy of FTD/TPI monotherapy in the KRAS G12-mutated population.
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Affiliation(s)
- B Doleschal
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Linz.
| | - H Taghizadeh
- Department of Internal Medicine, Universitätsklinikum St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten
| | - T Lentner
- Department of Internal Medicine, Universitätsklinikum St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten
| | - J M Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz
| | - J Granitzer
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz
| | - D Morariu
- Department of Internal Medicine, State Hospital Wiener Neustadt, Wiener Neustadt
| | - J Decker
- Department of Internal Medicine, State Hospital Rohrbach, Rohrbach
| | - K J Aichberger
- Department of Internal Medicine, State Hospital Rohrbach, Rohrbach
| | - G Webersinke
- Laboratory for Molecular Genetic Diagnostics, Ordensklinikum Linz, Linz
| | - P Kirchweger
- Department of General and Visceral Surgery, Ordensklinikum Linz, Linz; Medical Faculty, Johannes Kepler University Linz, Linz; Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
| | - A Petzer
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology, and Medical Oncology, Ordensklinikum Linz, Linz
| | - H Rumpold
- Medical Faculty, Johannes Kepler University Linz, Linz; Gastrointestinal Cancer Center, Ordensklinikum Linz, Linz, Austria
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Scheipner L, Smolle MA, Barth D, Posch F, Stotz M, Pichler M, StÖger H, Gerger A, Riedl JM. The AST/ALT Ratio Is an Independent Prognostic Marker for Disease-free Survival in Stage II and III Colorectal Carcinoma. Anticancer Res 2021; 41:429-436. [PMID: 33419840 DOI: 10.21873/anticanres.14792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The Aspartate aminotransaminase/Alanine aminotransaminase ratio (AST/ALT ratio) has been identified as a prognostic marker for several malignancies. In this study, we evaluated the prognostic value of the AST/ALT ratio in a large cohort of non-metastatic colorectal cancer patients (CRC). PATIENTS AND METHODS A total of 536 patients with stage II and III CRC, as well as available AST/ALT ratio were included in this single-center retrospective analysis. Laboratory data were measured within two weeks before histological tumor diagnosis. Co-Primary endpoints for this analysis were disease-free survival (DFS) and overall survival (OS). RESULTS In univariate cox regression DFS was significantly shorter in patients with an elevated AST/ALT ratio (HR=1.568, 95%CI=1.10-2.23, p=0.012). In multivariable analysis, the prognostic association between an elevated AST/ALT ratio and a poor survival prevailed statistically significant (HR=1.53, 95%C=1.05-2.22, p=0.026). No statistically significant association between the AST/ALT ratio and OS was observed (HR=1.4, 95% CI=0.89-2.22, p=0.14). CONCLUSION In this study, the serum AST/ALT ratio emerged as a valid prognostic marker for DFS in non-metastatic colorectal cancer patients at stage II and III.
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Affiliation(s)
- Lukas Scheipner
- Division of Oncology, Department of Internal Medicine, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Dominik Barth
- Division of Oncology, Department of Internal Medicine, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Graz, Austria.,Center for Biomarker Research in Medicine, Graz, Austria
| | - Michael Stotz
- Division of Oncology, Department of Internal Medicine, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Graz, Austria
| | - Herbert StÖger
- Division of Oncology, Department of Internal Medicine, Graz, Austria
| | - Armin Gerger
- Division of Oncology, Department of Internal Medicine, Graz, Austria; .,Center for Biomarker Research in Medicine, Graz, Austria
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Barth DA, Brenner C, Riedl JM, Prinz F, Klocker EV, Schlick K, Kornprat P, Lackner K, Stöger H, Stotz M, Gerger A, Pichler M. External validation of the prognostic relevance of the advanced lung cancer inflammation index (ALI) in pancreatic cancer patients. Cancer Med 2020; 9:5473-5479. [PMID: 32537935 PMCID: PMC7402815 DOI: 10.1002/cam4.3233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The advanced lung cancer inflammation index (ALI) was first introduced for prognosis prediction in lung cancer patients and since then evaluated in several other malignancies. However, in pancreatic cancer (PC) the ALI and its prognostic utility were only investigated in a comparably small and specific cohort of locally advanced PC patients treated with chemoradiotherapy. METHODS In our single-center cohort study, we included 429 patients with histologically verified PC who were treated between 2003 and 2015 at our academic institution. The ALI was defined as body mass index (BMI; kg/m2 ) × serum albumin levels (g/dL)/neutrophil-lymphocyte ratio (NLR) and we defined the optimal cutoff for biomarker dichotomization by ROC-analysis. Kaplan-Meier method as well as uni- and multivariate Cox regression Hazard proportional models were implemented to assess the prognostic potential of ALI in PC patients. We considered cancer-specific survival (CSS) as the primary endpoint of the study. RESULTS The ALI showed a significant negative correlation with CA19-9 levels and C-reactive protein levels whereas we found an association with localized tumor stage and better performance status (P < .05 for all mentioned variables). As opposed to patients with a high ALI, decreased ALI was significantly associated with shorter CSS (HR = 0.606, 95% CI: 0.471-0.779, P = .001). Multivariate analysis demonstrated tumor grade, tumor stage, chemotherapy, C-reactive protein levels, and CA19-9 levels to independently predict for CSS (all P < .05). In contrast the ALI failed to independently predict for CSS in the performed multivariate models (HR = 0.878, 95% CI: 0.643-1.198, P = .411). CONCLUSION In this large cohort of PC patients, the ALI did not complement existing clinicopathological factors for outcome determination.
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Affiliation(s)
- Dominik Andreas Barth
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Carina Brenner
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Jakob Michael Riedl
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Felix Prinz
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Eva Valentina Klocker
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical OncologyHemostaseology, Rheumatology and Infectious DiseasesLaboratory for Immunological and Molecular Cancer ResearchOncologic CenterParacelsus Medical University SalzburgSalzburgAustria
| | - Peter Kornprat
- Division of General SurgeryDepartment of SurgeryMedical University of GrazGrazAustria
| | | | - Herbert Stöger
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Michael Stotz
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Armin Gerger
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Center for Biomarker Research in MedicineGrazAustria
| | - Martin Pichler
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Department of Experimental TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
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Klocker EV, Barth DA, Riedl JM, Prinz F, Szkandera J, Schlick K, Kornprat P, Lackner K, Lindenmann J, Stöger H, Stotz M, Gerger A, Pichler M. Decreased Activity of Circulating Butyrylcholinesterase in Blood Is an Independent Prognostic Marker in Pancreatic Cancer Patients. Cancers (Basel) 2020; 12:cancers12051154. [PMID: 32375339 PMCID: PMC7281496 DOI: 10.3390/cancers12051154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction: The activity of butyrylcholinesterase (BChE) in blood reflects liver function and has recently been associated with systemic inflammatory response and tumor cachexia. As these conditions have been previously linked with pancreatic cancer (PC), the purpose of the present study was to evaluate the prognostic impact of plasma BChE in PC. Methods: Data from 574 consecutive PC patients, treated between 2004 and 2018 at a single academic center, was evaluated. The primary endpoint was cancer-specific survival (CSS), analyzed by Kaplan–Meier curve, and both univariate and multivariate Cox proportional models. Results: BChE activity negatively correlated with other liver parameters (bilirubin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP)), and positively correlated with albumin levels, respectively (p < 0.01). In univariate analysis, a low plasma BChE activity was a factor of poor CSS (hazard ratio: 1.4, 95% confidence interval: 1.129–1.754, p = 0.002). In multivariate analysis, tumor stage, tumor grade, administration of chemotherapy, bilirubin levels and a low BChE activity (hazard ratio: 1.42, 95% confidence interval: 1.10–1.82; p = 0.006) were identified as independent prognostic factors. Conclusion: Decreased activity of BChE in blood plasma predicts shorter survival time in PC patients. Therefore, BChE might be helpful in additional stratification of patients into different prognostic risk groups.
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Affiliation(s)
- Eva Valentina Klocker
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Dominik Andreas Barth
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
- Research Unit “Non-coding RNAs and Genome Editing in Cancer”, Medical University of Graz, 8010 Graz, Austria
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jakob Michael Riedl
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Felix Prinz
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
| | - Peter Kornprat
- Division of General Surgery, Department of Surgery, Medical University of Graz, 8010 Graz, Austria;
| | - Karoline Lackner
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria;
| | - Jörg Lindenmann
- Division of Thoracic Surgery, Department of Surgery, Medical University of Graz, 8010 Graz, Austria;
| | - Herbert Stöger
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
- Research Unit “Non-coding RNAs and Genome Editing in Cancer”, Medical University of Graz, 8010 Graz, Austria
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +43316-385-30196; Fax: +43316-385-13355
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7
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Riedl JM, Posch F, Prager G, Eisterer W, Oehler L, Sliwa T, Wilthoner K, Petzer A, Pichler P, Hubmann E, Winder T, Burgstaller S, Korger M, Andel J, Greil R, Neumann HJ, Pecherstorfer M, Philipp-Abbrederis K, Djanani A, Gruenberger B, Laengle F, Wöll E, Gerger A. The AST/ALT (De Ritis) ratio predicts clinical outcome in patients with pancreatic cancer treated with first-line nab-paclitaxel and gemcitabine: post hoc analysis of an Austrian multicenter, noninterventional study. Ther Adv Med Oncol 2020; 12:1758835919900872. [PMID: 32313566 PMCID: PMC7153180 DOI: 10.1177/1758835919900872] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background: The pretreatment De Ritis ratio [aspartate transaminase (AST)/alanine transaminase (ALT)] has been shown to be an adverse prognostic marker in various cancer entities. However, its relevance to advanced pancreatic ductal adenocarcinoma (PDAC) has not yet been studied. In the present study we investigated the AST/ALT ratio as a possible predictor of treatment response and disease outcome in patients with advanced PDAC treated with first-line gemcitabine/nab-paclitaxel. Methods: A post hoc analysis of a prospective, multicenter, noninterventional study was performed. A total of 202 patients with advanced PDAC treated with first-line gemcitabine/nab-paclitaxel for whom the AST/ALT ratio was measured were included in this analysis. Results: Median and 1-year progression-free survival estimates were 4.8 months and 5.1%, respectively in patients with an AST/ALT ratio above the 75th percentile of its distribution, and 6.0 months and 18.7%, respectively in patients with an AST/ALT ratio less than or equal to this cutoff, respectively (log-rank p = 0.004). In univariable Cox regression, a doubling of the AST/ALT ratio was associated with a 1.4-fold higher relative risk of progression or death [hazard ratio = 1.38, 95% confidence interval (CI): 1.06–1.80, p = 0.017]. The prognostic association was also found in multivariable analysis adjusting for Eastern Cooperative Oncology Group performance status and lung metastases (hazard ratio per AST/ALT ratio doubling = 1.32, 95% CI: 1.00–1.75, p = 0.047). In treatment response analysis, a doubling of the AST/ALT ratio was associated with a 0.5-fold lower odds of objective response (odds ratio = 0.54, 95% CI: 0.31–0.94, p = 0.020). Conclusions: The pretreatment serum AST/ALT ratio predicts poor disease outcome and response rate in patients with advanced PDAC treated with gemcitabine/nab-paclitaxel and might represent a novel and inexpensive marker for individual risk assessment in the treatment of pancreatic cancer.
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Affiliation(s)
- Jakob Michael Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Eisterer
- Department of Internal Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße Sarcoma Platform Austria, Austria
| | - Leopold Oehler
- Department of Medicine, St. Joseph Hospital, Vienna, Vienna, Austria
| | - Thamer Sliwa
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Andreas Petzer
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Petra Pichler
- Universitätsklinikum St. Pölten, Sankt Pölten, Austria
| | - Eva Hubmann
- Department of Internal Medicine 1, Hospital of the Brothers of St. John of God, Graz, Austria
| | - Thomas Winder
- Division of Oncology, Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Sonja Burgstaller
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Korger
- Krankenhaus der barmherzigen Brüder, Eisenstadt, Austria
| | | | - Richard Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
| | | | - Martin Pecherstorfer
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Kathrin Philipp-Abbrederis
- Department of Internal Medicine I, Gastroenterology, Hepatology, Metabolism & Endocrinology, Medical University Innsbruck, Innsbruck, Austria
| | - Angela Djanani
- Department of Internal Medicine I, Gastroenterology, Hepatology, Metabolism & Endocrinology, Medical University Innsbruck, Innsbruck, Austria
| | - Birgit Gruenberger
- Department of Surgery, Landesklinikum Wr. Neustadt, Wr. Neustadt, Austria
| | - Friedrich Laengle
- Department of Surgery, Landesklinikum Wr. Neustadt, Wr. Neustadt, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital Zams, Sanatoriumstrasse, Zams, Austria
| | - Armin Gerger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
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Riedl JM, Stotz M, Gerger A. Role of immune checkpoint inhibitors in gastrointestinal cancer treatment. memo 2019; 12:71-76. [DOI: 10.1007/s12254-019-0470-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/08/2019] [Indexed: 08/30/2023]
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Riedl JM, Posch F, Moik F, Bezan A, Szkandera J, Smolle MA, Kasparek AK, Pichler M, Stöger H, Stotz M, Gerger A. Inflammatory biomarkers in metastatic colorectal cancer: prognostic and predictive role beyond the first line setting. Oncotarget 2017; 8:96048-96061. [PMID: 29221186 PMCID: PMC5707080 DOI: 10.18632/oncotarget.21647] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction Inflammatory biomarkers are useful prognostic tools in cancer patients. However, the prognostic and predictive value of inflammatory biomarkers beyond the 1st-line setting in metastatic colorectal cancer (mCRC) is unclear. Results In multivariate analysis 1 standard deviation increase in neutrophil-lymphocyte-ratio (NLR) was associated with an 8.5% absolute lower objective-response-rate (ORR) in 1st-line (p<0.0001), 3% lower ORR in 2nd-line (p< 0.0001), and 3% lower ORR in 3rd-line (p=0.24), respectively. Regarding progression free survival (PFS), an increase in the NLR was significantly associated with rising hazard-ratios (HR) over all treatment lines (HR=1.30, p= 0.021 1st-line); (HR=1.37, p<0.0001 2nd-line); (HR=1.44, p=0.042 3rd-line). The platelet-lymphocyte-ratio (PLR) was associated with 6-month PFS over all three treatment lines. Higher C-reactive-protein (CRP) predicted for worse PFS in the first two chemotherapy lines and in best supportive care (BSC). (HR=1.49 (p<0.0001 1st-line); HR=1.25 (p=0.007 2nd-line); HR=1.09 (95%CI 0.81–1.48, p=0.552 3rd-line and HR=1.43 (p= 0.002 in BSC)). Methods Two-hundred-fifty-eight patients with mCRC undergoing palliative chemo(immuno-)therapy were retrospectively included. Primary endpoints were 6-month PFS and ORR during 1st-line, 2nd-line, and 3rd-line treatment, and 6-month overall survival during BSC. Conclusion This study shows that inflammatory biomarkers are useful predictors of disease outcome and treatment response over several treatment lines in mCRC patients.
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Affiliation(s)
- Jakob Michael Riedl
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Florian Posch
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Florian Moik
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Angelika Bezan
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Maria Anna Smolle
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Anne-Katrin Kasparek
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Herbert Stöger
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8036 Graz, Austria.,Center for Biomarker Research in Medicine, 8010 Graz, Austria
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Riedl JM, Posch F, Bezan A, Szkandera J, Smolle MA, Winder T, Rossmann CH, Schaberl-Moser R, Pichler M, Stotz M, Stöger H, Gerger A. Patterns of venous thromboembolism risk in patients with localized colorectal cancer undergoing adjuvant chemotherapy or active surveillance: an observational cohort study. BMC Cancer 2017; 17:415. [PMID: 28619086 PMCID: PMC5471923 DOI: 10.1186/s12885-017-3392-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/26/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Venous thromoboembolism (VTE) is a frequent and burdensome complication of metastatic colorectal cancer (CRC). However, the epidemiology of VTE in patients with localized CRC after surgery in curative intent is incompletely understood. In this single-center observational cohort study, we investigate patterns of VTE risk in localized CRC, and define its relationship with baseline risk factors, adjuvant chemotherapy and CRC recurrence. METHODS Five-hundred-sixteen patients with stage II/III CRC were included retrospectively at the time of surgery, and followed until the occurrence of VTE, CRC recurrence, or death (median age = 65.1 years, stage II and III: n = 151 (29.5%), n = 361 (70.5%); adjCTX: n = 339 (65.7%)). RESULTS During a median follow-up of 2.7 years, 15 VTEs (2.7%) and 116 recurrences (22.5%) occurred, and 46 patients (8.9%) died. Six-month, 1-year, and 5-year VTE risks were 1.6%, 2.0% and 3.2%, respectively. In competing risk time-to-VTE regression, adjCTX was not associated with an increased risk of VTE (Subdistribution hazard ratio = 0.98, 95% CI:0.33-2.88, p = 0.97). The occurrence of disease recurrence strongly increased the risk of VTE (Multi-state model: Transition hazard ratio (THR) = 13.03, 95% CI:4.39-38.74, p < 0.0001)). Conversely, the onset of VTE did not predict for recurrence (THR = 1.95, 95% CI: 0.62-6.16, p = 0.25). CONCLUSION VTE risk is very low in localized CRC and does not appear to be increased by adjuvant chemotherapy. Thus, primary thromboprophylaxis is unlikely to result in clinical benefit in this population. The strongest determinant of VTE risk appears to be disease recurrence.
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Affiliation(s)
- Jakob Michael Riedl
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Florian Posch
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Angelika Bezan
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Maria Anna Smolle
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center for Biomarker Research in Medicine, Stiftingtalstrasse 5, 8010, Graz, Austria
| | - Thomas Winder
- Department of internal medicine II, LKH Feldkirch, Carinagasse 47, A-6807, Feldkirch, Austria
| | - Christopher H Rossmann
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Renate Schaberl-Moser
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Department of experimental therapeutics, The University of Texas MD Anderson Cancer Center, 1901 Eastroad, Houston, TX, 77054, USA
| | - Michael Stotz
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Herbert Stöger
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center for Biomarker Research in Medicine, Stiftingtalstrasse 5, 8010, Graz, Austria
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Chafetz L, Tsilifonis DC, Riedl JM. Facile differential UV determination of steroids with conjugated ketone chromophores via lithium borohydride reduction. J Pharm Sci 1972; 61:148-9. [PMID: 4110190 DOI: 10.1002/jps.2600610142] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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