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Ohnmacht AJ, Stahler A, Stintzing S, Modest DP, Holch JW, Westphalen CB, Hölzel L, Schübel MK, Galhoz A, Farnoud A, Ud-Dean M, Vehling-Kaiser U, Decker T, Moehler M, Heinig M, Heinemann V, Menden MP. The Oncology Biomarker Discovery framework reveals cetuximab and bevacizumab response patterns in metastatic colorectal cancer. Nat Commun 2023; 14:5391. [PMID: 37666855 PMCID: PMC10477267 DOI: 10.1038/s41467-023-41011-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
Precision medicine has revolutionised cancer treatments; however, actionable biomarkers remain scarce. To address this, we develop the Oncology Biomarker Discovery (OncoBird) framework for analysing the molecular and biomarker landscape of randomised controlled clinical trials. OncoBird identifies biomarkers based on single genes or mutually exclusive genetic alterations in isolation or in the context of tumour subtypes, and finally, assesses predictive components by their treatment interactions. Here, we utilise the open-label, randomised phase III trial (FIRE-3, AIO KRK-0306) in metastatic colorectal carcinoma patients, who received either cetuximab or bevacizumab in combination with 5-fluorouracil, folinic acid and irinotecan (FOLFIRI). We systematically identify five biomarkers with predictive components, e.g., patients with tumours that carry chr20q amplifications or lack mutually exclusive ERK signalling mutations benefited from cetuximab compared to bevacizumab. In summary, OncoBird characterises the molecular landscape and outlines actionable biomarkers, which generalises to any molecularly characterised randomised controlled trial.
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Affiliation(s)
- Alexander J Ohnmacht
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany
- Department of Biology, Ludwig-Maximilians University Munich, 82152, Martinsried, Germany
| | - Arndt Stahler
- Charité Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology, and Cancer Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Stintzing
- Charité Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology, and Cancer Immunology, Charitéplatz 1, 10117, Berlin, Germany
- German Cancer Consortium (DKTK), partner sites Berlin and Munich, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Dominik P Modest
- Charité Universitätsmedizin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology, and Cancer Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Julian W Holch
- German Cancer Consortium (DKTK), partner sites Berlin and Munich, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
- Department of Medicine III and Comprehensive Cancer Center Munich, University Hospital, Ludwig-Maximilians University Munich, 81377, Munich, Germany
| | - C Benedikt Westphalen
- Department of Medicine III and Comprehensive Cancer Center Munich, University Hospital, Ludwig-Maximilians University Munich, 81377, Munich, Germany
| | - Linus Hölzel
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany
| | - Marisa K Schübel
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany
- Department of Biology, Ludwig-Maximilians University Munich, 82152, Martinsried, Germany
| | - Ana Galhoz
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany
- Department of Biology, Ludwig-Maximilians University Munich, 82152, Martinsried, Germany
| | - Ali Farnoud
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany
| | - Minhaz Ud-Dean
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany
| | | | | | - Markus Moehler
- Department of Medicine I and Research Center for Immunotherapy (FZI), Johannes Gutenberg-University Clinic, 55131, Mainz, Germany
| | - Matthias Heinig
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany
| | - Volker Heinemann
- Department of Medicine III and Comprehensive Cancer Center Munich, University Hospital, Ludwig-Maximilians University Munich, 81377, Munich, Germany.
| | - Michael P Menden
- Computational Health Center, Helmholtz Munich, 85764, Neuherberg, Germany.
- Department of Biology, Ludwig-Maximilians University Munich, 82152, Martinsried, Germany.
- Department of Biochemistry and Pharmacology, University of Melbourne, Victoria, 3010, Australia.
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Hofmann FO, Heinemann V, D’Anastasi M, Gesenhues AB, Hesse N, von Weikersthal LF, Decker T, Kiani A, Moehler M, Kaiser F, Heintges T, Kahl C, Kullmann F, Scheithauer W, Link H, Modest DP, Stintzing S, Holch JW. Standard diametric versus volumetric early tumor shrinkage as a predictor of survival in metastatic colorectal cancer: subgroup findings of the randomized, open-label phase III trial FIRE-3 / AIO KRK-0306. Eur Radiol 2023; 33:1174-1184. [PMID: 35976398 PMCID: PMC9889429 DOI: 10.1007/s00330-022-09053-2] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/16/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Early tumor shrinkage (ETS) quantifies the objective response at the first assessment during systemic treatment. In metastatic colorectal cancer (mCRC), ETS gains relevance as an early available surrogate for patient survival. The aim of this study was to increase the predictive accuracy of ETS by using semi-automated volumetry instead of standard diametric measurements. METHODS Diametric and volumetric ETS were retrospectively calculated in 253 mCRC patients who received 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) combined with either cetuximab or bevacizumab. The association of diametric and volumetric ETS with overall survival (OS) and progression-free survival (PFS) was compared. RESULTS Continuous diametric and volumetric ETS predicted survival similarly regarding concordance indices (p > .05). In receiver operating characteristics, a volumetric threshold of 45% optimally identified short-term survivors. For patients with volumetric ETS ≥ 45% (vs < 45%), median OS was longer (32.5 vs 19.0 months, p < .001) and the risk of death reduced for the first and second year (hazard ratio [HR] = 0.25, p < .001, and HR = 0.39, p < .001). Patients with ETS ≥ 45% had a reduced risk of progressive disease only for the first 6 months (HR = 0.26, p < .001). These survival times and risks were comparable to those of diametric ETS ≥ 20% (vs < 20%). CONCLUSIONS The accuracy of ETS in predicting survival was not increased by volumetric instead of diametric measurements. Continuous diametric and volumetric ETS similarly predicted survival, regardless of whether patients received cetuximab or bevacizumab. A volumetric ETS threshold of 45% and a diametric ETS threshold of 20% equally identified short-term survivors. KEY POINTS • ETS based on volumetric measurements did not predict survival more accurately than ETS based on standard diametric measurements. • Continuous diametric and volumetric ETS predicted survival similarly in patients receiving FOLFIRI with cetuximab or bevacizumab. • A volumetric ETS threshold of 45% and a diametric ETS threshold of 20% equally identified short-term survivors.
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Affiliation(s)
- Felix O. Hofmann
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,German Cancer Consortium (DKTK), partner site Munich, and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Volker Heinemann
- German Cancer Consortium (DKTK), partner site Munich, and German Cancer Research Centre (DKFZ), Heidelberg, Germany ,Department of Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Melvin D’Anastasi
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany ,Mater Dei Hospital, University of Malta, Triq tal-Qroqq, Msida, MSD2090 Malta
| | - Alena B. Gesenhues
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | | | | | - Alexander Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany ,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Markus Moehler
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | | | | | - Christoph Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - Frank Kullmann
- Department of Internal Medicine I, Hospital Weiden, Weiden, Germany
| | - Werner Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hartmut Link
- Department of Medicine I, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | - Dominik P. Modest
- Medical Department of Hematology, Oncology and Cancer Immunology (CCM), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Stintzing
- Medical Department of Hematology, Oncology and Cancer Immunology (CCM), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julian W. Holch
- German Cancer Consortium (DKTK), partner site Munich, and German Cancer Research Centre (DKFZ), Heidelberg, Germany ,Department of Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Kumbrink J, Bohlmann L, Mamlouk S, Redmer T, Peilstöcker D, Li P, Lorenzen S, Algül H, Kasper S, Hempel D, Kaiser F, Michl M, Bartsch H, Neumann J, Klauschen F, von Bergwelt-Baildon M, Modest DP, Stahler A, Stintzing S, Jung A, Kirchner T, Schäfer R, Heinemann V, Holch JW. Serial Analysis of Gene Mutations and Gene Expression during First-Line Chemotherapy against Metastatic Colorectal Cancer: Identification of Potentially Actionable Targets within the Multicenter Prospective Biomarker Study REVEAL. Cancers (Basel) 2022; 14:cancers14153631. [PMID: 35892888 PMCID: PMC9367450 DOI: 10.3390/cancers14153631] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The emergence of resistant cells remains a major obstacle for chemotherapy treatment of metastatic colorectal cancers. Improvement of the therapeutic response requires a thorough understanding of the mechanisms of resistance as well as informative biomarkers. In the REVEAL study, we have systematically compared the mutational patterns and expression profiles of primary tumor specimens before and after first-line chemotherapy treatment in the metastatic situation. In addition, we analyzed liquid biopsies pre, during, and after treatment. Alterations in gene expression appeared as the major drivers of chemotherapy resistance. We identified a gene expression signature differentiating primary tumors and metastases and validated this signature in two independent patient cohorts. Moreover, we evaluated the expression of two signature genes, SFRP2 and SPP1, as prognostic and potentially druggable biomarkers. Abstract Most metastatic colorectal cancer (mCRC) patients succumb to refractory disease due to secondary chemotherapy resistance. To elucidate the molecular changes associated with secondary resistance, we recruited 64 patients with mCRC and hepatic metastases before standard first-line chemotherapy between 2014 and 2018. We subjected DNA from primary tumor specimens (P), hepatic metastasis specimens after treatment (M), and liquid biopsies (L) taken prior to (pre), during (intra), and after (post) treatment to next generation sequencing. We performed Nanostring expression analysis in P and M specimens. Comparative bioinformatics and statistical analysis revealed typical mutational patterns with frequent alterations in TP53, APC, and KRAS in P specimens (n = 48). P and pre-L (n = 42), as well as matched P and M (n = 30), displayed a similar mutation spectrum. In contrast, gene expression profiles classified P (n = 31) and M (n = 23), distinguishable by up-regulation of immune/cytokine receptor and autophagy programs. Switching of consensus molecular subtypes from P to M occurred in 58.3% of cases. M signature genes SFRP2 and SPP1 associated with inferior survival, as validated in an independent cohort. Molecular changes during first-line treatment were detectable by expression profiling rather than by mutational tumor and liquid biopsy analyses. SFRP2 and SPP1 may serve as biomarkers and/or actionable targets.
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Affiliation(s)
- Jörg Kumbrink
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
- Correspondence:
| | - Lisa Bohlmann
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
| | - Soulafa Mamlouk
- Partner Site Berlin, German Cancer Consortium (DKTK), 10117 Berlin, Germany; (S.M.); (D.P.M.); (A.S.); (S.S.); (R.S.)
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Pathology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Torben Redmer
- Institute of Medical Biochemistry, University of Veterinary Medicine Vienna, 1210 Vienna, Austria;
| | - Daniela Peilstöcker
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
| | - Pan Li
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
| | - Sylvie Lorenzen
- Klinik und Poliklinik für Innere Medizin III, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Hana Algül
- School of Medicine, Technical University of Munich, 81675 Munich, Germany;
- Comprehensive Cancer Center Munich, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
| | - Dirk Hempel
- Steinbeishochschule Berlin, 12489 Berlin, Germany;
- Steinbeis Transfer Institute Clinical Hematology-Oncology, 86609 Donauwörth, Germany
| | | | - Marlies Michl
- Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany;
- Comprehensive Cancer Center, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Harald Bartsch
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
| | - Frederick Klauschen
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
| | - Michael von Bergwelt-Baildon
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
- Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Dominik Paul Modest
- Partner Site Berlin, German Cancer Consortium (DKTK), 10117 Berlin, Germany; (S.M.); (D.P.M.); (A.S.); (S.S.); (R.S.)
- Department of Hematology, Oncology and Cancer Immunology (CCM), Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Arndt Stahler
- Partner Site Berlin, German Cancer Consortium (DKTK), 10117 Berlin, Germany; (S.M.); (D.P.M.); (A.S.); (S.S.); (R.S.)
- Department of Hematology, Oncology and Cancer Immunology (CCM), Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Sebastian Stintzing
- Partner Site Berlin, German Cancer Consortium (DKTK), 10117 Berlin, Germany; (S.M.); (D.P.M.); (A.S.); (S.S.); (R.S.)
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Hematology, Oncology and Cancer Immunology (CCM), Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Andreas Jung
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
| | - Thomas Kirchner
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University of Munich (LMU), 80337 Munich, Germany; (L.B.); (D.P.); (P.L.); (H.B.); (J.N.); (F.K.); (A.J.); (T.K.)
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
| | - Reinhold Schäfer
- Partner Site Berlin, German Cancer Consortium (DKTK), 10117 Berlin, Germany; (S.M.); (D.P.M.); (A.S.); (S.S.); (R.S.)
- Charité Comprehensive Cancer Center, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Volker Heinemann
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
- Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany;
- Comprehensive Cancer Center, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Julian W. Holch
- Partner Site Munich, German Cancer Consortium (DKTK), 80336 Munich, Germany; (M.v.B.-B.); (V.H.); (J.W.H.)
- Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany;
- Comprehensive Cancer Center, University Hospital, LMU Munich, 81377 Munich, Germany
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4
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Liu L, Erickson NT, Ricard I, von Weikersthal LF, Lerch MM, Decker T, Kiani A, Kaiser F, Heintges T, Kahl C, Kullmann F, Scheithauer W, Link H, Höffkes HG, Moehler M, Gesenhues AB, Theurich S, Michl M, Modest DP, Algül H, Stintzing S, Heinemann V, Holch JW. Early weight loss is an independent risk factor for shorter survival and increased side effects in patients with metastatic colorectal cancer undergoing first-line treatment within the randomized Phase III trial FIRE-3 (AIO KRK-0306). Int J Cancer 2022; 150:112-123. [PMID: 34431518 DOI: 10.1002/ijc.33775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
Body weight loss is frequently regarded as negatively related to outcomes in patients with malignancies. This retrospective analysis of the FIRE-3 study evaluated the evolution of body weight in patients with metastatic colorectal cancer (mCRC). FIRE-3 evaluated first-line FOLFIRI (folinic acid, fluorouracil and irinotecan) plus cetuximab or bevacizumab in mCRC patients with RAS-WT tumors (ie, wild-type in KRAS and NRAS exons 2-4). The prognostic and predictive relevance of early weight loss (EWL) regarding patient outcomes and treatment side effects were evaluated. Retrospective data on body weight during first 6 months of treatment were evaluated (N = 326). To correlate with efficacy endpoints and treatment side effects, patients were grouped according to clinically significant EWL ≥5% and <5% at Month 3. Age constituted the only significant predictor of EWL following a linear relationship with the corresponding log odds ratio (P = .016). EWL was significantly associated with the incident frequencies of diarrhea, edema, fatigue, nausea and vomiting. Further, a multivariate analysis revealed EWL to be an independent negative prognostic factor for overall survival (32.4 vs 21.1 months; hazard ratio [HR]: 1.64; 95% confidence interval [CI] = 1.13-2.38; P = .0098) and progression-free survival (11.8 vs 9.0 months; HR: 1.72; 95% CI = 1.18-2.5; P = .0048). In conclusion, EWL during systemic treatment against mCRC is significantly associated with patient age. Patients exhibiting EWL had worse survival and higher frequencies of adverse events. Early preventative measures targeted at weight maintenance should be evaluated, especially in elderly patients being at highest risk of EWL.
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Affiliation(s)
- Lian Liu
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany
| | | | - Ingrid Ricard
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany
| | | | - Markus M Lerch
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | | | - Florian Kaiser
- Praxis Hämatologie/Onkologie/Palliativmedizin-Tagesklinik, Landshut, Germany.,VK&K Studien GbR, Landshut, Germany
| | | | - Christoph Kahl
- Städtisches Klinikum Magdeburg, Hämatologie/ Onkologie, Magdeburg, Germany
| | | | - Werner Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hartmut Link
- Department of Medicine I, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | | | - Markus Moehler
- Medical Department 1, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | | | - Sebastian Theurich
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Cancer- and Immunometabolism Research Group, Gene Center LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Marlies Michl
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Dominik P Modest
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Department of Hematology, Oncology, and Tumorimmunology, Charité - Universitaetsmedizin, Berlin, Germany
| | - Hana Algül
- Comprehensive Cancer Center Munich TUM, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sebastian Stintzing
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Department of Hematology, Oncology, and Tumorimmunology, Charité - Universitaetsmedizin, Berlin, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Julian W Holch
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
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5
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Gebauer L, Moltz JH, Mühlberg A, Holch JW, Huber T, Enke J, Jäger N, Haas M, Kruger S, Boeck S, Sühling M, Katzmann A, Hahn H, Kunz WG, Heinemann V, Nörenberg D, Maurus S. Quantitative Imaging Biomarkers of the Whole Liver Tumor Burden Improve Survival Prediction in Metastatic Pancreatic Cancer. Cancers (Basel) 2021; 13:cancers13225732. [PMID: 34830885 PMCID: PMC8616514 DOI: 10.3390/cancers13225732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Finding prognostic biomarkers and associated models with high accuracy in patients with pancreatic cancer remains a challenge. The aim of this study was to analyze whether the combination of quantitative imaging biomarkers based on geometric and radiomics analysis of whole liver tumor burden and established clinical parameters improves the prediction of survival in patients with metastatic pancreatic cancer. In this retrospective study a total of 75 patients with pancreatic cancer and liver metastases were analyzed. Segmentations of whole liver tumor burden from baseline contrast-enhanced CT images were used to derive different quantitative imaging biomarkers. For comparison, we chose two clinical prognostic models from the literature. We found that a combined clinical and imaging-based model has a significantly higher predictive performance to discriminate survival than the underlying clinical models alone (p < 0.003). Abstract Finding prognostic biomarkers with high accuracy in patients with pancreatic cancer (PC) remains a challenging problem. To improve the prediction of survival and to investigate the relevance of quantitative imaging biomarkers (QIB) we combined QIB with established clinical parameters. In this retrospective study a total of 75 patients with metastatic PC and liver metastases were analyzed. Segmentations of whole liver tumor burden (WLTB) from baseline contrast-enhanced CT images were used to derive QIBs. The benefits of QIBs in multivariable Cox models were analyzed in comparison with two clinical prognostic models from the literature. To discriminate survival, the two clinical models had concordance indices of 0.61 and 0.62 in a statistical setting. Combined clinical and imaging-based models achieved concordance indices of 0.74 and 0.70 with WLTB volume, tumor burden score (TBS), and bilobar disease being the three WLTB parameters that were kept by backward elimination. These combined clinical and imaging-based models have significantly higher predictive performance in discriminating survival than the underlying clinical models alone (p < 0.003). Radiomics and geometric WLTB analysis of patients with metastatic PC with liver metastases enhances the modeling of survival compared with models based on clinical parameters alone.
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Affiliation(s)
- Leonie Gebauer
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.W.H.); (M.H.); (S.K.); (S.B.); (V.H.)
- Correspondence:
| | - Jan H. Moltz
- Fraunhofer Institute for Digital Medicine MEVIS, Max-von-Laue-Str. 2, 28359 Bremen, Germany; (J.H.M.); (H.H.)
| | - Alexander Mühlberg
- CT R&D Image Analytics, Siemens Healthineers, Siemensstr. 1, 91301 Forchheim, Germany; (A.M.); (M.S.); (A.K.)
| | - Julian W. Holch
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.W.H.); (M.H.); (S.K.); (S.B.); (V.H.)
| | - Thomas Huber
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (T.H.); (J.E.); (N.J.); (W.G.K.); (D.N.); (S.M.)
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Johanna Enke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (T.H.); (J.E.); (N.J.); (W.G.K.); (D.N.); (S.M.)
| | - Nils Jäger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (T.H.); (J.E.); (N.J.); (W.G.K.); (D.N.); (S.M.)
| | - Michael Haas
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.W.H.); (M.H.); (S.K.); (S.B.); (V.H.)
| | - Stephan Kruger
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.W.H.); (M.H.); (S.K.); (S.B.); (V.H.)
| | - Stefan Boeck
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.W.H.); (M.H.); (S.K.); (S.B.); (V.H.)
| | - Michael Sühling
- CT R&D Image Analytics, Siemens Healthineers, Siemensstr. 1, 91301 Forchheim, Germany; (A.M.); (M.S.); (A.K.)
| | - Alexander Katzmann
- CT R&D Image Analytics, Siemens Healthineers, Siemensstr. 1, 91301 Forchheim, Germany; (A.M.); (M.S.); (A.K.)
| | - Horst Hahn
- Fraunhofer Institute for Digital Medicine MEVIS, Max-von-Laue-Str. 2, 28359 Bremen, Germany; (J.H.M.); (H.H.)
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (T.H.); (J.E.); (N.J.); (W.G.K.); (D.N.); (S.M.)
| | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (J.W.H.); (M.H.); (S.K.); (S.B.); (V.H.)
| | - Dominik Nörenberg
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (T.H.); (J.E.); (N.J.); (W.G.K.); (D.N.); (S.M.)
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan Maurus
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (T.H.); (J.E.); (N.J.); (W.G.K.); (D.N.); (S.M.)
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6
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Stock S, Marcon J, Chaloupka M, Becker A, Kunz WG, Ormanns S, Pichler T, Mumm FHA, Holch JW, Lindner LH. Primary Chemotherapy in a 47-Year-Old Patient with Giant Ulcerative and Necrotizing Nonseminomatous Testicular Germ Cell Tumor. Case Rep Oncol 2021; 14:681-689. [PMID: 34054461 PMCID: PMC8138151 DOI: 10.1159/000514049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 11/19/2022] Open
Abstract
Testicular cancer is a rare disease; however, cure rates are high for all tumor stages. Mostly, the disease is diagnosed in an early (local) stage. We report the case of a 47-year-old male patient with a giant nonseminomatous germ cell tumor. At the time of diagnosis, the patient demonstrated a necrotizing and ulcerating growing mass in the left scrotum with an approximate size of 22 × 18 cm. According to the prognostic classification of the International Germ Cell Cancer Collaborative Group (IGCCCG 1997), the patient exhibited a high-risk profile due to alpha-fetoprotein >10,000 ng/mL and lactate dehydrogenase >10× the upper limit of normal in serum. Primary orchiectomy was infeasible due to the tumor's size, the patient's poor general condition and initial intensive care unit treatment. Primary systemic chemotherapy was applied. After 3 cycles of cisplatin, etoposide and bleomycin, along with 1 cycle of cisplatin, etoposide and ifosfamide, tumor resection with histomorphological examination showed a complete pathological response. Despite the delayed initiation of the therapy, primary chemotherapy was completed timely and showed promising results. Reasons for the late hospitalization were personal responsibilities regarding his family. Better awareness and knowledge of testicular cancer among young men might prevent the here reported delay of medical consultation and avoid testicular tumors of such enormous size. Psychosocial assessment and distress management is important as an integral part of comprehensive care of testicular cancer patients.
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Affiliation(s)
- Sophia Stock
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Steffen Ormanns
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Theresia Pichler
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Friederike H A Mumm
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Julian W Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
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7
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Holch JW, Held S, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Kaiser F, Heintges T, Kahl C, Kullmann F, Scheithauer W, Moehler M, von Einem JC, Michl M, Heinemann V. Relation of cetuximab-induced skin toxicity and early tumor shrinkage in metastatic colorectal cancer patients: results of the randomized phase 3 trial FIRE-3 (AIO KRK0306). Ann Oncol 2021; 31:72-78. [PMID: 31912799 DOI: 10.1016/j.annonc.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cetuximab-induced skin toxicity (Cet-ST) is positively associated with outcome in metastatic colorectal cancer (mCRC). Besides its predictive relevance for targeted therapy, we investigated its prognostic impact with early tumor shrinkage (ETS) ≥20%, another on-treatment surrogate for clinical outcome in FIRE-3. PATIENTS AND METHODS FIRE-3 evaluated first-line FOLFIRI (folinic acid, fluorouracil and irinotecan) plus cetuximab (FOLFIRI/Cet) versus FOLFIRI plus bevacizumab (FOLFIRI/Bev) in mCRC patients with RAS-WT tumors (i.e. wild-type in KRAS and NRAS exons 2-4). Retrospective data on Cet-ST that occurred during cycles 1-3 of treatment were correlated with efficacy endpoints, including ETS. To control for guarantee-time bias, only patients who had completed three or more treatment cycles were considered. RESULTS Of 199 patients treated with FOLFIRI/Cet, 181 (91.0%) completed three or more treatment cycles. A significant survival benefit of FOLFIRI/Cet over FOLFIRI/Bev was only evident in patients developing Cet-ST grade 2-3 [41.0 versus 26.6 months; hazard ratio (HR) = 0.73; 95% confidence interval (CI): 0.61-0.87; P < 0.001] compared with Cet-ST grade 0-1 (HR = 0.90; 95% CI: 0.67-1.20; P = 0.48). Regarding prognosis, Cet-ST grade 2-3 (n = 75; 41.4%), compared with Cet-ST grade 0-1 (n = 106; 58.6%), was associated with prolonged overall survival (OS; HR = 0.62; 95% CI: 0.42-0.91; P = 0.01). In multivariate analysis, both Cet-ST (HR = 0.66; 95% CI: 0.50-0.87; P = 0.003) and ETS (HR = 0.55; 95% CI: 0.41-0.74; P < 0.0001) were independently prognostic for OS. Absence of both Cet-ST grade ≥2 and ETS identified a subgroup of patients with very poor prognosis (median OS 15.1 months). CONCLUSIONS In FIRE-3, the addition of cetuximab to FOLFIRI was associated with superior OS compared with FOLFIRI/Bev only in patients developing Cet-ST grade ≥2. Regarding prognostic relevance, both Cet-ST and ETS were independent and early predictors of survival. The present analysis supports that a combined evaluation of on-treatment parameters such as Cet-ST and ETS may help to guide treatment of mCRC.
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Affiliation(s)
- J W Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - S Stintzing
- Medical Department, Division of Hematology, Oncology and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | - T Decker
- Onkologie Ravensburg, Ravensburg, Germany
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - F Kaiser
- Hämato-onkologische Tagesklinik, Landshut, Germany
| | - T Heintges
- Department of Medicine II, Lukaskrankenhaus, Neuss, Germany
| | - C Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - F Kullmann
- Department of Internal Medicine I, Klinikum Weiden, Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I & CCC, Medical University Vienna, Vienna, Austria
| | - M Moehler
- University Medical Center Mainz, I. Department of Internal Medicine, Mainz, Germany
| | - J C von Einem
- Medical Department, Division of Hematology, Oncology and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - M Michl
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
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8
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Thurmaier J, Heinemann V, Engel J, Schubert-Fritschle G, Wiedemann M, Nüssler NC, Ruppert R, Kleeff J, Schepp W, Löhe F, Karthaus M, Neumann J, Kumbrink J, Taverna F, Stahler A, Heinrich K, Westphalen CB, Holch JW, Kirchner T, Michl M. Patients with colorectal cancer and brain metastasis: The relevance of extracranial metastatic patterns predicting time intervals to first occurrence of intracranial metastasis and survival. Int J Cancer 2020; 148:1919-1927. [PMID: 33113215 DOI: 10.1002/ijc.33364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 01/20/2023]
Abstract
The aim of the study was to investigate the predictive impact of extracranial metastatic patterns on course of disease and survival in patients with colorectal cancer (CRC) and brain metastasis (BM). A total of 228 patients (134 male [59%], 94 female [41%]) with histologically proven CRC and BM were classified into different groups according to extracranial metastatic patterns. Time intervals to metastatic events and survival times from initial CRC diagnosis, extracranial and intracranial metastasis were analyzed. Extracranial organs mostly affected were liver (102 of 228 [44.7%]) and lung (96 of 228 [42.1%]). Liver and lung metastases were detected in 31 patients (13.6%). Calculated over the entire course of disease, patients with lung metastasis showed longer overall survival (OS) than patients with liver metastasis or patients without lung metastasis (43.9 vs 34.6 [P = .002] vs 35.0 months [P = .002]). From the date of initial CRC diagnosis, lung metastasis occurred later in CRC history than liver metastasis (24.3 vs 7.5 months). Once lung metastasis was diagnosed, BM occurred faster than in patients with liver metastasis (15.8 vs 26.0 months; Δ 10.2 months). Accordingly, OS from the diagnosis of liver metastasis was longer than from lung metastasis (27.1 vs 19.6 months [P = .08]). Once BM was present, patients with lung metastasis lived longer than patients with liver metastasis (3.8 vs 1.1 months [P = .028]). Shortest survival times in all survival categories analyzed revealed patients with concurrent liver and lung metastasis. Patients with CRC and BM form a heterogeneous cohort where extracranial metastasis to liver or lungs predicts survival.
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Affiliation(s)
- Johannes Thurmaier
- Department of General Pediatrics, Ostschweizer Kinderspital, St. Gallen, Switzerland
| | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR), Ludwig-Maximilians-University of Munich, Munich, Germany.,Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Germany
| | - Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR), Ludwig-Maximilians-University of Munich, Munich, Germany.,Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Germany
| | - Max Wiedemann
- Munich Cancer Registry (MCR), Ludwig-Maximilians-University of Munich, Munich, Germany.,Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Germany
| | | | - Reinhard Ruppert
- Department of Surgery, München Klinik Neuperlach, Munich, Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Germany
| | - Wolfgang Schepp
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, München Klinik Bogenhausen, Munich, Germany
| | - Florian Löhe
- Department of Surgery, Klinikum Landshut, Landshut, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology and Palliative Care, München Klinik Harlaching and Neuperlach, Munich, Germany
| | - Jens Neumann
- German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany
| | - Jörg Kumbrink
- German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany
| | - Francesco Taverna
- Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany
| | - Arndt Stahler
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Kathrin Heinrich
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Christoph Benedikt Westphalen
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Julian W Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Thomas Kirchner
- German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Institute of Pathology, Ludwig-Maximilians-University of Munich, Germany
| | - Marlies Michl
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
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9
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Mühlberg A, Holch JW, Heinemann V, Huber T, Moltz J, Maurus S, Jäger N, Liu L, Froelich MF, Katzmann A, Gresser E, Taubmann O, Sühling M, Nörenberg D. The relevance of CT-based geometric and radiomics analysis of whole liver tumor burden to predict survival of patients with metastatic colorectal cancer. Eur Radiol 2020; 31:834-846. [PMID: 32851450 DOI: 10.1007/s00330-020-07192-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the prediction of 1-year survival (1-YS) in patients with metastatic colorectal cancer with use of a systematic comparative analysis of quantitative imaging biomarkers (QIBs) based on the geometric and radiomics analysis of whole liver tumor burden (WLTB) in comparison to predictions based on the tumor burden score (TBS), WLTB volume alone, and a clinical model. METHODS A total of 103 patients (mean age: 61.0 ± 11.2 years) with colorectal liver metastases were analyzed in this retrospective study. Automatic segmentations of WLTB from baseline contrast-enhanced CT images were used. Established biomarkers as well as a standard radiomics model building were used to derive 3 prognostic models. The benefits of a geometric metastatic spread (GMS) model, the Aerts radiomics prior model of the WLTB, and the performance of TBS and WLTB volume alone were assessed. All models were analyzed in both statistical and predictive machine learning settings in terms of AUC. RESULTS TBS showed the best discriminative performance in a statistical setting to discriminate 1-YS (AUC = 0.70, CI: [0.56, 0.90]). For the machine learning-based prediction for unseen patients, both a model of the GMS of WLTB (0.73, CI: [0.60, 0.84]) and the Aerts radiomics prior model (0.76, CI: [0.65, 0.86]) applied on the WLTB showed a numerically higher predictive performance than TBS (0.68, CI: [0.54, 0.79]), radiomics (0.65, CI: [0.55, 0.78]), WLTB volume alone (0.53, CI: [0.40. 0.66]), or the clinical model (0.56, CI: [0.43, 0.67]). CONCLUSIONS The imaging-based GMS model may be a first step towards a more fine-grained machine learning extension of the TBS concept for risk stratification in mCRC patients without the vulnerability to technical variance of radiomics. KEY POINTS • CT-based geometric distribution and radiomics analysis of whole liver tumor burden in metastatic colorectal cancer patients yield prognostic information. • Differences in survival are possibly attributable to the spatial distribution of metastatic lesions and the geometric metastatic spread analysis of all liver metastases may serve as robust imaging biomarker invariant to technical variation. • Imaging-based prediction models outperform clinical models for 1-year survival prediction in metastatic colorectal cancer patients with liver metastases.
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Affiliation(s)
| | - Julian W Holch
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Huber
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Jan Moltz
- Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany
| | - Stefan Maurus
- Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Nils Jäger
- Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Lian Liu
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Radiology, Munich University Hospitals, Munich, Germany
| | | | - Eva Gresser
- Department of Radiology, Munich University Hospitals, Munich, Germany
| | - Oliver Taubmann
- CT R&D Image Analytics, Siemens Healthineers, Forchheim, Germany
| | - Michael Sühling
- CT R&D Image Analytics, Siemens Healthineers, Forchheim, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,Department of Radiology, Munich University Hospitals, Munich, Germany.
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10
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Holch JW, Heinemann V. Reply to 'Cetuximab-related skin toxicity and efficacy: do we understand the mechanisms?' by Evesque et al. Ann Oncol 2020; 31:1261-1262. [PMID: 32439387 DOI: 10.1016/j.annonc.2020.05.007] [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] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- J W Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
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11
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Liu L, Erickson NT, Holch JW, Ricard I, Gesenhues AB, Theurich S, Stintzing S, Heinemann V. Effect of weight loss in patients with metastatic colorectal cancer treated within the randomized phase III FIRE-3 trial (AIO KRK 0306). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
87 Background: A subgroup of RAS wild-type metastatic colorectal cancer patients within the FIRE-3 study consisted of 400 patients. Gaining insight into frequency and effects of weight change among patients treated with FOLFIRI plus either cetuximab or bevacizumab was aim of this analysis. Methods: A subgroup of 400 RAS wild-type metastatic colorectal cancer (mCRC) patients of the FIRE-3 trial were evaluated. Linear mixed effect models were fitted to explore the mean evolution of weight over time. The presence of a breakpoint at month 1 was investigated by the addition of an adequate parameter into the model. A linear evolution was supposed from month 1. In this exploratory analysis, patients were grouped into cohorts according to weight change using the cut off ≥ 5%. Kaplan-Meier estimations and median survival times were analyzed using log-rank testing. Hazard ratios and corresponding 95% confidence interval from univariate Cox proportional hazards were followed by a multivariate analysis. Results: Patients lost in average 0.75 kg during the first month of treatment, whereas body weight increased hereafter 0.43 kg per month. Of note, patients older than 65 years lost most body weight at month one (1.35kg) and gained least hereafter (0.20kg per month). Within this population a weight loss of ≥ 5% was observed to be an independent prognostic factor for both PFS after 3 months (HR 1.72, 95% CI 1.26-2.34, P = 0.001) and OS after 3 months (HR 1.754, 95% CI 1.29-2.39, P < 0.001). This remained significant when adjusted for age, sex, ECOG score, primary tumor side and treatment arm. Conclusions: In the overall RAS wild-type population, weight loss is an independent prognostic factor for survival in patients with RAS wild-type metastatic colorectal cancer patients and may predict the frequency of adverse events. Therefore, we assume that early preventative measures targeted at weight maintenance might contribute to improved outcomes among this population.
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Affiliation(s)
- Lian Liu
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany
| | | | - Julian W. Holch
- Comprehensive Cancer Center, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany, German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany, Munich, Germany
| | - Ingrid Ricard
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany
| | | | - Sebastian Theurich
- Department of Medicine III, University Hospital, LMU Munich, Germany, Gene Center, Cancer- and Immunometabolism Research Group, LMU Munich, Germany, Munich, Germany
| | - Sebastian Stintzing
- Medical Department, Division of Hematology, Oncology, and Tumor Immunology (CCM), Charité Universitätsmedizin, Berlin, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany, Gene Center, Cancer, and Immunometabolism Research Group, Munich, Germany
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12
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von Baumgarten L, Kumbrink J, Jung A, Reischer A, Flach M, Liebmann S, Metzeler KH, Holch JW, Niyazi M, Thon N, Straube A, von Bergwelt-Baildon M, Heinemann V, Kirchner T, Westphalen CB. Therapeutic management of neuro-oncologic patients - potential relevance of CSF liquid biopsy. Am J Cancer Res 2020; 10:856-866. [PMID: 31903155 PMCID: PMC6929982 DOI: 10.7150/thno.36884] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/08/2019] [Indexed: 01/09/2023] Open
Abstract
Background: In the era of precision medicine, cancer treatment is increasingly tailored according to tumor-specific genomic alterations. The analysis of tumor-derived circulating nucleic acids in cerebrospinal fluid (CSF) by next generation sequencing (NGS) may facilitate precision medicine in the field of CNS cancer. We therefore evaluated whether NGS from CSF of neuro-oncologic patients reliably detects tumor-specific genomic alterations and whether this may help to guide the management of patients with CNS cancer in clinical practice. Patient and methods: CSF samples from 27 patients with various primary and secondary CNS malignancies were collected and evaluated by NGS using a targeted, amplicon-based NGS-panel (Oncomine Focus Assay). All cases were discussed within the framework of a molecular tumor board at the Comprehensive Cancer Center Munich. Results: NGS was technically successful in 23/27 patients (85%). Genomic alterations were detectable in 20/27 patients (74%), 11/27 (40%) of which were potentially actionable. After discussion in the MTB, a change of therapeutic management was recommended in 7/27 (26%) of the cases. However, due to rapid clinical progression, only 4/27 (15%) of the patients were treated according to the recommendation. In a subset of patients (6/27, 22%), a high number of mutations of unknown significance suggestive of a high tumor mutational burden (TMB) were detected. Conclusions: NGS from cerebrospinal fluid is feasible in routine clinical practice and yields therapeutically relevant alterations in a large subset of patients. Integration of this approach into a precision cancer medicine program might help to improve therapeutic options for patients with CNS cancer.
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13
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von Einem JC, Guenther C, Volk HD, Grütz G, Hirsch D, Salat C, Stoetzer O, Nelson PJ, Michl M, Modest DP, Holch JW, Angele M, Bruns C, Niess H, Heinemann V. Treatment of advanced gastrointestinal cancer with genetically modified autologous mesenchymal stem cells: Results from the phase 1/2 TREAT-ME-1 trial. Int J Cancer 2019; 145:1538-1546. [PMID: 30801698 DOI: 10.1002/ijc.32230] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
TREAT-ME-1, a Phase 1/2 open-label multicenter, first-in-human, first-in-class trial, evaluated the safety, tolerability and efficacy of treatment with genetically modified autologous mesenchymal stromal cells (MSC), MSC_ apceth_101, in combination with ganciclovir in patients with advanced gastrointestinal adenocarcinoma. Immunological and inflammatory markers were also assessed. All patients (3 in Phase 1; 7 in Phase 2) received three treatment cycles of MSC_apceth_101 at one dose level on Day 0, 7, and 14 followed by ganciclovir administration according to the manufacturer's instructions for 48─72 h after MSC_apceth_101 injection. Ten patients were treated with a total dose of 3.0 x 106 cells/kg MSC_apceth_101. 36 adverse events and six serious adverse events were reported. Five patients achieved stable disease (change in target lesions of -2 to +28%). For all patients, the median time to progression was 1.8 months (95% CI: 0.5, 3.9 months). Median overall survival could not be estimated as 8/10 patients were still alive at the end of the study (1 year) and therefore censored. Post-study observation of patients showed a median overall survival of 15.6 months (ranging from 2.2─27.0 months). Treatment with MSC_apceth_101 and ganciclovir did not induce a consistent increase or decrease in levels of any of the tumor markers analyzed. No clear trends in the immunological markers assessed were observed. MSC_apceth_101 in combination with ganciclovir was safe and tolerable in patients with advanced gastrointestinal adenocarcinoma, with preliminary signs of efficacy in terms of clinical stabilization of disease.
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Affiliation(s)
- Jobst Christian von Einem
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | | | - Hans-Dieter Volk
- Institute for Medical Immunology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin, Berlin, Germany
| | - Gerald Grütz
- Institute for Medical Immunology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin, Berlin, Germany
| | | | - Christoph Salat
- Medizinisches Zentrum für Haematologie und Onkologie Muenchen MVZ GmbH, Munich, Germany
| | - Oliver Stoetzer
- Medizinisches Zentrum für Haematologie und Onkologie Muenchen MVZ GmbH, Munich, Germany
| | - Peter J Nelson
- Department of Medicine IV, University Hospital of Munich, LMU, Munich, Germany
| | - Marlies Michl
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | - Dominik P Modest
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | - Julian W Holch
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | - Martin Angele
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christiane Bruns
- General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Hanno Niess
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
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Baraniskin A, Buchberger B, Pox C, Graeven U, Holch JW, Schmiegel W, Heinemann V. Efficacy of bevacizumab in first-line treatment of metastatic colorectal cancer: A systematic review and meta-analysis. Eur J Cancer 2019; 106:37-44. [DOI: 10.1016/j.ejca.2018.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022]
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Holch JW, Ricard I, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Heintges T, Kahl C, Kullmann F, Scheithauer W, Moehler M, Jelas I, Modest DP, Westphalen CB, von Einem JC, Michl M, Heinemann V. Relevance of baseline carcinoembryonic antigen for first-line treatment against metastatic colorectal cancer with FOLFIRI plus cetuximab or bevacizumab (FIRE-3 trial). Eur J Cancer 2018; 106:115-125. [PMID: 30496943 DOI: 10.1016/j.ejca.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Increased baseline carcinoembryonic antigen (CEA) serum level is associated with inferior overall survival (OS) in metastatic colorectal cancer (mCRC). However, limited data exist on its predictive relevance for targeted therapies. Therefore, we analysed its relevance in FIRE-3, a randomised phase III study. EXPERIMENTAL DESIGN FIRE-3 evaluated first-line FOLFIRI plus cetuximab (FOLFIRI/Cet) versus FOLFIRI plus bevacizumab (FOLFIRI/Bev) in mCRC patients with RAS-WT tumour (i.e. wild-type in KRAS and NRAS exons 2-4). Herein, the impact of CEA on patient outcome was investigated. RESULTS Of 400 patients, 356 (89.0%) were evaluable for CEA. High CEA (>10 ng/ml; N = 237) compared to low CEA (≤10 ng/ml; N = 119) was associated with shorter OS in the FOLFIRI/Bev arm (hazard ratio [HR] = 1.50; P = 0.036), while no significant OS difference was observed in the FOLFIRI/Cet arm (HR = 1.07; P = 0.74). In patients with high CEA, FOLFIRI/Cet compared to FOLFIRI/Bev showed a greater OS benefit (HR = 0.56; P < 0.001) than in patients with low CEA (HR = 0.78; P = 0.30). Furthermore, FOLFIRI/Cet exhibited significantly superior objective response rate in patients with high CEA (odds ratio = 2.21; P = 0.006) in contrast to patients with low CEA (odds ratio = 0.90; P = 0.85). CONCLUSION In patients with RAS-WT mCRC receiving first-line chemotherapy with FOLFIRI/Cet versus FOLFIRI/Bev, elevated CEA was associated with inferior survival in the bevacizumab arm, while this was not the case when cetuximab was applied. Comparison of OS and objective response rate according to treatment arms indicated that cetuximab was greatly superior to bevacizumab in patients with elevated CEA, while this effect was markedly lower and lost statistical significance in patients with low CEA.
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Affiliation(s)
- J W Holch
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - I Ricard
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - S Stintzing
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - L Fischer von Weikersthal
- Praxis für Onkologie/Haematologie, Gesundheitszentrum St. Marien GmbH, Mariahilfbergweg 7, 92224 Amberg, Germany
| | - T Decker
- Onkologie Ravensburg, Elisabethenstrasse 19, 88212 Ravensburg, Germany
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Preuschwitzer Strasse 101, 95445 Bayreuth, Germany
| | - U Vehling-Kaiser
- Hämato-onkologische Tagesklinik, Dr. Med. Ursula Vehling-Kaiser, Ländgasse 132-135, 84028 Landshut, Germany
| | - T Heintges
- Department of Medicine II, Lukaskrankenhaus, Preußenstrasse 84, 41462 Neuss, Germany
| | - C Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130 Magdeburg, Germany
| | - F Kullmann
- Department of Internal Medicine I, Klinikum Weiden, Söllnerstrasse 16, 92637 Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I & CCC, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - M Moehler
- University Medical Center Mainz, I. Dept. of Internal Medicine, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - I Jelas
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - D P Modest
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C B Westphalen
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - J C von Einem
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - M Michl
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - V Heinemann
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Froelich MF, Heinemann V, Sommer WH, Holch JW, Schoeppe F, Hesse N, Baumann AB, Kunz WG, Reiser MF, Ricke J, D’Anastasi M, Stintzing S, Modest DP, Kazmierczak PM, Hofmann FO. CT attenuation of liver metastases before targeted therapy is a prognostic factor of overall survival in colorectal cancer patients. Results from the randomised, open-label FIRE-3/AIO KRK0306 trial. Eur Radiol 2018; 28:5284-5292. [DOI: 10.1007/s00330-018-5454-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 02/01/2023]
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17
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von Einem JC, Peter S, Günther C, Volk HD, Grütz G, Salat C, Stoetzer O, Nelson PJ, Michl M, Modest DP, Holch JW, Angele M, Bruns C, Niess H, Heinemann V. Treatment of advanced gastrointestinal cancer with genetically modified autologous mesenchymal stem cells - TREAT-ME-1 - a phase I, first in human, first in class trial. Oncotarget 2017; 8:80156-80166. [PMID: 29113291 PMCID: PMC5655186 DOI: 10.18632/oncotarget.20964] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 05/10/2017] [Accepted: 08/26/2017] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This phase I, first in human, first in class clinical study aimed at evaluating the safety, tolerability and efficacy of treatment with genetically modified mesenchymal stromal cells (MSC) in combination with ganciclovir (GCV). MSC_apceth_101 are genetically modified autologous MSCs used as vehicles for a cell-based gene therapy in patients with advanced gastrointestinal adenocarcinoma. EXPERIMENTAL DESIGN The study design consisted of a dose-escalation 3 + 3 design. All patients (n = 6) were treated with up to three applications of MSC_apceth_101, followed by GCV infusions given on three consecutive days starting 48 hours after injection of MSC_apceth_101. Three of six patients received a total dose of 1.5 × 106 cells/kg. Two patients received three doses of 1 × 106 cells/kg, while one patient received only two doses of 1 × 106 cells/kg due to a SADR. RESULTS Six patients received MSC_apceth_101. No IMP-related serious adverse events occurred. Adverse-events related to IMP-injection were increased creatinine, cough, fever, and night sweat. TNF, IL-6, IL-8, IL-10 and sE-Selectin, showed that repeated application is immunologically safe, but induces a switch of the functional properties of monocytes to an inflammatory phenotype. Treatment induced stable disease in 4/6 patients, and progressive disease in 2/6 patients. CONCLUSION Treatment with MSC_apceth_101 in combination with GCV demonstrated acceptable safety and tolerability in patients with advanced gastrointestinal adenocarcinoma.
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Affiliation(s)
- Jobst C. von Einem
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | | | | | - Hans-Dieter Volk
- Institute for Medical Immunology and Berlin-Brandenburg Center for Regenerative Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | - Gerald Grütz
- Institute for Medical Immunology and Berlin-Brandenburg Center for Regenerative Medicine, Charité-Universitätsmedizin, Berlin, Germany
| | - Christoph Salat
- Haemato-Onkologische Schwerpunktpraxis Prof. Salat, Dr. Stoetzer, Munich, Germany
| | - Oliver Stoetzer
- Haemato-Onkologische Schwerpunktpraxis Prof. Salat, Dr. Stoetzer, Munich, Germany
| | - Peter J. Nelson
- Department of Medicine IV, University Hospital of Munich, LMU, Munich, Germany
| | - Marlies Michl
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | - Dominik P. Modest
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | - Julian W. Holch
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
| | - Martin Angele
- Department of Surgery, University Hospital Grosshadern, LMU, Munich, Germany
| | - Christiane Bruns
- General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Hanno Niess
- Department of Surgery, University Hospital Grosshadern, LMU, Munich, Germany
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, LMU, Munich, Germany
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18
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Modest DP, Ricard I, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Kahl C, Seipelt G, Kullmann F, Scheithauer W, Moehler M, Westphalen CB, Holch JW, von Einem JC, Held S, Heinemann V. Evaluation of survival across several treatment lines in metastatic colorectal cancer: Analysis of the FIRE-3 trial (AIO KRK0306). Eur J Cancer 2017; 84:262-269. [PMID: 28843184 DOI: 10.1016/j.ejca.2017.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We explored the impacts of sequential application of various treatment lines on survival kinetics. Therefore, differences in overall survival (OS) observed in FIRE-3 were investigated in the context of time and exposure to applied treatment. PATIENTS AND METHODS OS analyses (stratified by treatment with FOLFIRI plus either cetuximab or bevacizumab) were performed according to time intervals as well as using a Cox model to define changes of hazard ratio (HR) over time. RESULTS The fraction of patients with systemic treatment and time on treatment markedly decreases over treatment lines and time. OS evaluation by a Cox model indicated a trend towards a non-proportional hazard between treatment arms (P = 0.12/P = 0.09 for KRAS-intention-to-treat (ITT)/all-RAS wild-type populations, respectively). To improve the fit of the model, a change-point (point of curve separation) was estimated at 22.6 months (day 687) after randomisation. The HR between the two arms before 22.6 months was not significantly different from one. However, markedly different survival kinetics in favour of the cetuximab arm were apparent after the change-point (KRAS-ITT: P = 0.0018; HR, 0.60 [95% confidence interval [CI], 0.44-0.83] and RAS: P = 0.0006; HR, 0.51 [95% CI, 0.35-0.75]). CONCLUSION The differences in OS favouring the cetuximab arm become apparent about 22.6 months after randomisation, indicating that only those patients who survive 22.6 months after randomisation benefit from the superiority of the cetuximab arm. When OS curves separate, only few patients receive active systemic treatment in short courses, suggesting that earlier treatment effects are responsible for later kinetics of survival curves.
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Affiliation(s)
- D P Modest
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - I Ricard
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany
| | - S Stintzing
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - T Decker
- Oncological Practice, Ravensburg, Germany
| | - A Kiani
- Medizinische Klinik IV, Klinikum Bayreuth, Bayreuth, Germany
| | | | - S-E Al-Batran
- Department of Hematology and Oncology, Krankenhaus Nordwest Frankfurt/Main, Germany
| | - T Heintges
- Department of Medicine II, Städtisches Klinikum Neuss, Germany
| | - C Kahl
- Haematology and Oncology, Staedtisches Klinikum Magdeburg, Germany
| | - G Seipelt
- Oncological Practice, Bad Soden, Germany
| | - F Kullmann
- Department of Medicine I, Klinikum Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University Vienna, Austria
| | - M Moehler
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Medical Department 1, Johannes-Gutenberg Universität Mainz, Mainz, Germany; University Cancer Center Frankfurt/Mainz, Germany
| | - C B Westphalen
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany
| | - J W Holch
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany
| | - J C von Einem
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - V Heinemann
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
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