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Digklia A, Kollár A, Dietrich D, Kronig MN, Britschgi C, Rordorf T, Joerger M, Krasniqi F, Metaxas Y, Colombo I, Ribi K, Rothermundt C. SAKK57/16 Nab-paclitaxel and Gemcitabine in Soft Tissue Sarcoma (NAPAGE): a phase I/II trial. Eur J Cancer 2024; 197:113470. [PMID: 38096656 DOI: 10.1016/j.ejca.2023.113470] [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: 09/04/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND To determine whether the combination of nab-paclitaxel with gemcitabine has activity in patients with pretreated soft tissue sarcoma (STS). PATIENTS AND METHODS NAPAGE is a phase Ib/II clinical trial investigating the combination of nab-paclitaxel (nab-pc) with gemcitabine employing two cohorts. One of a dose-de-escalation phase and one of expansion. In phase I, nab-pc was given at 150 mg/m2 in combination with gemcitabine 1000 mg/m2 every two weeks, until disease progression or unacceptable toxicity. This dose was recommended for phase II (RP2D), as there was no dose limiting toxicity (DLT) or discontinuations due to adverse events (AEs). The primary endpoint of the phase II was progression-free rate (PFR) at 3 months (H0: 20%, H1:40%). The secondary endpoints included progression free survival (PFS), overall survival (OS), AEs, objective response and patient-reported outcomes (PRO). Efficacy analysis was by intention to treat. RESULTS The 3-month PFR was 56.4% (95% confidence interval CI: 39.6-72.2%). The 3-month and 6-month PFS were 58.4% (95% CI: 41.3-72.1%) and 44.6% (95% CI: 28.4-59.5%), respectively. Median PFS was 5.3 months (95% CI: 1.4-8.2) and median OS was 12.8 months (95% CI: 10.5-39.2). The most common treatment-related grade ≥ 3 AE were neutropenia (18%), followed by anemia (2.6%), hypertension (2.6%) and alanine aminotransferase increase (2.6%). Grade 1 and grade 2 peripheral sensory neuropathy (PNP) occurred in 15.4% and 20.5%, respectively. No grade 3-4 PNP was reported. CONCLUSIONS Combining nab-pc and gemcitabine is safe. Promising activity is observed in pretreated STS patients with manageable toxicity. This regimen should be considered for further exploration.
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Affiliation(s)
- A Digklia
- Department of Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - A Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Dietrich
- Swiss Group for Clinical Cancer Research (SAKK) Competence Center, Bern, Switzerland
| | - M N Kronig
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Britschgi
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - T Rordorf
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - M Joerger
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F Krasniqi
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - Y Metaxas
- Department of Medical Oncology, Cantonal Hospital, Grison Chur, Switzerland, now at Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland
| | - I Colombo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - K Ribi
- International Breast Cancer Study Group IBCSG (IBCSG), Bern, Switzerland
| | - C Rothermundt
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Honecker F, Müller A, Schär S, Rosset L, Corke M, Schwitter M, Güth U, Jakob A, Balmelli-Cattelan C, Leo C, Fehr M, Thorn D, Riniker S, Chouiter-Djebaili A, Musilova J, Ribi K, Hoefnagels N. Effect of a 24 week home-based walking program on the incidence of aromatase inhibitor induced musculoskeletal pain: The WISE prospective, randomized, multicenter trial [SAKK 95/17]. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ribi K, Kalbermatten N, Eicher M, Strasser F. Corrigendum to 'Towards a novel approach guiding the decision-making process for anticancer treatment in patients with advanced cancer: framework for systemic anticancer treatment with palliative intent': [ESMO Open volume 7 (2022) 100496]. ESMO Open 2022; 7:100614. [PMID: 36567081 PMCID: PMC9808468 DOI: 10.1016/j.esmoop.2022.100614] [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: 01/07/2023] Open
Affiliation(s)
- K. Ribi
- International Breast Cancer Study Group, Coordinating Center, Quality of Life Office, Bern,Correspondence to: Dr Karin Ribi
| | - N. Kalbermatten
- Clinic Medical Oncology and Hematology, Department Internal Medicine, Cantonal Hospital, St. Gallen
| | - M. Eicher
- Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University Hospital Lausanne, University of Lausanne, Lausanne
| | - F. Strasser
- Cantonal Hospital St. Gallen, Department Medical Oncology and Hematology, St. Gallen, Switzerland; University of Bern, Switzerland,University of Bern, Bern, Switzerland
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Digklia A, Kollar A, Kronig MN, Britschgi C, Rordorf T, Joerger M, Krasniqi F, Metaxas Y, Colombo I, Dietrich D, Chiquet S, Ribi K, Rothermundt C. 1495P SAKK 57/16 nab-paclitaxel and gemcitabine in soft tissue sarcoma (NAPAGE): Final results from the phase Ib/II trial with >2y median follow up. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1598] [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: 11/17/2022] Open
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Ribi K, Kalbermatten N, Eicher M, Strasser F. Towards a novel approach guiding the decision-making process for anticancer treatment in patients with advanced cancer: framework for systemic anticancer treatment with palliative intent. ESMO Open 2022; 7:100496. [PMID: 35597176 PMCID: PMC9271509 DOI: 10.1016/j.esmoop.2022.100496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 01/06/2023] Open
Abstract
Background Weighing risks and benefits is currently the primary criterion for decisions regarding systemic anticancer treatment (SACT) in far advanced cancer patients, also in the modern immunotherapy- and molecular-targeted driven oncology. Decision aids rarely include substantially key concepts of early integrated palliative care (PC) and communication science. We compiled decisional factors (DFs) important for guiding the use of SACT with palliative intent (SACT-PI) and explored these DFs regarding their applicability in routine clinical care. Patients and methods Clinician (participants: n = 28) and patient (n = 15) focus groups were conducted in an integrated oncology and PC setting. Thematic analysis was used to identify DFs. A Delphi survey of clinicians ranked the importance of DFs in routine decision-making. DFs were aligned with elements of the typical decision-making process, resulting in an eight-step guide for making SACT-PI decisions in clinical practice. Results Eight focus groups revealed 55 DFs relating to established topics like providing information and risk–benefit analysis, as well as to PC topics like patients’ attitudes, beliefs, and hopes; patient–physician interaction; and physician attitudes. Agreement on the relative importance was reached for 34 (62%) of 55 DFs, assigned to five elements: patient/family, clinicians/system, patient-clinician-interaction, information/patient education, risk–benefit weighting/actual decision. These themes are embedded in a potential clinically useful SACT-PI Decision Framework, which includes eight steps: assess, educate, verify, reflect, discuss, weigh, pause, and decide. Conclusions The SACT-PI Decision Framework integrates subjective patient factors, interpersonal factors, and PC issues into decision-making. Our findings complement existing decision aids and prompt lists by framing DFs in the context of SACT-PI and enforce the decision ‘process’, not the decision act. Further research is needed to explore the relative importance of DFs in specific patient situations and test structured decision-making processes, such as our SACT-PI Decision Framework, against standard care. Patient-centered decisions in advanced cancer care demand a stepwise decisional process, not a single decision act. The decision process includes key palliative care domains, e.g. illness understanding, symptom control, or end-of-life preparation. Patients’ attitudes, beliefs, hopes, patient–physician interaction, and physician attitudes demand structured observation. The SACT-PI Decision Framework includes concrete steps: assess, educate, verify, reflect, discuss, weigh, pause, decide. Interprofessionally working oncology clinicians may transform decision-making processes in oncology beyond decision aids.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Coordinating Center, Quality of Life Office, Bern, Switzerland.
| | - N Kalbermatten
- Clinic Medical Oncology and Hematology, Department Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland
| | - M Eicher
- Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - F Strasser
- Cancer Fatigue Clinic at Onkologie Schaffhausen, Schaffhausen and Center Integrative Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Center Integrative Medicine, Department Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Jerusalem G, Farah S, Courtois A, Chirgwin J, Aebi S, Karlsson P, Neven P, Hitre E, Graas MP, Simoncini E, Abdi E, Kamby C, Thompson A, Loibl S, Gavilá J, Kuroi K, Marth C, Müller B, O'Reilly S, Gombos A, Ruhstaller T, Burstein HJ, Rabaglio M, Ruepp B, Ribi K, Viale G, Gelber RD, Coates AS, Loi S, Goldhirsch A, Regan MM, Colleoni M. Continuous versus intermittent extended adjuvant letrozole for breast cancer: final results of randomized phase III SOLE (Study of Letrozole Extension) and SOLE Estrogen Substudy. Ann Oncol 2021; 32:1256-1266. [PMID: 34384882 DOI: 10.1016/j.annonc.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Late recurrences in postmenopausal women with hormone receptor-positive breast cancers remain an important challenge. Avoidance or delayed development of resistance represents the main objective in extended endocrine therapy (ET). In animal models, resistance was reversed with restoration of circulating estrogen levels during interruption of letrozole treatment. This phase III, randomized, open-label Study of Letrozole Extension (SOLE) studied the effect of extended intermittent letrozole treatment in comparison with continuous letrozole. In parallel, the SOLE estrogen substudy (SOLE-EST) analyzed the levels of estrogen during the interruption of treatment. PATIENTS AND METHODS SOLE enrolled 4884 postmenopausal women with hormone receptor-positive, lymph node-positive, operable breast cancer between December 2007 and October 2012 and among them, 104 patients were enrolled in SOLE-EST. They must have undergone local treatment and have completed 4-6 years of adjuvant ET. Patients were randomized between continuous letrozole (2.5 mg/day orally for 5 years) and intermittent letrozole treatment (2.5 mg/day for 9 months followed by a 3-month interruption in years 1-4 and then 2.5 mg/day during all of year 5). RESULTS Intention-to-treat population included 4851 women in SOLE (n = 2425 in the intermittent and n = 2426 in the continuous letrozole groups) and 103 women in SOLE-EST (n = 78 in the intermittent and n = 25 in the continuous letrozole groups). After a median follow-up of 84 months, 7-year disease-free survival (DFS) was 81.4% in the intermittent group and 81.5% in the continuous group (hazard ratio: 1.03, 95% confidence interval: 0.91-1.17). Reported adverse events were similar in both groups. Circulating estrogen recovery was demonstrated within 6 weeks after the stop of letrozole treatment. CONCLUSIONS Extended adjuvant ET by intermittent administration of letrozole did not improve DFS compared with continuous use, despite the recovery of circulating estrogen levels. The similar DFS coupled with previously reported quality-of-life advantages suggest intermittent extended treatment is a valid option for patients who require or prefer a treatment interruption.
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Affiliation(s)
- G Jerusalem
- International Breast Cancer Study Group, Bern, Switzerland; Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium.
| | - S Farah
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA
| | - A Courtois
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium
| | - J Chirgwin
- Breast Cancer Trials-Australia and New Zealand, University of Newcastle, Callaghan, Australia; Box Hill and Maroondah Hospitals, Monash University, Clayton, Australia
| | - S Aebi
- Division of Medical Oncology, Cancer Center, Lucerne Cantonal Hospital, Lucerne, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - E Hitre
- Department of Medical Oncology and Clinical Pharmacology "B", National Institute of Oncology, Budapest, Hungary
| | | | - E Simoncini
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Abdi
- The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - C Kamby
- Danish Breast Cancer Group and Rigshospitalet, Copenhagen, Denmark
| | - A Thompson
- Scottish Cancer Trials Breast Group and Division of Surgical Oncology, Baylor College of Medicine, Houston, USA
| | - S Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - J Gavilá
- SOLTI Group and Fundación Instituto Valenciano de Oncologia, Valencia, Spain
| | - K Kuroi
- Japan Breast Cancer Research Group and Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - C Marth
- Austrian Breast & Colorectal Cancer Study Group and Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Providencia, Santiago, Chile
| | - S O'Reilly
- Cancer Trials Ireland, Dublin, Ireland; University College Cork, Cork University Hospital, Cork, Ireland
| | - A Gombos
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - T Ruhstaller
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Breast Center St. Gallen, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - H J Burstein
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium; Harvard Medical School, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Rabaglio
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Ruepp
- International Breast Cancer Study Group, Bern, Switzerland
| | - K Ribi
- International Breast Cancer Study Group, Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - R D Gelber
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA; Frontier Science Foundation, Boston, USA
| | - A S Coates
- International Breast Cancer Study Group, Bern, Switzerland; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Loi
- International Breast Cancer Study Group, Bern, Switzerland; Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group, Bern, Switzerland; IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Colleoni
- International Breast Cancer Study Group, Bern, Switzerland; Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Ribi K, Thuerlimann B, Schär C, Dietrich D, Cathomas R, Zuerrer U, Von Briel T, Anchisi S, Bohanes P, Blum V, von Burg P, Mannhart M, Caspar C, von Moos R, Mark M. 1867P Quality of life and pain in patients with metastatic bone disease from solid tumors treated with bone-targeted agents: A real-world cross-sectional study from Switzerland (SAKK 95/16). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1514] [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: 11/16/2022] Open
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Weber W, Henke G, Ribi K, Hayoz S, Seiler S, Maddox C, Ruhstaller T, Zwahlen D, Muenst S, Ackerknecht M, Fitzal F, Matrai Z, Újhelyi M, Kurzeder C, Lelièvre L, Tausch C, Heil J, Knauer M. 126TiP Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (SAKK 23/16 / IBCSG 57-18 / ABCSG-53 / GBG 101 - TAXIS): A multicenter randomized phase III trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.229] [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: 11/26/2022] Open
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Mark M, Thuerlimann B, Ribi K, Schaer C, Dietrich D, Zuerrer U, von Moos R. Patterns of care for patients with metastatic bone disease in solid tumors: A cross-sectional study (SAKK 95/16). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vetter M, Rothgiesser K, Li Q, Hawle H, Schönfeld W, Ribi K, Riniker S, von Moos R, Müller A, Thürlimann B. SAKK 21/12: A stratified, multicenter phase II trial of transdermal CR1447 in endocrine responsive-HER2 negative and triple negative-androgen receptor positive metastatic or locally advanced breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz100.014] [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: 11/13/2022] Open
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Huober J, Ribi K, Weder P, Li Q, Vanlemmens L, Gerard MA, Lemonnier J, Thürlimann B, Boven E, Bonnefoi H. Pertuzumab (P) + trastuzumab (T) with or without chemotherapy both followed by T-DM1 in case of progression in patients with HER2-positive metastatic breast cancer (MBC) - The PERNETTA trial (SAKK 22/10), a randomized open label phase II study (SAKK, UNICANCER, BOOG). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz100.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Colomer-Lahiguera S, Bryant-Lukosius D, Rietkoetter S, Martelli L, Ribi K, Orcurto A, Juergens R, Eicher M. The use of patient reported outcome (PRO) instruments in immune checkpoint inhibitor (ICI) therapy for cancer: A systematic review. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy341.028] [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: 11/14/2022] Open
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Vees H, Caparrotti F, Xyrafas A, Fuhrer A, Meier U, Mark M, Elicin O, Aebersold D, Betticher D, Biaggi Rudolf C, Ribi K, Finazzi T, Zwahlen D. Impact of early prophylactic cranial irradiation with hippocampal avoidance on neurocognitive function in patients with limited disease small cell lung cancer: A multicenter phase II trial (SAKK 15/12). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.003] [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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Ribi K, Bana M, Peters S, Kropf-Straub S, Näf E, Zürcher S, Eicher M. Nurse-led approaches to self-management of symptoms in routine Swiss outpatient care: A qualitative exploration. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy278.001] [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: 11/14/2022] Open
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Gennari A, Sun Z, Hasler-Strub U, Colleoni M, Kennedy M, Von Moos R, Cortés J, Vidal M, Hennessy B, Walshe J, Parraga KA, Ribi K, Bernhard J, Murillo SM, Pagani O, Barbeaux A, Borstnar S, Rabaglio-Poretti M, Maibach R, Regan M, Jerusalem G. A randomized phase II study evaluating different maintenance schedules of nab-paclitaxel in the first-line treatment of metastatic breast cancer: final results of the IBCSG 42-12/BIG 2-12 SNAP trial. Ann Oncol 2018; 29:661-668. [DOI: 10.1093/annonc/mdx772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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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Ribi K, Luo W, Colleoni M, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, Neven P, Di Lauro V, Gomez HL, Ruhstaller T, Abdi E, Di Leo A, Müller B, Maibach R, Gelber RD, Goldhirsch A, Coates AS, Regan MM, Bernhard J. Abstract P5-18-01: Extended continuous vs intermittent adjuvant letrozole in postmenopausal women with lymph node-positive, early breast cancer (IBCSG 37-05/BIG 1-07 SOLE): Impact on patient-reported symptoms and quality of life. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-18-01] [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: 11/16/2022]
Abstract
Abstract
Background: SOLE efficacy results presented at ASCO 2017 showed that extended intermittent vs continuous letrozole for 5 years did not improve disease-free survival in postmenopausal women who had received 4-6 years of adjuvant endocrine therapy for hormone-receptor positive (HR+), lymph-node positive breast cancer. Previous studies showed that the burden by symptoms related to endocrine therapy can be substantial. Even if symptoms improve during the treatment course, extending treatment implies continuation of symptoms. We compared differences in patient-reported symptoms (PRS) and quality of life (QoL) between extended continuous and intermittent letrozole over the first two years of trial treatment.
Methods: From Nov 2007 to Dec 2010, 956 postmenopausal women who were disease-free following 4-6 years of prior adjuvant endocrine therapy for HR+, node-positive breast cancer were enrolled in the QoL substudy of the randomized phase III trial SOLE at selected centers. Patients receive extended continuous letrozole (2.5 mg daily) for 5 years or intermittent letrozole, taken for the first 9 months of years 1-4, and 12 months in year 5. 955 patients completed the 18-item Breast Cancer Prevention Trial (BCPT) Symptom Scales and further symptom-specific and global QoL indicators at baseline, and at 6, 12, 18 and 24 months after randomization. Differences in change of PRS and QoL from baseline between the two administration schedules were tested at 12 and 24 months for 8 symptom scales, 4 additional symptom and 4 global QoL indicators using mixed models with repeated measures.
Results: Small changes in PRS and QoL scores were observed between baseline and 12 months after randomization, i.e. at the end of the first treatment-free interval in the intermittent arm. These changes showed a consistent pattern of greater worsening for patients receiving continuous compared to patients receiving intermittent letrozole. Patients receiving continuous letrozole reported a significantly greater worsening in vaginal problems (p<.02), musculoskeletal pain (p<.03), sleep disturbance (p<.01), physical wellbeing (p<.01) and mood (p<.03). At 24 months (after 2nd treatment-free interval) patients with intermittent letrozole reported a greater improvement in hot flushes (p<.03) than those with continuous letrozole. Changes in the other outcomes did not significantly differ between arms at 24 months.
Conclusion: Although changes in PRS and QoL were small, there was a consistent pattern favoring the intermittent arm. For several symptoms and global QoL indicators, significantly less worsening was observed with the intermittent administration, mainly during the first year of extended treatment, due to small improvements during the treatment-free interval. Froma QoL perspective, women who suffer from endocrine side-effects in the extended setting may benefit from an intermittent administration.
Citation Format: Ribi K, Luo W, Colleoni M, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, Neven P, Di Lauro V, Gomez HL, Ruhstaller T, Abdi E, Di Leo A, Müller B, Maibach R, Gelber RD, Goldhirsch A, Coates AS, Regan MM, Bernhard J. Extended continuous vs intermittent adjuvant letrozole in postmenopausal women with lymph node-positive, early breast cancer (IBCSG 37-05/BIG 1-07 SOLE): Impact on patient-reported symptoms and quality of life [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-18-01.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Breast International Group
| | - W Luo
- International Breast Cancer Study Group, Breast International Group
| | - M Colleoni
- International Breast Cancer Study Group, Breast International Group
| | - P Karlsson
- International Breast Cancer Study Group, Breast International Group
| | - J Chirgwin
- International Breast Cancer Study Group, Breast International Group
| | - S Aebi
- International Breast Cancer Study Group, Breast International Group
| | - G Jerusalem
- International Breast Cancer Study Group, Breast International Group
| | - P Neven
- International Breast Cancer Study Group, Breast International Group
| | - V Di Lauro
- International Breast Cancer Study Group, Breast International Group
| | - HL Gomez
- International Breast Cancer Study Group, Breast International Group
| | - T Ruhstaller
- International Breast Cancer Study Group, Breast International Group
| | - E Abdi
- International Breast Cancer Study Group, Breast International Group
| | - A Di Leo
- International Breast Cancer Study Group, Breast International Group
| | - B Müller
- International Breast Cancer Study Group, Breast International Group
| | - R Maibach
- International Breast Cancer Study Group, Breast International Group
| | - RD Gelber
- International Breast Cancer Study Group, Breast International Group
| | - A Goldhirsch
- International Breast Cancer Study Group, Breast International Group
| | - AS Coates
- International Breast Cancer Study Group, Breast International Group
| | - MM Regan
- International Breast Cancer Study Group, Breast International Group
| | - J Bernhard
- International Breast Cancer Study Group, Breast International Group
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Ribi K, Sun Z, Jerusalem G, Hasler-Strub U, Colleoni M, von Moos R, Cortés J, Vidal M, Hennessy B, Walshe J, Amillano Parraga K, Morales Muriilo S, Pagani O, Barbeaux A, Bortsnar S, Maibach R, Regan MM, Gennari A, Bernhard J. Abstract P5-18-02: Nab-Paclitaxel-based therapy in the first line treatment of metastatic breast cancer (IBCSG 42-12/BIG 2-12 SNAP): Impact of different schedules on quality of life. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-18-02] [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: 11/16/2022]
Abstract
Abstract
Background: The randomized phase II SNAP trial assessed three alternative reduced maintenance chemotherapy regimens using nab-Paclitaxel after a short term induction phase at conventional doses as first line treatment in patients (pts) with metastatic breast cancer (MBC). For all three regimens median progression-free survival was greater than achieved with full dose docetaxel (historical reference). Symptom palliation and quality of life (QoL) are important when deciding on therapeutic agents and schedules in MBC pts.
Methods: Of the 258 pts with MBC enrolled from April 2013 to August 2015 in the SNAP trial, 255 were included in the QoL analysis. Pts were randomized to three arms, each receiving the same induction chemotherapy based on 3 cycles of nab-Paclitaxel 150 mg/m2 dd 1, 8, 15 Q28, which was reduced to 125 mg/m2 after a safety review. The schedules of nab-Paclitaxel in maintenance therapy differed in each arm: Arm A) 150 mg/m2 dd 1,15 Q28; Arm B) 100 mg/m2 dd 1,8,15 Q28; Arm C) 75 mg/m2 dd 1,8,15,22 Q28. Pts completed a QoL form to assess global and symptom-specific indicators (range 0-100) at baseline, and at day 1 of every cycle for the first 12 cycles on treatment, or until treatment discontinuation. Changes in QoL scores during induction (day 1 cycle 4 − baseline) and maintenance (day 1 cycle 12 – day 1 cycle 4) therapy were summarized descriptively per arm. Treatment effects on changes in QoL during maintenance therapy were analyzed by repeated measurement models including timepoints (from day 1 of cycle 4 to day 1 of cycle 12), induction start dose, age, and treatment arms as covariates.
Results: During induction therapy, mean changes [SD] in hair loss (Arm A:−70.2 [41.9]; Arm B: −77.3 [34.5]; Arm C: −72.6 [32.8]), sensory neuropathy (Arm A: −19.0 [25.2]; Arm B: −20.6 [22.7]; Arm C: −18.8 [23.8]), and treatment burden (Arm A: −12.9 [33.4]; Arm B: −13.4 [33.5]; Arm C: −11.4 [34.8]) showed the most pronounced worsening. During maintenance therapy, scores for sensory neuropathy remained impaired without worsening. No significant differences in changes for sensory neuropathy or the other symptoms were seen between arms, except for hair loss, with pts in arm C (mean difference 10.91; 95% CI [0.35, 21.48]; p=0.04) ] and B (mean difference 18.55; 95% CI [7.52, 29.59]; p=0.001) reporting a greater improvement compared to those in arm A. Pts in arm C reported a significantly greater improvement in mood compared to arm A (mean difference 13.34; 95% CI [6.08, 20.60]; p<0.001) and arm B (mean difference 9.62; 95% CI [2.84, 16.40]; p=0.01)].
Conclusion: The effectiveness of alternative maintenance chemotherapy schedules with reduced doses after a short term induction phase at conventional doses must be weighed against a substantial worsening in sensory neuropathy during induction therapy, and scores continuing to be impaired without worsening with prolonged administration. During maintenance therapy, improvements were seen in the perception of hair loss and in mood, particularly in Arm B and C, with a similar tendency seen for some other QoL domains. A more frequent administration of reduced dose chemotherapy agents is favorable with respect to QoL in this setting.
Citation Format: Ribi K, Sun Z, Jerusalem G, Hasler-Strub U, Colleoni M, von Moos R, Cortés J, Vidal M, Hennessy B, Walshe J, Amillano Parraga K, Morales Muriilo S, Pagani O, Barbeaux A, Bortsnar S, Maibach R, Regan MM, Gennari A, Bernhard J. Nab-Paclitaxel-based therapy in the first line treatment of metastatic breast cancer (IBCSG 42-12/BIG 2-12 SNAP): Impact of different schedules on quality of life [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-18-02.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - Z Sun
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - G Jerusalem
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - U Hasler-Strub
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - M Colleoni
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - R von Moos
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - J Cortés
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - M Vidal
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - B Hennessy
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - J Walshe
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - K Amillano Parraga
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - S Morales Muriilo
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - O Pagani
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - A Barbeaux
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - S Bortsnar
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - R Maibach
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - MM Regan
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - A Gennari
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - J Bernhard
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
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18
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Ribi K, Luo W, Burstein HJ, Naughton MJ, Chirgwin J, Ansari RH, Walley BA, Salim M, van der Westhuizen A, Abdi E, Francis PA, Budman DR, Kennecke H, Harvey VJ, Giobbie-Hurder A, Fleming GF, Pagani O, Regan MM, Bernhard J. Abstract P2-09-09: The effects of treatment-induced symptoms, depression and age on sexuality in premenopausal women with early breast cancer receiving adjuvant endocrine therapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-09-09] [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: 11/16/2022]
Abstract
Abstract
Background: In premenopausal women with breast cancer any treatment that causes abrupt, premature ovarian failure increases the risk of sexual problems. Randomized-controlled trials in this population reported a worsening in sexual functioning over time irrespective of adjuvant endocrine treatment. We investigated key symptoms related to endocrine therapy, depression and age as predictors of sexual problems in premenopausal women with early breast cancer treated in the IBCSG TEXT/SOFT trials over the first two years of endocrine therapy.
Methods: A subset of patients (pts) enrolled by centers with English as primary language to TEXT (1027 of 2672 pts) and SOFT (1260 of 3066 pts) completed a questionnaire consisting of global and symptom-specific quality of life indicators, the CES-Depression (CES-D) and the MOS- Sexual Problems (MOS-SP) measures at baseline, 6, 12 and 24 months. The analysis considered 5 cohorts of pts according to chemotherapy use (yes/no), trial (SOFT/TEXT) and endocrine treatment assignment (tamoxifen alone [T], T or exemestane [E] with ovarian function suppression [OFS]). Mixed modeling was used to test the effect of the following on changes in sexual problems (MOS-SP total score) over two years: changes in treatment-induced symptoms (hot flushes, vaginal dryness, sleep disturbances, bone/joint pain, troubled by weight gain, tiredness, nausea/vomiting) from baseline to 6 months; depression at 6 months; and age at randomization. The model included severity groups of symptoms, depression (all dichotomized by median) and age (< 40 vs ≥40 years), 5 cohorts, time points (6, 12, 24 months), baseline covariates, and interactions of symptoms, timepoints and cohorts.
Results: Overall across cohorts, pts with more severe worsening of vaginal dryness and sleep disturbances at 6 months reported a greater increase in sexual problems at all timepoints (p<.0001). The effect of vaginal dryness on sexual problems was most pronounced in the cohort of pts who received T+OFS or E+OFS without chemotherapy; the effect of sleep disturbances was most pronounced in the cohort with prior chemotherapy and T alone. All other symptoms had a smaller impact on differences in changes of sexual problems. Significant effects were only seen in the short-term and varied according to cohort. Severity of depression at six months did not predict sexual problems at the later timepoints in the overall population. In the cohort that received T+OFS or E+OFS without chemotherapy, pts who had more severe depression scores at 6 months reported significantly worse sexual problems at all timepoints (p<.05). No differences were found for younger vs. older pts with respect to sexual problems at any timepoint.
Conclusion: Among several key symptoms related to endocrine therapy, only vaginal dryness and sleep disturbances significantly predicted sexual problems during the first two years in pts who received adjuvant endocrine therapy with or without chemotherapy. Depression predicted sexual problems only in the cohort of pts who received combined endocrine treatment without chemotherapy. Early identification of vaginal dryness, sleep disturbances and depression is important for timely and tailored interventions.
Citation Format: Ribi K, Luo W, Burstein HJ, Naughton MJ, Chirgwin J, Ansari RH, Walley BA, Salim M, van der Westhuizen A, Abdi E, Francis PA, Budman DR, Kennecke H, Harvey VJ, Giobbie-Hurder A, Fleming GF, Pagani O, Regan MM, Bernhard J. The effects of treatment-induced symptoms, depression and age on sexuality in premenopausal women with early breast cancer receiving adjuvant endocrine therapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-09-09.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - W Luo
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - HJ Burstein
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - MJ Naughton
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - J Chirgwin
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - RH Ansari
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - BA Walley
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - M Salim
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - A van der Westhuizen
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - E Abdi
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - PA Francis
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - DR Budman
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - H Kennecke
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - VJ Harvey
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - A Giobbie-Hurder
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - GF Fleming
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - O Pagani
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - MM Regan
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
| | - J Bernhard
- International Breast Cancer Study Group (Switzerland) and North American Breast Cancer Group (USA)
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Pagani O, Klingbiel D, Ruhstaller T, Nolè F, Eppenberger S, Oehlschlegel C, Bernhard J, Brauchli P, Hess D, Mamot C, Munzone E, Pestalozzi B, Rabaglio M, Aebi S, Ribi K, Rochlitz C, Rothgiesser K, Thürlimann B, von Moos R, Zaman K, Goldhirsch A. Do all patients with advanced HER2 positive breast cancer need upfront-chemo when receiving trastuzumab? Randomized phase III trial SAKK 22/99. Ann Oncol 2017; 28:305-312. [DOI: 10.1093/annonc/mdw622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Koeberle D, Dufour JF, Demeter G, Li Q, Ribi K, Samaras P, Saletti P, Roth AD, Horber D, Buehlmann M, Wagner AD, Montemurro M, Lakatos G, Feilchenfeldt J, Peck-Radosavljevic M, Rauch D, Tschanz B, Bodoky G. Sorafenib with or without everolimus in patients with advanced hepatocellular carcinoma (HCC): a randomized multicenter, multinational phase II trial (SAKK 77/08 and SASL 29). Ann Oncol 2016; 27:856-61. [PMID: 26884590 DOI: 10.1093/annonc/mdw054] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 11/28/2015] [Accepted: 01/29/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sorafenib (S), a multitargeted tyrosine kinase inhibitor, is the standard of care for first-line systemic treatment of advanced hepatocellular carcinoma (HCC). Everolimus (E) is a potent inhibitor of mTOR, a pathway frequently activated in HCC. Preclinical data suggest that the combination S + E has additive effects compared with single-agent S. PATIENTS AND METHODS Patients with unresectable or metastatic HCC and Child-Pugh ≤7 liver dysfunction were randomized to receive daily S 800 mg alone or with E 5 mg until progression or unacceptable toxicity. The primary end point was progression-free survival at 12 weeks (PFS12). The secondary end points included response rate, PFS, time to progression (TTP), overall survival (OS), duration of disease stabilization (DDS), safety, and quality-of-life (QoL) assessments. RESULTS A total of 106 patients were randomized: 46 patients received S and 60 patients received S + E. Ninety-three patients were assessable for the primary end point and 105 patients for the safety analysis. The PFS12 rate was 70% [95% confidence interval (CI) 54-83] and 68% (95% CI 53-81) in patients randomized to S and S + E, respectively. The RECIST (mRECIST) response rate was 0% (23%) in the S arm and 10% (35%) in the S + E arm. Median PFS (6.6 versus 5.7 months), TTP (7.6 versus 6.3 months), DDS (6.7 versus 6.7 months), and OS (10 versus 12 months) were similar in the S and S + E arms, respectively. Grade 3/4 adverse events occurred in 72% and 86% of patients in arm S and arm S + E, respectively. Patients had similar QoL scores over time, except for a greater worsening in physical well-being and mood in the arm S + E. CONCLUSIONS No evidence was found that S + E improves the efficacy compared with S alone. Combining 5 mg E with full-dose S is feasible, but more toxic than S alone. Further testing of this drug combination in molecularly unselected HCCs appears unwarranted. CLINICALTRIALSGOV NCT01005199.
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Affiliation(s)
- D Koeberle
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen
| | - J-F Dufour
- Department of Hepatology, University Hospital Bern, Bern, Switzerland
| | - G Demeter
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
| | - Q Li
- SAKK Coordinating Center, Berne
| | - K Ribi
- Quality of life Office, International Breast Cancer Study Group, Bern
| | - P Samaras
- Department of Medical Oncology, University Hospital Zurich, Zürich
| | - P Saletti
- Department of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona
| | - A D Roth
- Department of Medical Oncology, University Hospital of Geneva, Geneva
| | - D Horber
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen
| | - M Buehlmann
- Department of Medical Oncology, University Hospital Bern, Bern
| | - A D Wagner
- Department of Medical Oncology, University Hospital Lausanne, Lausanne
| | - M Montemurro
- Department of Medical Oncology, University Hospital Lausanne, Lausanne
| | - G Lakatos
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
| | - J Feilchenfeldt
- Department of Medical Oncology, Hôpital du Valais (RSV)-CHCVs, Lausanne, Switzerland
| | - M Peck-Radosavljevic
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - D Rauch
- Department of Medical Oncology, Spital STS AG, Bern, Switzerland
| | | | - G Bodoky
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
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Strasser F, Blum D, von Moos R, Cathomas R, Ribi K, Aebi S, Betticher D, Hayoz S, Klingbiel D, Brauchli P, Haefner M, Mauri S, Kaasa S, Koeberle D. The effect of real-time electronic monitoring of patient-reported symptoms and clinical syndromes in outpatient workflow of medical oncologists: E-MOSAIC, a multicenter cluster-randomized phase III study (SAKK 95/06). Ann Oncol 2015; 27:324-32. [PMID: 26646758 DOI: 10.1093/annonc/mdv576] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with advanced, incurable cancer receiving anticancer treatment often experience multidimensional symptoms. We hypothesize that real-time monitoring of both symptoms and clinical syndromes will improve symptom management by oncologists and patient outcomes. PATIENTS AND METHODS In this prospective multicenter cluster-randomized phase-III trial, patients with incurable, symptomatic, solid tumors, who received new outpatient chemotherapy with palliative intention, were eligible. Immediately before the weekly oncologists' visit, patients completed the palm-based E-MOSAIC assessment (Edmonton-Symptom-Assessment-Scale, ≤3 additional symptoms, estimated nutritional intake, body weight change, Karnofsky Performance Status, medications for pain, fatigue, nutrition). A cumulative, longitudinal monitoring sheet (LoMoS) was printed immediately. Eligible experienced oncologists were defined as one cluster each and randomized to receive the immediate print-out LoMoS (intervention) or not (control). Primary analysis limited to patients having uninterrupted (>4/6 visits with same oncologist) patient-oncologist sequences was a mixed model for the difference in patients global quality of life (G-QoL; items 29/30 of EORTC-QlQ-c30) between baseline (BL) and week 6. Intention-to-treat (ITT) analysis included all eligible patients. RESULTS In 8 centers, 82 oncologists treated 264 patients (median 66 years; overall survival intervention 6.3, control 5.4 months) with various tumors. The between-arm difference in G-QoL of 102 uninterrupted patients (intervention: 55; control: 47) was 6.8 (P = 0.11) in favor of the intervention; in a sensitivity analysis (oncologists treating ≥2 patients; 50, 39), it was 9.0 (P = 0.07). ITT analysis revealed improvement in symptoms (difference last study visit-BL: intervention -5.4 versus control 2.1, P = 0.003) and favored the intervention for communication and coping. More patients with high symptom load received immediate symptom management (chart review, nurse-patient interview) by oncologists getting the LoMoS. CONCLUSION Monitoring of patient symptoms, clinical syndromes and their management clearly reduced patients' symptoms, but not QoL. Our results encourage the implementation of real-time monitoring in the routine workflow of oncologist with a computer solution.
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Affiliation(s)
- F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - D Blum
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - R von Moos
- Department of Oncology, Cantonal Hospital Chur, Chur
| | - R Cathomas
- Department of Oncology, Cantonal Hospital Chur, Chur
| | | | - S Aebi
- Department of Oncology, University Hospital Bern, Bern
| | - D Betticher
- Department of Oncology, Cantonal Hospital Fribourg, Fribourg
| | - S Hayoz
- SAKK Coordinating Center, Bern
| | | | | | | | - S Mauri
- Department of Oncology, Cantonal Hospital Lugano, Lugano
| | - S Kaasa
- European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - D Koeberle
- Clinic Oncology/Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Blum D, Koeberle D, Omlin A, Walker J, Von Moos R, Mingrone W, deWolf-Linder S, Hayoz S, Kaasa S, Strasser F, Ribi K. Feasibility and acceptance of electronic monitoring of symptoms and syndromes using a handheld computer in patients with advanced cancer in daily oncology practice. Support Care Cancer 2014; 22:2425-34. [DOI: 10.1007/s00520-014-2201-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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Lee CK, Coates AS, Hudson M, Ribi K, Bernhard J. Abstract P6-08-04: Prognostic significance of quality-of-life scores in early stage and relapsed breast cancer: Results from seven randomized trials of the International breast cancer study group. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-08-04] [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: 11/16/2022]
Abstract
Abstract
We performed an individual patient meta-analysis to investigate the prognostic value of patient self-reported quality-of-life (QL) scores at baseline, and at several times prior to and following disease relapse on subsequent overall survival (OS) in seven randomized trials of the International Breast Cancer Study Group.
Patients with early stage breast cancer who participated in randomized trials that compared adjuvant therapies, and who had subsequent disease relapse, completed QL assessments for physical well-being, mood, appetite, nausea and vomiting, arm swelling, flushing, coping effort, and utility at study entry, prior to and after disease relapse. We tested the relationships between baseline QL scores and OS using Cox regression analyses. We performed landmark analyses to assess the relationships between pre-relapse QL scores with OS using QL assessments at 1, 2 and 3 months prior to disease relapse, at the time of relapse and at two subsequent QL assessments where these were available. All Cox models were stratified by trial and included other factors related to QL and/or outcome.
Among 8,024 patients, 3,834 (48%) had disease relapse after a median follow-up time of 12 years. Amongst these patients, QL score at baseline, and at 1, 2, and 3 months prior disease relapse were not significantly prognostic for OS. At disease relapse, scores for physical well-being (hazards ratio [HR] per 10 unit increase of QL score for death, 1.05; P = 0.003), mood (HR 1.05; P = 0.007), appetite (HR 1.08; P<0.001), and utility (HR 1.13; P = 0.008) were prognostic for subsequent OS. Nausea and vomiting (HR 1.05; P = 0.11), arm swelling (HR 1.00; P = 0.20), flushing (HR 1.01; P = 0.73), and coping effort (HR 1.02; P = 0.29) were not prognostic for subsequent OS. At post-relapse assessments at median times of 1 (HR 1.07; P<0.001), 6 (HR 1.08; P<0.001) and 10 months (HR 1.13; P<0.001) after disease relapse, scores for physical well-being showed increasing prognostic significance. Scores for mood, nausea and vomiting, appetite, coping effort and utility showed patterns similar to those for physical wellbeing, but scores for arm swelling and flushing were not prognostic for subsequent OS.
These findings confirm and extend those of Coates et al. (J Clin Oncol 2000;18:3768 - 3774) based on two of the trials included in the present analysis. At baseline and prior to relapse, QL scores did not have any prognostic significance for subsequent OS. At and after disease relapse, QL scores substantially predicted for subsequent OS, with stronger association for QL scores later in the course of relapsed disease. Patient perception of the severity of underlying illness after relapse might be a potential reason that determines the reported QL scores and thus contributes to their prognostic significance.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-04.
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Affiliation(s)
- CK Lee
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia; International Breast Cancer Study Group, Bern, Switzerland
| | - AS Coates
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia; International Breast Cancer Study Group, Bern, Switzerland
| | - M Hudson
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia; International Breast Cancer Study Group, Bern, Switzerland
| | - K Ribi
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia; International Breast Cancer Study Group, Bern, Switzerland
| | - J Bernhard
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia; International Breast Cancer Study Group, Bern, Switzerland
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Blum D, Koeberle D, von Moos R, Ribi K, Aebi S, Betticher D, Hayoz S, Nadig J, Mauri S, Strasser F. Real-Time Electronic Monitoring of Patient-Reported Symptoms and Syndromes (PRS): E-Mosaic, a Multicenter Phase iii Study (Sakk 95/06). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33977-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Affiliation(s)
- K Ribi
- International Breast Cancer study Group (IBCSG) Coordinating Center, Bern, Switzerland.
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Ribi K, Aldridge J, Phillips KA, Thompson A, Harvey V, Thürlimann B, Cardoso F, Pagani O, Coates AS, Goldhirsch A, Price KN, Gelber RD, Bernhard J. Subjective cognitive complaints one year after ceasing adjuvant endocrine treatment for early-stage breast cancer. Br J Cancer 2012; 106:1618-25. [PMID: 22531635 PMCID: PMC3349183 DOI: 10.1038/bjc.2012.156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 11/09/2022] Open
Abstract
BACKGROUND In the BIG 1-98 trial objective cognitive function improved in postmenopausal women 1 year after cessation of adjuvant endocrine therapy for breast cancer. This report evaluates changes in subjective cognitive function (SCF). METHODS One hundred postmenopausal women, randomised to receive 5 years of adjuvant tamoxifen, letrozole, or a sequence of the two, completed self-reported measures on SCF, psychological distress, fatigue, and quality of life during the fifth year of trial treatment (year 5) and 1 year after treatment completion (year 6). Changes between years 5 and 6 were evaluated using the Wilcoxon signed-rank test. Subjective cognitive function and its correlates were explored. RESULTS Subjective cognitive function and the other patient-reported outcomes did not change significantly after cessation of endocrine therapy with the exception of improvement for hot flushes (P=0.0005). No difference in changes was found between women taking tamoxifen or letrozole. Subjective cognitive function was the only psychosocial outcome with a substantial correlation between year 5 and 6 (Spearman's R=0.80). Correlations between SCF and the other patient-reported outcomes were generally low. CONCLUSION Improved objective cognitive function but not SCF occur following cessation of adjuvant endocrine therapy in the BIG 1-98 trial. The substantial correlation of SCF scores over time may represent a stable attribute.
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Affiliation(s)
- K Ribi
- IBCSG Coordinating Center, Effingerstr. 40, Bern 3008, Switzerland
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Zappa F, Droege C, Betticher DC, von Moos R, Brutsche MH, Baty F, Bubendorf L, Ochsenbein A, Oppliger Leibundgut E, Gautschi O, Froesch P, Stahel RA, Rauch D, Schmid P, Mayer M, Crowe S, Brauchli P, Ribi K, Pless M. Bevacizumab (B) and erlotinib (E) as first-line therapy in metastatic nonsquamous non-small cell lung cancer (NSCLC) followed by platinum-based chemotherapy (CT) at disease progression (PD): A multicenter phase II trial, SAKK 19/05. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ribi K, Aldridge J, Phillips K, Sun Z, Thompson AM, Harvey VJ, Thürlimann B, Cardoso F, Coates AS, Bernhard J. Changes in cognitive function in postmenopausal women 1 year after completing adjuvant letrozole or tamoxifen in the Breast International Group (BIG) 1-98 trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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D'Addario G, Rauch D, Stupp R, Pless M, Stahel R, Mach N, Jost L, Widmer L, Tapia C, Bihl M, Mayer M, Ribi K, Lerch S, Bubendorf L, Betticher DC. Multicenter phase II trial of gefitinib first-line therapy followed by chemotherapy in advanced non-small-cell lung cancer (NSCLC): SAKK protocol 19/03. Ann Oncol 2007; 19:739-45. [PMID: 18096565 DOI: 10.1093/annonc/mdm564] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gefitinib is active in patients with pretreated non-small-cell lung cancer (NSCLC). We evaluated the activity and toxicity of gefitinib first-line treatment in advanced NSCLC followed by chemotherapy at disease progression. PATIENTS AND METHODS In all, 63 patients with chemotherapy-naive stage IIIB/IV NSCLC received gefitinib 250 mg/day. At disease progression, gefitinib was replaced by cisplatin 80 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1, 8 for up to six 3-week cycles. Primary end point was the disease stabilization rate (DSR) after 12 weeks of gefitinib. RESULTS After 12 weeks of gefitinib, the DSR was 24% and the response rate (RR) was 8%. Median time to progression (TtP) was 2.5 months and median overall survival (OS) 11.5 months. Never smokers (n = 9) had a DSR of 56% and a median OS of 20.2 months; patients with epidermal growth factor receptor (EGFR) mutation (n = 4) had a DSR of 75% and the median OS was not reached after the follow-up of 21.6 months. In all, 41 patients received chemotherapy with an overall RR of 34%, DSR of 71% and median TtP of 6.7 months. CONCLUSIONS First-line gefitinib monotherapy led to a DSR of 24% at 12 weeks in an unselected patients population. Never smokers and patients with EGFR mutations tend to have a better outcome; hence, further trials in selected patients are warranted.
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Affiliation(s)
- G D'Addario
- Department of Oncology, Kantonsspital St.Gallen, St. Gallen, Switzerland.
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Ribi K, Nitzsche E, Schuller J, Klaeser B, Hany T, Roth A, Hess V, Zuend M, Lombriser N, Ruhstaller T. PET scanning and patient reported dysphagia before and after chemotherapy (CT) for prediction of pathological response after CT and chemoradiotherapy (CRT) in patients with locally advanced esophageal cancer (EC): A multicenter phase ll trial of the Swiss. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4587 Background: Only responding patients (pts) ultimately benefit from preoperative therapy for locally advanced EC. To predict response quality after CRT and detect non-responders earlier, we evaluated changes from baseline in FDG uptake by PET scans and patient reported dysphagia after two cycles of CT. Methods: Pts with resectable, locally advanced squamous cell carcinoma or adenocarcinoma of the esophagus were treated with 2 cycles of CT with docetaxel/cisplatin (DC) q3w followed by CRT (DC weekly x5 with concomitant 45 Gy RT) and surgery. PET imaging using [F]-deoxyglucose (FDG) uptake and subjective dysphagia assessment using a quality of life module specific to EC (EORTC QLQ-OES24) were performed at baseline and after the 2nd cycle of CT. 40% decrease of FDG uptake was prospectively hypothesized to be an early predictor for a pathological complete remission (tumor regression grade 1, TRG) and subtotal regression (TRG 2) after the CRT. The predictive value of improvement in dysphagia was tested by analysis of covariance with baseline dysphagia as covariate. Results: Out of included 66 pts, 56 completed preoperative therapy and surgery. Dysphagia scores (range 0–100) were available in 51 pts, mean changes were 14 (n=13), 12 (n=16) and 12 (n=22) for pts with TRG 1, 2 or >2, respectively, lacking any significance. 44 pts had two PET scans (5: centers not participating, 3: no FDG-uptake at baseline, 4: second scan too late or not done). Mean FDG-decrease was 49% (n=7), 44% (n=17), 15% (n=20) for pts with TRG 1, 2 or >2, respectively. Less than 40% reduction in FDG uptake predicted non-response (TRG>2) with sensitivity 70%, specificity 50%, negative predictive value 70% and positive predictive value 50%. FDG- uptake reduction indicated reduced risk of TRG>2 in a logistic regression model (p<0.01, 95%-CI 2–273). Conclusions: Decreased FDG uptake in sequential PET scans strongly correlates with tumor response, but is not accurate enough to early identify non- responders. Early improvement of dysphagia after 2 cycles CT did not predict TRG after CRT. No significant financial relationships to disclose.
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Affiliation(s)
- K. Ribi
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - E. Nitzsche
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - J. Schuller
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - B. Klaeser
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - T. Hany
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - A. Roth
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - V. Hess
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - M. Zuend
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - N. Lombriser
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - T. Ruhstaller
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
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Ribi K, Bernhard J, Rufibach K, Thürlimann B, von Moos R, Ruhstaller T, Glaus A, Böhme C. Endocrine symptom assessment in women with breast cancer: what a simple “yes” means. Support Care Cancer 2007; 15:1349-56. [PMID: 17530302 DOI: 10.1007/s00520-007-0258-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
GOALS OF WORK To investigate the self-reported symptoms related to endocrine therapy in women with early or advanced breast cancer and the impact of these symptoms on quality of life (QL) indicators. MATERIALS AND METHODS Symptom occurrence was assessed by the Checklist for Patients on Endocrine Therapy (C-PET) and symptom intensity was assessed by linear analogue self-assessment (LASA) indicators. Patients also responded to global LASA indicators for physical well-being, mood, coping effort and treatment burden. Associations between symptoms and these indicators were analysed by linear regression models. MAIN RESULTS Among 373 women, the distribution of symptom intensity showed considerable variation in patients reporting a symptom as present. Even though patients recorded a symptom as absent, some patients reported having experienced that symptom when responding to symptom intensity, as seen for decreased sex drive, tiredness and vaginal dryness. Six of 13 symptoms and lower age had a detrimental impact on the global indicators, particularly tiredness and irritability. CONCLUSIONS Patients' experience of endocrine symptoms needs to be considered both in patient care and research, when interpreting the association between symptoms and QL.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland.
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Hess D, Köberle D, Thürlimann B, Pagani O, Schönenberger A, Mattmann S, Rochlitz C, Rauch D, Schuller J, Ballabeni P, Ribi K. Capecitabine and Vinorelbine as First-Line Treatment in Elderly Patients (≥65 Years) with Metastatic Breast Cancer. Oncology 2007; 73:228-37. [DOI: 10.1159/000127414] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 09/08/2007] [Indexed: 11/19/2022]
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D’Addario G, Strasser F, Ribi K, Rauch D, Stupp R, Pless M, Stahel RA, Rufibach K, Lerch S, Betticher D. Quality of life (QoL) in SAKK 19/03: A multicenter phase II study of first-line gefitinib followed by chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18559] [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
18559 Background: 63 patients (pts) were accrued in this first study testing first-line tyrosine-kinase inhibitor treatment with gefitinib followed by chemotherapy at disease progression (gemcitabine-cisplatin q3w x6, 41 pts) in stage IIIB/IV NSCLC (ASCO 2005 # 7128). We investigated the longitudinal QoL patterns on both subsequent treatment modalities. Methods: FACT-L including TOI (Trial Outcome Index) and LCS (Lung Cancer Subscale) scores were assessed during both treatment phases (gefitinib: baseline, weeks 3,6,12,18 and every 12 weeks thereafter; chemotherapy: baseline and at d1 of cycle 3 and 5). QoL changes from baseline were descriptively analysed. Improvement was defined as a 6 point (FACT-L, TOI) and 2 point (LCS) increase. Results: QoL-scores are shown in the table below. On gefitinib, at week 6 31/18/32% of pts had improvements of FACT-L, TOI and LCS, respectively and 29/15/41% at week 12 (% based on pts with available data). During chemotherapy the respective improvement rates were 60/60/70% of pts at week 6 and 43/29/43% at week 12. At week 12 of gefitinib, 4 of the pts analysed had partial remission (PR, independently confirmed), 31 pts dropped out (none due to toxicity) and QoL submission rate was 84% based on expected forms. Chemotherapy week 12: 5 PR in analysed pts, 18 drop outs (5 due to toxicity), 43% submission rate. Conclusions: QoL was maintained in pts continuing treatment with gefitinib and decreased at disease progression. QoL and tumor symptoms improved in a considerable part of pts during gefitinib therapy despite low remission rates. Declining submission rate during treatment introduces a potential, unquantifiable bias in QoL. [Table: see text] [Table: see text]
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Affiliation(s)
- G. D’Addario
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - F. Strasser
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - K. Ribi
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - D. Rauch
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - R. Stupp
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - M. Pless
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - R. A. Stahel
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - K. Rufibach
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - S. Lerch
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
| | - D. Betticher
- Kantonsspital, St. Gallen, Switzerland; IBCSG/SAKK QoL Office Coordinating Center, Bern, Switzerland; Spital, Thun, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Universitaetsspital, Basel, Switzerland; Universitaetsspital, Zuerich, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital, Fribourg, Switzerland
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Abstract
To study the outcomes in long-term survivors of paediatric medulloblastoma (MB), we followed 51 consecutive children who were treated between 1980 and 2000 in a single institution. In 18 of 26 survivors (mean follow-up time 12.2 years), tumour control, neurological, endocrine, and neurocognitive complications and their impact on behavioural and psychological adjustment, and health-related quality of life (QoL) were comprehensively assessed using qualitative and quantitative measures. Endocrine deficits occurred in 61 %, neurological complications in 72 %, and significant school problems in 72 %. All patients had significant deficits in neurocognitive functioning: attention and processing speed was impaired in 79 %, learning and memory in 88 %, language in 56 %, visual perception in 50 %, and executive functions in 64 %. In comparison with healthy controls, social functioning was rated by the patients as the QoL dimension most affected. Parents' ratings were considerably lower than those of the patients. No MB survivor > 18 years of age (n = 12) had a boy- or girlfriend. Because of their treatment, including craniospinal radiotherapy, MB long-time survivors are not only at great risk for neurological, endocrine, and neurocognitive complications, but also of social isolation thereby decreasing self-rated QoL substantially.
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Affiliation(s)
- K Ribi
- Division of Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
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Abstract
AIM To assess the prevalence of specific coping strategies and predictors of coping strategy selection in 179 patients (mean age = 10.2 y). The children were investigated one month after the occurrence of an accident (n = 105), diagnosis of cancer (n = 26) or diagnosis of diabetes mellitus type I (n = 48). RESULTS Patients used a great variety of coping strategies. The most frequent strategies were cognitive avoidance, positive cognitive restructuring and avoidant actions. The strategies of seeking problem-focused support and emotion-focused support were rarely used. Diagnostic category, length of hospital stay, and gender were not associated with coping strategy use. Age, socioeconomic status and functional status of the patient were found to predict coping strategy selection. Younger children made less use of active coping, distraction and seeking support. Patients of lower socioeconomic status used religious coping strategies significantly more often, whereas patients with lower functional status used avoidance and support-seeking strategies more often. CONCLUSION In this study it was found that paediatric patients used a wide variety of coping strategies, irrespective of diagnosis and gender. Age of the child and functional status were the most important predictors of coping strategy selection.
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Ribi E, Filz C, Ribi K, Goode G, Brown W, Niwa M, Smith R. Chromatography of microbial lipids by centrifugation through microparticulate gel. J Bacteriol 1970; 102:250-60. [PMID: 4314479 PMCID: PMC284993 DOI: 10.1128/jb.102.1.250-260.1970] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
An improved apparatus and a procedure are described by which the migration of sample components in column chromatography is accelerated by centrifugal force, thereby making it possible to use beds of densely packed gel prepared with ultrafine silica. This technique was used to resolve components of certain lipid mixtures where other methods have failed, and it has been found generally useful as an adjunct to other methods for the fractionation of lipids. Biologically active phosphoglycolipids from Mycobacterium tuberculosis and a phosphatidylglycerol-like substance from Mycoplasma pneumoniae which formed single spots on thin-layer chromatographic plates were each found to contain a major and several minor components by centrifugal chromatography. The method enabled us to isolate individual components of Wax D from M. tuberculosis rather than a spectrum of components. Minor components were resolved which, although present in insufficient quantity to influence results of chemical analyses, may be responsible for biological activity. The apparatus provides an essentially closed system which reduces highly volatile solvents to minimal evaporation during the chromatographic process. Samples are applied in solution and are not allowed to dry on the columns until after separation has been achieved. Consequently, polar, labile microbial lipids can be resolved without the use of harsh reagents which destroy some of their properties. Single components may be harvested by cutting and removing appropriate segments of the larger chromatograms or by eluting them from the columns.
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