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Zendt M, Bustos Carrillo FA, Kelly S, Saturday T, DeGrange M, Ginigeme A, Wu L, Callier V, Ortega-Villa A, Faust M, Chang-Rabley E, Bugal K, Kenney H, Khil P, Youn JH, Osei G, Regmi P, Anderson V, Bosticardo M, Daub J, DiMaggio T, Kreuzburg S, Pala F, Pfister J, Treat J, Ulrick J, Karkanitsa M, Kalish H, Kuhns DB, Priel DL, Fink DL, Tsang JS, Sparks R, Uzel G, Waldman MA, Zerbe CS, Delmonte OM, Bergerson JRE, Das S, Freeman AF, Lionakis MS, Sadtler K, van Doremalen N, Munster V, Notarangelo LD, Holland SM, Ricotta EE. Characterization of the antispike IgG immune response to COVID-19 vaccines in people with a wide variety of immunodeficiencies. Sci Adv 2023; 9:eadh3150. [PMID: 37824621 PMCID: PMC10569702 DOI: 10.1126/sciadv.adh3150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
Research on coronavirus disease 2019 vaccination in immune-deficient/disordered people (IDP) has focused on cancer and organ transplantation populations. In a prospective cohort of 195 IDP and 35 healthy volunteers (HV), antispike immunoglobulin G (IgG) was detected in 88% of IDP after dose 2, increasing to 93% by 6 months after dose 3. Despite high seroconversion, median IgG levels for IDP never surpassed one-third that of HV. IgG binding to Omicron BA.1 was lowest among variants. Angiotensin-converting enzyme 2 pseudo-neutralization only modestly correlated with antispike IgG concentration. IgG levels were not significantly altered by receipt of different messenger RNA-based vaccines, immunomodulating treatments, and prior severe acute respiratory syndrome coronavirus 2 infections. While our data show that three doses of coronavirus disease 2019 vaccinations induce antispike IgG in most IDP, additional doses are needed to increase protection. Because of the notably reduced IgG response to Omicron BA.1, the efficacy of additional vaccinations, including bivalent vaccines, should be studied in this population.
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Affiliation(s)
- Mackenzie Zendt
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Fausto A. Bustos Carrillo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
- Office of Data Science and Emerging Technologies, Office of Science Management and Operations, NIAID, NIH, Rockville, MD, USA
| | - Sophie Kelly
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH, Bethesda, MD, USA
| | | | - Maureen DeGrange
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Anita Ginigeme
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
- Medical Science and Computing LLC, Rockville, MD, USA
| | - Lurline Wu
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Viviane Callier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Ana Ortega-Villa
- Biostatistics Research Branch, Division of Clinical Research, NIAID, NIH, Rockville, MD, USA
| | | | - Emma Chang-Rabley
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Kara Bugal
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Heather Kenney
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Pavel Khil
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Jung-Ho Youn
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Gloria Osei
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Pravesh Regmi
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Victoria Anderson
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Marita Bosticardo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Janine Daub
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Thomas DiMaggio
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Samantha Kreuzburg
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Francesca Pala
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Justina Pfister
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jennifer Treat
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jean Ulrick
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Heather Kalish
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH, Bethesda, MD, USA
| | - Douglas B. Kuhns
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Debra L. Priel
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Danielle L. Fink
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - John S. Tsang
- Department of Immunobiology and Yale Center for Systems and Engineering Immunology, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT,USA
| | - Rachel Sparks
- Laboratory of Immune System Biology, DIR, NIAID, NIH, Bethesda, MD,USA
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Meryl A. Waldman
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Christa S. Zerbe
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ottavia M. Delmonte
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jenna R. E. Bergerson
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Sanchita Das
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Alexandra F. Freeman
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Michail S. Lionakis
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Kaitlyn Sadtler
- Section for Immunoengineering, NIBIB, NIH, Bethesda, MD, USA
| | | | | | - Luigi D. Notarangelo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Emily E. Ricotta
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
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Sparks R, Rachmaninoff N, Hirsch DC, Bansal N, Lau WW, Martins AJ, Chen J, Liu CC, Cheung F, Failla LE, Biancotto A, Fantoni G, Sellers BA, Chawla DG, Howe KN, Mostaghimi D, Farmer R, Kotliarov Y, Calvo KR, Palmer C, Daub J, Foruraghi L, Kreuzburg S, Treat J, Urban AK, Jones A, Romeo T, Deuitch NT, Moura NS, Weinstein B, Moir S, Ferrucci L, Barron KS, Aksentijevich I, Kleinstein SH, Townsley DM, Young NS, Frischmeyer-Guerrerio PA, Uzel G, Pinto-Patarroyo GP, Cudrici CD, Hoffmann P, Stone DL, Ombrello AK, Freeman AF, Zerbe CS, Kastner DL, Holland SM, Tsang JS. Multiomics integration of 22 immune-mediated monogenic diseases reveals an emergent axis of human immune health. Res Sq 2023:rs.3.rs-2070975. [PMID: 36993430 PMCID: PMC10055521 DOI: 10.21203/rs.3.rs-2070975/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Monogenic diseases are often studied in isolation due to their rarity. Here we utilize multiomics to assess 22 monogenic immune-mediated conditions with age- and sex-matched healthy controls. Despite clearly detectable disease-specific and "pan-disease" signatures, individuals possess stable personal immune states over time. Temporally stable differences among subjects tend to dominate over differences attributable to disease conditions or medication use. Unsupervised principal variation analysis of personal immune states and machine learning classification distinguishing between healthy controls and patients converge to a metric of immune health (IHM). The IHM discriminates healthy from multiple polygenic autoimmune and inflammatory disease states in independent cohorts, marks healthy aging, and is a pre-vaccination predictor of antibody responses to influenza vaccination in the elderly. We identified easy-to-measure circulating protein biomarker surrogates of the IHM that capture immune health variations beyond age. Our work provides a conceptual framework and biomarkers for defining and measuring human immune health.
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Affiliation(s)
- Rachel Sparks
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Nicholas Rachmaninoff
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
- Graduate Program in Biological Sciences, University of Maryland, College Park, MD 20742, USA
| | - Dylan C. Hirsch
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Neha Bansal
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
| | - William W. Lau
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
- Office of Intramural Research, CIT, NIH, Bethesda, MD 20892, USA
| | - Andrew J. Martins
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Jinguo Chen
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Candace C. Liu
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Foo Cheung
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Laura E. Failla
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
| | | | - Giovanna Fantoni
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Brian A. Sellers
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Daniel G. Chawla
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06511, USA
| | - Katherine N. Howe
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Darius Mostaghimi
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Rohit Farmer
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Yuri Kotliarov
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Katherine R. Calvo
- Hematology Section, Department of Laboratory Medicine, NIH Clinical Center, Bethesda, MD 20892, USA
| | - Cindy Palmer
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Janine Daub
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Ladan Foruraghi
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Samantha Kreuzburg
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Jennifer Treat
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Amanda K. Urban
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, NIH, Frederick, MD 21701, USA
| | - Anne Jones
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Tina Romeo
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Natalie T. Deuitch
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Natalia Sampaio Moura
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Barbara Weinstein
- Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892, USA
| | - Susan Moir
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD 20892, USA
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
| | - Karyl S. Barron
- Divison of Intramural Research, NIAID, NIH, Bethesda, MD 20892, USA
| | - Ivona Aksentijevich
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Steven H. Kleinstein
- Interdepartmental Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT 06511, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Danielle M. Townsley
- Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892, USA
| | - Neal S. Young
- Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892, USA
| | | | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | | | - Cornelia D. Cudrici
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda MD 20892, USA
| | - Patrycja Hoffmann
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Deborah L. Stone
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Amanda K. Ombrello
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Alexandra F. Freeman
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Christa S. Zerbe
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - Daniel L. Kastner
- Inflammatory Diseases Section, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD 20892, USA
| | - John S. Tsang
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD 20892, USA
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD 20892, USA
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3
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Totten AH, Uzel G, Khil PP, Youn JH, Treat J, Soutar CD, Holland SM, Dekker JP, Zerbe CS. Disseminated Mycoplasma orale infection in patients with Phosphoinositide-3-Kinase Regulatory Subunit 1 Mutations. Open Forum Infect Dis 2022; 9:ofac472. [DOI: 10.1093/ofid/ofac472] [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] [Received: 07/21/2022] [Accepted: 09/09/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Mycoplasma orale is a rare cause of invasive infection in immunodeficient hosts. Phosphatidylinositol 3-Kinase, Regulatory Subunit 1 (PI3KR1) mutations predispose patients to sinopulmonary infections, alongside bronchiectasis autoimmunity and lymphoproliferation. We report the two cases of PI3KR1 deficiency with invasive M. orale and effective treatment options.
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Affiliation(s)
- Arthur H Totten
- Clinical Center, National Institutes of Health , Bethesda, MD , USA
| | - Gulbu Uzel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, MD , USA
| | - Pavel P Khil
- Clinical Center, National Institutes of Health , Bethesda, MD , USA
| | - Jung Ho Youn
- Clinical Center, National Institutes of Health , Bethesda, MD , USA
| | - Jennifer Treat
- National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, MD , USA
| | - Craig D Soutar
- Clinical Center, National Institutes of Health , Bethesda, MD , USA
| | - Steven M Holland
- National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, MD , USA
| | - John P Dekker
- National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, MD , USA
| | - Christa S Zerbe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, MD , USA
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Nguyen K, Heimall J, Henrickson S, Khurana M, Romberg N, Treat J, Brown-Whitehorn T, Sun D. M164 NOVEL ERBIN VARIANT AND ASSOCIATED SEVERE ECZEMA IN A 3-MONTH-OLD. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.305] [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: 10/19/2022]
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Ochoa S, Ding L, Kreuzburg S, Treat J, Holland SM, Zerbe CS. Daratumumab (Anti-CD38) for Treatment of Disseminated Nontuberculous Mycobacteria in a Patient With Anti-Interferon-γ Autoantibodies. Clin Infect Dis 2021; 72:2206-2208. [PMID: 32745179 DOI: 10.1093/cid/ciaa1086] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
Patients with autoantibodies to interferon-γ (IFN-γ) may develop severe nontuberculous mycobacterial infections. We describe the novel use of daratumumab in a patient with autoantibodies to IFN-γ who had progressive infection, resulting in clinical and radiographic improvement.
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Affiliation(s)
- Sebastian Ochoa
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Li Ding
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Samantha Kreuzburg
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christa S Zerbe
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Rocco JM, Rosen LB, Hong GH, Treat J, Kreuzburg S, Holland SM, Zerbe CS. Bortezomib treatment for refractory nontuberculous mycobacterial infection in the setting of interferon gamma autoantibodies. J Transl Autoimmun 2021; 4:100102. [PMID: 34041472 PMCID: PMC8141761 DOI: 10.1016/j.jtauto.2021.100102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022] Open
Abstract
Interferon-γ autoantibodies increase the risk of disseminated nontuberculous mycobacterial infections. Addition of rituximab to antibiotics accelerates and improves outcomes, but refractory infections can occur due to persistent production of autoantibodies. We combined bortezomib with rituximab to reduce autoantibodies leading to clinical and radiographic improvement in infection. IFNγ autoantibodies increase the risk of disseminated infections with intracellular pathogens. Rituximab combined with antibiotics improves outcomes, but infections can become refractory. The addition of bortezomib is safe with close monitoring and can improve clinical outcomes.
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Affiliation(s)
- Joseph M Rocco
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Lindsey B Rosen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gloria H Hong
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Treat
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Samantha Kreuzburg
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Steven M Holland
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christa S Zerbe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Bodor J, Bauman J, Handorf E, Zawislak C, Ross E, Clapper M, Treat J. OA05.04 Real-World Progression-Free Survival in Oncogenic Driver-Mutated Non-Small Cell Lung Cancer (NSCLC) Treated With Single-Agent Immunotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.029] [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: 10/22/2022]
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Bodor J, Fisher S, Treat J, Clapper M. OA09.05 Lung Cancer as a Second Primary Malignancy Among Women with Breast Cancer: The Role of Hormone Replacement and Smoking. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.456] [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: 11/25/2022]
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Bodor J, Patel J, Ross E, Litwin S, Treat J. P1.01-109 Phase II Trial of Pemetrexed/Carboplatin/Bevacizumab +/- Atezolizumab in NSCLC Patients That Are EGFR Mutated or Never Smoked. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.824] [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: 10/25/2022]
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Reck M, Smit EF, Garon E, Cappuzzo F, Bidoli P, Cohen R, Gao L, Ernest II CS, Lee P, Zimmermann A, Ferry D, Treat J, Melemed A, Perol M. Exposure Response-Analyse von Ramucirumab (RAM) in der randomisierten, doppelblinden Phase III Studie REVEL (Docetaxel [DOC] versus DOC und RAM) in der Zweitlinienbehandlung des metastasierten Nicht-Kleinzelligen Lungenkarzinoms (NSCLC). Pneumologie 2016. [DOI: 10.1055/s-0036-1572231] [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: 10/22/2022]
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Reck M, Paz-Ares L, Perol M, Ciuleanu TE, Kowalyszyn RD, Lewanski CR, Syrigos K, Arrieta O, Prabhash K, Park K, Pikiel J, Göksel T, Lee P, Zimmermann A, Treat J, Ferry D, Melemed A, Carter GC, Alexandris E, Garon E. Wirksamkeit und Sicherheit der Kombination Ramucirumab (RAM) plus Docetaxel (DOC) versus Placebo (PL) plus DOC bei Patienten mit vorbehandeltem nicht plattenepithelialen nicht kleinzelligen Lungenkarzinom (NSCLC): explorative Analyse der REVEL Studie (RAM plus DOC versus PL plus DOC in der Zweitlinientherapie des NSCLC im Stadium IV). Pneumologie 2016. [DOI: 10.1055/s-0036-1571967] [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: 10/22/2022]
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Mornex F, Senan S, Hennequin C, Lartigau E, Brade A, Wang L, Vansteenkiste J, Dakhil S, Biesma B, Martinez Aguillo M, Aerts J, Govindan R, Rubio-Viqueira B, Lewanski C, Gandara D, Choy H, Mok T, Hossain A, Iscoe N, Treat J, Koustenis A, Chouaki N, Vokes E. PROCLAIM : résultats finaux de survie globale de l’essai de phase III : pemetrexed cisplatine ou étoposide cisplatine, plus radiothérapie thoracique suivie d’une chimiothérapie de consolidation dans le CBNPC non épidermoïde localement avancé. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.674] [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: 11/27/2022]
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Treat J, Scagliotti G, Peng G, Monberg MJ, Obasaju CK. Comparison of pemetrexed plus cisplatin with other first-line doublets in advanced non-small cell lung cancer (NSCLC): A combined analysis of three phase III trials. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18004] [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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Ortuzar WF, Pennella EJ, John WJ, Simms L, Peng G, Treat J, Obasaju CK. Brain metastases (BM) as the primary site of relapse in two randomized phase III pemetrexed (P) trials in advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18047] [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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Choy H, Schwartzberg LS, Dakhil SR, Garon EB, Choksi JK, Govindan R, Peng G, Koustenis AG, Treat J, Obasaju CK. Ongoing phase II study of pemetrexed plus carboplatin or cisplatin with concurrent radiation therapy followed by pemetrexed consolidation in patients with favorable-prognosis inoperable stage IIIA/b non-small cell lung cancer: Interim update. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7082] [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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Shen X, Werner-Wasik M, DeNittis A, Axelrod R, Gilman P, Meyer T, Treat J, Curran W, Machtay M. Final Report of a Pilot Study of Carboplatin Plus Dose Dense Pemetrexed and Radiotherapy for Locally-advanced Non–small-cell Lung Carcinoma. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.380] [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: 11/28/2022]
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Ansari RH, Edelman MJ, Belani CP, Socinski MA, Obasaju CK, Monberg MJ, Chen R, Treat J. Outcomes for the elderly (≥70 years) from a three-arm phase III trial of gemcitabine in combination with carboplatin (GC) or paclitaxel (GP) versus paclitaxel plus carboplatin (PC) for advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8052] [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
8052 Background: Approximately 50% of lung cancer patients (pts) are ≥ 70 y, however, this population has been historically underrepresented in clinical trials. Even among pts ≥ 70 y, doublet chemotherapy has been shown to be superior to single-agent therapy (Lilenbaum JCO 2005, Sederholm JCO, 2005), and the efficacy and safety of platinum-based chemotherapy doublets in NSCLC pts ≥ 70 years with good PS have been reported to be similar to those in younger pts (Fossella, ASCO 2003, #2528, Kelly, ASCO 2001, A-1313). The current analysis examined whether any differences were present by age in a three arm trial of GC or GP versus a standard regimen of PC. Methods: 1135 chemonaïve pts with stage IIIB or IV NSCLC were randomized to receive: G 1000 mg/m2 d 1,8 plus C AUC 5.5 d 1; or G 1000 mg/m2 d 1,8 plus P 200 mg/m2 d 1; or P 225 mg/m2 plus C AUC 6.0 d 1. Stratification was based on stage, baseline weight loss, and brain metastases. Cycles were repeated every 21 days up to 6 cycles or disease progression. Clinical results were retrospectively analyzed in by patient age. Results: See Table . Conclusions: In this trial of commonly used regimens for advanced NSCLC, pts 70–74 years of age had significantly longer survival than pts 75–79 years of age. Pts 80+ years of age also had lower survival than the 70–74 year age group, but this difference was not statistically significant. No pts 80+ years of age had brain metastases at study entry. There was no clear pattern with respect to the effectiveness of individual treatment regimens by age group. [Table: see text] [Table: see text]
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Affiliation(s)
- R. H. Ansari
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
| | - M. J. Edelman
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
| | - C. P. Belani
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
| | - M. A. Socinski
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
| | - C. K. Obasaju
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
| | - M. J. Monberg
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
| | - R. Chen
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
| | - J. Treat
- Michiana Hematology Oncology, South Bend, IN; University of Maryland Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Lilly USA, LLC, Indianapolis, IN
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Heinzerling JH, Hughes RS, Govindan R, Bradley JD, Schiller J, Peng G, Treat J, Obasaju C, Tran T, Choy H. A phase I study of pemetrexed plus carboplatin or cisplatin with concurrent chest radiation therapy (CRT) for patients with locally advanced non-small cell lung cancer (LANSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7545] [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
7545 Background: Pemetrexed is a multi-targeted antifolate that inhibits the synthesis of both pyrimidines and purines. Pemetrexed is an effective new chemotherapeutic agent in advanced non-small cell lung cancer. Pemetrexed has also shown preclinical activity as a radiosensitizer in lung cancer. A phase I study was performed to establish the maximum tolerated dose (MTD) and phase 2 dose of carboplatin or cisplatin given with pemetrexed and CRT in LANSCLC. Methods: Patients (pts) with LANSCLC were enrolled. Initial intent was to establish the MTD of both weekly cisplatin and weekly carboplatin in combination with pemetrexed and CRT as an alternating two-arm phase I trial. Subsequently and based on early results from the CALGB 30407 trial (also evaluating the MTD of carboplatin), the protocol was amended to establish the safety of the planned phase II doses of cisplatin and carboplatin combined with pemetrexed 500 mg/m2 and given every 3 weeks with concurrent CRT. Dose limiting toxicity (DLT) was defined as ≥ Grade 3 hematologic or nonhematologic toxicity based on Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. MTD was determined by occurrence of 2 DLTs among 6 pts in each cohort. Results: 22 pts were enrolled on 3 cohorts. All pts received pemetrexed, 9 with carboplatin AUC=2, 9 with cisplatin 30 mg/m2, and 4 with cisplatin 75 mg/m2. One DLT occurred in each of the carboplatin and cisplatin 30 mg/m2 cohorts, prompting enrollment of 3 additional patients. No DLTs were seen in the cisplatin 75 mg/m2 cohort. Conclusions: The MTD of cisplatin in combination with pemetrexed and CRT was not reached. Based on these results and those from CALGB 30407, either carboplatin AUC=5 or cisplatin 75 mg/m2 in combination with pemetrexed 500 mg/m2 given every 3 weeks with CRT appears to be well tolerated, and are currently being studied in a randomized phase II trial in pts with LANSCLC. [Table: see text]
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Affiliation(s)
- J. H. Heinzerling
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - R. S. Hughes
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - R. Govindan
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - J. D. Bradley
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - J. Schiller
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - G. Peng
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - J. Treat
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - C. Obasaju
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - T. Tran
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
| | - H. Choy
- University of Texas Southwest Medical Center, Dallas, TX; Washington University, St. Louis, MO; Lilly USA, LLC, Indianapolis, IN
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Edelman MJ, Belani CP, Socinski MA, Ansari R, Obasaju CK, Monberg MJ, Chen R, Treat J. Incidence and outcomes associated with brain metastases (BM) in a three-arm phase III trial of gemcitabine in combination with carboplatin (GC) or paclitaxel (GP) versus paclitaxel plus carboplatin (PC) for advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8076] [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
8076 Background: A limited number of randomized phase III studies of advanced or metastatic NSCLC have included a mixed population of patients (pts) with and without BM at presentation. Analyses of pts with lung cancer from the 1970s and 1980s indicated that the incidence of BM at the time of diagnosis was approximately 10%. Methods: 1135 chemonaïve pts with stage IIIB or IV NSCLC were randomized to receive: G 1000 mg/m2 d 1, 8 plus C AUC 5.5 d 1; or G 1000 mg/m2 days 1 and 8 plus P 200 mg/m2 d 1; or P 225 mg/m2 plus C AUC 6.0 d 1. Stratification was based on stage, baseline weight loss, and presence or absence of BM. Cycles were repeated every 21 d up to 6 cycles or disease progression. Pts who developed BM as the only evidence of progression were able to be treated with whole brain radiation and steroids and remained on study. Results were retrospectively analyzed in by presence or absence of BM at study entry. Results: BM rates by subgroup were as follows (%): overall (17.1), nonsquamous (19.3), squamous (6.9), <70 y (21.3), ≥ 70 y (7.1), female (19.2), male (15.7), Caucasian (16.7), African American (18.8%), Hispanic (22.2), PS 0 (12.9), PS 1 (19.7), weight loss <5% (18.3), weight loss ≥ 5% (15.1), and stage IV (19.0). Among pts with (N=194) and without (N=941) BM, response rates=28.9% and 29.1%, median survival = 7.7 mos (95% CI: 6.7, 9.3) and 8.6 mos (95% CI: 7.9, 9.5), and median time to progression = 4.3 mos (95% CI: 3.4, 5.6) and 4.6 mos (95% CI: 4.2, 5.1), respectively. Rates of grade 3 or 4 adverse events were not different among pts with and without BM. Median survival among pts with BM was 7.6 mos for GC (N=66, 95% CI: 6.3, 10.1), 8.2 mos for GP (N=64, 95% CI: 4.6, 10.5), and 7.7 mos for PC (N=64, 95% CI: 6.1, 10.2). Conclusions: 1) The higher incidence of BM (17.1%) observed in this trial may be related to the increasing incidence of adenocarcinoma, or to the increasing sensitivity of imaging modalities. 2) There was no difference in response, time to progression or survival for pts with or w/o BM. [Table: see text]
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Affiliation(s)
- M. J. Edelman
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
| | - C. P. Belani
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
| | - M. A. Socinski
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
| | - R. Ansari
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
| | - C. K. Obasaju
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
| | - M. J. Monberg
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
| | - R. Chen
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
| | - J. Treat
- Greenebaum Cancer Center, Baltimore, MD; Penn State Hershey Cancer Institute, Hershey, PA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC; Northern Indiana Cancer Research Consortium, South Bend, IN; Lilly USA, LLC, Indianapolis, IN
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Obasaju CK, Raju RN, Stinchcombe T, Couch LS, Jotte R, Kocs DM, Wang Y, Bromund J, Treat J, Socinski MA. Final results of a randomized phase II trial of pemetrexed (P) + carboplatin (Cb) ± enzastaurin (E) versus docetaxel (D) + Cb as first-line treatment of patients (pts) with stage IIIB/IV non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8037 Background: E is a selective, oral serine/threonine kinase inhibitor. The combination of PCb has shown clinical activity in two phase 2 trials of advanced NSCLC. A phase 3 trial among pts with stage IIIB/IV NSCLC showed that P + cisplatin provides similar efficacy with better tolerability than gemcitabine + cisplatin (Scagliotti, JCO, 2008). The toxicity profile observed with P + platinum doublets makes these regimens attractive for the integration of novel agents with different mechanisms of action. In the TAX 326 trial, D + cisplatin was associated with a median survival of 11.3 mos vs. 10.1 mos for vinorelbine + cisplatin (P=.04). The current open-label three- arm trial was designed to assess PCb ± E versus a control arm of DCb. Methods: Between 3/06 and 5/08, pts with stage IIIB (with pleural effusion) or IV NSCLC, ECOG PS of 0 or 1, and no prior systemic therapy were enrolled. Pts were equally randomized to 3 arms: (A) P 500 mg/m2 and Cb AUC 6 every 3 wks × 6 cycles with E given orally as a loading dose of 1200 mg or 1125 mg followed by 500 mg daily until disease progression; (B) The same regimen of PCb without E; or (C) D 75 mg/m2 and Cb AUC 6 every 3 wks × 6 cycles. Pts receiving P were administered folic acid, vitamin B12 and steroid prophylaxis. Pts on D also received steroid prophylaxis. Results: See table . Conclusions: First-line treatment with PCb was associated with a significantly longer overall survival than DCb in advanced or metastatic NSCLC. E did not add to the activity of the PCb doublet. PCbE, PCb, and DCb appeared to be well tolerated. Complete results for all patients in the study will be available at the time of the meeting. [Table: see text] [Table: see text]
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Affiliation(s)
- C. K. Obasaju
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - R. N. Raju
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - T. Stinchcombe
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - L. S. Couch
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - R. Jotte
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - D. M. Kocs
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - Y. Wang
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - J. Bromund
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - J. Treat
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
| | - M. A. Socinski
- Lilly USA, LLC, Indianapolis, IN; US Oncology, Houston, TX; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC
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Patel JD, Hensing TA, Rademaker F, Hart E, Obasaju CK, Treat J, Milton D, Bonomi PD. Pemetrexed and carboplatin plus bevacizumab with maintenance pemetrexed and bevacizumab as first-line therapy for advanced non-squamous non-small cell lung cancer (NSCLC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8044] [Citation(s) in RCA: 7] [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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Machtay M, Werner-Wasik M, DeNittis A, Axelrod RA, Gilman P, Lavarino J, Meyer T, Treat J, Curran WJ. Pilot study of carboplatin/radiotherapy plus ‘dose-dense’ pemetrexed for locally advanced non-small cell lung carcinoma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7571] [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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Borghaei H, Langer CJ, Millenson M, Tuttle H, Seldomridge J, Rovito M, Mintzer D, Treat J. Phase II trial of cetuximab (C225) in combination with monthly carboplatin (Cb) and weekly paclitaxel (Pac) in patients with advanced NSCLC: Promising early results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8104] [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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Kocs DM, Raju RN, Socinski MA, Stinchcombe TE, Rousey SR, Barrera D, Wang Y, Bromund J, Treat J, Obasaju CK. Preliminary results of a randomized phase II trial of pemetrexed (P) + carboplatin (Cb) ± enzastaurin (ENZ) versus docetaxel (D) + Cb as first-line treatment of patients with stage IIIB/IV non-small cell lung cancer (NSCLC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8061] [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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Peng G, Zinner RG, Wang Y, Treat J, Monberg M, Obasaju CK, Herbst RS, Novello S, Scagliotti GV. Comparison of patient outcomes stratified by histology among pemetrexed (P)-treated patients (pts) with stage IIIB/IV non-small cell lung cancer (NSCLC) in two phase II trials. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Napier T, Olson JT, Windmiller J, Treat J. A long-term follow-up of a single rural surgeon's experience with laparoscopic inguinal hernia repair. WMJ 2008; 107:136-139. [PMID: 18575098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Inguinal hernia repair is one of the most common surgical procedures performed in the United States, with an estimated 700,000 or more completed annually. OBJECTIVE This study looks at 7 years of laparoscopic totally extra-peritoneal (TEP) inguinal hernia repair at a rural Wisconsin medical center. The goal is to accurately measure recurrence rates and mechanisms of recurrences within a single professional's practice using a follow-up of no less than 2 years. A secondary goal was to record the percentage of patients with short-term and long-term complications. METHOD Patients with laparoscopic TEP inguinal hernia repairs from 1997 through 2004 were seen in follow-up visits > or =2 years after their initial repair. Of a possible 165 patients, 100 (61%) participated, returning for a total of 141 (64%) follow-up exams. Follow-up range was 2-7 years, with a mean of 3.7 years. All repairs were completed using a single technique (TEP) by a single surgeon. Repair variables included mesh thickness, style of mesh to cord accommodation, and fixation technique. Study participants ranged from 16 to 88 years, with an average age of 65.9 years. A wide range of socioeconomic indicators were represented, including education, occupation, and household income. Five participants were female and 95 were male. MAIN OUTCOME MEASURE The primary study outcome was the identification of an accurate recurrence rate along with the mechanism of hernia recurrence. Patients with long-term groin pain (dysesthesia) and identification of short-term complications were also noted. RESULTS Between 2004 and 2007, 100 patients were seen for follow-up. None had symptomatic hernia recurrences. One recurrence was found at exam and confirmed with a herniogram and laparoscopic surgical exploration. Two additional patients, identified by exam and herniograms as having suspected recurrences, are awaiting surgical exploration. In the case of 1 recurrence, the mechanism appears to be partial migration of mesh from the placement area. Long-term groin dysesthesias (moderate or occasional) occurred in 2 patients or 1.4% of repairs. Spermatic cord hematoma (18% of repairs) was the most common short-term complication. CONCLUSIONS Laparoscopic TEP inguinal hernia repairs are effective and durable in a rural setting. An acceptable recurrence rate (0.7%-2.1%) may be related to mesh placement, completeness of dissection, and the small but real risk of mesh migration or displacement prior to healing fixation. Long-term pain complications are reasonably low.
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Affiliation(s)
- Tim Napier
- Mile Bluff Medical Center, Mauston, WI 53948, USA.
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Krathen M, Treat J, James WD. Capecitabine induced inflammation of actinic keratoses. Dermatol Online J 2007; 13:13. [PMID: 18319010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Capecitabine, an oral prodrug of 5-fluorouracil, is a systemic chemotherapeutic agent used in the treatment of metastatic breast and colon cancer. Patients undergoing capecitabine therapy may experience inflammation and irritation of existing actinic keratoses. Oncologists and dermatologists alike should be aware of this side effect.
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Affiliation(s)
- M Krathen
- Department of Dermatology, Hospital of University of Pennsylvania, Philadelphia, USA.
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Lang K, Marciniak MD, Faries D, Stokes M, Buesching D, Earle C, Treat J, Thompson D. Temporal trends in first-line chemotherapy treatment among elderly stage IIIB/IV non-small cell lung cancer (NSCLC) patients in the United States: Evidence from SEER-Medicare data. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17002] [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
17002 Background: Data regarding first-line chemotherapy treatment among advanced-staged NSCLC patients is lacking. The purpose of this analysis was to assess first-line treatment patterns over time among elderly patients with Stage IIIB/IV NSCLC. Methods: Patients aged 65 years and older diagnosed with Stage IIIB/IV NSCLC between 1997 and 2002 were identified and followed over time using the SEER-Medicare database to evaluate temporal trends in first-line chemotherapy treatment. Results: Chemotherapy use increased from approximately 28% of Stage IIIB/IV patients diagnosed in 1997 to 36% of patients diagnosed in 2002. Among identifiable first-line treatments, cisplatin or carboplatin and taxane (C/CT) doublet therapy was the most common treatment in all years (approximately 50% or greater). The use of single-agent taxanes and gemcitabine increased over time (taxane use increased from 3.3% in 1997 to 7.6% in 2002; gemcitabine use increased from 0.6% in 1997 to 5.1% in 2002), while use of single agent cisplatin or carboplatin (C/C) declined (from 10.0% in 1997 to 3.1% in 2002). Use of doublet therapy with C/C and either a taxane or gemcitabine also increased over time (with the largest increase for the gemcitabine combination from 0.3% in 1997 to 11.8% in 2002). Correspondingly, use of doublet C/C and any other therapy declined markedly (from 18.9% in 1997 to 3.7% in 2002). Use of 3 or more agents as first-line treatment was infrequent across study years (<1.0%). Treatment discontinuation was substantial (>60% for all regimens). Conclusions: Our findings indicate relatively low but increasing use of first-line chemotherapy treatment among elderly Stage IIIB/IV NSCLC patients. [Table: see text]
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Affiliation(s)
- K. Lang
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M. D. Marciniak
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Faries
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Stokes
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Buesching
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C. Earle
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - J. Treat
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Thompson
- i3 Innovus, Medford, MA; Eli Lilly and Company, Indianapolis, IN; United BioSource Corporation, Medford, MA; Dana-Farber Cancer Institute, Boston, MA
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Fidias P, Dakhil S, Lyss A, Loesch D, Waterhouse D, Cunneen J, Chen R, Treat J, Obasaju C, Schiller J. Phase III study of immediate versus delayed docetaxel after induction therapy with gemcitabine plus carboplatin in advanced non-small cell lung cancer: Updated report with survival. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.lba7516] [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
LBA7516 Background: Gemcitabine (G) plus carboplatin (C) therapy is active in patients with advanced non-small-cell lung cancer (NSCLC). For nonprogressing patients, optimal timing of second-line therapy with a non-cross-resistant agent is unclear. This Phase III, randomized trial assessed the efficacy and safety of docetaxel (D) administered either immediately after GC induction therapy or upon disease progression (PD). Methods: Patients having either Stage IIIB with pleural effusion or Stage IV NSCLC were enrolled. Prior chemotherapy for NSCLC was not permitted. For GC induction, G 1000 mg/m2 was administered on Days 1, 8 followed by C AUC 5 on Day 1. After four 21-day cycles, nonprogressors were randomized to either the immediate D group (D 75 mg/m2 administered on Day 1 every 21 days, for a maximum of 6 cycles) or the delayed D group (patients given best supportive care after randomization and the same D regimen after first evidence of PD) treatment arms. Primary endpoint was overall survival (OS). Additional analyses included response rates, toxicity and progression-free survival (PFS). Results: Results are summarized in the table below. OS was not statistically different (p=0.071) between the two D arms. However, 31 patients (20.1%) in the delayed D arm and 38 patients (24.8%) in the immediate D arm were censored for OS analysis. PFS analysis (from randomization to first evidence of PD or death) showed a statistically significant (p=<0.0001) improvement in the immediate D arm. D given to NSCLS patients immediately after GC induction did not increase toxicity. Conclusions: Comparison of PFS for each D arm suggests a possible clinical benefit for immediate D therapy. However, even though OS trended in favor of immediate D therapy, the OS result did not reach statistical significance. The implications of these results will be discussed. [Table: see text] [Table: see text]
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Affiliation(s)
- P. Fidias
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - S. Dakhil
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - A. Lyss
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - D. Loesch
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - D. Waterhouse
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - J. Cunneen
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - R. Chen
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - J. Treat
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - C. Obasaju
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
| | - J. Schiller
- Massachusetts General Hosp, Boston, MA; Penrose Cancer Center of Kansas, Wichita, KS; Missouri Baptist Cancer Center, St. Louis, MO; Central Indiana Cancer Centers, Indianapolis, IN; Oncology Hematology Care, Inc., Cincinnati, OH; Eli Lilly and Company, Indianapolis, IN; University of Wisconsin Hospital, Madison, WI
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Langer CJ, Huang C, Ruth K, Shafer D, Borghaei H, Millenson M, Mintzer D, Staddon A, Seldomridge J, Tuttle H, Treat J. Phase II study of weekly docetaxel and gemcitabine in relapsed patients (pts) with advanced, platinum-exposed non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18039] [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
18039 Background: Docetaxel (D) has, clear-cut therapeutic superiority compared to best supportive care, or ifosfamide/vinorelbine in relapsed NSCLC and, as a result, is the standard of comparison in the second line setting. In the pre-pemetrexed era, gemcitabine (G) in phase II studies also demonstrated activity in the salvage setting with favorable survival rates. We therefore mounted a phase II trial pairing these two agents in pts with progressive disease (PD) after prior platinum-based therapy. Methods: Pts with advanced NSCLC and ECOG PS 0–1 progressing either during or after prior platin-based therapy received D 40 mg/m2 days 1 and 8, in combination with G 800 mg/m2 days 1 and 8 every 3 wks. In the absence of dose limiting myelosuppression or other gr=3 toxicities, the dose of G was escalated on an intra-patient basis to 1 g/m2 days 1 and 8. Pts continued treatment until disease progression or unacceptable toxicity. Results: 35 pts were enrolled: 20 pts (57%) were male; 69% were ECOG PS 1; 57% had received prior XRT. Median age was 61 (range 30–79); median time from initial diagnosis to enrollment was 12.4 months. 170 cycles total were administered (median 4, range 1–16). Overall response rate was 23% (95% CI 12–39%). Median event free survival (EFS) was 5.7 months; median overall survival 12.5 mos; with 1 year survival rate of 51%, and 2 year survival rate 20%. Those enrolled within 12 months of initial diagnosis had poorer EFS compared to those beyond 12 months (log rank p=0.04). There were no treatment-related deaths. Typical grade = 3 toxicities included neutropenia (43%), neutropenic fever (9%) diarrhea (6%), pneumonitis (9%), LFT elevations (9%) and dermatitis (9%), including nail changes. Conclusions: Combination docetaxel and gemcitabine administered days 1 and 8 every 3 weeks in good performance NSCLC pts with PD after/during platinum-based therapy appears encouraging, and presents a viable option in this population. Proof of benefit vs. docetaxel alone requires phase III testing. No significant financial relationships to disclose.
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Affiliation(s)
- C. J. Langer
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - C. Huang
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - K. Ruth
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - D. Shafer
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - H. Borghaei
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - M. Millenson
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - D. Mintzer
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - A. Staddon
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - J. Seldomridge
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - H. Tuttle
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
| | - J. Treat
- Fox Chase Cancer Center, Philadelphia, PA; Kansas University Medical Center, Kansas City, KS; Pennsylvania Oncology Hematology Association, Philadelphia, PA; Oncology Physician Network, Inc, Rockledge, PA
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Treat J, Gonin R, Edelman M, Belani CP, Socinski M, Catalano R, Marinucci D, Ansari R, Comis R, Obasaju C. Subgroup analysis of African American patients from a randomized phase 3 trial of gemcitabine (G) in combination with carboplatin (Cb) or paclitaxel (P) compared to P plus Cb in advanced (stage IIIB, IV) non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18066] [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
18066 Background: A relationship between race and prognosis in patients with NSCLC has been suggested with African Americans (AA) having higher incidence and lower survival rates compared to whites (W) with a similar stage of disease. However, due to under representation of AA in clinical trials there is little data to substantiate this hypothesis. To investigate the possibility of a race effect on the efficacy and safety of standard chemotherapy doublet regimens in AA pts, we conducted a retrospective subgroup analysis of our Phase 3 randomized trial comparing 3 regimens for advanced NSCLC (Treat, et al: Abst#7025, Proc ASCO 2005). Methods: A Phase 3 study in advanced (stage IIIB/IV) NSCLC chemonaive patients with ECOG PS <2 was designed to compare the efficacy of a G-containing platinum regimen GCb (G 1000 mg/m2 IV D 1, 8 plus Cb AUC 5.5, D 1) to a nonplatinum G doublet GP (G 1000 mg/m2 IV D 1,8 plus P 200 mg/m2, D 1) and a reference regimen of PCb (P 225 mg/m2 plus Cb AUC 6.0, D 1). Outcome and toxicity data of AA pts vs. W pts were compared. Survival (OS) was the primary endpoint with secondary endpoints being response rate (RR), time to progression (TTP) and toxicity. Data from all 3 arms were pooled for this analysis. Results: A total of 128 AA and 906 W pts were analyzed. There were no significant differences in the OS or TTP distributions in AA compared to W pts ( Table 1 ). The incidence and grade of hematologic toxicity in AA vs. W pts were comparable. AA demonstrated slightly lower incidences of Grade 3–4 constitutional (5.1% vs. 9.0%), hemorrhage (1.4 % vs. 2.5 %), and metabolic (4.4% vs. 7.0%) toxicities compared with W pts. Conclusions: Use of standard chemotherapy doublets as first-line chemotherapy in AA pts with advanced NSCLC demonstrated similar efficacy and safety compared to W pts treated under similar conditions. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Treat
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - R. Gonin
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - M. Edelman
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - C. P. Belani
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - M. Socinski
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - R. Catalano
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - D. Marinucci
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - R. Ansari
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - R. Comis
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
| | - C. Obasaju
- Eli Lilly and Company, Indianapolis, IN; Westat, Rockville, MD; University of Maryland, College Park, MD; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Drexel University College of Medicine, Philadelphia, PA; Michiana Hematology Oncology, PC, South Bend, IN
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Treat J, Belani CP, Schiller J, Monberg MJ, Cunneen J, Chen R, Ye Z, Obasaju CK. Gemcitabine (G) plus carboplatin (C) at AUC 5 demonstrates reduced grade 4 thrombocytopenia rate compared to AUC 5.5 in first line therapy of patients with advanced stage NSCLC. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
7130 Background: GC is a commonly used regimen in first-line therapy of advanced stage NSCLC. Various dosing of carboplatin in the GC regimen produces different toxicity profiles. This report summarizes three recent large clinical trials, including the Coalition Trial, using GC regimens that had comparable efficacy to other modern doublets. Methods: Three trials using GC as first-line treatment for advanced NSCLC with recent best response and toxicity data were selected. Pt populations were similarly defined, including measurable or evaluable Stage IIIB (with pleural effusion) or IV disease. All utilized similar 21-d regimens of G 1000 mg/m2 d 1,8 and C AUC 5.5 or 5.0 d1. Results: Despite a grade 4-thrombocytopenia rate of 12% in Trial 1 (Coalition) there was no difference in serious bleeding events compared to the other arms (paclitaxel/carboplatin and paclitaxel/gemcitabine). Discussion: In these three trials, 1126 pts with advanced NSCLC were treated with first-line GC. This database of 743 patients assessed for safety suggests that GC AUC 5 results in a 4.7% (95% CI: 3.3–6.5%) grade 4-thrombocytopenia rate with similar anti-tumor efficacy. The regimen of G 1000 mg/m2 on d1, 8 with C AUC 5 on d1 of a 21-d cycle may be optimal for treatment of advanced NSCLC. [Table: see text] [Table: see text]
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Affiliation(s)
- J. Treat
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
| | - C. P. Belani
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
| | - J. Schiller
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
| | - M. J. Monberg
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
| | - J. Cunneen
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
| | - R. Chen
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
| | - Z. Ye
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
| | - C. K. Obasaju
- Eli Lilly and Company, Indianapolis, IN; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Wisconsin Hospital, Madison, WI
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Treat J, Belani CP, Edelman MJ, Socinski MA, Ansari RH, Obasaju CK, Bloss JD, Marinucci DM, Catalano RB, Comis RL. A randomized phase III trial of gemcitabine (G) in combination with carboplatin (C) or paclitaxel (P) versus paclitaxel plus carboplatin in advanced (Stage IIIB, IV) non-small cell lung cancer (NSCLC): Update of the Alpha Oncology trial (A1–99002L). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba7025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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. Treat
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - C. P. Belani
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - M. J. Edelman
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - M. A. Socinski
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - R. H. Ansari
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - C. K. Obasaju
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - J. D. Bloss
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - D. M. Marinucci
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - R. B. Catalano
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
| | - R. L. Comis
- Fox Chase Temple Cancer Ctr, Philadelphia, PA; Univ of Pittsburgh Cancer Institute, Pittsburgh, PA; Univ of Maryland Greenebaum Cancer Ctr, Baltimore, MD; Univ of North Carolina, Chapel Hill, NC; Michana Hematology Oncology, PC, South Bend, IN; Lilly Oncology, Indianapolis, IN; Drexel Univ Coll of Medicine, Philadelphia, PA
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McCleod M, Treat J, Christiansen NP, Mintzer DM, Bonomi P, Bloss LP, Taylor L, Monberg MJ, Ye Z, Obasaju CK. Pemetrexed (P) plus gemcitabine (G) as front-line chemotherapy for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC): A phase II clinical trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7121] [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)
- M. McCleod
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - J. Treat
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - N. P. Christiansen
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - D. M. Mintzer
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - P. Bonomi
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - L. P. Bloss
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - L. Taylor
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - M. J. Monberg
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - Z. Ye
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
| | - C. K. Obasaju
- Florida Cancer Spclsts, Fort Myers, FL; Fox Chase Temple Cancer Ctr, Philadelphia, PA; SC One Assoc PA, Columbia, SC; Pennsylvania Hosp, Philadelphia, PA; Rush Medcl Ctr, Chicago, IL; Eli Lilly & Co, Indianapolis, IN
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Pisters K, Vallieres E, Bunn P, Crowley J, Ginsberg R, Ellis P, Meyers B, Marks R, Treat J, Gandara D. S9900: A phase III trial of surgery alone or surgery plus preoperative (preop) paclitaxel/carboplatin (PC) chemotherapy in early stage non-small cell lung cancer (NSCLC): Preliminary results. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba7012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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)
- K. Pisters
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - E. Vallieres
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - P. Bunn
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - J. Crowley
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - R. Ginsberg
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - P. Ellis
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - B. Meyers
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - R. Marks
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - J. Treat
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
| | - D. Gandara
- MD Anderson Cancer Ctr, Houston, TX; Swedish Cancer Institute, Seattle, WA; Univ of Colorado Cancer Ctr, Denver, CO; SWOG Statistical Ctr, Seattle, WA; Univ of Toronto, Toronto, ON, Canada; The Juravinski Cancer Ctr, Hamilton, ON, Canada; Washington Univ, St Louis, MO; Mayo Clinic, Rochester, MN; Fox Chase Temple Univ Cancer Ctr, Philadelphia, PA; Univ of CA Davis Cancer Ctr, Sacramento, CA
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Huang CH, Langer CJ, Millenson MM, Sherman E, Seldomridge J, Schol J, Rogatko A, Treat J. Phase II trial evaluating combination, weekly gemcitabine and docetaxel in progressive, chemotherapy-exposed NSCLC: Preliminary results of OPN 003. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7295] [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)
- C. H. Huang
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
| | - C. J. Langer
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
| | - M. M. Millenson
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
| | - E. Sherman
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
| | - J. Seldomridge
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
| | - J. Schol
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
| | - A. Rogatko
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
| | - J. Treat
- Kansas Univ Medcl Ctr, Overland Park, KS; Fox Chase Cancer Ctr, Philadelphia, PA
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Levin J, Lilenbaum RC, Masters GA, Lane SR, Treat J. Association of topotecan with improved performance status (PS) in relapsed small cell lung cancer (SCLC) patients with poor PS at baseline. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7208] [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)
- J. Levin
- GlaxoSmithKline, Philadelphia, PA; Mount Sinai Comprehensive Cancer Center, Miami Beach, FL; Helen Graham Cancer Center, Newark, DE; Fox Chase-Temple University Cancer Center, Philadelphia, PA
| | - R. C. Lilenbaum
- GlaxoSmithKline, Philadelphia, PA; Mount Sinai Comprehensive Cancer Center, Miami Beach, FL; Helen Graham Cancer Center, Newark, DE; Fox Chase-Temple University Cancer Center, Philadelphia, PA
| | - G. A. Masters
- GlaxoSmithKline, Philadelphia, PA; Mount Sinai Comprehensive Cancer Center, Miami Beach, FL; Helen Graham Cancer Center, Newark, DE; Fox Chase-Temple University Cancer Center, Philadelphia, PA
| | - S. R. Lane
- GlaxoSmithKline, Philadelphia, PA; Mount Sinai Comprehensive Cancer Center, Miami Beach, FL; Helen Graham Cancer Center, Newark, DE; Fox Chase-Temple University Cancer Center, Philadelphia, PA
| | - J. Treat
- GlaxoSmithKline, Philadelphia, PA; Mount Sinai Comprehensive Cancer Center, Miami Beach, FL; Helen Graham Cancer Center, Newark, DE; Fox Chase-Temple University Cancer Center, Philadelphia, PA
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Treat J, McCleod M, Mintzer D, Christiansen N, Bonomi P, Monberg M, Taylor L, Obasaju C. Pemetrexed plus gemcitabine as front-line therapy for patients with advanced stage non-small cell lung cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7130] [Citation(s) in RCA: 2] [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)
- J. Treat
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
| | - M. McCleod
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
| | - D. Mintzer
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
| | - N. Christiansen
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
| | - P. Bonomi
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
| | - M. Monberg
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
| | - L. Taylor
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
| | - C. Obasaju
- Temple University, Philadelphia, PA; Florida Cancer Center, Fort Myers, FL; Pennsylvania Oncology, Philadelphia, PA; South Carolina Oncology Associates, Columbia, SC; Rush Medical College, Chicago, IL; Lilly Oncology, Indianapolis, IN
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Treat J, Schiller J, Quoix E, Mauer A, Edelman M, Modiano M, Bonomi P, Ramlau R, Lemarie E. ZD0473 treatment in lung cancer: an overview of the clinical trial results. Eur J Cancer 2002; 38 Suppl 8:S13-8. [PMID: 12645908 DOI: 10.1016/s0959-8049(02)80016-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Three open-label, non-comparative, multicentre Phase II trials have examined the efficacy and tolerability of ZD0473 as first-and second-line therapy in non-small-cell lung cancer (NSCLC) patients and second-line therapy in small-cell lung cancer (SCLC) patients. Patients with second-line NSCLC or SCLC were evaluated as either platinum-sensitive or -resistant, based upon their time to relapse/progression after platinum-based therapy. First-line NSCLC patients (n = 18) received a total of 60 treatment cycles (median number per patient 2.5) whilst second-line NSCLC (n = 50) and SCLC (n = 48) patients both received a total of 127 treatment cycles (median number per patient 2.0). Grade 3/4 anaemia, neutropenia and thrombocytopenia was observed in: 38.8%, 22.2% and 27.7% of first-line NSCLC patients; 12.0%, 24.0% and 50% of second-line NSCLC patients; and 10.4%, 25.0% and 47.9% of second-line SCLC patients, respectively. The most common grade 3/4 non-haematological toxicities in all three trials were lethargy and dyspnoea. No clinically significant oto-, nephro- or neurotoxicity was observed. The first-line treatment of NSCLC produced an overall response rate (OR) of 6.3%. No OR was seen after second-line treatment of NSCLC, while ORs of 15.4% and 8.3% were seen in the platinum-resistant and -sensitive second-line SCLC patients, respectively.
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Affiliation(s)
- J Treat
- Fox Chase Temple University Cancer Center, Philadelphia, PA, USA.
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Abstract
Objective tumor responses and survival rates with standard chemotherapy options for small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) have been disappointing. However, several promising new classes of agents have emerged in recent years, including the taxanes, mitotic spindle inhibitors, antimetabolites, and topoisomerase I and II inhibitors. The molecular target of several of these new agents is topoisomerase I, an enzyme that is essential for DNA replication and is up-regulated in tumor cells. Inhibition of this enzyme by drugs such as topotecan and irinotecan leads to cell death and is the basis for their anticancer activity. The process of DNA replication is halted by the covalent binding of the drug in a topoisomerase I drug/DNA ternary reaction intermediate. The pharmacokinetics of the approved regimen--a 30-min infusion daily for 5 days at 21-day intervals--are well defined, with proportional increases in the area under the plasma concentration-time curve, peak plasma concentration, and steady state concentration following application of higher doses. The antitumor activities of both the intravenous and oral formulations of topotecan have been tested in clinical trials. Topotecan is well tolerated and has demonstrated good efficacy in patients with relapsed SCLC when administered as monotherapy or in combination regimens as first-line or second-line therapy. Preliminary trials also indicate that topotecan is well tolerated and has activity in the first-line treatment of NSCLC. In this article an overview of new agents in lung cancer chemotherapy is provided, with particular attention paid to the topoisomerase I inhibitors. A review of topotecan--the first topoisomerase I inhibitor to be approved for second-line therapy in SCLC--is presented as an illustration of the promise these new agents hold for the treatment of SCLC and NSCLC.
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Affiliation(s)
- C H Huang
- Fox Chase-Temple Cancer Center, Philadelphia, PA 19140, USA
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Treat J, Damjanov N, Huang C, Zrada S, Rahman A. Liposomal-encapsulated chemotherapy: preliminary results of a phase I study of a novel liposomal paclitaxel. Oncology (Williston Park) 2001; 15:44-8. [PMID: 11396365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Liposome encapsulation of antineoplastic drugs entered clinical testing in the late 1980s. As carriers for a variety of agents, liposomes can allow successful delivery of agents that may be subject to rapid degradation in the serum and can modify the toxicity profile. In general, liposomes have demonstrated an ability to attenuate toxicities by their different pharmacokinetic profile and pattern of distribution. Differences in the constitution of the liposome can greatly affect the pharmacokinetic profile resulting in different patterns of toxicity. Characteristics such as size, charge, composition, and integrity can affect performance of the liposome. Liposome encapsulation of doxorubicin has been shown to reduce cardiac toxicity. Preliminary data suggest that encapsulation of paclitaxel can greatly modify neurotoxicity without the need for cremephor.
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Affiliation(s)
- J Treat
- Department of Medical Oncology, Fox Chase-Temple Cancer Center, Philadelphia, Pennsylvania, USA.
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Treat J, Huang C, Damanjov N, Jahanzeb M, Edelman M, Koehler M. ZD0473 phase II monotherapy trial in second-line non-small cell lung cancer. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sterman DH, Molnar-Kimber K, Iyengar T, Chang M, Lanuti M, Amin KM, Pierce BK, Kang E, Treat J, Recio A, Litzky L, Wilson JM, Kaiser LR, Albelda SM. A pilot study of systemic corticosteroid administration in conjunction with intrapleural adenoviral vector administration in patients with malignant pleural mesothelioma. Cancer Gene Ther 2000; 7:1511-8. [PMID: 11228529 DOI: 10.1038/sj.cgt.7700269] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
One of the primary limitations of adenoviral (Ad) -mediated gene therapy is the generation of anti-Ad inflammatory responses that can induce clinical toxicity and impair gene transfer efficacy. The effects of immunosuppression on these inflammatory responses, transgene expression, and toxicity have not yet been systematically examined in humans undergoing Ad-based gene therapy trials. We therefore conducted a pilot study investigating the use of systemic corticosteroids to mitigate antivector immune responses. In a previous phase I clinical trial, we demonstrated that Ad-mediated intrapleural delivery of the herpes simplex virus thymidine kinase gene (HSVtk) to patients with mesothelioma resulted in significant, but relatively superficial, HSVtk gene transfer and marked anti-Ad humoral and cellular immune responses. When a similar group of patients was treated with Ad.HSVtk and a brief course of corticosteroids, decreased clinical inflammatory responses were seen, but there was no demonstrable inhibition of anti -Ad antibody production or Ad-induced peripheral blood mononuclear cell activation. Corticosteroid administration also had no apparent effect on the presence of intratumoral gene transfer. Although limited by the small numbers of patients studied, our data suggest that systemic administration of steroids in the context of Ad-based gene delivery may limit acute clinical toxicity, but may not inhibit cellular and humoral responses to Ad vectors.
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Affiliation(s)
- D H Sterman
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
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von Pawel J, von Roemeling R, Gatzemeier U, Boyer M, Elisson LO, Clark P, Talbot D, Rey A, Butler TW, Hirsh V, Olver I, Bergman B, Ayoub J, Richardson G, Dunlop D, Arcenas A, Vescio R, Viallet J, Treat J. Tirapazamine plus cisplatin versus cisplatin in advanced non-small-cell lung cancer: A report of the international CATAPULT I study group. Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors. J Clin Oncol 2000; 18:1351-9. [PMID: 10715308 DOI: 10.1200/jco.2000.18.6.1351] [Citation(s) in RCA: 217] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A phase III trial, Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors (CATAPULT I), was designed to determine the efficacy and safety of tirapazamine plus cisplatin for the treatment of non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with previously untreated NSCLC were randomized to receive either tirapazamine (390 mg/m(2) infused over 2 hours) followed 1 hour later by cisplatin (75 mg/m(2) over 1 hour) or 75 mg/m(2) of cisplatin alone, every 3 weeks for a maximum of eight cycles. RESULTS A total of 446 patients with NSCLC (17% with stage IIIB disease and pleural effusions; 83% with stage IV disease) were entered onto the study. Karnofsky performance status (KPS) was >/= 60 for all patients (for 10%, KPS = 60; for 90%, KPS = 70 to 100). Sixty patients (14%) had clinically stable brain metastases. The median survival was significantly longer (34.6 v 27. 7 weeks; P =.0078) and the response rate was significantly greater (27.5% v 13.7%; P <.001) for patients who received tirapazamine plus cisplatin (n = 218) than for those who received cisplatin alone (n = 219). The tirapazamine-plus-cisplatin regimen was associated with mild to moderate adverse events, including acute, reversible hearing loss, reversible, intermittent muscle cramping, diarrhea, skin rash, nausea, and vomiting. There were no incremental increases in myelosuppression, peripheral neuropathy, or renal, hepatic, or cardiac toxicity and no deaths related to tirapazamine. CONCLUSION The CATAPULT I study shows that tirapazamine enhances the activity of cisplatin in patients with advanced NSCLC and confirms that hypoxia is an exploitable therapeutic target in human malignancies.
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Affiliation(s)
- J von Pawel
- Asklepios Fachkliniken München-Gauting, Gauting, and Hospital Grosshansdorf, Hamburg, Germany
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Machtay M, Aviles V, Kligerman MM, Treat J, Weinstein GS, Weber RS, Mirza N, Chalian AA, Rosenthal DI. A phase I trial of 96-hour paclitaxel infusion plus accelerated radiotherapy of unrespectable head and neck cancer. Int J Radiat Oncol Biol Phys 1999; 44:311-5. [PMID: 10760424 DOI: 10.1016/s0360-3016(99)00027-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the maximum tolerated dose (MTD) of paclitaxel given as a 96-hour continuous infusion during Weeks 1 and 5 of an accelerated radiotherapy schedule for the definitive treatment of advanced (nonmetastatic) unresectable squamous cell carcinoma of the head and neck (SCCHN). METHODS AND MATERIALS Thirteen patients with Stage IV SCCHN were enrolled. Radiotherapy consisted of 70-72 Gy over 6 weeks, with a fractionation scheme of 2 Gy q.d. for 4 weeks followed by 1.6 Gy b.i.d. for 2 weeks, with no planned interruptions. Paclitaxel was administered over a 96-hour continuous infusion during Weeks 1 and 5 of radiotherapy at the following dose levels: Dose Level 1: 40 mg/m(2)/96-hours (3 patients); Dose Level 2: 80 mg/m(2)/96-hrs (5 patients); Dose Level 3: 120 mg/m(2)/96-hours (2 patients); and Dose Level 2A: 100 mg/m(2)/96-hours (3 patients). RESULTS The MTD of Paclitaxel was 100 mg/m(2)/96-hours. All but one patient (who experienced progressive disease after receiving 61 Gy and both cycles of paclitaxel) completed therapy as planned. Dose-limiting toxicity occurred in both patients enrolled at Dose Level 3, with one patient experiencing Grade 4 diffuse moist desquamation and the other patient experiencing Grade 4 mucositis and febrile neutropenia. Thus, Dose Level 2A was opened and no dose limiting toxicity was noted. Grade 3 non-dose limiting mucositis and dermatitis occurred at all paclitaxel dose levels. There were no treatment-related deaths. All Grade 3 and 4 toxicities were reversible. Complete responses were seen in 8 of 13 patients, 4 patients achieved partial responses, and 1 patient had no response/progressive disease. CONCLUSIONS Infusional paclitaxel over 96 hours during Weeks 1 and 5 of this accelerated radiotherapy schedule is feasible. The MTD of paclitaxel in this protocol was 100 mg/m(2)/96-hours. Dose-limiting toxicities were primarily enhanced epithelial reactions, but febrile neutropenia also occurred. All patients develop non-dose limiting Grade 3 skin and mucosal reactions, reflecting the high treatment intensity. This regimen merits further investigation.
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Affiliation(s)
- M Machtay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia 19104, USA.
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Treat J, Johnson E, Langer C, Belani C, Haynes B, Greenberg R, Rodriquez R, Drobins P, Miller W, Meehan L, McKeon A, Devin J, von Roemeling R, Viallet J. Tirapazamine with cisplatin in patients with advanced non-small-cell lung cancer: a phase II study. J Clin Oncol 1998; 16:3524-7. [PMID: 9817270 DOI: 10.1200/jco.1998.16.11.3524] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A phase II study was conducted to evaluate the safety and efficacy of tirapazamine combined with cisplatin for the treatment of patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Forty-four patients with stage IIIB/IV NSCLC were treated with a combination of tirapazamine and cisplatin. Patients received tirapazamine 260 mg/m2 administered intravenously over 2 hours, followed 1 hour later by cisplatin 75 mg/m2 administered over an additional hour, repeated every 21 days. The duration of therapy was meant to be limited to four cycles for nonresponders and eight cycles for responders. RESULTS Ten of 44 patients (23%) showed a partial response. The estimated median survival for all patients was 37 weeks. Toxicities were treatable and included grade 3 nausea or vomiting (25%), fatigue (27.3%), and muscle cramps (4.5%). No dose reductions were necessary. CONCLUSION The results show that tirapazamine can safely be added to cisplatin. Both the median survival and response rate observed strongly suggest that tirapazamine with cisplatin is more active than cisplatin alone.
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Affiliation(s)
- J Treat
- Allegheny University of the Health Sciences, Hahnemann Division, Philadelphia, PA 19104, USA
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Abstract
Tirapazamine is a novel bioreductive agent with selective cytotoxicity against hypoxic tumour cells. Synergy with cisplatin and other chemotherapeutic agents has been shown in preclinical trials. Pharmacokinetic studies of tirapazamine have revealed that exposure increases with dose over the range of 18-450 mg m(-2) for a single dose and of 9-390 mg m(-2) for multiple doses. Plasma clearance is high. Tirapazamine has been clinically tested in combination with cisplatin at escalating doses in a phase I trial and at therapeutic doses in three separate phase II trials in patients with advanced non-small-cell lung cancer (NSCLC) in 11 study centres. Limiting toxicity for tirapazamine at an intravenous dose of 390 mg m(-2) was acute, reversible hearing loss. Other frequently observed side-effects included muscle cramping and gastrointestinal symptoms. Tirapazamine did not cause myelosuppression, and no toxic deaths were reported in these trials. The anti-tumour efficacy against previously untreated, advanced NSCLC was evaluated by cumulative intent-to-treat analysis of 132 patients. The objective response rate (confirmed by two independent measurements) was 25% [confidence interval (CI) 17.8-33.33], with a median survival of 38.9 weeks (CI 29.4-49.9). The efficacy of tirapazamine plus cisplatin shown in these trials was better than that of historical controls with cisplatin monotherapy. Two large-scale international trials have been conducted, involving more than 70 centres, to confirm these results. The CATAPULT I trial compares tirapazamine plus cisplatin with cisplatin and has finished accrual with 446 patients. The CATAPULT II trial, which is comparing tirapazamine plus cisplatin with etoposide plus cisplatin, had enrolled 550 patients by June 1997. Follow-up is ongoing. Tirapazamine is the promising first drug from a new class of cytotoxic agents with a novel mechanism of action. It can be effectively combined with cisplatin, and possibly with other agents, because of its safety profile and lack of overlapping dose-limiting toxicity, such as myelosuppression. The combination of tirapazamine and cisplatin appears to be safe and effective in the treatment of NSCLC.
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Affiliation(s)
- U Gatzemeier
- Department of Thoracic Oncology, Hospital Grosshansdorf, Hamburg, Germany
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Sterman DH, Treat J, Litzky LA, Amin KM, Coonrod L, Molnar-Kimber K, Recio A, Knox L, Wilson JM, Albelda SM, Kaiser LR. Adenovirus-mediated herpes simplex virus thymidine kinase/ganciclovir gene therapy in patients with localized malignancy: results of a phase I clinical trial in malignant mesothelioma. Hum Gene Ther 1998; 9:1083-92. [PMID: 9607419 DOI: 10.1089/hum.1998.9.7-1083] [Citation(s) in RCA: 270] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malignant pleural mesothelioma is a fatal neoplasm that is unresponsive to standard modalities of cancer therapy. We conducted a phase I dose-escalation clinical trial of adenoviral (Ad)-mediated intrapleural herpes simplex virus thymidine kinase (HSVtk)/ganciclovir (GCV) gene therapy in patients with mesothelioma as a model for treatment of a localized malignancy. The goals of this phase I trial were to assess the safety, toxicity, and maximally tolerated dose of intrapleural Ad.HSVtk, to examine patient inflammatory response to the viral vector, and to evaluate the efficiency of intratumoral gene transfer. Twenty-one previously untreated patients were enrolled in this single-arm, dose-escalation study with viral doses ranging from 1 x 10(9) plaque-forming units (pfu) to 1 x 10(12) pfu. A replication-incompetent recombinant adenoviral vector containing the HSVtk gene under control of the Rous sarcoma virus (RSV) promoter-enhancer was introduced into the pleural cavity of patients with malignant mesothelioma followed by 2 weeks of systemic therapy with GCV at a dose of 5 mg/kg twice a day. The initial 15 patients underwent thoracoscopic pleural biopsy prior to, and 3 days after, vector delivery. The last six patients underwent only the post-vector instillation biopsy. Dose-limiting toxicity was not reached. Side effects were minimal and included fever, anemia, transient liver enzyme elevations, and bullous skin eruptions, as well as a temporary systemic inflammatory response in those receiving the highest dose. Strong intrapleural and intratumoral immune responses were generated. Using RNA PCR, in situ hybridization, immunohistochemistry, and immunoblotting, HSVtk gene transfer was documented in 11 of 20 evaluable patients in a dose-related fashion. This study demonstrates that intrapleural administration of an adenoviral vector containing the HSVtk gene is well tolerated and results in detectable gene transfer when delivered at high doses. Further development of therapeutic trials for treatment of localized malignancy using this vector is thus warranted.
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Affiliation(s)
- D H Sterman
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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Vaughn DJ, Treat J. Cancers of the large bowel and hepatobiliary tract. Cancer Chemother Biol Response Modif 1998; 17:476-91. [PMID: 9551227] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- D J Vaughn
- University of Pennsylvania Cancer Center, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA
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