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Dasari A, Lonardi S, Garcia-Carbonero R, Elez E, Yoshino T, Sobrero A, Yao J, García-Alfonso P, Kocsis J, Cubillo Gracian A, Sartore-Bianchi A, Satoh T, Randrian V, Tomasek J, Chong G, Paulson AS, Masuishi T, Jones J, Csőszi T, Cremolini C, Ghiringhelli F, Shergill A, Hochster HS, Krauss J, Bassam A, Ducreux M, Elme A, Faugeras L, Kasper S, Van Cutsem E, Arnold D, Nanda S, Yang Z, Schelman WR, Kania M, Tabernero J, Eng C. Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2): an international, multicentre, randomised, double-blind, phase 3 study. Lancet 2023; 402:41-53. [PMID: 37331369 DOI: 10.1016/s0140-6736(23)00772-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/21/2023] [Accepted: 04/05/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND There is a paucity of effective systemic therapy options for patients with advanced, chemotherapy-refractory colorectal cancer. We aimed to evaluate the efficacy and safety of fruquintinib, a highly selective and potent oral inhibitor of vascular endothelial growth factor receptors (VEGFRs) 1, 2, and 3, in patients with heavily pretreated metastatic colorectal cancer. METHODS We conducted an international, randomised, double-blind, placebo-controlled, phase 3 study (FRESCO-2) at 124 hospitals and cancer centres across 14 countries. We included patients aged 18 years or older (≥20 years in Japan) with histologically or cytologically documented metastatic colorectal adenocarcinoma who had received all current standard approved cytotoxic and targeted therapies and progressed on or were intolerant to trifluridine-tipiracil or regorafenib, or both. Eligible patients were randomly assigned (2:1) to receive fruquintinib (5 mg capsule) or matched placebo orally once daily on days 1-21 in 28-day cycles, plus best supportive care. Stratification factors were previous trifluridine-tipiracil or regorafenib, or both, RAS mutation status, and duration of metastatic disease. Patients, investigators, study site personnel, and sponsors, except for selected sponsor pharmacovigilance personnel, were masked to study group assignments. The primary endpoint was overall survival, defined as the time from randomisation to death from any cause. A non-binding futility analysis was done when approximately one-third of the expected overall survival events had occurred. Final analysis occurred after 480 overall survival events. This study is registered with ClinicalTrials.gov, NCT04322539, and EudraCT, 2020-000158-88, and is ongoing but not recruiting. FINDINGS Between Aug 12, 2020, and Dec 2, 2021, 934 patients were assessed for eligibility and 691 were enrolled and randomly assigned to receive fruquintinib (n=461) or placebo (n=230). Patients had received a median of 4 lines (IQR 3-6) of previous systemic therapy for metastatic disease, and 502 (73%) of 691 patients had received more than 3 lines. Median overall survival was 7·4 months (95% CI 6·7-8·2) in the fruquintinib group versus 4·8 months (4·0-5·8) in the placebo group (hazard ratio 0·66, 95% CI 0·55-0·80; p<0·0001). Grade 3 or worse adverse events occurred in 286 (63%) of 456 patients who received fruquintinib and 116 (50%) of 230 who received placebo; the most common grade 3 or worse adverse events in the fruquintinib group included hypertension (n=62 [14%]), asthenia (n=35 [8%]), and hand-foot syndrome (n=29 [6%]). There was one treatment-related death in each group (intestinal perforation in the fruquintinib group and cardiac arrest in the placebo group). INTERPRETATION Fruquintinib treatment resulted in a significant and clinically meaningful benefit in overall survival compared with placebo in patients with refractory metastatic colorectal cancer. These data support the use of fruquintinib as a global treatment option for patients with refractory metastatic colorectal cancer. Ongoing analysis of the quality of life data will further establish the clinical benefit of fruquintinib in this patient population. FUNDING HUTCHMED.
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Affiliation(s)
- Arvind Dasari
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sara Lonardi
- Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS Padua, Padua, Italy
| | | | - Elena Elez
- Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Alberto Sobrero
- Department of Medical Oncology, Azienda Ospedaliera San Martino, Genoa, Italy
| | - James Yao
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pilar García-Alfonso
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Judit Kocsis
- Department of Oncoradiology, Bács -Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Antonio Cubillo Gracian
- Medical Oncology, Hospital Universitario HM Sanchinarro Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Andrea Sartore-Bianchi
- Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Taroh Satoh
- Palliative and Supportive Care Center, Osaka University Hospital, Osaka, Japan
| | - Violaine Randrian
- Department of Hepato-Gastroenterology, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Jiri Tomasek
- Department of Complex Oncology Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Geoff Chong
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, VIC, Australia
| | - Andrew Scott Paulson
- Texas Oncology-Baylor Charles A Sammons Cancer Center, US Oncology Research, Dallas, TX, USA
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Jeremy Jones
- Division of Hematology and Medical Oncology, Mayo Clinic Cancer Center, Jacksonville, FL, USA
| | - Tibor Csőszi
- Hetényi Géza Kórház, Onkológiai Központ, Szolnok, Hungary
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Ardaman Shergill
- University of Chicago, Biological Sciences Division, Chicago, IL, USA
| | | | - John Krauss
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ali Bassam
- Békés Megyei Központi Kórház, Pándy Kálmán Tagkórház, Megyei Onkológiai Központ, Gyula, Hungary
| | - Michel Ducreux
- Gustave Roussy Cancer Center, Inserm U1279 Tumors Cell Dynamics, Université Paris Saclay, Villejuif, France
| | - Anneli Elme
- Oncology and Haematology Clinic, North Estonia Medical Centre, Tallinn, Estonia
| | | | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, Department of Oncology and Hematology, AK Altona, Hamburg, Germany
| | - Shivani Nanda
- HUTCHMED International Corporation, Florham Park, NJ, USA
| | - Zhao Yang
- HUTCHMED International Corporation, Florham Park, NJ, USA
| | | | - Marek Kania
- HUTCHMED International Corporation, Florham Park, NJ, USA
| | - Josep Tabernero
- Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology (VHIO), IOB-Quiron, Barcelona, Spain
| | - Cathy Eng
- Division Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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2
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Shah MA, Yoshino T, Tebbutt NC, Grothey A, Tabernero J, Xu RH, Cervantes A, Oh SC, Yamaguchi K, Fakih M, Falcone A, Wu C, Chiu VK, Tomasek J, Bendell J, Fontaine M, Hitron M, Xu B, Taieb J, Van Cutsem E. Napabucasin Plus FOLFIRI in Patients With Previously Treated Metastatic Colorectal Cancer: Results From the Open-Label, Randomized Phase III CanStem303C Study. Clin Colorectal Cancer 2023; 22:100-110. [PMID: 36503738 DOI: 10.1016/j.clcc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Napabucasin is an investigational, orally administered reactive oxygen species generator bioactivated by intracellular antioxidant NAD(P)H:quinone oxidoreductase 1 that has been evaluated in various solid tumors, including metastatic colorectal cancer (mCRC). Phosphorylated signal transducer and activator of transcription 3 (pSTAT3) is hypothesized to predict response in napabucasin-treated patients with mCRC. PATIENT AND METHODS In the multi-center, open-label, phase III CanStem303C (NCT02753127) study, adults with histologically confirmed mCRC that progressed on first-line fluoropyrimidine plus oxaliplatin ± bevacizumab were randomized to twice-daily napabucasin plus FOLFIRI (napabucasin) or FOLFIRI alone (control). The primary endpoint was overall survival (OS) in the general study population and in patients with pSTAT3-positive tumors (biomarker-positive). RESULTS In the general study population (napabucasin, n = 624; control, n = 629), median OS was 14.3 months for napabucasin and 13.8 months for control (hazard ratio [HR], 0.976, one-sided P = .74). Overall, 44% of patients were biomarker-positive (napabucasin, n = 275; control, n = 272). In the biomarker-positive population, median OS was 13.2 months for napabucasin and 12.1 months for control (HR, 0.969; one-sided P > .99). In the control arm, median OS was shorter for biomarker-positive versus biomarker negative patients (12.1 vs. 18.5 months; HR, 1.518; nominal 2-sided P = .0002). The most common treatment-emergent adverse events (TEAEs) were diarrhea (napabucasin, 84.6%; control, 53.9%), nausea (60.5%, 50.5%), vomiting (41.2%, 29.3%), and abdominal pain (41.0%, 25.2%). Grade ≥3 TEAEs occurred in 73.8% of napabucasin-treated and 66.7% of control-treated patients, most commonly diarrhea (21.2%, 7.0%), neutrophil count decreased (13.7%, 19.2%), and neutropenia (13.3%, 15.2%). Safety was similar in biomarker-positive patients. CONCLUSION In patients with previously treated mCRC, adding napabucasin to FOLFIRI did not improve OS. Results from the control arm indicate that pSTAT3 is an adverse prognostic factor in mCRC.
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Affiliation(s)
- Manish A Shah
- Weill Cornell Medicine, New York, NY; New York-Presbyterian Hospital, New York, NY.
| | | | - Niall C Tebbutt
- Department of Medical Oncology, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Axel Grothey
- West Cancer Center and Research Institute, Germantown, TN
| | - Josep Tabernero
- Vall d'Hebron Hospital, Campus and Institute of Oncology (VHIO), IOB-Quiron, UVic- UCC, Barcelona, Spain
| | - Rui-Hua Xu
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Andres Cervantes
- Incliva Biomedical Research Institute, Valencia, Spain; University of Valencia, Valencia, Spain
| | - Sang Cheul Oh
- Korea University College of Medicine, Seoul, South Korea
| | - Kensei Yamaguchi
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Marwan Fakih
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Alfredo Falcone
- University of Pisa, Pisa, Italy; Department of Translational Research, University of Pisa, Pisa, Italy
| | - Christina Wu
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Vi K Chiu
- The Angeles Clinic & Research Institute, a Cedars-Sinai affiliate, Los Angeles, CA
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Johanna Bendell
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN
| | | | | | - Bo Xu
- Sumitomo Dainippon Pharma Oncology, Inc., Cambridge, MA
| | - Julien Taieb
- Hôpital Europeen Georges Pompidou, APHP, Paris, France; Université de Paris, Paris, France; CARPEM Cancer Institute, Paris, France
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven & KULeuven, Leuven, Belgium
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3
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Sobrero AF, Dasari A, Lonardi S, Garcia-Carbonero R, Elez E, Yoshino T, Yao JC, Garcia-Alfonso P, Kocsis J, Cubillo A, Sartore-Bianchi A, Satoh T, Randrian V, Tomasek J, Chong G, Yang Z, Schelman WR, Kania MK, Tabernero J, Eng C. Health-related quality of life (HRQoL) associated with fruquintinib in the global phase 3, placebo-controlled, double-blind FRESCO-2 study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.67] [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: 01/25/2023] Open
Abstract
67 Background: The global phase 3 FRESCO-2 study, (NCT04322539) demonstrated that fruquintinib (F) vs placebo (P) significantly improved OS (HR=0.66 [95% CI: 0.55-0.80]; p<0.001) and PFS (HR=0.32 [95% CI: 0.27-0.39]; p<0.001) in heavily pre-treated patients (pts) with refractory metastatic colorectal cancer (mCRC). F safety profile was consistent with the established monotherapy profile. Here we report the HRQoL and tolerability results. Methods: Pts were randomized 2:1 to F + BSC or P + BSC. EORTC QLQ-C30 and EQ-5D-5L were assessed at baseline and on Day (D) 1 of each Cycle (C) until treatment discontinuation, and ECOG PS was assessed at baseline, D1 of each C, and D21 of C1 to C3. Least-squares mean (LSM) change from baseline to post-baseline visits and the difference between F and P in QLQ-C30 scale scores (e.g. global health status [GHS]/QoL) and EQ-5D-5L scale scores (e.g. visual analog scale [VAS]) were calculated using mixed model repeated measures approach. For each scale, the appropriate minimally important difference (MID) thresholds were determined to evaluate the improvement or deterioration. Time to deterioration (TTD), defined as worsening from baseline in scale-specific MID or death, was analyzed using Kaplan-Meier method, adjusted log-rank test, and stratified Cox PH model. QLQ-C30 and EQ-5D-5L analyses were conducted on the ITT population, and ECOG PS was on the safety population. Results: 691 pts were randomized (F: 461 vs P: 230) and 686 pts received study drug (F: 456 vs P: 230). Median treatment Cycles received (range) were 3 (1, 20) for F vs 2 (1, 13) for P. More than 79% of pts on both arms had a baseline and ≥1 post-baseline assessment for QLQ-C30, EQ-5D-5L, and ECOG PS. GHS/QoL was similar between F and P at baseline; the LSM differences between F and P were 1.7 (95% CI: -1.7, 5.0) for C2 and 1.6 (95% CI: -3.2, 6.4) for C3. At C4, <30 P patients were available. The % of patients who remained stable (MID -6.38 to <8.43) or improved (≥8.43) was numerically higher for F vs P (C2: 61.5% vs 57.1%; C3: 56.4% vs 50.9%). Median TTD was 2.1 months in F and 1.8 months in P (HR=0.9; 95% CI: 0.7-1.0; P=0.098). EQ-5D VAS was similar between F and P at baseline; the LSM differences between F and P were 0.6 (95% CI: -2.3, 3.5) for C2 and 1.4 (95% CI: -2.8, 5.6) for C3. The % of patients who remained stable (MID -7 to <7) or improved (≥7) was similar for F and P (C2: 64.6% vs 58.3%; C3: 64.2% vs 64.8%). Median TTD was 2.6 months in F and 1.9 months in P (HR=0.8; 95% CI: 0.6-0.9; P=0.001). The % of patients with ≥1-point increase from baseline in ECOG PS was 52.1% in F vs 54.0% in P. Conclusions: HRQoL is not negatively impacted by treatment with F. TTD in health utility instrument EQ-5D is improved for patients receiving F. These results, along with improved OS and PFS and favorable toxicity profile, further support F as a potential new treatment option for patients with refractory mCRC. Clinical trial information: NCT04322539 .
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Affiliation(s)
- Alberto F. Sobrero
- Department of Medical Oncology, Azienda Ospealiera San Martino, Genoa, Italy
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sara Lonardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Elena Elez
- Vall d'Hebron Hospital Campus, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - James C. Yao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Antonio Cubillo
- Medical Oncology, Hospital Universitario Madrid Sanchinarro Centro Integral Oncologico, Clara Campal, Madrid, Spain
| | | | - Taroh Satoh
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Violaine Randrian
- Hepato-Gastroenterology Department, Poitiers University Hospital, Poitiers, France
| | - Jiri Tomasek
- Department of Complex Oncology Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Geoff Chong
- Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - Zhao Yang
- HUTCHMED International, Florham Park, NJ
| | | | | | - Josep Tabernero
- Vall d’Hebron Hospital Campus and Institute of Oncology, Barcelona, Spain
| | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN
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4
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Galle PR, Kudo M, Llovet JM, Finn RS, Karwal M, Pezet D, Kim TY, Yang TS, Lonardi S, Tomasek J, Phelip JM, Touchefeu Y, Koh SJ, Stirnimann G, Liang K, Ogburn KD, Wang C, Abada P, Widau RC, Zhu AX. Ramucirumab in patients with previously treated advanced hepatocellular carcinoma: Impact of liver disease aetiology. Liver Int 2021; 41:2759-2767. [PMID: 34173317 DOI: 10.1111/liv.14994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is a common complication of chronic liver disease with diverse underlying aetiologies. REACH/REACH-2 were global phase III studies investigating ramucirumab in advanced HCC (aHCC) following sorafenib treatment. We performed an exploratory analysis of outcomes by liver disease aetiology and baseline serum viral load. METHODS Meta-analysis was conducted in patients with aHCC and alpha-fetoprotein (AFP) ≥400 ng/mL (N = 542) from REACH/REACH-2 trials. Individual patient-level data were pooled with results reported by aetiology subgroup (hepatitis B [HBV] or C [HCV] and Other). Pre-treatment serum HBV DNA and HCV RNA were quantified using Roche COBAS AmpliPrep/COBAS TaqMan. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method and Cox proportional hazard model (stratified by study). RESULTS Baseline characteristics were generally balanced between arms in each subgroup (HBV: N = 225, HCV: N = 127, Other: N = 190). No significant difference in treatment effect by aetiology subgroup was detected (OS interaction P-value = .23). Median OS (ramucirumab vs placebo) in months was 7.7 versus 4.5 (HR 0.74, 95% CI 0.55-0.99) for HBV, 8.2 versus 5.5 (HR 0.82, 95% CI 0.55-1.23) for HCV and 8.5 versus 5.4 (HR 0.56, 95% CI 0.40-0.79) for Other. Ramucirumab showed similar overall safety profiles across subgroups. Worst outcomes were noted in patients with a detectable HBV load. Use of HBV antiviral therapy, irrespective of viral load, was beneficial for survival, liver function and liver-specific adverse events. CONCLUSIONS Ramucirumab improved survival across aetiology subgroups with a tolerable safety profile, supporting its use in patients with aHCC and elevated AFP.
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Affiliation(s)
- Peter R Galle
- Department of Internal Medicine, Mainz University Medical Center, Mainz, Germany
| | - Masatoshi Kudo
- Departments of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Josep M Llovet
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institució Catalana d'Estudis Avançats (ICREA), Barcelona, Spain
| | | | - Mark Karwal
- University of Iowa Hospitals and Clinics, University of Iowa Health Care, Iowa City, IA, USA
| | - Denis Pezet
- Estaing Hospital, Aubrac, Clermont-Ferrand, France
| | - Tae-You Kim
- Seoul National University Hospital, Seoul, Korea
| | | | - Sara Lonardi
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | | | | | - Su-Jin Koh
- Division of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Guido Stirnimann
- University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Kun Liang
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Paolo Abada
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Jiahui International Cancer Center, Jiahui Health, Shanghai, China
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5
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Shah M, Yoshino T, Tebbutt N, Grothey A, Tabernero J, Xu R, Taieb J, Cervantes A, Oh S, Yamaguchi K, Fakih M, Falcone A, Wu C, Chiu V, Tomasek J, Bendell J, Fontaine M, Hitron M, Xu B, Van Cutsem E. O-7 FOLFIRI ± napabucasin in patients with previously treated metastatic colorectal cancer: Overall survival results from the phase 3 CanStem303C study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.011] [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] Open
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6
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Galle PR, Kudo M, Llovet JM, Finn RS, Karwal M, Pezet D, Kim TY, Yang TS, Zagonel V, Tomasek J, Phelip JM, Touchefeu Y, Koh SJ, Stirnimann G, Wang C, Ogburn K, Abada P, Widau RC, Zhu AX. Impact of baseline hepatitis B viremia and management on outcomes in patients (Pts) with advanced hepatocellular carcinoma (HCC) and elevated alpha-fetoprotein (AFP): Outcomes from REACH-2. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.569] [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
569 Background: REACH (NCT01140347) and REACH-2 (NCT02435433) were global, randomized, blinded, placebo (PL)-controlled phase 3 trials of ramucirumab (RAM) in pts with advanced HCC following sorafenib. REACH-2 limited enrollment to pts with AFP ≥400 ng/mL, and met its primary OS endpoint, consistent with the prespecified REACH subgroup with baseline AFP ≥400 ng/mL. Analysis of pooled individual pt data from REACH (AFP ≥400 ng/mL) and REACH-2 showed improved OS with RAM vs PL for pts with hepatitis B virus (HBV) etiology (7.7 vs 4.5 mos; HR 0.74, 95% CI 0.55, 0.99). Here we investigate survival and liver function in REACH-2 pts with HBV etiology tested for serum HBV DNA. Methods: Pts had advanced HCC, Child-Pugh A, ECOG PS 0/1, AFP ≥400 ng/mL, prior sorafenib treatment, and were randomized (2:1) to receive RAM 8 mg/kg or PL Q2W. Pretreatment serum HBV DNA was quantified by HBV-specific PCR (Roche) by a central lab. HBV DNA > 15 IU/mL were detectable (HBV DNA+), < 15 IU/mL were undetectable (HBV DNA-). OS in pooled treatment arms was evaluated using Kaplan-Meier method and Cox proportional hazards model. Liver function was assessed at baseline and before each cycle with the ALBI linear predictor. Outcomes were assessed by concomitant antiviral therapy. Adverse events (AEs) were graded by NCI-CTCAE v4.0. Results: Of 107 REACH-2 pts with HBV etiology, 106 had available PCR samples and were included in a pooled analysis (70 RAM and 36 PL pts). 48 pts were HBV DNA+ and 58 pts were HBV DNA-. HBV DNA+ pts had poorer median OS vs HBV DNA- pts (5.3 vs 10.1 mos, unstratified HR 1.45 95% CI 0.93, 2.28). HBV DNA+ pts taking concomitant antiviral therapy (n = 36) had numerically improved OS compared with those without (n = 12) (5.8 vs 4.0 mos). No difference in OS was noted for HBV DNA- pts by antiviral therapy use (n = 39 antiviral; n = 19 no antiviral) (10.2 vs 9.7 mos for yes vs no antiviral). In pts taking antiviral therapy, regardless of HBV DNA serology, liver function was improved and liver injury/failure related AEs were less frequent. Conclusions: Our data reinforce the use of antiviral therapy to improve outcomes in pts with advanced HBV-associated HCC and elevated AFP. Clinical trial information: NCT02435433.
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Affiliation(s)
| | | | | | | | - Mark Karwal
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Jean Marc Phelip
- Saint Etienne University Hospital, Saint Priest en Jarez, France
| | | | - Su-Jin Koh
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Guido Stirnimann
- University Clinic for Visceral Surgery, Freiburgstrasse, Switzerland
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7
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Van Cutsem E, Yoshino T, Lenz HJ, Lonardi S, Falcone A, Limón ML, Saunders M, Sobrero A, Park YS, Ferreiro R, Hong YS, Tomasek J, Taniguchi H, Ciardiello F, Stoehr J, Oum'Hamed Z, Vlassak S, Studeny M, Argiles G. Nintedanib for the treatment of patients with refractory metastatic colorectal cancer (LUME-Colon 1): a phase III, international, randomized, placebo-controlled study. Ann Oncol 2019; 29:1955-1963. [PMID: 30010751 PMCID: PMC6158765 DOI: 10.1093/annonc/mdy241] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Angiogenesis is critical to colorectal cancer (CRC) growth and metastasis. Phase I/II studies have demonstrated the efficacy of nintedanib, a triple angiokinase inhibitor, in patients with metastatic CRC. This global, randomized, phase III study investigated the efficacy and safety of nintedanib in patients with refractory CRC after failure of standard therapies. Patients and methods Eligible patients (Eastern Cooperative Oncology Group performance status 0–1, with histologically/cytologically confirmed metastatic/locally advanced CRC adenocarcinoma unamenable to surgery and/or radiotherapy) were randomized 1 : 1 to receive nintedanib (200 mg twice daily) or placebo (twice daily), until disease progression or undue toxicity. Patients were stratified by previous regorafenib, time from onset of metastatic disease to randomization, and region. Co-primary end points were overall survival (OS) and progression-free survival (PFS) by central review. Secondary end points included objective tumor response and disease control by central review. Results From October 2014 to January 2016, 768 patients were randomized; 765 were treated (nintedanib n = 384; placebo n = 381). Median follow-up was 13.4 months (interquartile range 11.1–15.7). OS was not improved [median OS 6.4 months with nintedanib versus 6.0 months with placebo; hazard ratio (HR), 1.01; 95% confidence interval (CI), 0.86–1.19; P = 0.8659]. There was a significant but modest increase in PFS with nintedanib versus placebo (median PFS 1.5 versus 1.4 months, respectively; HR 0.58; 95% CI 0.49–0.69; P < 0.0001). There were no complete or partial responses. Adverse events (AEs) occurred in 97% of 384 nintedanib-treated patients and 93% of 381 placebo-treated patients. The most frequent grade ≥3 AEs were liver-related AEs (nintedanib 16%; placebo 8%) and fatigue (nintedanib 9%; placebo 6%). Conclusions The study failed to meet both co-primary end points. Nintedanib did not improve OS and was associated with a significant but modest increase in PFS versus placebo. Nintedanib was well tolerated. ClinicalTrials.gov number NCT02149108 (LUME-Colon 1).
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Affiliation(s)
- E Van Cutsem
- Division of Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium.
| | - T Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H J Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Los Angeles, USA
| | - S Lonardi
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto - IRCCS, Padua
| | - A Falcone
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M L Limón
- Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - M Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Sobrero
- Department of Medical Oncology, Azienda Ospedaliera San Martino, Genoa, Italy
| | - Y S Park
- Department of Hematology and Oncology, Samsung Medical Center, Seoul, South Korea
| | - R Ferreiro
- Department of Clinical Oncology, Ramón y Cajal Hospital, Madrid, Spain
| | - Y S Hong
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - J Tomasek
- Department of Complex Oncology Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - H Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - F Ciardiello
- Oncologia Medica, Seconda Università deli Studi di Napoli, Naples, Italy
| | - J Stoehr
- Boehringer Ingelheim, Pharma GmbH & Co. KG, Biberach, Germany
| | - Z Oum'Hamed
- Boehringer Ingelheim France S.A.S, Reims, France
| | - S Vlassak
- SCS Boehringer Ingelheim Comm.V, Brussels, Belgium
| | - M Studeny
- Division of Medicine/Clinical Development Department, Boehringer Ingelheim, Vienna, Austria
| | - G Argiles
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
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8
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Kudo M, Galle P, Motomura K, Assenat E, Merle P, Brandi G, Daniele B, Okusaka T, Tomasek J, Borg C, Zagonel V, Morimoto M, Pracht M, Finn R, Llovet J, Homma G, Jen MH, Shinozaki K, Yoshikawa R, Zhu A. Efficacy and safety of ramucirumab (RAM) for advanced hepatocellular carcinoma (HCC) with elevated alpha-fetoprotein (AFP) following first-line sorafenib across age subgroups in two global phase III trials (REACH and REACH-2). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Fazio N, Martini JF, Croitoru AE, Schenker M, Li S, Rosbrook B, Fernandez K, Tomasek J, Thiis-Evensen E, Kulke M, Raymond E. Pharmacogenomic analyses of sunitinib in patients with pancreatic neuroendocrine tumors. Future Oncol 2019; 15:1997-2007. [DOI: 10.2217/fon-2018-0934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: Evaluate associations between clinical outcomes and SNPs in patients with well-differentiated pancreatic neuroendocrine tumors receiving sunitinib. Patients & methods: Kaplan–Meier and Cox proportional hazards models were used to analyze the association between SNPs and survival outcomes using data from a sunitinib Phase IV (genotyped, n = 56) study. Fisher’s exact test was used to analyze objective response rate and genotype associations. Results: After multiplicity adjustment, progression-free and overall survivals were not significantly correlated with SNPs; however, a higher objective response rate was significantly associated with IL1B rs16944 G/A versus G/G (46.4 vs 4.5%; p = 0.001). Conclusion: IL1B SNPs may predict treatment response in patients with pancreatic neuroendocrine tumors. VEGF pathway SNPs are potentially associated with survival outcomes.
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Affiliation(s)
- Nicola Fazio
- Division of Gastrointestinal Medical Oncology & Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | | | - Adina E Croitoru
- Department of Medical Oncology, Fundeni Clinical Institute, Bucharest, Romania
| | - Michael Schenker
- Centrul de Oncologie Sf. Nectarie, Oncologie Medicala, Craiova, Romania
| | | | | | | | - Jiri Tomasek
- Faculty of Medicine, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Espen Thiis-Evensen
- Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Matthew Kulke
- Boston University & Boston Medical Center, Boston, MA, USA
| | - Eric Raymond
- Department of Medical Oncology, Paris Saint-Joseph Hospital Group, Paris, France
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10
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Hebart H, Kiehl M, Tomasek J, Csoszi T, Koukakis R, Kafatos G, Kuhn A, Bjorklof K, Demonty G, Buchler T. Prospective Observational Cohort Study to Describe the Use of Panitumumab in Combination with Chemotherapy in Real-World Clinical Practice for Patients with Wild-Type RAS mCRC. Adv Ther 2019; 36:670-683. [PMID: 30689133 PMCID: PMC6824336 DOI: 10.1007/s12325-019-0874-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study aimed to better understand panitumumab use in real-life clinical practice in first- and second-line treatment of metastatic colorectal cancer in five European countries. METHODS This is a combined analysis of two observational, non-interventional prospective cohort studies, one of which was conducted in Germany and France, the other in Bulgaria, Czech Republic, and Hungary. The studies observed patients with wild-type [Kirsten] rat sarcoma viral oncogene homolog ([K]RAS/RAS) metastatic colorectal cancer (mCRC), who had been treated with panitumumab in combination with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) in the first line or with panitumumab combined with fluorouracil, leucovorin, and irinotecan (FOLFIRI) in the second line following fluoropyrimidine-based chemotherapy. The planned duration of observation was 12 months from the first dose of panitumumab. RESULTS A total of 332 patients treated with panitumumab + FOLFOX in the first line and 94 patients treated with panitumumab + FOLFIRI in the second line were analyzed. The median number of panitumumab infusions was 10.0 in first-line FOLFOX patients and 11.5 in second-line FOLFIRI patients; the median duration of panitumumab exposure was 5.7 and 6.9 months, respectively. The unadjusted overall response rate (complete or partial response) in patients with available post-baseline response assessment (n = 290) was 51.7% in first-line FOLFOX and 44.9% in second-line FOLFIRI patients. In the first-line setting, resectability was achieved in 9.3%. Reported hospitalizations were mostly cancer-related visits such as scheduled anticancer treatment administrations, tumor assessment visits, or interventions. The majority of adverse drug reactions were skin disorders, with 75.3% in first-line FOLFOX patients and 72.3% in second-line FOLFIRI patients. CONCLUSION Overall, the study results show that treatment patterns, clinical efficacy, and the safety profile of panitumumab in routine clinical practice were comparable to those in randomized controlled trials. The relatively low skin toxicity rate could be attributed to increasing experience in managing panitumumab-associated rash and some degree of underreporting. FUNDING Amgen.
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Affiliation(s)
- Holger Hebart
- Department of Internal Medicine, Stauferklinikum Schwäbisch Gmünd, Mutlangen, Germany.
| | - Michael Kiehl
- Medical Clinic I, Klinikum Frankfurt (Oder) GmbH, Frankfurt (Oder), Germany
| | - Jiri Tomasek
- Clinic of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tibor Csoszi
- Oncology Department, Hetenyi G. County Hospital, Szolnok, Hungary
| | | | - George Kafatos
- Center for Observational Research, Amgen Ltd, Uxbridge, UK
| | - Anja Kuhn
- Research and Development, Amgen GmbH, Munich, Germany
| | - Katja Bjorklof
- EU Medical Affairs, Amgen (Europe) GmbH, Rotkreuz, Switzerland
| | | | - Tomas Buchler
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
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Fazio N, Martini JF, Croitoru AE, Schenker M, Li S, Rosbrook B, Fernandez KC, Tomasek J, Thiis-Evensen E, Kulke MH, Raymond E. Sunitinib in patients with pancreatic neuroendocrine tumors (panNETs): Exploratory pharmacogenomic analyses. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.255] [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
255 Background: In a phase IV trial (NCT01525550), median progression-free survival (PFS) was 13.2 mo in sunitinib-treated patients (pts) with well-differentiated panNETs. Objective response rate (ORR) was 24.5% and median overall survival (OS) was 37.8 mo. Exploratory analyses evaluated potential associations between single nucleotide polymorphisms (SNP) in genes involved in angiogenesis, protein transport or inflammatory response and clinical outcomes. Methods: Blood samples were genotyped using TaqMan assays for 12 SNPs previously associated with panNET risk, prognosis or drug effect. Associations between SNP and PFS or OS were assessed by comparing genotypes within treatment-naïve (TN), previously treated (PT) and combined groups, and within a genotype between treatment groups, using Kaplan-Meier analysis and Cox proportional hazards models. Fisher’s exact test was used for association between ORR and genotype. PFS and ORR were investigator-assessed. P values displayed are unadjusted and Bonferroni method was used for multiplicity adjustment. Results: 56 pts were genotyped: 25 TN and 31 PT. There were no significant associations between genotype and PFS or OS but there was a trend toward shorter PFS in pts with VEGFR1 rs9554320 C/A versus C/C (hazard ratio [HR] 1.78; 95% confidence interval [CI] 0.83–3.82; p = 0.117) and VEGFR1 rs9582036 A/C versus A/A (HR 1.88; 95% CI 0.9–3.93; p = 0.102). The genotypes G/G of VEGFA rs2010963 (p = 0.041) , G/G of VEGFA rs833068 (p = 0.041) and A/C of VEGFR1 rs9582036 (p = 0.046) showed a trend toward a higher ORR in the PT versus TN group. Genotype T/T of VEGFR2 rs7692791 (p = 0.103) showed a trend toward to a lower ORR in the TN versus PT group. Higher ORR was associated with IL1B rs16944 G/A versus G/G (46.4% vs 4.5%; p = 0.001) in the combined group. Conclusions: Potential associations between ORR and VEGFA rs2010963 and rs833068, VEGFR1 rs9582036 and VEGFR2 rs7692791 were observed. IL1B rs16944 was significantly associated with ORR, consistent with the role of IL1B in panNET etiology and development. Most correlations were not significant after adjustment for multiplicity. Clinical trial information: NCT01525550.
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Affiliation(s)
| | | | | | | | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Eric Raymond
- Paris Saint-Joseph Hospital Group, Paris, France
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12
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Kopeckova K, Chloupkova R, Melichar B, Linke Z, Petruzelka L, Finek J, Fiala O, Tomasek J, Kiss I, Prausova J, Buchler T. Regorafenib for metastatic colorectal carcinoma: A registry-based analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.016] [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: 11/13/2022] Open
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13
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Hebart HF, Tomasek J, Csõszi T, Koukakis R, Kafatos G, Kuhn A, Björklöf K, Buchler T. Clinical practice use of panitumumab combined with chemotherapy in patients with wild-type RAS metastatic colorectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.852] [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
852 Background: This study aimed to understand panitumumab (pmab) use in clinical practice for patients with wild-type RAS metastatic colorectal cancer (mCRC), in first-line (1L) with FOLFOX or second-line (2L) with FOLFIRI following fluoropyrimidine-based chemotherapy (excl. irinotecan). Methods: This is a combined analysis of two observational, non-interventional prospective cohort studies conducted in Germany/France (2012-2016) and Bulgaria/Czech Republic/Hungary (2013-2016). Results: Results are presented in the order of 1L FOLFOX (n = 332) followed by 2L FOLFIRI (n = 94). Patients received a median of 10 and 11.5 pmab infusions. The median duration of pmab exposure was 5.7 and 6.9 months (note that 53 and 10 patients continued pmab use after study end). The unadjusted overall response rate (complete or partial response) was 42% and 29%, based on 45% and 44% of patients with available response data post-baseline. In the 1L setting, resectability was achieved in 9%, not achieved in 42%, and unknown in 48%. Hospitalizations were reported for 100% and 99%, mostly cancer-related visits such as scheduled anticancer treatment (e.g. chemotherapy/pmab administrations), tumor assessment visits, or interventions; 93% in both groups reported outpatient, 66% and 60% inpatient visits. Conclusions: Overall, the study results show that treatment patterns and clinical efficacy of pmab in routine clinical practice were comparable to randomized controlled trials (RCTs). The ADR/SADR skin toxicity events are lower than expected based on findings from RCTs, however, similar findings have been shown in a previous observational study. More investigation is required to understand the reason for this.[Table: see text]
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Affiliation(s)
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Tibor Csõszi
- JNSZ Megyei Hetényi Géza Kórház-Rendelöintézet, Szolnok, Hungary
| | | | | | | | | | - Tomas Buchler
- Charles University/ Thomayer Hospital, Prague, Czech Republic
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14
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Singh S, Carnaghi C, Buzzoni R, Pommier RF, Raderer M, Tomasek J, Lahner H, Valle JW, Voi M, Bubuteishvili-Pacaud L, Lincy J, Wolin E, Okita N, Libutti SK, Oh DY, Kulke M, Strosberg J, Yao JC, Pavel ME, Fazio N. Everolimus in Neuroendocrine Tumors of the Gastrointestinal Tract and Unknown Primary. Neuroendocrinology 2018; 106:211-220. [PMID: 28554173 DOI: 10.1159/000477585] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/18/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE The RADIANT-4 randomized phase 3 study demonstrated significant prolongation of median progression-free survival (PFS) with everolimus compared to placebo (11.0 [95% CI 9.2-13.3] vs. 3.9 [95% CI 3.6-7.4] months) in patients with advanced, progressive, nonfunctional gastrointestinal (GI) and lung neuroendocrine tumors (NET). This analysis specifically evaluated NET patients with GI and unknown primary origin. METHODS Patients in the RADIANT-4 trial were randomized 2:1 to everolimus 10 mg/day or placebo. The effect of everolimus on PFS was evaluated in patients with NET of the GI tract or unknown primary site. RESULTS Of the 302 patients enrolled, 175 had GI NET (everolimus, 118; placebo, 57) and 36 had unknown primary (everolimus, 23; placebo, 13). In the GI subset, the median PFS by central review was 13.1 months (95% CI 9.2-17.3) in the everolimus arm versus 5.4 months (95% CI 3.6-9.3) in the placebo arm; the hazard ratio (HR) was 0.56 (95% CI 0.37-0.84). In the unknown primary patients, the median PFS was 13.6 months (95% CI 4.1-not evaluable) for everolimus versus 7.5 months (95% CI 1.9-18.5) for placebo; the HR was 0.60 (95% CI 0.24-1.51). Everolimus efficacy was also demonstrated in both midgut and non-midgut populations; a 40-46% reduction in the risk of progression or death was reported for patients in the combined GI and unknown primary subgroup. Everolimus had a benefit regardless of prior somatostatin analog therapy. CONCLUSIONS Everolimus showed a clinically meaningful PFS benefit in patients with advanced progressive nonfunctional NET of GI and unknown primary, consistent with the overall RADIANT-4 results, providing an effective new standard treatment option in this patient population and filling an unmet treatment need for these patients.
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Affiliation(s)
- Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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15
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Raymond E, Kulke MH, Qin S, Yu X, Schenker M, Cubillo A, Lou W, Tomasek J, Thiis-Evensen E, Xu JM, Croitoru AE, Khasraw M, Sedlackova E, Borbath I, Ruff P, Oberstein PE, Ito T, Jia L, Hammel P, Shen L, Shrikhande SV, Shen Y, Sufliarsky J, Khan GN, Morizane C, Galdy S, Khosravan R, Fernandez KC, Rosbrook B, Fazio N. Efficacy and Safety of Sunitinib in Patients with Well-Differentiated Pancreatic Neuroendocrine Tumours. Neuroendocrinology 2018; 107:237-245. [PMID: 29991024 DOI: 10.1159/000491999] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND In a phase III study, sunitinib led to a significant increase in progression-free survival (PFS) versus placebo in patients with pancreatic neuroendocrine tumours (panNETs). This study was a post-marketing commitment to support the phase III data. METHODS In this ongoing, open-label, phase IV trial (NCT01525550), patients with progressive, advanced unresectable/metastatic, well-differentiated panNETs received continuous sunitinib 37.5 mg once daily. Eligibility criteria were similar to those of the phase III study. The primary endpoint was investigator-assessed PFS per Response Evaluation Criteria in Solid Tumours v1.0 (RECIST). Other endpoints included PFS per Choi criteria, overall survival (OS), objective response rate (ORR), and adverse events (AEs). RESULTS Sixty-one treatment-naive and 45 previously treated patients received sunitinib. By March 19, 2016, 82 (77%) patients had discontinued treatment, mainly due to disease progression. Median treatment duration was 11.7 months. Investigator-assessed median PFS per RECIST (95% confidence interval [CI]) was 13.2 months (10.9-16.7): 13.2 (7.4-16.8) and 13.0 (9.2-20.4) in treatment-naive and previously treated patients, respectively. ORR (95% CI) per RECIST was 24.5% (16.7-33.8) in the total population: 21.3% (11.9-33.7) in treatment-naive and 28.9% (16.4-44.3) in previously treated patients. Median OS, although not yet mature, was 37.8 months (95% CI, 33.0-not estimable). The most common treatment-related AEs were neutropenia (53.8%), diarrhoea (46.2%), and leukopenia (43.4%). CONCLUSIONS This phase IV trial confirms sunitinib as an efficacious and safe treatment option in patients with advanced/metastatic, well-differentiated, unresectable panNETs, and supports the phase III study outcomes. AEs were consistent with the known safety profile of sunitinib.
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Affiliation(s)
- Eric Raymond
- Department of Medical Oncology, Paris Saint-Joseph Hospital Group, Paris, France
| | - Matthew H Kulke
- Program in Neuroendocrine and Carcinoid Tumors, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shukui Qin
- PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China
| | - Xianjun Yu
- Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Michael Schenker
- Centrul de Oncologie Sf. Nectarie, Oncologie Medicala, Craiova, Romania
| | - Antonio Cubillo
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Wenhui Lou
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiri Tomasek
- Faculty of Medicine, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Espen Thiis-Evensen
- Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jian-Ming Xu
- No. 307 Hospital, Academy of Military Medical Sciences, Beijing, China
| | - Adina E Croitoru
- Department of Medical Oncology, Fundeni Clinical Institute, Bucharest, Romania
| | - Mustafa Khasraw
- Andrew Love Cancer Center, Geelong Hospital, Victoria, Victoria, Australia
| | - Eva Sedlackova
- Všeobecné Fakultní Nemocnice v Praze Onkologická Klinika, Prague, Czech Republic
| | - Ivan Borbath
- Hepato-Gastroenterology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Paul Ruff
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul E Oberstein
- Division of Hematology/Oncology, Columbia University Medical Center, New York, New York, USA
| | - Tetsuhide Ito
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Liqun Jia
- China-Japan Friendship Hospital, Beijing, China
| | - Pascal Hammel
- Service d'Oncologie Digestive, Hôpital Beaujon, Clichy, France
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Yali Shen
- West China Hospital of Sichuan University, Chengdu, China
| | - Jozef Sufliarsky
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | | | - Salvatore Galdy
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, Milan, Italy
| | - Reza Khosravan
- Pfizer Oncology, Pfizer Inc., San Diego, California, USA
| | | | - Brad Rosbrook
- Pfizer Oncology, Pfizer Inc., San Diego, California, USA
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, Milan,
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16
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Fazio N, Buzzoni R, Delle Fave G, Tesselaar ME, Wolin E, Van Cutsem E, Tomassetti P, Strosberg J, Voi M, Bubuteishvili-Pacaud L, Ridolfi A, Herbst F, Tomasek J, Singh S, Pavel M, Kulke MH, Valle JW, Yao JC. Everolimus in advanced, progressive, well-differentiated, non-functional neuroendocrine tumors: RADIANT-4 lung subgroup analysis. Cancer Sci 2017; 109:174-181. [PMID: 29055056 PMCID: PMC5765303 DOI: 10.1111/cas.13427] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 07/05/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 12/23/2022] Open
Abstract
In the phase III RADIANT-4 study, everolimus improved median progression-free survival (PFS) by 7.1 months in patients with advanced, progressive, well-differentiated (grade 1 or grade 2), non-functional lung or gastrointestinal neuroendocrine tumors (NETs) vs placebo (hazard ratio, 0.48; 95% confidence interval [CI], 0.35-0.67; P < .00001). This exploratory analysis reports the outcomes of the subgroup of patients with lung NETs. In RADIANT-4, patients were randomized (2:1) to everolimus 10 mg/d or placebo, both with best supportive care. This is a post hoc analysis of the lung subgroup with PFS, by central radiology review, as the primary endpoint; secondary endpoints included objective response rate and safety measures. Ninety of the 302 patients enrolled in the study had primary lung NET (everolimus, n = 63; placebo, n = 27). Median PFS (95% CI) by central review was 9.2 (6.8-10.9) months in the everolimus arm vs 3.6 (1.9-5.1) months in the placebo arm (hazard ratio, 0.50; 95% CI, 0.28-0.88). More patients who received everolimus (58%) experienced tumor shrinkage compared with placebo (13%). Most frequently reported (≥5% incidence) grade 3-4 drug-related adverse events (everolimus vs. placebo) included stomatitis (11% vs. 0%), hyperglycemia (10% vs. 0%), and any infections (8% vs. 0%). In patients with advanced, progressive, well-differentiated, non-functional lung NET, treatment with everolimus was associated with a median PFS improvement of 5.6 months, with a safety profile similar to that of the overall RADIANT-4 cohort. These results support the use of everolimus in patients with advanced, non-functional lung NET. The trial is registered with ClinicalTrials.gov (no. NCT01524783).
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Affiliation(s)
- Nicola Fazio
- European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Buzzoni
- Fondazione IRCCS Foundation, The National Institute of Tumors, Milan, Italy
| | | | - Margot E Tesselaar
- Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Edward Wolin
- Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg/Leuven and KU Leuven, Leuven, Belgium
| | - Paola Tomassetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Maurizio Voi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Jiri Tomasek
- Faculty of Medicine, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Marianne Pavel
- Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | | | - Juan W Valle
- Institute of Cancer Sciences, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - James C Yao
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Kopeckova K, Buchler T, Bortlicek Z, Hejduk K, Chloupkova R, Melichar B, Pokorna P, Tomasek J, Linke Z, Petruzelka L, Kiss I, Prausova J. Regorafenib in the Real-Life Clinical Practice: Data from the Czech Registry. Target Oncol 2017; 12:89-95. [PMID: 27638381 DOI: 10.1007/s11523-016-0458-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the use of regorafenib for the treatment of metastatic colorectal cancer (mCRC) in clinical practice in the Czech Republic, and to describe the clinical outcomes of patients in terms of safety and survival. PATIENTS AND METHODS The data of patients treated with regorafenib were extracted from the national CORECT registry. The CORECT registry is a non-interventional post-marketing database, gathering information about patients with CRC and treated with targeted agents. Twenty oncology centres in the Czech Republic contributed to this registry. Collected data included patients' characteristics, disease history, cancer treatments, response to treatments and safety. RESULTS A total of 148 patients treated with regorafenib in clinical practice were analysed. At regorafenib initiation, almost all patients were fully active or slightly restricted in physical activity. Regorafenib was not administered as first-line treatment in any patient. Median progression-free survival was 3.5 months and median overall survival was 9.3 months. One-year survival rate was 44.6 %. Four partial responses were observed and 51 stable diseases. Progression was observed in 66 patients (44.6 %). The main reported adverse events were skin toxicity (5.4 %) and fatigue (2.0 %). CONCLUSIONS Regorafenib is a well-established treatment for pretreated patients with mCRC, however real-life data are scarce. Our results demonstrated slightly better efficacy of regorafenib and better safety profile in patients with mCRC compared to the randomised trials.
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Affiliation(s)
- Katerina Kopeckova
- Department of Oncology, University Hospital in Motol, Charles University, V Uvalu 84, 150 00, Prague, Czech Republic.
| | - Tomas Buchler
- Department of Oncology, First Faculty of Medicine and Thomayer Hospital, Charles University, Prague, Czech Republic
| | - Zbynek Bortlicek
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Karel Hejduk
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Renata Chloupkova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Palacky University Medical and Teaching Hospital, Olomouc, Czech Republic
| | - Petra Pokorna
- Department of Oncology, University Hospital in Motol, Charles University, V Uvalu 84, 150 00, Prague, Czech Republic
| | - Jiri Tomasek
- Department of Oncology, Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Zdenek Linke
- Department of Oncology, University Hospital in Motol, Charles University, V Uvalu 84, 150 00, Prague, Czech Republic
| | - Lubos Petruzelka
- Department of Oncology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Igor Kiss
- Department of Oncology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Jana Prausova
- Department of Oncology, University Hospital in Motol, Charles University, V Uvalu 84, 150 00, Prague, Czech Republic
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18
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Tabernero J, Ohtsu A, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Ajani JA, Tomasek J, Safran H, Chandrawansa K, Hsu Y, Heathman M, Khan A, Ni L, Melemed AS, Gao L, Ferry D, Fuchs CS. Exposure-Response Analyses of Ramucirumab from Two Randomized, Phase III Trials of Second-line Treatment for Advanced Gastric or Gastroesophageal Junction Cancer. Mol Cancer Ther 2017; 16:2215-2222. [PMID: 28716815 DOI: 10.1158/1535-7163.mct-16-0895] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/06/2017] [Accepted: 06/22/2017] [Indexed: 11/16/2022]
Abstract
Ramucirumab is an IgG1 monoclonal antibody specific for the vascular endothelial growth factor receptor-2. Ramucirumab, 8 mg/kg every 2 weeks, administered as monotherapy (REGARD) or in combination with paclitaxel (RAINBOW), was safe and effective in patients with previously treated advanced gastric or gastroesophageal junction (GEJ) cancer. We evaluated exposure-efficacy and exposure-safety relationships of ramucirumab from two randomized, placebo-controlled phase III trials. Sparse pharmacokinetic samples were collected, and a population pharmacokinetic analysis was conducted to predict ramucirumab minimum trough concentration at steady state (Cmin,ss). Kaplan-Meier methods and Cox proportional hazards models were used to evaluate the ramucirumab exposure (Cmin,ss)-efficacy relationship to overall survival (OS) and progression-free survival (PFS). Logistic regression analyses were used to evaluate exposure-safety relationships. Analyses included 321 ramucirumab + paclitaxel and 335 placebo + paclitaxel patients from RAINBOW and 72 ramucirumab and 35 placebo patients from REGARD. Exposure-efficacy analysis showed ramucirumab Cmin,ss was a significant predictor of OS and PFS in both trials. Higher ramucirumab exposure was associated with longer OS and PFS. In RAINBOW, grade ≥3 hypertension, leukopenia, and neutropenia, but not febrile neutropenia, significantly correlated with Cmin,ss, with increased exposure leading to increased incidence. Exploratory exposure-response analyses suggest a positive relationship between efficacy and ramucirumab exposure with manageable toxicities at exposures generated from a dose of 8 mg/kg ramucirumab given every 2 weeks for patients with advanced gastric/GEJ cancer. These findings suggest an opportunity to further optimize benefit versus risk profiles of ramucirumab treatment in patients with gastric/GEJ cancer. Mol Cancer Ther; 16(10); 2215-22. ©2017 AACR.
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Affiliation(s)
- Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Atsushi Ohtsu
- National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kei Muro
- Aichi Cancer Center Hospital, Nagoya, Japan
| | | | | | | | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Yanzhi Hsu
- Eli Lilly and Company, Bridgewater, New Jersey
| | | | - Azhar Khan
- Eli Lilly and Company, Windlesham, Surrey, United Kingdom
| | - Lan Ni
- Eli Lilly and Company, Indianapolis, Indiana
| | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, New Jersey
| | - David Ferry
- Eli Lilly and Company, Indianapolis, Indiana
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19
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Fuchs CS, Muro K, Tomasek J, Van Cutsem E, Cho JY, Oh SC, Safran H, Bodoky G, Chau I, Shimada Y, Al-Batran SE, Passalacqua R, Ohtsu A, Emig M, Ferry D, Chandrawansa K, Hsu Y, Sashegyi A, Liepa AM, Wilke H. Prognostic Factor Analysis of Overall Survival in Gastric Cancer from Two Phase III Studies of Second-line Ramucirumab (REGARD and RAINBOW) Using Pooled Patient Data. J Gastric Cancer 2017; 17:132-144. [PMID: 28680718 PMCID: PMC5489542 DOI: 10.5230/jgc.2017.17.e16] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify baseline prognostic factors for survival in patients with disease progression, during or after chemotherapy for the treatment of advanced gastric or gastroesophageal junction (GEJ) cancer. MATERIALS AND METHODS We pooled data from patients randomized between 2009 and 2012 in 2 phase III, global double-blind studies of ramucirumab for the treatment of advanced gastric or GEJ adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing therapy (REGARD and RAINBOW). Forty-one key baseline clinical and laboratory factors common in both studies were examined. Model building started with covariate screening using univariate Cox models (significance level=0.05). A stepwise multivariable Cox model identified the final prognostic factors (entry+exit significance level=0.01). Cox models were stratified by treatment and geographic region. The process was repeated to identify baseline prognostic quality of life (QoL) parameters. RESULTS Of 1,020 randomized patients, 953 (93%) patients without any missing covariates were included in the analysis. We identified 12 independent prognostic factors of poor survival: 1) peritoneal metastases; 2) Eastern Cooperative Oncology Group (ECOG) performance score 1; 3) the presence of a primary tumor; 4) time to progression since prior therapy <6 months; 5) poor/unknown tumor differentiation; abnormally low blood levels of 6) albumin, 7) sodium, and/or 8) lymphocytes; and abnormally high blood levels of 9) neutrophils, 10) aspartate aminotransferase (AST), 11) alkaline phosphatase (ALP), and/or 12) lactate dehydrogenase (LDH). Factors were used to devise a 4-tier prognostic index (median overall survival [OS] by risk [months]: high=3.4, moderate=6.4, medium=9.9, and low=14.5; Harrell's C-index=0.66; 95% confidence interval [CI], 0.64-0.68). Addition of QoL to the model identified patient-reported appetite loss as an independent prognostic factor. CONCLUSIONS The identified prognostic factors and the reported prognostic index may help clinical decision-making, patient stratification, and planning of future clinical studies.
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Affiliation(s)
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eric Van Cutsem
- University Hospital Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | | | | | - Howard Safran
- Oncology Research Group, Brown University, Providence, RI, USA
| | | | - Ian Chau
- Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Yasuhiro Shimada
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Salah-Eddin Al-Batran
- Institute of Clinical Research, Universitären Centrum für Tumorerkrankungen-University Cancer Center, Frankfurt, Germany
| | | | - Atsushi Ohtsu
- Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | | | | | | | - Yanzhi Hsu
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | | | - Hansjochen Wilke
- Departments of Oncology and Hematology with Integrated Palliative Care, Kliniken Essen-Mitte, Essen, Germany
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20
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Raymond E, Kulke MH, Qin S, Schenker M, Cubillo A, Lou W, Tomasek J, Thiis-Evensen E, Xu J, Racz DK, Croitoru AE, Khasraw M, Sedlackova E, Borbath I, Ruff P, Oberstein PE, Ito T, Fernandez KC, Rosbrook B, Fazio N. The efficacy and safety of sunitinib in patients with advanced well-differentiated pancreatic neuroendocrine tumors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
380 Background: Sunitinib was approved by the FDA in 2011 for treatment of progressive, well-differentiated, advanced pancreatic neuroendocrine tumors (pNETs) based on a pivotal phase III study (NCT00428597) that showed a significant increase in progression-free survival (PFS) over placebo following early study termination. Subsequently, the FDA requested a post-approval study to support these findings. Methods: In this open-label, phase IV clinical trial (NCT01525550), patients with progressive, well-differentiated, unresectable advanced/metastatic pNETs received continuous sunitinib 37.5 mg once daily. Eligibility criteria were similar to the phase III study. Primary endpoint was investigator-assessed PFS per RECIST 1.0. This study is ongoing. Results: Sixty one treatment-naïve and 45 previously treated patients with progressive pNETs were treated with sunitinib: mean age, 54.6 years; males, 59.4%; white, 63.2%; ECOG PS 0, 65.1% or PS 1, 34.0%; and prior somatostatin analog, 48.1% (treatment-naïve, 39.3%; previously treated, 60.0%). At the data cutoff date, 82 (77%) patients discontinued treatment, mainly due to disease progression (46%). Median duration of treatment was ~11.9 months. Investigator-assessed median PFS (mPFS) was 13.2 months (95% CI, 10.9–16.7) in the overall population, with comparable mPFS in treatment-naïve and previously treated patients (13.2 vs 13.0 months). mPFS per independent radiologic review was 11.1 months (95% CI, 7.4–16.6). Objective response rate (ORR) per RECIST was 24.5%: 21.3% in treatment-naïve and 28.9% in previously treated patients. Median overall survival, although not yet mature, was 37.8 months. Treatment-emergent, all-causality adverse events (AEs) reported by ≥ 20% of all patients included neutropenia, diarrhea, leukopenia, fatigue, hand–foot syndrome, hypertension, abdominal pain, dysgeusia, and nausea. Most common grade 3/4 AEs were neutropenia (22%) and diarrhea (9%). Conclusions: The mPFS of 13.2 months and ORR of 24.5% observed in this study support the outcomes of the pivotal phase III study of sunitinib in pNETs and confirm its activity in this setting. AEs were consistent with known safety profile of sunitinib. Clinical trial information: NCT01525550.
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Affiliation(s)
| | | | | | | | - Antonio Cubillo
- Centro Integral Oncologico Clara Campal- Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | | | | | - Dr. Karoly Racz
- SEMMELWEISZ EGYETEM - II. BELGYOGYASZATI KLINIKA, Budapest, Hungary
| | | | | | - Eva Sedlackova
- First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic
| | - Ivan Borbath
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Paul Ruff
- University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Tetsuhide Ito
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Nicola Fazio
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy
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21
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Lenz HJ, Tabernero J, Yoshino T, Lonardi S, Falcone A, Limón Mirón ML, Saunders MP, Sobrero AF, Park YS, Ferreiro Monteagudo R, Hong YS, Tomasek J, Taniguchi H, Ciardiello F, Sassi M, Peil B, Hastedt C, Studeny M, Van Cutsem E. Nintedanib (N) plus best supportive care (BSC) versus placebo plus BSC for the treatment of patients (pts) with metastatic colorectal cancer (mCRC) refractory to standard therapies: Health-related quality of life (HRQoL) results of the Phase III LUME-Colon 1 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.671] [Citation(s) in RCA: 2] [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
671 Background: N is a multiple angiokinase inhibitor (including VEGFR, PDGFR and FGFR). A randomised Phase III study, LUME-Colon 1 (NCT02149108), evaluated the efficacy and safety of N in pts with refractory mCRC after failure of standard therapies. LUME-Colon 1 showed a statistically significant improvement in PFS (HR [95% CI] 0.58 [0.49–0.69]; p < 0.0001) but no difference in OS (HR [95% CI]: 1.01 [0.86–1.19]; p = 0.8659). Here, we report the HRQoL outcomes. Methods: 768 pts with mCRC adenocarcinoma refractory to standard chemotherapy were randomised 1:1 to receive either N (200 mg bid) + BSC or P (bid) + BSC in 21-day courses until disease progression or undue toxicity. HRQoL was assessed every 21 days using the EORTC QLQ-C30 instrument; the main endpoints of interest were the differences in mean scores up to median follow-up time (treatment difference, TD) for physical functioning (PF) and global health status/QoL (QL) scales using a longitudinal model, with 95% CIs and associated p-values adjusted for baseline stratification factors. Time to deterioration (TTD) of scores and status change ( ≥ 10 point change from baseline) were also assessed. Results: Compliance with questionnaire completion was high ( > 85% in first 12 cycles). Mean baseline (N vs P) PF (80 vs 80) and QL (65 vs 65) scale scores were balanced between treatment arms. The mean TD favoured N vs P for PF scale scores (TD 2.66 [95% CI: 0.97–4.34]; p = 0.0020) and QL scale scores (TD 1.61 [95% CI: −0.04–3.27]; p = 0.0555). TTD of PF (HR 0.84; 95% CI: 0.69–1.03; p = 0.0904) and QL (HR 0.90; 95% CI: 0.75–1.08; p = 0.2674) scores were not significantly different between treatment groups, although the percentage of patients with improved PF (17.2% vs 11.8%; p = 0.0462) and QL scores (30.3% vs 21.6%: p = 0.0102) were both significantly higher for N vs P. Conclusions: In LUME-Colon 1, patient reported outcomes confirmed that overall HRQoL was not impaired by treatment with N. There was evidence for improvement of PF and QL with N vs P, corresponding to the significant increase in PFS observed. Clinical trial information: NCT02149108.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Young Suk Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Yong Sang Hong
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Hiroya Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Yao JC, Fazio N, Singh S, Buzzoni R, Carnaghi C, Wolin EM, Tomasek J, Raderer M, Lahner H, Voi M, Bubuteishvili-Pacaud L, Lincy J, Valle JW, Delle Fave G, Van Cutsem E, Oh DY, Strosberg JR, Kulke MH, Pavel ME. Everolimus (EVE) in advanced, nonfunctional, well-differentiated neuroendocrine tumors (NET) of gastrointestinal (GI) or lung origin: Second interim overall survival (OS) results from the RADIANT-4 study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nicola Fazio
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Markus Raderer
- University Klinik f. Innere Medizin I, AKH, Wien, Austria
| | - Harald Lahner
- Universitaetsklinikum Essen, Zentrum f. Innere Medizin, Essen, Germany
| | | | | | | | - Juan W. Valle
- Institute of Cancer Studies, University of Manchester, The Christie Hospital, Manchester, United Kingdom
| | | | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg/Leuven and KULeuven, Leuven, Belgium
| | - Do-Youn Oh
- Seoul National University Hospital, Seoul, Korea, The Republic of
| | | | | | - Marianne E. Pavel
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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23
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Yao JC, Fazio N, Singh S, Buzzoni R, Carnaghi C, Wolin E, Tomasek J, Raderer M, Lahner H, Voi M, Pacaud LB, Rouyrre N, Sachs C, Valle JW, Fave GD, Van Cutsem E, Tesselaar M, Shimada Y, Oh DY, Strosberg J, Kulke MH, Pavel ME. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Lancet 2016; 387:968-977. [PMID: 26703889 PMCID: PMC6063317 DOI: 10.1016/s0140-6736(15)00817-x] [Citation(s) in RCA: 781] [Impact Index Per Article: 97.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Effective systemic therapies for patients with advanced, progressive neuroendocrine tumours of the lung or gastrointestinal tract are scarce. We aimed to assess the efficacy and safety of everolimus compared with placebo in this patient population. METHODS In the randomised, double-blind, placebo-controlled, phase 3 RADIANT-4 trial, adult patients (aged ≥18 years) with advanced, progressive, well-differentiated, non-functional neuroendocrine tumours of lung or gastrointestinal origin were enrolled from 97 centres in 25 countries worldwide. Eligible patients were randomly assigned in a 2:1 ratio by an interactive voice response system to receive everolimus 10 mg per day orally or identical placebo, both with supportive care. Patients were stratified by tumour origin, performance status, and previous somatostatin analogue treatment. Patients, investigators, and the study sponsor were masked to treatment assignment. The primary endpoint was progression-free survival assessed by central radiology review, analysed by intention to treat. Overall survival was a key secondary endpoint. This trial is registered with ClinicalTrials.gov, number NCT01524783. FINDINGS Between April 3, 2012, and Aug 23, 2013, a total of 302 patients were enrolled, of whom 205 were allocated to everolimus 10 mg per day and 97 to placebo. Median progression-free survival was 11·0 months (95% CI 9·2-13·3) in the everolimus group and 3·9 months (3·6-7·4) in the placebo group. Everolimus was associated with a 52% reduction in the estimated risk of progression or death (hazard ratio [HR] 0·48 [95% CI 0·35-0·67], p<0·00001). Although not statistically significant, the results of the first pre-planned interim overall survival analysis indicated that everolimus might be associated with a reduction in the risk of death (HR 0·64 [95% CI 0·40-1·05], one-sided p=0·037, whereas the boundary for statistical significance was 0·0002). Grade 3 or 4 drug-related adverse events were infrequent and included stomatitis (in 18 [9%] of 202 patients in the everolimus group vs 0 of 98 in the placebo group), diarrhoea (15 [7%] vs 2 [2%]), infections (14 [7%] vs 0), anaemia (8 [4%] vs 1 [1%]), fatigue (7 [3%] vs 1 [1%]), and hyperglycaemia (7 [3%] vs 0). INTERPRETATION Treatment with everolimus was associated with significant improvement in progression-free survival in patients with progressive lung or gastrointestinal neuroendocrine tumours. The safety findings were consistent with the known side-effect profile of everolimus. Everolimus is the first targeted agent to show robust anti-tumour activity with acceptable tolerability across a broad range of neuroendocrine tumours, including those arising from the pancreas, lung, and gastrointestinal tract. FUNDING Novartis Pharmaceuticals Corporation.
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Affiliation(s)
- James C Yao
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Nicola Fazio
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Roberto Buzzoni
- Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Edward Wolin
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Harald Lahner
- Universitaetsklinikum Essen, Zentrum f. Innere Medizin, Essen, Germany
| | - Maurizio Voi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Juan W Valle
- Institute of Cancer Studies, University of Manchester, The Christie Hospital, Manchester, UK
| | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg/Leuven and KU Leuven, Leuven, Belgium
| | - Margot Tesselaar
- Nederlands Kanker Instituut, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Do-Youn Oh
- Seoul National University Hospital, Seoul, South Korea
| | | | | | - Marianne E Pavel
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Singh S, Carnaghi C, Buzzoni R, Pommier RF, Raderer M, Tomasek J, Lahner H, Valle JW, Voi M, Bubuteishvili-Pacaud L, Lincy J, Sachs C, Okita N, Libutti SK, Oh DY, Kulke MH, Strosberg JR, Yao JC, Pavel ME, Fazio N. Efficacy and safety of everolimus in advanced, progressive, nonfunctional neuroendocrine tumors (NET) of the gastrointestinal (GI) tract and unknown primary: A subgroup analysis of the phase III RADIANT-4 trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
315 Background: In the groundbreaking, phase 3 RCT RADIANT-4 study, everolimus (EVE) significantly prolonged median progression-free survival (PFS) by 7.1 mo in patients (pts) with advanced, progressive, nonfunctional NET of GI or lung vs placebo (PBO); HR, 0.48 (95%CI, 0.35-0.67), P<0.00001 [Yao JC et al, ECC-ESMO, 2015]. Methods: InRADIANT-4, pts with advanced, progressive, well-differentiated (G1/G2), nonfunctional GI or lung NET were randomized (2:1) to EVE (10 mg/d) or PBO. In this analysis, pts with NET of GI tract (stomach, colon, rectum, appendix, caecum, ileum, duodenum, jejunum, or small intestine) and unknown primary were included. Results: Of 302 pts, 175 had GI NET (EVE [n=118], PBO [n=57]); 36 had NET of unknown primary (EVE [23], PBO [13]). In GI NET pts, median age was 63 y; females: 55%; G1/G2: 75%/25%; WHO PS: 0, 78% or 1, 22%; Caucasian: 73%. Similar baseline characteristics were observed in pts with NET of unknown primary. Ileum (41%), rectum (23%) and jejunum (13%) were the most common locations in GI subgroup. The table below lists prior treatments. In pts with GI NET, median PFS (95% CI) by central review (EVE vs PBO) was 13.1 (9.2-17.3) mo vs 5.4 (3.6-9.3) mo with an estimated 44% risk-reduction in favor of EVE (HR, 0.56; 95% CI, 0.37-0.84). In pts with NET of unknown primary, median PFS (95% CI) by central review (EVE vs PBO) was 13.6 (4.1-not evaluable) mo vs 7.5 (1.9-18.5) mo (HR, 0.60; 95% CI, 0.24-1.51). The most frequent G3/4 adverse events irrespective of drug-relationship reported in ≥5% pts in GI subgroup were diarrhea, hypertension, stomatitis, abdominal pain, fatigue, and acute renal failure. Conclusions: The present subgroup analysis of RADIANT-4 study demonstrated improvement in PFS with EVE for pts with GI NET, and suggests efficacy in NET of unknown primary, with an estimated 40% to 44% risk-reduction in favor of EVE vs PBO. Safety profile for EVE is consistent with that previously reported. Clinical trial information: NCT01524783. [Table: see text]
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Affiliation(s)
- Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Harald Lahner
- Universitaetsklinikum Essen, Zentrum f. Innere Medizin, Essen, Germany
| | - Juan W. Valle
- Institute of Cancer Studies, University of Manchester, The Christie Hospital, Manchester, United Kingdom
| | - Maurizio Voi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | | | - Natsuko Okita
- National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | | | - Do-Youn Oh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | - James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marianne E. Pavel
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Nicola Fazio
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy
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25
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Trojan J, Kafatos G, Bennett J, Demonty G, Downey G, Mineur L, Tomasek J, Rouleau E, Fabian P, De Maglio G, Garcia Alfonso P, Aprile G, van Krieken JH. RAS testing awareness amongst oncologists and panitumumab prescription for metastatic colorectal cancer: A European physician survey and medical records review. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.530] [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
530 Background: Patients with metastatic colorectal cancer (mCRC) must have a confirmed RAS wild-type status before starting panitumumab (pmab). Two studies, a physician survey and a medical records review (MRR), were carried out to evaluate physician awareness of the need for biomarker testing in mCRC. Methods: Both studies were carried out in three rounds. Rounds 1 and 2 (2012–14) examined KRAS testing only as they were completed before guidelines changed, and have been published previously. Round 3 (2014–15), reported here, was performed after guidelines changed and covered full RAS testing. Participants were from nine European countries:France, Germany, Italy, Spain, the Czech Republic, the Netherlands, Belgium, Denmark, and Sweden. For the survey, oncologists who had prescribed pmab to mCRC patients in the previous 6 months were interviewed by telephone using a standard questionnaire.For the MRR,oncologists were asked to provide clinical information extracted from their patients’ medical records. Results: 152 oncologists and 131 patients’ records were included in Round 3 of the physician survey and the MMR, respectively, compared with 301 oncologists and 306 records in Rounds 1 and 2. In Round 3 of the physician survey, 95.4% (n = 145) of participants correctly reported that pmab should be prescribed in RAS wild-type mCRC only, compared with 99.0% (n = 298) in Rounds 1 and 2, responding to the same question about KRAS testing. In Round 3 of the MRR, 100% (n = 131) of patients had a confirmed RAS or KRAS wild-type status prior to initiation of pmab. Of those patients, 83.2% (n = 109) were tested for RAS status and 16.8% (n = 22) were tested for KRAS status only. Conclusions: Round 3 of the survey demonstrated a high level of knowledge amongst oncologists about the need for RAS testing in mCRC. The MRR supported these findings, showing that this knowledge is being applied to clinical practice. Comparisons between Round 3 and Rounds 1 and 2 show that physician awareness and adherence to prescribing guidelines remained high over time, despite recommendations changing with RAS testing replacing KRAS testing.
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Affiliation(s)
- Jorg Trojan
- Goethe University Medical Center, Frankfurt, Germany
| | | | | | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | - Pavel Fabian
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
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26
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Motzer RJ, Hutson TE, Glen H, Michaelson MD, Molina A, Eisen T, Jassem J, Zolnierek J, Maroto JP, Mellado B, Melichar B, Tomasek J, Kremer A, Kim HJ, Wood K, Dutcus C, Larkin J. Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial. Lancet Oncol 2015; 16:1473-1482. [PMID: 26482279 DOI: 10.1016/s1470-2045(15)00290-9] [Citation(s) in RCA: 627] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, metastatic renal cell carcinoma is treated with sequential single agents targeting VEGF or mTOR. Here, we aimed to assess lenvatinib, everolimus, or their combination as second-line treatment in patients with metastatic renal cell carcinoma. METHODS We did a randomised, phase 2, open-label, multicentre trial at 37 centres in five countries and enrolled patients with advanced or metastatic, clear-cell, renal cell carcinoma. We included patients who had received treatment with a VEGF-targeted therapy and progressed on or within 9 months of stopping that agent. Patients were randomised via an interactive voice response system in a 1:1:1 ratio to either lenvatinib (24 mg/day), everolimus (10 mg/day), or lenvatinib plus everolimus (18 mg/day and 5 mg/day, respectively) administered orally in continuous 28-day cycles until disease progression or unacceptable toxic effects. The randomisation procedure dynamically minimised imbalances between treatment groups for the stratification factors haemoglobin and corrected serum calcium. The primary objective was progression-free survival in the intention-to-treat population. This study is closed to enrolment but patients' treatment and follow-up is ongoing. This study is registered with ClinicalTrials.gov, number NCT01136733. FINDINGS Between March 16, 2012, and June 19, 2013, 153 patients were randomly allocated to receive either the combination of lenvatinib plus everolimus (n=51), single-agent lenvatinib (n=52), or single-agent everolimus (n=50). Lenvatinib plus everolimus significantly prolonged progression-free survival compared with everolimus alone (median 14·6 months [95% CI 5·9-20·1] vs 5·5 months [3·5-7·1]; hazard ratio [HR] 0·40, 95% CI 0·24-0·68; p=0·0005), but not compared with lenvatinib alone (7·4 months [95% CI 5·6-10·2]; HR 0·66, 95% CI 0·30-1·10; p=0·12). Single-agent lenvatinib significantly prolonged progression-free survival compared with everolimus alone (HR 0·61, 95% CI 0·38-0·98; p=0·048). Grade 3 and 4 events occurred in fewer patients allocated single-agent everolimus (25 [50%]) compared with those assigned lenvatinib alone (41 [79%]) or lenvatinib plus everolimus (36 [71%]). The most common grade 3 or 4 treatment-emergent adverse event in patients allocated lenvatinib plus everolimus was diarrhoea (ten [20%]), in those assigned single-agent lenvatinib it was proteinuria (ten [19%]), and in those assigned single-agent everolimus it was anaemia (six [12%]). Two deaths were deemed related to study drug, one cerebral haemorrhage in the lenvatinib plus everolimus group and one myocardial infarction with single-agent lenvatinib. INTERPRETATION Lenvatinib plus everolimus and lenvatinib alone resulted in a progression-free survival benefit for patients with metastatic renal cell carcinoma who have progressed after one previous VEGF-targeted therapy. Further study of lenvatinib is warranted in patients with metastatic renal cell carcinoma. FUNDING Eisai Inc.
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Affiliation(s)
| | | | - Hilary Glen
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Ana Molina
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Timothy Eisen
- Addenbrooke's Hospital, Cambridge Biomedical Research Centre, Cambridge, UK
| | | | | | | | - Begoña Mellado
- Medical Oncology Department, Translational Genomics and Targeted Therapeutics in Solid Tumors Group, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Bohuslav Melichar
- Onkologicka klinika, Lekarska fakulta Univerzity Palackeho a Fakultni nemocnice, Olomouc, Czech Republic
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | | | | | | | | | - James Larkin
- Royal Marsden Hospital NHS Foundation Trust, London, UK
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27
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Chau I, Fuchs C, Muro K, Tomasek J, Van Cutsem E, Cho J, Oh S, Safran H, Bodoky G, Shimada Y, Dumitru F, Passalacqua R, Ohtsu A, Hsu Y, Liepa A, Chandrawansa K, Emig M, Ferry D, Wilke H, Al-Batran S. 2343 Quality of life (QoL) as a prognostic factor for survival in previously treated advanced gastric or gastroesophageal junction (GEJ) cancer: Analysis of pooled data from two phase 3 studies (REGARD and RAINBOW). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Yao J, Fazio N, Singh S, Buzzoni R, Carnaghi C, Wolin E, Tomasek J, Raderer M, Lahner H, Voi M, Pacaud L, Lincy J, Sachs C, Valle J, Delle Fave G, Van Cutsem E, Tesselaar M, Shimada Y, Oh D, Strosberg J, Kulke M, Pavel M. 5LBA Everolimus in advanced nonfunctional neuroendocrine tumors (NET) of lung or gastrointestinal (GI) origin: Efficacy and safety results from the placebo-controlled, double-blind, multicenter, Phase 3 RADIANT-4 study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31928-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Singh S, Buzzoni R, Carnaghi C, Fazio N, Pavel ME, Wolin EM, Tomasek J, Raderer M, Lahner H, Lam DH, Cauwel H, Valle JW, Delle Fave G, Van Cutsem E, Strosberg JR, Tesselaar ME, Shimada Y, Oh DY, Kulke MH, Yao JC. Baseline demographics of patients from the randomized, placebo-controlled, double-blind, phase III RADIANT-4 study of everolimus in nonfunctional gastrointestinal (GI) or lung neuroendocrine tumors (NET). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15197] [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)
- Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Roberto Buzzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Nicola Fazio
- European Institute of Oncology (IEO), Milan, Italy
| | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Harald Lahner
- Universitaetsklinikum Essen, Zentrum f. Innere Medizin, Essen, Germany
| | - Du Hung Lam
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Juan W. Valle
- Institute of Cancer Studies, University of Manchester, The Christie Hospital, Manchester, United Kingdom
| | | | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg/Leuven and KULeuven, Leuven, Belgium
| | | | - Margot Et Tesselaar
- Nederlands Kanker Instituut - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | - James C. Yao
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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30
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Fuchs CS, Tabernero J, Tomasek J, Chau I, Melichar B, Safran H, Tehfe MA, Dumitru F, Topuzov E, Schlittler L, Udrea AA, Campbell W, Brincat S, Emig M, Melemed SA, Hozak RR, Ferry D, Caldwell W, Ajani JA. Candidate biomarker analyses in gastric or gastro-esophageal junction carcinoma: REGARD trial of single-agent ramucirumab (RAM) vs. placebo (PL). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.4029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
| | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ian Chau
- Royal Marsden, London & Surrey, United Kingdom
| | - Bohuslav Melichar
- Onkologicka Klinika, Lekarska Fakulta Univerzity Palackeho a Fakultni Nemocnice, Olomouc, Czech Republic
| | - Howard Safran
- Brown University Oncology Research Group, Providence, RI
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jaffer A. Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
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31
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Fuchs CS, Muro K, Tomasek J, Van Cutsem E, Cho JY, Oh SC, Safran H, Bodoky G, Chau I, Shimada Y, Dumitru F, Al-Batran SE, Passalacqua R, Ohtsu A, Emig M, Ferry D, Chandrawansa K, Hsu Y, Sashegyi A, Wilke H. Prognostic factor analysis of overall survival (OS) in gastric cancer from two phase III studies of second-line ramucirumab (RAM) (REGARD and RAINBOW) using pooled individual patient (pt) data. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.4028] [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)
| | - Kei Muro
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eric Van Cutsem
- Digestive Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Howard Safran
- Brown University Oncology Research Group, Providence, RI
| | | | - Ian Chau
- Royal Marsden, London & Surrey, United Kingdom
| | | | | | | | | | - Atsushi Ohtsu
- Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Japan, Kashiwa, Japan
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32
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Motzer R, Hutson T, Glen H, Michaelson D, Molina AM, Eisen T, Jassem J, Zolnierek J, Maroto P, Mellado B, Melichar B, Tomasek J, Kim HJ, Wood K, Dutcus C, Larkin JMG. Randomized phase II, three-arm trial of lenvatinib (LEN), everolimus (EVE), and LEN+EVE in patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.4506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
- Robert Motzer
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas Hutson
- Texas Oncology–Baylor Charles A. Sammons Cancer Center, Dallas, TX
| | - Hilary Glen
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Ana M. Molina
- Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | | | | | | | - Pablo Maroto
- Departamento de Oncología Médica, Barcelona, Spain
| | - Begona Mellado
- Translational Genomics and Targeted Therapeutics in Oncology.IDIBAPS. Medical Oncology Department. Hospital Clinic, Barcelona, Spain
| | - Bohuslav Melichar
- Onkologicka Klinika, Lekarska Fakulta Univerzity Palackeho a Fakultni Nemocnice, Olomouc, Czech Republic
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
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33
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Tabernero J, Ohtsu A, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Ajani JA, Tomasek J, Safran H, Chandrawansa K, Hsu Y, Heathman M, Khan AZ, Ni L, Melemed AS, Gao L, Ferry D, Fuchs CS. Exposure-response (E-R) relationship of ramucirumab (RAM) from two global, randomized, double-blind, phase 3 studies of patients (Pts) with advanced second-line gastric cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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
121 Background: We evaluated the E-R relationship of RAM in pts with advanced gastric cancer from the REGARD and RAINBOW trials. Methods: Pts received RAM (8 mg/kg) or placebo (PL) q2w in REGARD; or RAM (8 mg/kg) or PL q2w + paclitaxel (PAC) 80 mg/m2 on days 1, 8, and 15 (28-day cycle) in RAINBOW. Sparse pharmacokinetic (PK) samples were collected; a population PK analysis was conducted. A model-predicted minimum concentration after first RAM dose (Cmin,1) was used for correlation with efficacy and safety variables. Kaplan-Meier, Cox regression, and logistic regression analyses evaluated E-R relationships. Results: Analyses included 72 RAM and 35 PL pts from REGARD and 321 RAM+PAC and 335 PL+PAC pts from RAINBOW. Conclusions: Ram was safe and effective at 8 mg/kg q2w. Population PK suggests higher RAM exposures were associated with longer PFS and OS, better hazard ratios, and increased toxicity. Further studies to validate the PK model and evaluate RAM dosing are warranted. [Table: see text]
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Affiliation(s)
| | - Atsushi Ohtsu
- Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | | | | | | | - Shuichi Hironaka
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan
| | - Jaffer A. Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Howard Safran
- Brown University Oncology Research Group, Providence, RI
| | | | | | | | | | - Lan Ni
- Eli Lilly and Company, Indianapolis, IN
| | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, NJ
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34
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Trojan J, Taylor A, Terwey JH, Downey G, Kafatos G, Garcia Alfonso P, Tomasek J, Mineur L, van Krieken H, Aprile G. Awareness of KRAS testing by oncologists and panitumumab use in colorectal cancer patients: A European survey. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.547] [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
547 Background: Panitumumab (Pmab) is licensed for treatment in metastatic colorectal cancer (mCRC) patients with wild type KRAS mutation status (US) and wild type RAS (KRAS and NRAS) mutation status (most other countries). To resolve uncertainties about KRAS testing, a survey and medical records review (MRR) are being carried out in Europe in three rounds: the first two rounds (2012-2013) evaluated KRAS testing and round 3 is evaluating RAS testing. These studies are specific obligations in Europe for the conditional marketing authorization for Pmab. Here we present results of rounds 1 and 2. Methods: Eligible oncologists were contacted by telephone in nine European countries (France, Germany, Italy, Spain, Czech Republic, Netherlands, Belgium, Denmark, and Sweden). To be eligible, the physician was required to be a practicing oncologist and have prescribed Pmab to mCRC patients. Results: 299 of 301 (99.3%) oncologists participating in the survey were aware of the need to perform KRAS testing prior to first dose of Pmab and 294 (97.7%) were aware of patients’ KRAS mutation status prior to first dose. 283 of 301 (94.0%) did not prescribe Pmab to mCRC patients with mutant or unknown KRAS status. 164 physicians administered Pmab simultaneously with oxaliplatin-containing chemotherapy to patients and 10 (6.1%) to patients with mutant or unknown KRAS status. 306 patients from 79 participating oncologists were included in the MRR. 302 of 306 mCRC patients (98.7%) were tested for KRAS tumor status, known by the oncologist before first dose of Pmab. 299 of 302 patients (99.0%) had wild-type KRAS tumor status. 83 of 85 patients (97.6%) treated with Pmab and oxaliplatin-containing chemotherapy had wild-type KRAS tumor status. 55 of 56 linked pathology laboratories (98.2%) participated in a Quality Assurance scheme; all used a CE marked or otherwise validated KRAS detection method. Conclusions: Results from both studies show a high level of knowledge among oncologists of the need for KRAS testing in mCRC patients prior to treatment with Pmab and the contraindication with oxaliplatin-containing chemotherapy with mutant or unknown KRAS tumour status. The final round of this study evaluating RAS testing in Europe is currently underway.
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Affiliation(s)
- Jorg Trojan
- Johann Wolfgang Goethe University, Frankfurt, Germany
| | | | | | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
| | - Han van Krieken
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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35
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Yao JC, Buzzoni R, Carnaghi C, Fazio N, Singh S, Wolin EM, Tomasek J, Raderer M, Lahner H, Lam DH, Cauwel H, Valle JW, Delle Fave G, Van Cutsem E, Strosberg JR, Tesselaar ME, Shimada Y, Oh DY, Kulke M, Pavel ME. Baseline demographics of the randomized, placebo-controlled, double-blind, phase III RADIANT-4 study of everolimus in nonfunctional gastrointestinal (GI) or lung neuroendocrine tumors (NET). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.276] [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
276 Background: NET are malignant tumors arising from neuroendocrine cells throughout the body. Everolimus (EVE), a mammalian target of rapamycin inhibitor, is approved for the treatment of advanced, well-differentiated pancreatic NET. There is an unmet medical need in GI and lung NET; targeted therapies, such as everolimus, are of particular interest. Methods: Patients with advanced nonfunctional NET of GI or lung origin with progressive disease (PD) within the past 6 months were randomized (2:1) to EVE 10 mg/d or placebo, both with best supportive care. Concomitant use of somatostatin analogue (SSA) was not allowed during the study, except for control of emergent carcinoid symptoms not manageable by standard therapy. Patients were stratified based on tumor sites, prior SSA exposure, and WHO performance status (PS) at baseline. Primary endpoint was progression-free survival (PFS) as assessed by central radiology review using modified RECIST 1.0 criteria. Primary analysis is planned after ~176 PFS events. Crossover to open label EVE after progression would not be allowed prior to the primary analysis. Overall survival was the key secondary endpoint. Results: Recruitment is completed. Of 388 patients screened, 302 were randomized (planned, 285). Median age was 63 years, 53% were females, and majority of them (76.2%) were white. The most common tumor sites were lung (29.8%), ileum (23.5%), and rectum (13.2%). WHO PS was 0 in 219 (72.5%) patients and 1 in 82 (27.2%) patients; 52% had received SSA prior to study entry. As of Sep 16, 2013, 173 (57.3%) patients remain on treatment, 127 (42.1%) discontinued treatment and 2 (0.7%) were not treated. PD (24.2%) and adverse events (10.6%) were the most common reasons for treatment discontinuation. Results of primary analysis are expected by early 2015. Conclusions: RADIANT-4 is the first phase III study to assess the efficacy and safety of EVE in patients with nonfunctional NET of GI or lung origin. Non-crossover design and prospective stratification of the population based on known prognostic factors should minimize confounding in the estimation of the treatment effect. Clinical trial information: NCT01524783.
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Affiliation(s)
- James C. Yao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto Buzzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Simron Singh
- Sunnybrook Odette Cancer Center, Toronto, ON, Canada
| | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Harald Lahner
- Universitaetsklinikum Essen, Zentrum f. Innere Medizin, Essen, Germany
| | - Du Hung Lam
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Juan W. Valle
- University of Manchester, Manchester Academic Health Science Centre; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | | | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | - Marianne E. Pavel
- Charité, Universitätsmedizin Berlin/Campus Virchow Klinikum, Berlin, Germany
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Fuchs CS, Tomasek J, Cho JY, Tomasello G, Goswami C, dos Santos LV, Aprile G, Ferry D, Melichar B, Tehfe MA, Topuzov E, Zalcberg JR, Chau I, Tabernero J, Hsu Y, Schwartz JD, Koshiji M, Safran H. REGARD: A phase 3, randomized, double-blind trial of ramucirumab (RAM) and best supportive care (BSC) versus placebo (PL) and BSC in the treatment of metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma following disease progression (PD) on first-line platinum- and/or fluoropyrimidine-containing combination therapy: Age subgroup analysis. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | | | | | | | - David Ferry
- New Cross Hospital, Wolverhampton, United Kingdom
| | - Bohuslav Melichar
- Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | | | | | | | - Ian Chau
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | | | - Yanzhi Hsu
- ImClone Systems, a wholly owned subsidiary of Eli Lilly & Co., Bridgewater, NJ
| | | | - Minori Koshiji
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company, Kobe, Japan
| | - Howard Safran
- Brown University Oncology Research Group, Providence, RI
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Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, Safran H, Dos Santos LV, Aprile G, Ferry DR, Melichar B, Tehfe M, Topuzov E, Zalcberg JR, Chau I, Campbell W, Sivanandan C, Pikiel J, Koshiji M, Hsu Y, Liepa AM, Gao L, Schwartz JD, Tabernero J. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2014; 383:31-39. [PMID: 24094768 DOI: 10.1016/s0140-6736(13)61719-5] [Citation(s) in RCA: 1463] [Impact Index Per Article: 146.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) and VEGF receptor-2 (VEGFR-2)-mediated signalling and angiogenesis can contribute to the pathogenesis and progression of gastric cancer. We aimed to assess whether ramucirumab, a monoclonal antibody VEGFR-2 antagonist, prolonged survival in patients with advanced gastric cancer. METHODS We did an international, randomised, double-blind, placebo-controlled, phase 3 trial between Oct 6, 2009, and Jan 26, 2012, at 119 centres in 29 countries in North America, Central and South America, Europe, Asia, Australia, and Africa. Patients aged 24-87 years with advanced gastric or gastro-oesophageal junction adenocarcinoma and disease progression after first-line platinum-containing or fluoropyrimidine-containing chemotherapy were randomly assigned (2:1), via a central interactive voice-response system, to receive best supportive care plus either ramucirumab 8 mg/kg or placebo, intravenously once every 2 weeks. The study sponsor, participants, and investigators were masked to treatment assignment. The primary endpoint was overall survival. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00917384. FINDINGS 355 patients were assigned to receive ramucirumab (n=238) or placebo (n=117). Median overall survival was 5·2 months (IQR 2·3-9·9) in patients in the ramucirumab group and 3·8 months (1·7-7·1) in those in the placebo group (hazard ratio [HR] 0·776, 95% CI 0·603-0·998; p=0·047). The survival benefit with ramucirumab remained unchanged after multivariable adjustment for other prognostic factors (multivariable HR 0·774, 0·605-0·991; p=0·042). Rates of hypertension were higher in the ramucirumab group than in the placebo group (38 [16%] vs nine [8%]), whereas rates of other adverse events were mostly similar between groups (223 [94%] vs 101 [88%]). Five (2%) deaths in the ramucirumab group and two (2%) in the placebo group were considered to be related to study drug. INTERPRETATION Ramucirumab is the first biological treatment given as a single drug that has survival benefits in patients with advanced gastric or gastro-oesophageal junction adenocarcinoma progressing after first-line chemotherapy. Our findings validate VEGFR-2 signalling as an important therapeutic target in advanced gastric cancer. FUNDING ImClone Systems.
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Affiliation(s)
- Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Jiri Tomasek
- Department of Complex Oncology Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Cho Jae Yong
- Department of Medical Oncology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Filip Dumitru
- Oncology Department, Emergency County Hospital "Dr Constantin Opris", Baia Mare, Romania
| | | | - Chanchal Goswami
- Department of Medical Oncology, B P Poddar Hospital and Medical Research, Kolkata, West Bengal
| | - Howard Safran
- Department of Medicine, The Brown University Oncology Group, Brown University, Providence, RI, USA
| | - Lucas Vieira Dos Santos
- Medical Oncology Department, Gastrointestinal Oncology Division, Hospital de Câncer de Barretos and Hemomed Instituto de Oncologia e Hematologia, São Paulo, Brazil
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
| | - David R Ferry
- Department of Medical Oncology, New Cross Hospital, West Midlands, UK
| | - Bohuslav Melichar
- Department of Oncology, Palacky University Medical School and Teaching Hospital, Olomouc, CzechRepublic
| | - Mustapha Tehfe
- Department of Medical Oncology, Hôpital Notre Dame de CHUM, Montreal, Quebec
| | - Eldar Topuzov
- State Budgetary Educational Institution of Higher Professional Education (SBEIHPE), "Northwest State Medical University na II Mechnikov", Ministry of Healthcare of the Russian Federation, Russia
| | - John Raymond Zalcberg
- Division of Cancer Medicine, Peter McCallum Cancer Centre, East Melbourne, VIC, Australia; Departments of Medicine and Oncology, Faculty of Medicine, University of Melbourne, Australia
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London and Surrey, England
| | - William Campbell
- Department of Oncology, Hospital Herrera Llerandi-Clinicas Médicas, Guatemala
| | | | | | | | - Yanzhi Hsu
- ImClone Systems LLC, Bridgewater, NJ, USA
| | | | - Ling Gao
- ImClone Systems LLC, Bridgewater, NJ, USA
| | | | - Josep Tabernero
- Medical Oncology Department Vall d'Hebron University Hospital, UniversitatAutònoma de Barcelona, Barcelona, Spain
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Tabernero J, Tomasek J, Filip D, Passalacqua R, Goswami C, Safran H, Santos LD, Aprile G, Ferry D, Cho JY, Melichar B, Tehfe M, Topuzov E, Zalcberg J, Chau I, Schwartz J, Koshiji M, Hsu Y, Fuchs C. Regard Phase 3, Randomized Trial of Ramucirumab in Patients with Metastatic Gastric or Gej Adenocarcinoma Following Progression on First-Line Chemotherapy. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt201.8] [Citation(s) in RCA: 3] [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: 11/13/2022] Open
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Bechter OE, Unger N, Borbath I, Ricci S, Hwang TL, Park YS, Tomasek J, Raef H, Laohavinij S, JeanLouis L, Panneerselvam A, Saletan S, Stergiopoulos SG, Pavel ME. Open-label, phase IIIb, multicenter, expanded access study of everolimus in patients with advanced neuroendocrine tumors (NET). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4138] [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
4138 Background: Everolimus (EVE) antitumor efficacy in patients (pts) with advanced NET was demonstrated in 2 double-blind, placebo (P)–controlled, phase III trials (RADIANT-2 and RADIANT-3). Median PFS in pancreatic (pNET) pts was 11.0 months (EVE) vs. 4.6 months (P) (HR 0.35, 95% CI 0.27-0.45, P <0.001) in RADIANT-3. Median EVE exposure in RADIANT-3 was 38 wks. EVE was approved for advanced pNET in the US and Europe in 2011. An expanded access protocol was launched to gather additional safety data and provide access to EVE for pts with advanced NET while awaiting regulatory approval. Methods: Pts aged ≥18 years with biopsy-proven NET; WHO performance status 0-2; and adequate bone, hepatic, and renal function were enrolled. Main exclusion criteria were poorly differentiated NET and cytotoxic therapy within 4 wks of enrollment. EVE (10 mg/d) was administered until disease progression, unacceptable toxicity, discontinuation, death, commercial availability of EVE, or until May 30, 2012. Pts were enrolled from April 21, 2011 to April 20, 2012. Primary objective was grade 3/4 and serious adverse events (AEs). Secondary objectives included investigator-assessed best overall response rate and PFS. Results: The full analysis set included 246 pts (pNET, n=126; non-pNET, n=120); the safety set included 240 pts (pNET, n=123; non-pNET, n=117). Median age was 61 and 66 years; 54% and 49% were male. Main primary tumor sites in non-pNET pts included small intestine (40%) and lung (22%). Median duration of EVE exposure was 12.1 wks and 24 wks in pNET and non-pNET. At data cutoff, there were 21 and 32 PFS events; 105 and 88 pts were censored. Grade 3/4 AEs were reported in 42.3% and 69.2% of pNET and non-pNET; those reported in ≥10% of pts in pNET and non-pNET included hyperglycemia (12.2% and 5.1%), diarrhea (10.6% and 31.6%), stomatitis (9.8% and 11.1%), nausea (8.1% and 10.3%), and anemia (5.7% and 11.1%). Median investigator-assessed PFS was 7.6 (95% CI 5.52-7.62) months and 10.8 (8.77-Not Estimable) months in pNET and non-pNET. Conclusions: EVE was well tolerated in pts with advanced NET. AEs were similar to those previously reported. Protocol-specified early termination of pts limits the interpretation of PFS medians. Clinical trial information: EudraCT Number: 2010-023032-17.
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Affiliation(s)
| | | | - Ivan Borbath
- Cliniques Universitaires Saint-Luc; Universite Catholique de Louvain, Brussels, Belgium
| | | | - Tsann-Long Hwang
- Chang Gung Memorial Hospital/Chang Gung University, Lin-Kou, Taiwan
| | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Hussein Raef
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sudsawat Laohavinij
- Oncology Unit, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | | | | | | | | | - Marianne E. Pavel
- Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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Gollerkeri A, Gordon MS, Burke JM, Hauke R, Tomasek J, Richards DA, DiSimone C, Tykodi SS, Mehta AR, Chen C, Perea R, Vogelzang NJ. Phase Ib safety trial of CVX-060, an intravenous humanized monoclonal CovX body inhibiting angiopoietin 2 (Ang-2), with axitinib in patients with previously treated metastatic renal cell cancer (RCC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2533 Background: PF-04856884 is a recombinant humanized monoclonal antibody fused to two Ang-2 binding peptides. Axitinib is a potent and selective second-generation inhibitor of vascular endothelial growth factors (VEGFs) that is approved for patients (pts) with advanced renal cell cancer who failed 1 prior therapy. Metastatic RCC (mRCC) is an angiogenic tumor sensitive to VEGF tyrosine kinase inhibitors. Resistance to VEGF targeted therapy may be mediated by Ang-2. Methods: In Part I (safety lead in) of the study, the primary endpoint was treatment related dose limiting toxicities (DLT) in pts with mRCC who had received 1-3 prior treatments. Pts received PF-04856884 (15 mg/kg/week) plus axitinib (5 mg BID) for 4 week cycles (the recommended Phase II dose of each) and were assessed for DLT, PK, and potential predictive biomarkers (Ang-2 and VEGF-A). For Part II (Phase II portion), pts with mRCC who had received 1 prior anti-VEGF agent were to be randomized to PF-04856884 + axitinib or axitinib alone to assess median progression free survival. Results: Part I enrolled 18 pts with median age of 62.5 years (39-82), and ECOG performance status of 0-1. One pt had a DLT of Grade 4 pulmonary embolism (PE). Most common related AEs: anorexia in 10 pts (56%), diarrhea 8 (44%), fatigue 8 (44%), nausea 7 (39%), hypertension 6 (33%) and vomiting 6 (33%). Treatment-related thromboembolic events (TEEs) were observed: PE in 2 pts (11%), and cerebrovascular accident (CVA), presumed bowel ischemia, and possible cardiac chest pain in 1 pt (6%) each. One pt had Grade 2 venous thrombosis unrelated to either treatment. Due to the reported TEE, PF-04856884 was reduced to 10 mg/kg in pts remaining on study and enrollment to Part II was not initiated. No significant PK interaction was observed. Two pts had partial response (PR) and 1 pt had unconfirmed PR. Twelve pts (66%) remained on study ≥91 days with a median duration of 120 days (8-279). Anti-PF-04856884 antibody results are not available. Conclusions: Due to the higher than expected TEEs, alternate doses of PF-04856884 and/or disease settings are being considered. Clinical trial information: NCT01441414.
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Affiliation(s)
| | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Scott S. Tykodi
- University of Washington/Seattle Cancer Care Alliance, Seattle, WA
| | - Amit R. Mehta
- Robert Wood Johnson Medical School; Cancer Institute of New Jersey, Durham, NC
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Fuchs CS, Tomasek J, Cho JY, Dumitru F, Passalacqua R, Goswami C, Safran H, dos Santos LV, Aprile G, Ferry DR, Melichar B, Tehfe M, Topuzov E, Tabernero J, Zalcberg JR, Chau I, Koshiji M, Hsu Y, Schwartz JD, Ajani JA. REGARD: A phase III, randomized, double-blinded trial of ramucirumab and best supportive care (BSC) versus placebo and BSC in the treatment of metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing combination therapy. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.lba5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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
LBA5 Background: VEGF and VEGF receptor-2 mediated signaling and angiogenesis may contribute to gastric cancer pathogenesis. Ramucirumab (RAM; IMC-1121B) is a fully human IgG1 monoclonal antibody targeting VEGF-receptor 2. We conducted a placebo-controlled, double-blind, phase III international trial to evaluate the safety and efficacy of RAM in pts with metastatic gastric or GEJ adenocarcinoma progressing on first-line platinum- and/or fluoropyrimidine containing combination therapy. Methods: Pts were randomized 2:1 to receive RAM (8 mg/kg IV) plus BSC or placebo (PL) plus BSC every 2 weeks (wks) until disease progression, unacceptable toxicity, or death. Eligible patients had disease progression within 4 months (m) after 1st-line therapy for metastatic disease or within 6 m after adjuvant therapy. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), 12-wk PFS rate, overall response rate (ORR) and safety. Results: From 10/09 to 01/12, 355 pts were randomized (RAM: 238; PL: 117). Baseline characteristics were well balanced between arms. The Hazard Ratio (HR) for OS was 0.776 (95% CI, 0.603-0.998; p = 0.0473). Median OS was 5.2 m for RAM and 3.8 m for PL. The HR for PFS was 0.483 (95% CI, 0.376-0.620; p < 0.0001). Median PFS was 2.1 m for RAM and 1.3 m for PL. 12-wk PFS was 40% for RAM and 16% for PL. ORR was 3.4% for RAM and 2.6% for PL. Disease control rate was 49% for RAM and 23% for PL (p < 0.0001). Use of anti-cancer therapy post-study: 32% RAM; 39% PL. The most frequent of grade ≥ 3 adverse events (AEs) were: hypertension (7.2% RAM; 2.6% PL), anemia (6.4% RAM; 7.8% PL), abdominal pain (5.1% RAM; 2.6% PL), ascites (4.2% RAM; 4.3% PL), fatigue (4.2% RAM; 3.5% PL), decreased appetite (3.4% RAM; 3.5% PL) and hyponatremia (3.4% RAM; 0.9% PL). Conclusions: Ramucirumab conferred a statistically significant benefit in OS and PFS compared to PL in metastatic gastric or GEJ adenocarcinoma following progression on 1st-line therapy with an acceptable safety profile. Clinical trial information: NCT00917384.
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Affiliation(s)
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Filip Dumitru
- Spitalul Judetean de Urgenta "Constantin Opris", Baia Mare, Romania
| | | | - Chanchal Goswami
- B.P. Poddar Hospital and Medical Research Ltd, Kolkata, West Bengal, India
| | | | | | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Bohuslav Melichar
- Fakultní Nemocnice Olomouc - Onkologická Klinika, Olomouc, Czech Republic
| | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Ian Chau
- Royal Marsden Hospital, Sutton, Surrey, England
| | - Minori Koshiji
- ImClone Systems, a wholly owned subsidiary of Eli Lilly & Co., Bridgewater, NJ
| | - Yanzhi Hsu
- ImClone Systems, a wholly owned subsidiary of Eli Lilly & Co., Bridgewater, NJ
| | | | - Jaffer A. Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Tomasek J, Kiss I, Prasek J, Dusek L, Tucek S, Valek V, Vyzula R, Kala Z, Zimova I, Podhorec J, Halamkova J, Krakorova DA. The liver function assessment: The indocyanine green retention in correlation with the cholescintigraphic measurement—Retrospective validation study in 107 patients with liver malignancies. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.155] [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
155 Background: The transarterial chemoembolization (TACE) and the radiofrequency ablation (RFA) are the keystones of interventional therapy of primary and secondary liver malignancies in oncology. A compromised liver function may be a relative contraindication to these therapies. Child-Pugh liver scoring system is widely used to exclude patients with low liver function. The indocyanine green (ICG) retention rate at 15 min. (ICGR15) is a frequently used liver function test in liver surgery, however it is not widely available. The quantification of dynamic cholescintigraphy and the calculation of hepatic extraction fraction (HEF) describes specifically a functional efficiency of the liver parenchyma. Methods: We retrospectively studied 107 patients with primary or secondary liver malignancies who underwent TACE or RFA between February 2005 and February 2012. ICG test and dynamic cholescintigraphy and Child-Pugh score were assessed before the procedure. The comparison of relative frequencies of categories was performed by binomial test (independent testing) or by McNemar’s test (paired design). The association in occurrence of different categories was tested by the help of Fisher’s exact test. Results: The comparison of categorized outcomes of ICGR15 and HEF examination revealed high degree of agreement between these techniques (p = 0.773). The statistically significant similarity in the outcome of both methods was also proved by the analysis of contingency tables. 81% of tested samples obtained the same scoring by both approaches. Clinically important discrepancies between these methods were rare and were not observed in the two extreme categories, i.e. normal and very low liver function. Conclusions: The ICGR15 correlates well with the HEF in liver function assessment. Thus either method can be used in patients who are to undergo liver directed therapies when the assessment by Child-Pugh score is not sufficient enough.
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Affiliation(s)
- Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Igor Kiss
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Jiri Prasek
- Department of Nuclear Medicine, The University Hospital Brno, Brno, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Brno, Czech Republic
| | - Stepan Tucek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Vlastimil Valek
- Department of Radiology, The University Hospital Brno, Brno, Czech Republic
| | | | - Zdenek Kala
- Department of Surgery, The University Hospital Brno, Brno, Czech Republic
| | - Iveta Zimova
- Department of Anesteziology, The University Hospital Brno, Brno, Czech Republic
| | - Jan Podhorec
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
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Tomasek J. [What was the ASCO 2013]. Klin Onkol 2013; 26:231. [PMID: 23961852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Halamkova J, Kiss I, Pavlovsky Z, Jarkovsky J, Tomasek J, Tucek S, Hanakova L, Moulis M, Cech Z, Zavrelova J, Penka M. Clinical relevance of uPA, uPAR, PAI 1 and PAI 2 tissue expression and plasma PAI 1 level in colorectal carcinoma patients. Hepatogastroenterology 2012; 58:1918-25. [PMID: 22234062 DOI: 10.5754/hge10232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Urokinase (uPA) is a serine protease, which together with uPAR, tPA, PAI 1 and PAI 2 forms the plasminogen activator system, a component of metastatic cascade contributing to the invasive growth and angiogenesis of malignant tumours. METHODOLOGY Both preceding therapy and after 6-8 weeks of the treatment, plasma PAI 1 levels (photometric microplate method on the ELISA) and uPA, uPAR, PAI 1 and PAI 2 tissue expression (immunohistochemical reaction) were analysed from 80 colorectal carcinoma patients. RESULTS Analysis showed higher pre-treatment plasma levels of PAI 1 in patients with advanced tumours, which decreased after surgery or the start of therapy (p=0.004); Patients with higher plasma level PAI 1 before (0.013) and after therapy (0.004) had significantly shorter survival. There was a higher expression of uPA (p<0.001), uPAR (p<0.001), PAI 1 (p=0.042) and PAI 2 (p<0.001) in advanced colorectal carcinoma. A relationship between PAI 2 (p=0.010) and uPAR (p=0.019) expression and survival was demonstrated. There is a correlation between pre-treatment plasma PAI 1 levels and PAI 2 (p=0.028) and uPAR (p=0.043) expression. CONCLUSIONS Immunohistochemical analysis of PAS in tumour tissue and plasma PAI 1 levels was found to be a useful prognostic factor in colorectal carcinoma patients. Plasma PAI 1 could be advantageous in evaluating the effectiveness of a mode of treatment.
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Affiliation(s)
- Jana Halamkova
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic.
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Adamkova Krakorova D, Vesely K, Zambo I, Tucek S, Tomasek J, Jureckova A, Janicek P, Cerny J, Pazourek L, Ondrusek S, Selingerova I. [Analysis of prognostic factors in osteosarcoma adult patients, a single institution experience]. Klin Onkol 2012; 25:346-358. [PMID: 23102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The objective of this report was to estimate long-term outcome and prognostic factors in adult patients with high-grade osteosarcoma. The intended therapeutic strategy included preoperative and/or postoperative chemotherapy as well as surgery of all operable lesions. PATIENTS AND METHODS We reviewed the clinical data of 36 newly diagnosed adult patients (aged 19-82, average 37.5, median 28.5 years) with high-grade osteosarcoma of the trunk or limbs evaluated by a multidisciplinary team and treated between 1999 and 2010 in Brno. Forty-five percent of patients were over thirty, more than 36% over forty. Thirty-one percent of patients had metastasis at the time of diagnosis. Demographic parameters, tumor-related and treatment-related variables included possible prognostic factors and their impact on response, overall survival (OS) and event-free survival (EFS) were analyzed. RESULTS All the patients were followed up after treatment. Seventy-three percent of patients were poor responders to chemotherapy. Sixteen patients are alive, and twenty patients died. The survival time ranged from 2 to 177 months (average 45 months, median survival 23 months). The 5-year OS of all patients was 52.4%. OS of patients without metastasis was 68.12%, while 2-year OS with metastasis was 26% only. 5-year EFS was 38.7%. Univariate analysis revealed that the prognosis of adult osteosarcoma patients was significantly related to distant metastasis (p = 0.006), surgical stage (p = 0.00582), serum alkaline phosphatase (ALP) level (p = 0.00841) and serum lactatdehydrogenase (LD) level (p = 0.047). The other analyzed prognostic factors including age had no statistically significant influence on outcome of osteosarcoma in adult patients. CONCLUSION The prognosis of osteosarcoma in adult patients was significantly correlated to surgical stage, distant metastasis, serum ALP and LD.
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Nemecek R, Tomasek J, Hejduk K, Bortlicek Z. [CORECT registry]. Klin Onkol 2012; 25:480-485. [PMID: 23346637] [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: 06/01/2023]
Affiliation(s)
- R Nemecek
- Klinika komplexni onkologicke pece, Masarykovy Univerzity, Brno
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Halamkova J, Kiss I, Pavlovsky Z, Tomasek J, Jarkovsky J, Cech Z, Tucek S, Hanakova L, Moulis M, Zavrelova J, Man M, Benda P, Robek O, Kala Z, Penka M. Clinical significance of the plasminogen activator system in relation to grade of tumor and treatment response in colorectal carcinoma patients. Neoplasma 2011; 58:377-85. [PMID: 21744990 DOI: 10.4149/neo_2011_05_377] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Urokinase (uPA) plays an essential role in the activation of plasminogen to plasmin, and together with its receptor (uPAR), tissue activator (tPA) and urokinase inhibitors (PAI 1, PAI 2, PAI 3 and protease nexin) forms the plasminogen activator system (PAS), a component of metastatic cascade importantly contributing to the invasive growth and angiogenesis of malignant tumours. In our project we examined the expression of uPA, uPAR, PAI 1 and PAI 2 in tumor tissue and we also studied the plasma levels of PAI 1 before and after the initiation of therapy in patients with colorectal carcinoma in relationship to grade of tumor and the treatment response. In our prospective evaluation we included 80 patients treated for adenocarcinoma of the colon and rectum. Analysis of collected data revealed statistically significant evidence of a relationship between the level of PAI 1 in plasma before treatment and grade of the tumor, which increases with tumor grade (p=0.025). We demonstrated that there exists a statistically significant relationship between the expression of PAI 2 (p<0.001) and uPAR (p=0.031) and grade of tumor. We also confirmed a statistically significant relationship between soluble levels of PAI 1 before treatment and therapeutic response (p=0.021). In our group of patients the expression of uPA, uPAR, PAI 1 and 2 in tumor tissue in relation to response to treatment was also assessed. Our results suggest that the greater expression of these parameters in tumor tissue is linked to a worse response to therapy. In conclusion, PAS factors help as a prognostic indicators and could also act as a predictive factor in colorectal carcinoma.
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Affiliation(s)
- J Halamkova
- Masaryk Memorial Cancer Institute, Faculty of Medicine Masaryk University Brno Zluty kopec, Brno, Czech Republic
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Hermanova M, Karasek P, Tomasek J, Lenz J, Jarkovsky J, Dite P. Comparative analysis of clinicopathological correlations of cyclooxygenase-2 expression in resectable pancreatic cancer. World J Gastroenterol 2010; 16:1879-84. [PMID: 20397266 PMCID: PMC2856829 DOI: 10.3748/wjg.v16.i15.1879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To perform a comparative analysis of clinicopathological correlations of cyclooxygenase-2 (COX-2) expression in pancreatic cancer, examined by monoclonal and polyclonal antibodies.
METHODS: The COX-2 expression in 85 resection specimens of pancreatic ductal adenocarcinoma was immunohistochemically examined using both monoclonal and polyclonal antibodies. The final immunoscores were obtained by multiplying the percentage of positive cells with the numeric score reflecting the staining intensity. COX-2 expression levels were classified into three categories (0, 1+, and 2+) and the clinicopathological correlations were statistically evaluated and analyzed.
RESULTS: The positive tumor expression rates of COX-2 were 80.5% using monoclonal antibody and 69.4% using polyclonal antibody. In the Kaplan-Meier analysis, no significant correlations were found between levels of COX-2 expression and overall survival (OS), but trends to longer OS were found in COX-2 negative cases using monoclonal antibody. Significantly longer disease free survival was revealed in COX-2 negative cases using monoclonal antibody (P = 0.019). No correlations between COX-2 expression levels and grade (G), tumor (T) status and nodal (N) status were demonstrated. Low histological grade showed a strong association with a longer OS (P < 0.001). Correlation of survival and T status revealed a shorter OS in T3 tumors, but the results reached only marginal statistical significance (P = 0.070). In the multivariate Cox proportional hazards regression model, histological grade, T and N status remained valuable predictors of a worse survival with borderline significance for T [hazards ratio (HR) = 4.18 for G (if G = 3, P < 0.001); HR = 1.64 for T (if T = 3, P = 0.065); HR = 2.53 for N (if N = 1, P = 0.006)]. Higher grade, T or N status was associated with a worse OS.
CONCLUSION: The immunohistochemically assessed level of COX-2 expression does not seem to represent a valuable independent prognostic factor and is not superior to the conventional prognostic factors.
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Tucek S, Tomasek J, Halámkova J, Kiss I, Andrasina T, Hemmelová B, Adámková-Krákorová D, Vyzula R. Bile duct malignancies. Klin Onkol 2010; 23:231-241. [PMID: 20806821] [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: 05/29/2023]
Abstract
Bile duct malignancies include intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), gall bladder carcinoma (GC) and carcinoma of Vater's ampulla (ampulloma). Bile duct neoplasms are rare tumours with overall poor prognosis. The overall incidence affects up to 12.5 per 100,000 persons in the Czech Republic. The mortality rate has risen recently to 9.5 per 100,000 persons. The incidence and mortality have been remarkably stable over the past 3 decades. The survival rate of patients with these tumours is poor, usually not exceeding 12 months. The diagnostic process is complex, uneasy and usually late. Most cases are diagnosed when unresectable, and palliative treatment is the main approach of medical care for these tumours. The treatment remains very challenging. New approaches have not brought much improvement in this field. Standards of palliative care are lacking and quality of life assessments are surprisingly not common. From the scarce data it seems, however, that multimodal individually tailored treatment can prolong patients'survival and improve the health-related quality of life. The care in specialized centres offers methods of surgery, interventional radiology, clinical oncology and high quality supportive care. These methods are discussed in the article in greater detail. Improvements in this field can be sought in new diagnostic methods and new procedures in surgery and interventional radiology. Understanding the tumour biology on the molecular level could shift the strategy to a more successful one, resulting in more cured patients. Further improvements in palliative care can be sought by defining new targets and new drug development. The lack of patients with bile duct neoplasms has been the limiting factor for any improvements. A new design of larger randomized international multicentric clinical trials with prompt data sharing could help to overcome this major problem. Defining standards of palliative care is a necessity. Addressing health-related quality of life could help to assess the real benefit of palliative treatment.
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Affiliation(s)
- S Tucek
- Department of Clinical Oncology, Faculty Hospital Brno.
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Tavella M, Tomasek J, Mills E, McConathy WJ. Lp(a) and LDL2: differences in fatty acid composition and collagen lattice contraction activity. Acta Physiol Pharmacol Ther Latinoam 2000; 49:93-9. [PMID: 10797846] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Lp(a) and LDL2 were used for detailed fatty acid analyses and tested in an in vitro model for promotion of fibroblast-mediated collagen lattice contraction to determine possible compositional and functional differences between these two apoB-containing lipoprotein species. Autologous Lp(a) was more saturated with respect to fatty acid composition than LDL2 in triglyceride and cholesterol ester lipid classes and had differences in the fatty acid content of phospholipids. Functionally, LDL2 promoted rapid fibroblast-mediated contraction while Lp(a) was significantly less active in promoting rapid contraction on a protein per weight basis. These studies suggest a synthetic route for Lp(a) diverging from the majority of other apoB-containing lipoproteins and significant activity of LDL2 in a collagen lattice contraction system.
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Affiliation(s)
- M Tavella
- PROPIA (Programa de Prevencion del Infarto en Argentina)-CIC (Comision de Investigaciones Científicas de la Provincia de Buenos Aires)-UNLP (Universidad Nacional de La Plata), Argentina
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