1
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Roohani S, Ehret F, Beck M, Veltsista DP, Nadobny J, Zschaeck S, Abdel-Rahman S, Eckert F, Flörcken A, Issels RD, Klöck S, Krempien R, Lindner LH, Notter M, Ott OJ, Pink D, Potkrajcic V, Reichardt P, Riesterer O, Spałek MJ, Stutz E, Wessalowski R, Zilli T, Zips D, Ghadjar P, Kaul D. Regional hyperthermia for soft tissue sarcoma - a survey on current practice, controversies and consensus among 12 European centers. Int J Hyperthermia 2024; 41:2342348. [PMID: 38653548 DOI: 10.1080/02656736.2024.2342348] [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: 02/12/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To analyze the current practice of regional hyperthermia (RHT) for soft tissue sarcoma (STS) at 12 European centers to provide an overview, find consensuses and identify controversies necessary for future guidelines and clinical trials. METHODS In this cross-sectional survey study, a 27-item questionnaire assessing clinical subjects and procedural details on RHT for STS was distributed to 12 European cancer centers for RHT. RESULTS We have identified seven controversies and five consensus points. Of 12 centers, 6 offer both, RHT with chemotherapy (CTX) or with radiotherapy (RT). Two centers only offer RHT with CTX and four centers only offer RHT with RT. All 12 centers apply RHT for localized, high-risk STS of the extremities, trunk wall and retroperitoneum. However, eight centers also use RHT in metastatic STS, five in palliative STS, eight for superficial STS and six for low-grade STS. Pretherapeutic imaging for RHT treatment planning is used by 10 centers, 9 centers set 40-43 °C as the intratumoral target temperature, and all centers use skin detectors or probes in body orifices for thermometry. DISCUSSION There is disagreement regarding the integration of RHT in contemporary interdisciplinary care of STS patients. Many clinical controversies exist that require a standardized consensus guideline and innovative study ideas. At the same time, our data has shown that existing guidelines and decades of experience with the technique of RHT have mostly standardized procedural aspects. CONCLUSIONS The provided results may serve as a basis for future guidelines and inform future clinical trials for RHT in STS patients.
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Affiliation(s)
- Siyer Roohani
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Ehret
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Danai P Veltsista
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jacek Nadobny
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany
| | - Sultan Abdel-Rahman
- Department of Medicine III, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, AKH, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Anne Flörcken
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Rolf D Issels
- Department of Medicine III, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Klöck
- Department of Radiation Oncology, Lindenhofspital Bern, Bern, Switzerland
| | - Robert Krempien
- Clinic for Radiotherapy, HELIOS Klinikum Berlin-Buch, Berlin, Germany
- MSB Medical School Berlin, Fakultät für Medizin, Berlin, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus Notter
- Department of Radiation Oncology, Lindenhofspital Bern, Bern, Switzerland
| | - Oliver J Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Daniel Pink
- Department of Medical Oncology, Helios Klinikum Bad Saarow, Bad Saarow, Germany
- Cinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Greifswald, Germany
| | - Vlatko Potkrajcic
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Reichardt
- Department of Medical Oncology, Helios Klinikum Berlin-Buch, and Medical School Berlin, Berlin, Germany
| | - Oliver Riesterer
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Emanuel Stutz
- Department of Radiation Oncology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rüdiger Wessalowski
- Department of Paediatric Haematology and Oncology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Facoltà di Scienze Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel Zips
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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2
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Hettmer S, Lindner LH. The AYA gap for rhabdomyosarcoma. Pediatr Blood Cancer 2024; 71:e30905. [PMID: 38311774 DOI: 10.1002/pbc.30905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Simone Hettmer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Lars H Lindner
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
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3
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Burkhard-Meier A, Jurinovic V, Berclaz LM, Albertsmeier M, Dürr HR, Klein A, Knösel T, Di Gioia D, Unterrainer LM, Schmidt-Hegemann NS, Ricke J, von Bergwelt-Baildon M, Kunz WG, Lindner LH. Differentiation of benign and metastatic lymph nodes in soft tissue sarcoma. Clin Exp Metastasis 2024; 41:131-141. [PMID: 38421522 PMCID: PMC10973039 DOI: 10.1007/s10585-024-10273-7] [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: 10/01/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
Lymph node metastasis (LNM) occurs in less than 5% of soft tissue sarcoma (STS) patients and indicates an aggressive course of disease. Suspicious lymph nodes (LN) in staging imaging are a frequent topic of discussion in multidisciplinary tumor boards. Predictive markers are needed to facilitate stratification and improve treatment of STS patients. In this study, 56 STS patients with radiologically suspicious and subsequently histologically examined LN were reviewed. Patients with benign (n = 26) and metastatic (n = 30) LN were analyzed with regard to clinical, laboratory and imaging parameters. Patients with LNM exhibited significantly larger short axis diameter (SAD) and long axis diameter (LAD) vs. patients with benign LN (median 22.5 vs. 14 mm, p < 0.001 and median 29.5 vs. 21 mm, p = 0.003, respectively). Furthermore, the presence of central necrosis and high maximal standardized uptake value (SUVmax) in FDG-PET-CT scans were significantly associated with LNM (60 vs. 11.5% of patients, p < 0.001 and median 8.59 vs. 3.96, p = 0.013, respectively). With systemic therapy, a slight median size regression over time was observed in both metastatic and benign LN. Serum LDH and CRP levels were significantly higher in patients with LNM (median 247 vs. 187.5U/L, p = 0.005 and 1.5 vs. 0.55 mg/dL, p = 0.039, respectively). This study shows significant associations between LNM and imaging features as well as laboratory parameters of STS patients. The largest SAD, SUVmax in FDG-PET-CT scan, the presence of central necrosis, and high serum LDH level are the most important parameters to distinguish benign from metastatic LNs.
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Affiliation(s)
| | - Vindi Jurinovic
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - Luc M Berclaz
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Hans Roland Dürr
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Klein
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Dorit Di Gioia
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Lena M Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
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Burkhard-Meier A, Berclaz LM, Di Gioia D, Lindner LH. [Current therapeutic standards in advanced soft tissue sarcomas]. Dtsch Med Wochenschr 2024; 149:303-307. [PMID: 38412986 DOI: 10.1055/a-2145-8047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Soft tissue sarcomas account for less than 1% of tumors in adults. With more than 80 different subtypes and often dismal prognosis, treatment of patients with soft tissue sarcomas is diagnostically and therapeutically complex. In patients with localized disease, surgery remains the mainstay of therapy. A multimodal approach consisting of neoadjuvant chemotherapy +/- regional hyperthermia may be suitable in patients with high-risk disease to maximize tumor shrinkage before surgery and to treat micrometastases. In patients with oligometastatic disease, local treatment options should be discussed within a specialized tumor board. In patients with disseminated metastatic disease, chemotherapy with anthracyclines remains the backbone of therapy. Immune checkpoint inhibitors have proven to be effective for patients with alveolar soft part sarcoma and targeted therapies with NTRK-inhibitors should be evaluated in patients with NTRK-fusions. This article focuses on current standards and developments in the treatment of soft tissue sarcomas.
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Affiliation(s)
| | - Luc M Berclaz
- Medizinische Klinik und Poliklinik III, LMU Klinikum, München, Deutschland
| | - Dorit Di Gioia
- Medizinische Klinik und Poliklinik III, LMU Klinikum, München, Deutschland
| | - Lars H Lindner
- Medizinische Klinik und Poliklinik III, LMU Klinikum, München, Deutschland
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5
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Berclaz LM, Burkhard-Meier A, Lange P, Di Gioia D, Schmidt M, Knösel T, Klauschen F, von Bergwelt-Baildon M, Heinemann V, Greif PA, Westphalen CB, Heinrich K, Lindner LH. Implementing precision oncology for sarcoma patients: the CCC LMUmolecular tumor board experience. J Cancer Res Clin Oncol 2023; 149:13973-13983. [PMID: 37542550 PMCID: PMC10590320 DOI: 10.1007/s00432-023-05179-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Due to poor outcomes and limited treatment options, patients with advanced bone and soft tissue sarcomas (BS/STS) may undergo comprehensive molecular profiling of tumor samples to identify possible therapeutic targets. The aim of this study was to determine the impact of routine molecular profiling in the setting of a dedicated precision oncology program in patients with BS/STS in a German large-volume sarcoma center. METHODS 92 BS/STS patients who received comprehensive genomic profiling (CGP) and were subsequently discussed in our molecular tumor board (MTB) between 2016 and 2022 were included. Patient records were retrospectively reviewed, and the clinical impact of NGS-related findings was analyzed. RESULTS 89.1% of patients had received at least one treatment line before NGS testing. At least one molecular alteration was found in 71 patients (82.6%). The most common alterations were mutations in TP53 (23.3% of patients), followed by PIK3CA and MDM2 mutations (9.3% each). Druggable alterations were identified, and treatment recommended in 32 patients (37.2%). Of those patients with actionable alterations, ten patients (31.2%) received personalized treatment and six patients did benefit from molecular-based therapy in terms of a progression-free survival ratio (PFSr) > 1.3. CONCLUSION Our single-center experience shows an increasing uptake of next-generation sequencing (NGS) and highlights current challenges of implementing precision oncology in the management of patients with BS/STS. A relevant number of patients were diagnosed with clinically actionable alterations. Our results highlight the potential benefit of NGS in patients with rare cancers and currently limited therapeutic options.
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Affiliation(s)
- Luc M Berclaz
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Anton Burkhard-Meier
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp Lange
- Department of Psychology, Philipps-Universität Marburg, Marburg, Germany
| | - Dorit Di Gioia
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Schmidt
- Munich Cancer Registry, Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Volker Heinemann
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp A Greif
- Comprehensive Cancer Center Munich and Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, 81377, Munich, Germany
- German Cancer Research Center (DKFZ), 69121, Heidelberg, Germany
| | - C Benedikt Westphalen
- Comprehensive Cancer Center Munich and Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kathrin Heinrich
- Comprehensive Cancer Center Munich and Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Joensuu H, Wardelmann E, Eriksson M, Reichardt A, Hall KS, Schütte J, Cameron S, Hohenberger P, Sihto H, Jost PJ, Lindner LH, Bauer S, Nilsson B, Kallio R, Pesonen T, Reichardt P. KIT and PDGFRA Mutations and Survival of Gastrointestinal Stromal Tumor Patients Treated with Adjuvant Imatinib in a Randomized Trial. Clin Cancer Res 2023; 29:3313-3319. [PMID: 37014660 PMCID: PMC10472091 DOI: 10.1158/1078-0432.ccr-22-3980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/04/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Limited data are available about the influence of KIT and PDGFRA mutations on overall survival (OS) of patients with gastrointestinal stromal tumor (GIST) treated with adjuvant imatinib. PATIENTS AND METHODS The Scandinavian Sarcoma Group XVIII/AIO multicenter trial accrued 400 patients with a high risk for GIST recurrence after macroscopically complete surgery between February 4, 2004, and September 29, 2008. The patients received adjuvant imatinib 400 mg/day for either 1 year or 3 years based on random allocation. We analyzed using conventional sequencing KIT and PDGFRA mutations centrally from 341 (85%) patients who had localized, centrally confirmed GIST, and correlated the results with recurrence-free survival (RFS) and OS in exploratory analyses. RESULTS During a median follow-up time of 10 years, 164 RFS events and 76 deaths occurred. Most patients were re-treated with imatinib when GIST recurred. Patients with KIT exon 11 deletion or indel mutation treated with 3 years of adjuvant imatinib survived longer than patients treated for 1 year [10-year OS 86% versus 64%, respectively; HR, 0.34; 95% confidence interval (CI), 0.15-0.72; P = 0.007], and also had longer RFS (10-year RFS 47% versus 29%; HR, 0.48; 95% CI, 0.31-0.74; P < 0.001). Patients with KIT exon 9 mutation had unfavorable OS regardless of the duration of adjuvant imatinib. CONCLUSIONS Compared with 1 year of imatinib, 3 years of adjuvant imatinib led to 66% reduction in the estimated risk of death and a high 10-year OS rate in the subset of patients with a KIT exon 11 deletion/indel mutation.
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Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University of Münster, Münster, Germany
| | - Mikael Eriksson
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Annette Reichardt
- Helios Klinikum Berlin-Buch, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany
| | - Kirsten Sundby Hall
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | | | - Silke Cameron
- Department of Gastroenterology, University of Göttingen, Göttingen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Harri Sihto
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Philipp J. Jost
- Medical Department III, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lars H. Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | | | - Bengt Nilsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raija Kallio
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | | | - Peter Reichardt
- Helios Klinikum Berlin-Buch, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany
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7
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Jakob J, Andreou D, Bedke J, Denschlag D, Dürr HR, Frese S, Gösling T, Graeter T, Grünwald V, Grützmann R, Hoffmann J, Juhasz-Boess I, Kasper B, Kogosov V, Knoefel WT, Lehner B, Lehnhardt M, Lindner LH, Matthies C, Sehouli J, Ugurel S, Hohenberger P. Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline "Adult Soft Tissue Sarcomas". Langenbecks Arch Surg 2023; 408:272. [PMID: 37430129 PMCID: PMC10333354 DOI: 10.1007/s00423-023-03002-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE The evidence-based (S3) guideline "Adult Soft Tissue Sarcomas" (AWMF Registry No. 032/044OL) published by the German Guideline Program in Oncology (GGPO) covers all aspects of sarcoma treatment with 229 recommendations. Representatives of all medical specialties involved in sarcoma treatment contributed to the guideline. This paper compiles the most important recommendations for surgeons selected by delegates from the surgical societies. METHODS A Delphi process was used. Delegates from the surgical societies involved in guideline process selected the 15 recommendations that were most important to them. Votes for similar recommendations were tallied. From the resulting ranked list, the 10 most frequently voted recommendations were selected and confirmed by consensus in the next step. RESULTS The statement "Resection of primary soft tissue sarcomas of the extremities should be performed as a wide resection. The goal is an R0 resection" was selected as the most important term. The next highest ranked recommendations were the need for a preoperative biopsy, performing preoperative MRI imaging with contrast, and discussing all cases before surgery in a multidisciplinary sarcoma committee. CONCLUSION The evidence-based guideline "Adult Soft Tissue Sarcomas" is a milestone to improve the care of sarcoma patients in Germany. The selection of the top ten recommendations by surgeons for surgeons has the potential to improve the dissemination and acceptance of the guideline and thus improve the overall outcome of sarcoma patients.
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Affiliation(s)
- Jens Jakob
- Sarcoma Unit, Department of Surgery and Mannheim Cancer Center, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68135, Mannheim, Germany.
| | - Dimosthenis Andreou
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Jens Bedke
- Department of Urology, Klinikum Stuttgart, Stuttgart, Germany
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany
| | - Hans Roland Dürr
- Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, LMU Klinikum, University Hospital, LMU Munich, Munich, Germany
| | | | - Thomas Gösling
- Department of Trauma and Orthopedic Surgery, Clinical Center Braunschweig, Braunschweig, Germany
| | - Thomas Graeter
- Thoracic Surgery, SLK-Lungenklinik Lowenstein, Lowenstein, Germany
| | - Viktor Grünwald
- Clinic for Urology, Clinic for Medical Oncology, University Hospital Essen, Essen, Germany
| | - Robert Grützmann
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology, Obstetrics and Reproductive Medicine, University of Freiburg Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Vlada Kogosov
- Comprehensive Cancer Center Göttingen G-CCC, University Medical Center Göttingen, Georg August University, Göttingen, Germany
- CCC-N (Comprehensive Cancer Center Lower Saxony), Göttingen, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Burkhard Lehner
- Department of Orthopaedics, Section Orthopedic Oncology and Septic Orthopedic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Comprehensive Cancer Center, University Medicine Berlin, Berlin, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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8
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Rysin A, Lokerse WJM, Paal M, Habler K, Wedmann B, Hossann M, Winter G, Lindner LH. Heat-Triggered Release of Dexamethasone from Thermosensitive Liposomes Using Prodrugs or Excipients. J Pharm Sci 2023; 112:1947-1956. [PMID: 37030437 DOI: 10.1016/j.xphs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/02/2023] [Accepted: 04/02/2023] [Indexed: 04/10/2023]
Abstract
Dexamethasone (DXM) is a potent glucocorticoid with an anti-inflammatory and anti-angiogenic activity which is widely clinically used. Systemic side effects limit the long-term use of DXM in patients requiring formulations which deliver and selectively release the drug to the diseased tissues. This in vitro study compares the suitability of DXM and commonly used prodrugs dexamethasone-21-phosphate (DXMP) and dexamethasone-21-palmitate (DP) as well as DXM complexed by 2-hydroxypropyl-γ-cyclodextrin (HP-γ-CD) for the use in thermosensitive liposomes (TSL). DXM showed a poor retention and a low final drug:lipid ratio in a 1,2-dipalmitoyl-sn‑glycero-3-phosphodiglycerol-based TSL (DPPG2-TSL) and a low-temperature sensitive liposome (LTSL). In contrast to DXM, DXMP and DP were stably retained at 37 °C in TSL in serum and could be encapsulated with high drug:lipid ratios in DPPG2-TSL and LTSL. DXMP showed a rapid release at mild hyperthermia (HT) from both TSL in serum, whereas DP remained incorporated in the TSL bilayer. According to release experiments with carboxyfluorescein (CF), HP-γ-CD and 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) are suitable vehicles for the loading of DXM into DPPG2-TSL and LTSL. Complexation of DXM with HP-γ-CD increased the aqueous solubility of the drug leading to approx. ten times higher DXM:lipid ratio in DPPG2-TSL and LTSL in comparison to un-complexed DXM. Both DXM and HP-γ-CD showed increased release at HT in comparison to 37 °C in serum. In conclusion, DXMP and DXM complexed by HP-γ-CD represent promising candidates for TSL delivery.
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Affiliation(s)
- Alexander Rysin
- Department of Medicine III, University Hospital, LMU Munich, Germany; Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, LMU Munich, Germany.
| | | | - Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Katharina Habler
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | | | | | - Gerhard Winter
- Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, LMU Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Germany
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9
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Berclaz LM, Altendorf-Hofmann A, Lindner LH, Burkhard-Meier A, Di Gioia D, Dürr HR, Klein A, Albertsmeier M, Schmidt-Hegemann NS, Klauschen F, Knösel T. TIM-3 Qualifies as a Potential Immunotherapeutic Target in Specific Subsets of Patients with High-Risk Soft Tissue Sarcomas (HR-STS). Cancers (Basel) 2023; 15:2735. [PMID: 37345075 DOI: 10.3390/cancers15102735] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
(1) Background: The expression of T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), an immune checkpoint receptor on T cells, has been associated with dismal outcomes and advanced tumor stages in various solid tumors. The blockade of TIM-3 is currently under examination in several clinical trials. This study examines TIM-3 expression in high-risk soft tissue sarcomas (HR-STS). (2) Methods: Tumor cell expression of TIM-3 on protein level was analyzed in pre-treatment biopsies of patients with HR-STS. TIM-3 expression was correlated with clinicopathological parameters including tumor-infiltrating lymphocyte (TIL) counts, programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PDL-1) expression in patients with HR-STS. Survival dependent on the expression of TIM-3 was analyzed. (3) Results: TIM-3 expression was observed in 101 (56%) out of 179 pre-treatment biopsies of patients with HR-STS. TIM-3 expression was significantly more often observed in undifferentiated pleomorphic sarcomas (UPS) compared to other histological subtypes (p < 0.001), high TIL counts (p < 0.001), and high PD-1 (p < 0.001) and PD-L1 expression (p < 0.001). TIM-3 expression did not have a prognostic impact on survival in patients with HR-STS. (4) Conclusions: This is the first study to demonstrate a significant tumor cell expression of TIM-3 in specific subsets of patients with HR-STS. TIM-3 qualifies as a potential immunotherapeutic target in HR-STS.
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Affiliation(s)
- Luc M Berclaz
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Annelore Altendorf-Hofmann
- Department of General, Visceral and Vascular Surgery, Friedrich-Schiller University Jena, 07747 Jena, Germany
| | - Lars H Lindner
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Anton Burkhard-Meier
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Dorit Di Gioia
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Hans Roland Dürr
- Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Alexander Klein
- Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Nina-Sophie Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, 81377 Munich, Germany
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10
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Gold L, Moser C, Fabritius MP, Seidensticker M, Ricke J, Albertsmeier M, Angele MK, Knösel T, Di Gioia D, Lindner LH, Armbruster M, Kunz WG. Diagnostic accuracy of biopsy after neoadjuvant treatment for well-differentiated and dedifferentiated retroperitoneal liposarcoma. Surg Oncol 2023; 48:101945. [PMID: 37099895 DOI: 10.1016/j.suronc.2023.101945] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Accurate histopathological grading of percutaneous biopsies is essential to guide adequate management of patients with suspected retroperitoneal liposarcoma. In this regard, however, limited reliability has been described. Therefore, we conducted a retrospective study to assess the diagnostic accuracy in retroperitoneal soft tissue sarcomas and simultaneously investigate its impact on patients' survival. MATERIALS AND METHODS Reports of an interdisciplinary sarcoma tumor board between 2012 and 2022 were systematically screened for patients with well-differentiated (WDLPS) and dedifferentiated retroperitoneal liposarcoma (DDLPS). Histopathological grading on pre-operative biopsy was correlated with corresponding postoperative histology. Additionally, patients' survival outcomes were examined. All analyses were performed in two subgroups: patients with primary surgery and patients with neoadjuvant treatment. RESULTS A total of 82 patients met our inclusion criteria. Diagnostic accuracy of patients who underwent upfront resection (n = 32) was significantly inferior to patients with neoadjuvant treatment (n = 50) (66% versus 97% for WDLPS, p < 0.001; 59% versus 97% for DDLPS, p < 0.001). For patients with primary surgery, histopathological grading on biopsy and surgery was concordant in only 47% of cases. Sensitivity for detecting WDLPS was higher than for DDLPS (70% versus 41%). Higher histopathological grading in surgical specimens correlated with worse survival outcomes (p = 0.01). CONCLUSION Histopathological grading of RPS may no longer be reliable after neoadjuvant treatment. The true accuracy of the percutaneous biopsy may need to be studied in patients who do not receive neoadjuvant treatment. Future biopsy strategies should aim to improve identification of DDLPS to inform patient management.
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Affiliation(s)
- Lukas Gold
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Moser
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Martin K Angele
- Department of Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Department of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Dorit Di Gioia
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Marco Armbruster
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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11
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Rückher J, Grießhammer E, Langer T, Wenzel G, Utzig M, Hohenberger P, Lindner LH, Jakob J, Wesselmann S. Quality measurement for soft tissue sarcomas in Germany – first results of the Certified Sarcoma Centres. Oncol Res Treat 2023:000530425. [PMID: 37004511 DOI: 10.1159/000530425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
Introduction: Soft tissue sarcomas (STS) are rare diseases. A high level of standardization and centralisation was lacking in Germany until 2018.
Methods: By developing an evidence-based guideline and a certification system for sarcoma centres, foundations for structured, guideline-based and centralised sarcoma care were defined. First results of the certified Sarcoma Centres are presented.
Results: The first three years of data collection show good results for case volume, presentation rates in pretherapeutic and postoperative tumor boards, psychooncological counselling and study rates. However, other indicators (e.g. preoperative or postoperative radiotherapy for operated high risk STS without GIST, counselling rates social services) still have potential for improvement. Based on these results, the set of indicators could be further improved.
Conclusions: A sarcoma-specific quality assurance scheme that includes guideline-derived quality indicators was developed. In future, a broader database will allow further insights into sarcoma care in Germany.
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12
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Issels RD, Boeck S, Pelzer U, Mansmann U, Ghadjar P, Lindner LH, Albertsmeier M, Angele MK, Schmidt M, Xu Y, Bahra M, Pratschke J, Schoenberg M, Thasler WE, Salat C, Stoetzer OJ, Knoefel WT, Graf D, Wessalowski R, Keitel-Anselmino V, Koenigsrainer A, Bitzer M, Zips D, Bamberg M, Fietkau R, Ott O, Kawecki M, Wyrwicz L, Rutkowski P, Rentsch M, Ababei J, Reichardt P, Rigamonti M, Weber B, Abdel-Rahman S, Tschoep-Lechner K, Jauch KW, Bruns CJ, Oettle H, von Bergwelt-Baildon M, Heinemann V, Werner J. Regional hyperthermia with cisplatin added to gemcitabine versus gemcitabine in patients with resected pancreatic ductal adenocarcinoma: The HEAT randomised clinical trial. Eur J Cancer 2023; 181:155-165. [PMID: 36657324 DOI: 10.1016/j.ejca.2022.12.009] [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: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Regional hyperthermia (RHT) with cisplatin added to gemcitabine showed efficacy in gemcitabine-pre-treated patients with advanced pancreatic ductal adenocarcinoma. We conducted a randomised clinical trial to investigate RHT with cisplatin added to gemcitabine (GPH) compared with gemcitabine (G) in the adjuvant setting of resected pancreatic ductal adenocarcinoma. METHODS This randomised, multicentre, open-label trial randomly assigned patients to either GPH (gemcitabine 1000 mg/m2 on day 1, 15 and cisplatin 25 mg/m2 with RHT on day 2, 3 and 15,16) or to G (gemcitabine 1000 mg/m2 on day 1,8,15), four-weekly over six cycles. Disease-free survival (DFS) was the primary end-point. Secondary end-points included overall survival (OS) and safety. RESULTS A total of 117 eligible patients (median age, 63 years) were randomly allocated to treatment (57 GPH; 60 G). With a follow-up time of 56.6 months, the median DFS was 12.7 compared to 11.2 months for GPH and G, respectively (p = 0.394). Median post-recurrence survival was significantly prolonged in the GPH-group (15.3 versus 9.8 months; p = 0.031). Median OS reached 33.2 versus 25.2 months (p = 0.099) with 5-year survival rates of 28.4% versus 18.7%. Excluding eight patients who received additional capecitabine in the G-arm (investigators choice), median OS favoured GPH (p = 0.052). Adverse events CTCAE (Common Terminology Criteria for Adverse Events) grade ≥3 occurred in 61.5% (GPH) versus 63.6% (G) of patients. Two patients in the G-group died because of treatment-related toxic effects. CONCLUSIONS The randomised controlled Hyperthermia European Adjuvant Trial study failed to demonstrate a significant difference in DFS. However, it suggests a difference in post-recurrence survival and a trend for improved OS. CLINICALTRIALS gov, number NCT01077427.
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Affiliation(s)
- Rolf D Issels
- Ludwig Maximilians University LMU University Hospital Munich, Germany.
| | - Stefan Boeck
- Ludwig Maximilians University LMU University Hospital Munich, Germany
| | - Uwe Pelzer
- Charite University Hospital Berlin, Germany
| | - Ulrich Mansmann
- Ludwig Maximilian University Munich Institute of Medical Data Processing Biometrics and Epidemiology, Germany
| | | | - Lars H Lindner
- Ludwig Maximilians University LMU University Hospital Munich, Germany
| | | | - Martin K Angele
- Ludwig Maximilians University LMU University Hospital Munich, Germany
| | - Michael Schmidt
- Ludwig Maximilian University Munich Institute of Medical Data Processing Biometrics and Epidemiology, Germany
| | - Yujun Xu
- Ludwig Maximilian University Munich Institute of Medical Data Processing Biometrics and Epidemiology, Germany
| | - Marcus Bahra
- Academic Hospital Waldfriede of the Charité, Berlin, Germany
| | | | | | | | - Christoph Salat
- Medical Center for Hematology and Oncology München GmbH, Germany
| | | | | | - Dirk Graf
- Rheinland Hospital Group Grevenbroich St Elizabeth Hospital, Grevenbroich, Germany
| | | | | | | | | | | | | | | | | | - Maciej Kawecki
- Maria Skłodowska Curie Memorial Cancer Centre, Warsaw, Poland
| | - Lucjan Wyrwicz
- Maria Skłodowska Curie Memorial Cancer Centre, Warsaw, Poland
| | - Piotr Rutkowski
- Maria Skłodowska Curie Memorial Cancer Centre, Warsaw, Poland
| | | | | | | | | | | | | | | | - Karl-Walter Jauch
- Ludwig Maximilians University LMU University Hospital Munich, Germany
| | | | | | | | - Volker Heinemann
- Ludwig Maximilians University LMU University Hospital Munich, Germany
| | - Jens Werner
- Ludwig Maximilians University LMU University Hospital Munich, Germany
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13
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Bielack SS, Lindner LH, Egerer G, Benzler K, Blattmann C, Grube M, Hahn D, Kager L, Kühne T, Mettmann V, Reichardt P, Hecker-Nolting S. Osteosarcomas in older adults: A report from the Cooperative Osteosarcoma Study Group. J Geriatr Oncol 2023; 14:101445. [PMID: 36842425 DOI: 10.1016/j.jgo.2023.101445] [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: 09/27/2022] [Revised: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Osteosarcoma is typically a disease of the young, but may affect any age. Little is known about the disease in older patients beyond retirement age. We aim to describe the characteristics, treatment, and outcomes of older adult patients registered with our cooperative group. MATERIALS AND METHODS The database of the Cooperative Osteosarcoma Study Group (COSS) was searched for osteosarcoma patients diagnosed from 1980 to 2020 who were aged 65 years or older at diagnosis. Affected individuals were analyzed for presenting factors, treatments employed, and outcomes. RESULTS Fifty-five eligible patients were detected (median age 68 [range: 65-84] years; male:female = 25:30). Among these patients, 15/55 (27%) tumors were secondary malignancies, 41/55 (75%) were high-grade central, 4/55 (7%) surface, and 10/55 (18%) extraosseous malignancies, and all but three high-grade. Primary metastases were present in 15/55 (27%) patients. Surgery was reported for 46/55 (84%) patients, radiotherapy for 6/54 (11%, 1 unknown), chemotherapy for 42/50 (84%, 5 unknown). A complete surgical remission was achieved in 31/55 (56%). There were two toxic deaths. With a median follow-up of 1.7 (range: 0.1-18.0) years for all 55 patients and 2.2 (0.1-12.4) years for 24 survivors, event-free and overall survival at 2/5 years were 39.6% (standard error: 6.8%) / 24.5% (6.5%) and 62.0% (7.1%) / 32.7% (7.5%), respectively. Tumor site, metastatic status, surgery, and a complete surgical remission were prognostic for event-free and/or overall survival. DISCUSSION Osteosarcomas can occur in older individuals. It is more often secondary, axially located, or extraosseous than in younger patients. However, the same treatment principles seem to apply, and selected patients may be cured. Multi-center cooperation is encouraged, thereby gathering expertise for such a rare disease presentation.
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Affiliation(s)
- Stefan S Bielack
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany; Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster, Münster, Germany.
| | | | - Gerlinde Egerer
- Universitätsklinikum Heidelberg, Innere Medizin V: Hämatologie, Onkologie und Rheumatologie, Heidelberg, Germany
| | - Katrin Benzler
- Universitätsklinikum Tübingen; Innere Medizin II, Zentrum für Weichteilsarkome/GIST und Knochentumore, Tübingen, Germany
| | - Claudia Blattmann
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Matthias Grube
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin III, Regensburg, Germany
| | - Dennis Hahn
- Klinik für Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Katharinenhospital, Stuttgart, Germany
| | - Leo Kager
- St. Anna Kinderspital, Universitätsklinik für Kinder- und Jugendheilkunde der Medizinischen Universität Wien, and St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Thomas Kühne
- Universitäts-Kinderspital beider Basel, Abteilung für Pädiatrische Onkologie / Hämatologie, Basel, Switzerland
| | - Vanessa Mettmann
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Peter Reichardt
- Onkologie und Palliativmedizin, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Stefanie Hecker-Nolting
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
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14
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Rothermundt C, Andreou D, Blay JY, Brodowicz T, Desar IME, Dileo P, Gelderblom H, Haas R, Jakob J, Jones RL, Judson I, Kunz WG, Liegl-Atzwanger B, Lindner LH, Messiou C, Miah AB, Reichardt P, Szkandera J, van der Graaf WTA, van Houdt WJ, Wardelmann E, Hofer S. Controversies in the management of patients with soft tissue sarcoma: Recommendations of the Conference on State of Science in Sarcoma 2022. Eur J Cancer 2023; 180:158-179. [PMID: 36599184 DOI: 10.1016/j.ejca.2022.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Owing to the rarity and heterogeneity in biology and presentation, there are multiple areas in the diagnosis, treatment and follow-up of soft tissue sarcoma (STS), with no, low-level or conflicting evidence. METHODS During the first Consensus Conference on the State of Science in Sarcoma (CSSS), we used a modified Delphi process to identify areas of controversy in the field of sarcoma, to name topics with limited evidence-based data in which a scientific and knowledge gap may remain and a consensus statement will help to guide patient management. We determined scientific questions which need to be addressed in the future in order to generate evidence and to inform physicians and caregivers in daily clinical practice in order to improve the outcomes of patients with sarcoma. We conducted a vote on STS key questions and controversies prior to the CSSS meeting, which took place in May 2022. RESULTS Sixty-two European sarcoma experts participated in the survey. Sixteen strong consensus (≥95%) items were identified by the experts, as well as 30 items with a ≥75% consensus on diagnostic and therapeutic questions. Ultimately, many controversy topics remained without consensus. CONCLUSIONS In this manuscript, we summarise the voting results and the discussion during the CSSS meeting. Future scientific questions, priorities for clinical trials, registries, quality assurance, and action by stakeholders are proposed. Platforms and partnerships can support innovative approaches to improve management and clinical research in STS.
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Affiliation(s)
- Christian Rothermundt
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Dimosthenis Andreou
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Jean-Yves Blay
- Department of Medicine, Léon Bérard Center, Lyon, France
| | - Thomas Brodowicz
- Department of Medical Oncology, General Hospital - Medical University of Vienna, Vienna, Austria
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center Nijmegen, the Netherlands
| | - Palma Dileo
- London Sarcoma Service, Department of Oncology, University College Hospital London, United Kingdom
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rick Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and the Leiden University Medical Center, Leiden, the Netherlands
| | - Jens Jakob
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Robin L Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Ian Judson
- The Institute of Cancer Research, London, United Kingdom
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Christina Messiou
- Department of Radiology, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Aisha B Miah
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Peter Reichardt
- Department of Oncology and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Joanna Szkandera
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Silvia Hofer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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15
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Veltsista PD, Oberacker E, Ademaj A, Corradini S, Eckert F, Flörcken A, Kaul D, Lindner LH, Issels R, Ott OJ, Pink D, Potkrajcic V, Reichardt P, Roohani S, Spalek MJ, Riesterer O, Zips D, Ghadjar P. Hyperthermia in the treatment of high-risk soft tissue sarcomas: a systematic review. Int J Hyperthermia 2023; 40:2236337. [PMID: 37468132 DOI: 10.1080/02656736.2023.2236337] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The therapy of high-risk soft tissue sarcomas (STS) remains an interdisciplinary challenge. Regional hyperthermia (RHT) sparked interest as it has been shown to improve overall survival when added to perioperative chemotherapy (CTX). However, questions arise on how RHT should be optimally integrated into current multi-modal therapies. MATERIALS AND METHODS We performed a systematic literature review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies written in English and focused mainly on radiative RHT and superficial hyperthermia were evaluated and included. Studies including patients below the age of 18, with metastatic disease or review articles, were excluded. RESULTS We identified 15 clinical reports from 1990 until July 2022. Three articles combined RHT + CTX, and twelve focused on combined RHT + radiotherapy (RT) or neoadjuvant chemoradiotherapy (CRT). Most treatments were based on invasive thermometry, and less on magnetic resonance imaging (MRI)-based, noninvasive thermometry for STS of the extremities. Perioperative chemotherapy was used for the combination of RHT and CTX, mostly Ifosfamide-based. The effectiveness of RT appeared to be increased by RHT, especially with two RHT sessions/week. The trimodal simultaneous approach of neoadjuvant RHT and CRT was also feasible. No significant toxicity of RHT was reported. CONCLUSIONS The gathered data strengthen the beneficial role of RHT in the multimodal setting. Further expert consensus and clinical trials are required to determine the optimal integration of RHT in treating STS.
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Affiliation(s)
| | - Eva Oberacker
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Adela Ademaj
- Kantonsspital Aarau, Centre for Radiation Oncology KSA-KSB, Aarau, Switzerland
- Doctoral Clinical Science Program, University of Zürich, Zürich, Switzerland
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital Ludwig Maximilians Universität, München, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, Eberhard Karls University Tuebingen, Tübingen, Germany
- Department of Radiation Oncology, Medical University of Vienna/AKH, Vienna, Austria
| | - Anne Flörcken
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lars H Lindner
- Department of Medical Oncology, University Hospital Ludwig Maximilians Universität, München, Germany
| | - Rolf Issels
- Department of Medical Oncology, University Hospital Ludwig Maximilians Universität, München, Germany
| | - Oliver J Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Daniel Pink
- Department of Medical Oncology, Helios Klinikum Bad Saarow, Bad Saarow, Germany
- Clinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Greifswald, Germany
| | - Vlatko Potkrajcic
- Department of Radiation Oncology, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - Peter Reichardt
- Department of Medical Oncology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Siyer Roohani
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mateusz Jacek Spalek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Oliver Riesterer
- Kantonsspital Aarau, Centre for Radiation Oncology KSA-KSB, Aarau, Switzerland
| | - Daniel Zips
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Burkhard-Meier A, Rémi C, Lindner LH, von Bergwelt-Baildon M. Cannabis in der Onkologie – viel Rauch um nichts? Laryngorhinootologie 2022. [PMID: 36543223 DOI: 10.1055/a-1949-3296] [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: 12/24/2022]
Abstract
ZusammenfassungDie medizinische Verwendung von Cannabis hat in den letzten Jahren in Europa und Nordamerika an Popularität gewonnen. Cannabinoide sind sowohl als Fertigarzneimittel als auch in Blüten- und Extraktform verfügbar. Der vorliegende Artikel legt den Fokus auf die supportive Therapie onkologischer Patienten. Mögliche Indikationen sind Schmerzen, Chemotherapie-bedingte Übelkeit und Erbrechen, Appetitlosigkeit und Geschmacksveränderungen. Trotz des enormen Hypes um Cannabis als Medizin ist die Evidenz für dessen Anwendung bei onkologischen Patienten unzureichend. Palliativpatienten mit refraktären Symptomen könnten jedoch geeignete Kandidaten für einen Therapieversuch darstellen. Der entscheidende Parameter für die Auswahl eines Cannabis-Arzneimittels ist die THC/CBD-Ratio. Orale Einnahmeformen bieten sich gerade für Cannabis-naive und ältere Patienten an. Psychische und kardiovaskuläre Nebenwirkungen sind nicht zu unterschätzen.
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Affiliation(s)
- Anton Burkhard-Meier
- Klinikum Grosshadern: Klinikum der Universitat Munchen Standort Grosshadern, München, GERMANY
| | - Constanze Rémi
- Klinik und Poliklinik für Palliativmedizin am Klinikum der LMU München, GERMANY
| | - Lars H. Lindner
- Medizinische Klinik und Poliklinik III am Klinikum der LMU München, GERMANY
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17
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Burkhard-Meier A, Rémi C, Lindner LH, von Bergwelt-Baildon M. [Cannabis in oncology - much ado about nothing?]. Dtsch Med Wochenschr 2022; 147:916-922. [PMID: 35868317 DOI: 10.1055/a-1872-2749] [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: 10/17/2022]
Abstract
The medical use of Cannabis has gained popularity in Europe and Northern America in recent years. Cannabinoids are available as finished pharmaceuticals, flowers and extracts. This article focuses on supportive medicine for oncological patients. Possible indications are pain, chemotherapy-induced nausea and vomiting, loss of appetite and altered taste perception. Despite the enormous cannabis hype in medicine, the evidence for its use in oncology patients is insufficient. However, palliative patients with refractory symptoms could be candidates for a therapeutic trial. The key parameter for choosing a cannabis medicinal product is the THC/CBD ratio. Oral forms of administration are particularly suitable for cannabis-naive and older patients. Mental and cardiovascular side effects should not be underestimated.
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Affiliation(s)
| | - Constanze Rémi
- Klinik und Poliklinik für Palliativmedizin am Klinikum der LMU München
| | - Lars H Lindner
- Medizinische Klinik und Poliklinik III am Klinikum der LMU München
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18
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Boehm C, Goeger-Neff M, Mulder HT, Zilles B, Lindner LH, van Rhoon GC, Karampinos DC, Wu M. Susceptibility artifact correction in MR thermometry for monitoring of mild radiofrequency hyperthermia using total field inversion. Magn Reson Med 2022; 88:120-132. [PMID: 35313384 DOI: 10.1002/mrm.29191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE MR temperature monitoring of mild radiofrequency hyperthermia (RF-HT) of cancer exploits the linear resonance frequency shift of water with temperature. Motion-induced susceptibility distribution changes cause artifacts that we correct here using the total field inversion (TFI) approach. METHODS The performance of TFI was compared to two background field removal (BFR) methods: Laplacian boundary value (LBV) and projection onto dipole fields (PDF). Data sets with spatial susceptibility change and B 0 -drift were simulated, phantom heating experiments were performed, four volunteer data sets at thermoneutral conditions as well as data from one cervical cancer, two sarcoma, and one seroma patients undergoing mild RF-HT were corrected using the proposed methods. RESULTS Simulations and phantom heating experiments revealed that using BFR or TFI preserves temperature-induced phase change, while removing susceptibility artifacts and B 0 -drift. TFI resulted in the least cumulative error for all four volunteers. Temperature probe information from four patient data sets were best depicted by TFI-corrected data in terms of accuracy and precision. TFI also performed best in case of the sarcoma treatment without temperature probe. CONCLUSION TFI outperforms previously suggested BFR methods in terms of accuracy and robustness. While PDF consistently overestimates susceptibility contribution, and LBV removes valuable pixel information, TFI is more robust and leads to more accurate temperature estimations.
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Affiliation(s)
- Christof Boehm
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | | | | | - Benjamin Zilles
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | | | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Mingming Wu
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
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19
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Ren H, Bazhin AV, Pretzsch E, Jacob S, Yu H, Zhu J, Albertsmeier M, Lindner LH, Knösel T, Werner J, Angele MK, Bösch F. A novel immune-related gene signature predicting survival in sarcoma patients. Mol Ther Oncolytics 2022; 24:114-126. [PMID: 35024438 PMCID: PMC8718575 DOI: 10.1016/j.omto.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023] Open
Abstract
Sarcomas are a heterogeneous group of rare mesenchymal tumors. The migration of immune cells into these tumors and the prognostic impact of tumor-specific factors determining their interaction with these tumors remain poorly understood. The current risk stratification system is insufficient to provide a precise survival prediction and treatment response. Thus, valid prognostic models are needed to guide treatment. This study analyzed the gene expression and outcome of 980 sarcoma patients from seven public datasets. The abundance of immune cells and the response to immunotherapy was calculated. Immune-related genes (IRGs) were screened through a weighted gene co-expression network analysis (WGCNA). A least absolute shrinkage and selection operator (LASSO) Cox regression was used to establish a powerful IRG signature predicting prognosis. The identified IRG signature incorporated 14 genes and identified high-risk patients in sarcoma cohorts. The 14-IRG signature was identified as an independent risk factor for overall and disease-free survival. Moreover, the IRG signature acted as a potential indicator for immunotherapy. The nomogram based on the risk score was built to provide a more accurate survival prediction. The decision tree with IRG risk score discriminated risk subgroups powerfully. This proposed IRG signature is a robust biomarker to predict outcomes and treatment responses in sarcoma patients.
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Affiliation(s)
- Haoyu Ren
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Alexandr V Bazhin
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Elise Pretzsch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Sven Jacob
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Haochen Yu
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Jiang Zhu
- Department of Liver Surgery and Liver Transplantation Centre, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Markus Albertsmeier
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, SarKUM, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Martin K Angele
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Florian Bösch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
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20
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Sebeke L, Gómez JDC, Heijman E, Rademann P, Maul AC, Ekdawi S, Vlachakis S, Toker D, Mink BL, Schubert-Quecke C, Yeo SY, Schmidt P, Lucas C, Brodesser S, Hossann M, Lindner LH, Grüll H. Hyperthermia-induced doxorubicin delivery from thermosensitive liposomes via MR-HIFU in a pig model. J Control Release 2022; 343:798-812. [DOI: 10.1016/j.jconrel.2022.02.003] [Citation(s) in RCA: 4] [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: 06/28/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 12/17/2022]
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21
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Issels RD, Noessner E, Lindner LH, Schmidt M, Albertsmeier M, Blay JY, Stutz E, Xu Y, Buecklein V, Altendorf-Hofmann A, Abdel-Rahman S, Mansmann U, von Bergwelt-Baildon M, Knoesel T. Immune infiltrates in patients with localised high-risk soft tissue sarcoma treated with neoadjuvant chemotherapy without or with regional hyperthermia: A translational research program of the EORTC 62961-ESHO 95 randomised clinical trial. Eur J Cancer 2021; 158:123-132. [PMID: 34666214 DOI: 10.1016/j.ejca.2021.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The EORTC 62961-ESHO 95 randomised trial showed improved long-term survival of patients with high-risk soft-tissue sarcoma by adding regional hyperthermia to neoadjuvant chemotherapy. We hypothesised that immune infiltrate of patients treated with neoadjuvant therapy associate with clinical outcome. METHODS Tumour infiltrating lymphocytes (TILs) and CD8, FOXP3, PD-1, and PD-L1 were evaluated in sequential biopsies of patients after four cycles of therapy. RESULTS From a subgroup of 109 patients who had been randomised between July 1997 and November 2006 to neoadjuvant chemotherapy (53 patients) or neoadjuvant chemotherapy with regional hyperthermia (56 patients), 137 biopsies were obtained. TILs increased in paired second biopsies independent of treatment allocation (p < 0.001). FOXP3 regulatory T cells decreased (p = 0.002), and PD-L1 expression of tumours became undetectable. In the multivariate analysis, post-treatment high TILs correlated to LPFS (HR: 0.34; 95% CI 0.15-0.75; p = 0.008) and DFS (HR: 0.38; 95% CI 0.17-0.82; p = 0.015). In comparing post-treatment immune infiltrate between treatment arms, tumour response was associated with neoadjuvant chemotherapy with regional hyperthermia (p = 0.013) and high TILs (p = 0.064). High CD8 cell infiltration was associated with improved LPFS (HR: 0.27; 95% CI 0.09-0.79; Log-rank p = 0.011) and DFS (HR: 0.25; 95% CI 0.09-0.73; Log-rank p = 0.006). Improved survival at 10 years was associated with immune infiltrate after neoadjuvant chemotherapy with regional hyperthermia. CONCLUSION Preoperative therapy re-programs a non-inflamed tumour at baseline into an inflamed tumour. The post-treatment immune infiltrate became predictive for clinical outcomes. The combination with regional hyperthermia primes the tumour microenvironment, enabling enhanced anti-tumour immune activity in high-risk soft tissue sarcomas. TRIAL REGISTRATION ClinicalTrials.gov, NCT00003052.
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Affiliation(s)
- Rolf D Issels
- Department of Medicine III, University Hospital, LMU, Marchioninistr.15, Munich, 81377, Germany.
| | - Elfriede Noessner
- Helmholtz Zentrum München, German Research Center for Environmental Health, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU, Marchioninistr.15, Munich, 81377, Germany
| | - Michael Schmidt
- Munich Cancer Registry, Institute of Medical Information Processing, Biometry and Epidemiology, LMU, Munich, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, LMU Munich, Munich, Germany
| | - Jean-Yves Blay
- Department of Medicine, Centre Leon Berard, 28 Rue Laennec1, Lyon, 69373, France
| | - Emanuel Stutz
- Dept. of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern Freiburgstr.18, Switzerland
| | - Yujun Xu
- Institute of Medical Informatics, Biometry and Epidemiology (IBE), LMU Munich, Germany
| | - Veit Buecklein
- Department of Medicine III, University Hospital, LMU, Marchioninistr.15, Munich, 81377, Germany
| | | | - Sultan Abdel-Rahman
- Department of Medicine III, University Hospital, LMU, Marchioninistr.15, Munich, 81377, Germany
| | - Ulrich Mansmann
- Institute of Medical Informatics, Biometry and Epidemiology (IBE), LMU Munich, Germany
| | - Michael von Bergwelt-Baildon
- Deutsches Konsortium für Translationale Krebsforschung, Bayrisches Zentrum für Krebsforschung, and Comprehensive Cancer Center LMU, Munich, Germany
| | - Thomas Knoesel
- Institute of Pathology, LMU, Thalkirchner Str.36, Munich, 80337, Germany
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22
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Brummelhuis ISG, Simons M, Lindner LH, Kort S, de Jong S, Hossann M, Witjes JA, Oosterwijk E. DPPG 2-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo. Int J Hyperthermia 2021; 38:1415-1424. [PMID: 34581259 DOI: 10.1080/02656736.2021.1983038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Recommended treatments for muscle-invasive bladder cancer (MIBC) come with considerable morbidity. Hyperthermia (HT) triggered drug release from phosphatidylglycerol-based thermosensitive liposomes (DPPG2-TSL) might prevent surgical bladder removal and toxicity from systemic chemotherapy. We aimed to assess the efficacy of DPPG2-TSL with HT in a syngeneic orthotopic rat urothelial carcinoma model. METHODS A total of 191 female Fischer F344 rats were used. Bladder tumors were initiated by inoculation of AY-27 cells and tumor-bearing rats were selected with cystoscopy and semi-randomized over treatment groups. On days 5 and 8, animals were treated with DOX in different treatment modalities: intravenous (iv) DPPG2-TSL-DOX with HT, iv free DOX without HT, intravesical DOX without HT, intravesical DOX with HT or no treatment (control group), respectively. Animals were euthanized on day 14 and complete tumor response was assessed by histopathological evaluation. RESULTS Iv DPPG2-TSL-DOX + HT resulted in a favorable rate of animals with complete tumor response (70%), compared to iv free DOX (18%, p = .02), no treatment (0%, p = .001), and intravesical DOX with (43%, p = .35) or without HT (50%, p = .41). All rats receiving intravesical DOX with HT and 24% of rats treated with DPPG2-TSL-DOX containing the same DOX dose with HT had to be euthanized before day 14 because of substantial bodyweight loss, which was associated with dilated ureters urine retention in a few rats. CONCLUSION Treatment with DPPG2-TSL-DOX combined with intravesical HT outperformed systemic and intravesical DOX in vivo. There might be a role for DPPG2-TSL encapsulating chemotherapeutics in the treatment of MIBC in the future.
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Affiliation(s)
- Iris S G Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Simons
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars H Lindner
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Simone Kort
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Sytse de Jong
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Berclaz LM, Altendorf-Hofmann A, Dürr HR, Klein A, Angele MK, Albertsmeier M, Schmidt-Hegemann NS, Di Gioia D, Knösel T, Lindner LH. Expression Patterns of TOP2A and SIRT1 Are Predictive of Survival in Patients with High-Risk Soft Tissue Sarcomas Treated with a Neoadjuvant Anthracycline-Based Chemotherapy. Cancers (Basel) 2021; 13:cancers13194877. [PMID: 34638362 PMCID: PMC8507907 DOI: 10.3390/cancers13194877] [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: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022] Open
Abstract
Molecular predictors of response to chemotherapy and survival have not been put into clinical practice in high-risk soft tissue sarcomas (HR-STS) by now. The expression of TOP2A and SIRT1 has implications for the mechanism of action of doxorubicin, which is the backbone of chemotherapy in HR-STS. Pre-treatment samples of 167 patients with HR-STS were collected. Protein expression levels of TOP2A and SIRT1 were evaluated with tissue microarrays and immunohistochemistry and correlated with clinicopathological parameters, including overall survival (OS). The expression of TOP2A and SIRT1 was seen in 47% and 60% of patients with HR-STS, respectively. TOP2A expression was associated with higher tumor grading and shorter 5-year OS. The expression of SIRT1 was correlated with a better 5- and 10-year OS. The combination of high SIRT1 and low TOP2A ("Top survivors") significantly predicted a better OS compared to other biomarker combinations. A multivariate analysis confirmed the expression of SIRT1 and the "Top survivor" biomarker combination as independent predictive factors of OS. This is the first study to associate SIRT1 overexpression with a statistically significant prolongation of OS in HR-STS. Both individual markers and their combination can be used as predictive indicators for HR-STS patients scheduled for neoadjuvant anthracycline-based chemotherapy.
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Affiliation(s)
- Luc M. Berclaz
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (D.D.G.); (L.H.L.)
- Correspondence:
| | - Annelore Altendorf-Hofmann
- Department of General, Visceral and Vascular Surgery, Friedrich-Schiller University Jena, Am Klinikum 1, 07743 Jena, Germany;
| | - Hans Roland Dürr
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.R.D.); (A.K.)
| | - Alexander Klein
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (H.R.D.); (A.K.)
| | - Martin K. Angele
- Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.K.A.); (M.A.)
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.K.A.); (M.A.)
| | - Nina-Sophie Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Dorit Di Gioia
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (D.D.G.); (L.H.L.)
| | - Thomas Knösel
- LMU Institute of Pathology, Ludwig-Maximilians-University (LMU) Munich, Thalkirchner Str. 36, 80337 Munich, Germany;
| | - Lars H. Lindner
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (D.D.G.); (L.H.L.)
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Nieto A, Albertsmeier M, Werner J, Di Gioia D, Lindner LH, Rauch J, Nachbichler S, Belka C, Schmidt-Hegemann NS. [Retroperitoneal soft tissue sarcoma: role of radiotherapy]. Chirurg 2021; 93:34-39. [PMID: 34524488 DOI: 10.1007/s00104-021-01498-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retroperitoneal soft tissue sarcomas (RPS) include tumors of mesenchymal origin with overall well-defined histological subtypes and heterogenic prognosis. For the first time with the publication of the STRASS study, which investigated the value of neoadjuvant radiotherapy in primary RPS, there is phase III evidence for the use of radiotherapy. OBJECTIVE The primary objective of the present article is to present the role of neoadjuvant radiotherapy in RPS since the publication of the STRASS study. MATERIAL AND METHODS We performed a non-systematic literature search. The results of retrospective and observational studies were compared to those of the STRASS study. RESULTS In the two of the largest analyses, the surveillance, epidemiology, and end results program (SEER) and the American National Cancer Database (NCDB), an improvement in overall survival due to radiotherapy in RPS could be shown. In contrast to these results, there was no significant improvement in 3‑year abdominal recurrence-free survival in the STRASS study. There was solely a trend to improved abdominal recurrence-free survival in initially unplanned subgroup analyses for patients with liposarcoma as well as low-grade sarcoma but not for leiomyosarcoma or high-grade sarcoma. CONCLUSION Thanks to international collaboration an academic randomized trial was even feasible in such a rare disease as RPS. The results of the STRASS study have relativized the potential benefit of radiotherapy in RPS. A longer follow-up especially regarding the role of radiotherapy in liposarcomas is desirable.
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Affiliation(s)
- Alexander Nieto
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Campus Großhadern, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Markus Albertsmeier
- Klinik und Poliklinik für Chirurgie, Campus Großhadern, LMU Klinikum, München, Deutschland
| | - Jens Werner
- Klinik und Poliklinik für Chirurgie, Campus Großhadern, LMU Klinikum, München, Deutschland
| | - Dorit Di Gioia
- Zentrum für Knochen- und Weichteiltumoren (SarKUM), Medizinische Klinik III, Campus Großhadern, LMU Klinikum, München, Deutschland
| | - Lars H Lindner
- Zentrum für Knochen- und Weichteiltumoren (SarKUM), Medizinische Klinik III, Campus Großhadern, LMU Klinikum, München, Deutschland
| | - Josefine Rauch
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Campus Großhadern, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Silke Nachbichler
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Campus Großhadern, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Claus Belka
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Campus Großhadern, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Nina-Sophie Schmidt-Hegemann
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Campus Großhadern, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
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Hossann M, Hirschberger J, Schmidt R, Baumgartner C, Zimmermann K, Baer S, Ratzlaff C, Peller M, Troedson K, Limmer S, Brühschwein A, Dörfelt R, Kreutzmann N, Wess G, Knösel T, Schagon O, Fischer J, Grüll H, Willerding L, Schmidt M, Meyer-Lindenberg A, Issels RD, Schwaiger M, Eggermont AM, ten Hagen TL, Lindner LH. A Heat‐Activated Drug‐Delivery Platform Based on Phosphatidyl‐(oligo)‐glycerol Nanocarrier for Effective Cancer Treatment. Adv NanoBio Res 2021. [DOI: 10.1002/anbr.202170061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Martin Hossann
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
- Thermosome GmbH 82152 Planegg/Martinsried Germany
| | | | - Rebecca Schmidt
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Christine Baumgartner
- Department of Nuclear Medicine Klinikum Rechts der Isar Ismaninger Straße 22 81675 Munich Germany
| | - Katja Zimmermann
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Silke Baer
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Christina Ratzlaff
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Michael Peller
- Department of Radiology University Hospital LMU Munich Marchioninistr. 15 81377 Munich Germany
| | - Karin Troedson
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Simone Limmer
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Andreas Brühschwein
- Clinic of Small Animal Surgery and Reproduction LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Rene Dörfelt
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Nina Kreutzmann
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Gerhard Wess
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Thomas Knösel
- Institute of Pathology LMU Munich Thalkirchner Str. 36 80337 Munich Germany
| | - Olaf Schagon
- Phospholipid Research Group Max Planck Institute for Biophysical Chemistry Am Faßberg 11 37073 Göttingen Germany
| | - Johannes Fischer
- Department of Nuclear Medicine Klinikum Rechts der Isar Ismaninger Straße 22 81675 Munich Germany
| | - Holger Grüll
- University of Cologne Faculty of Medicine University Hospital of Cologne Institute of Diagnostic and Interventional Radiology Kerpener Str. 62 50937 Cologne Germany
| | - Linus Willerding
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Michael Schmidt
- Munich Cancer Registry Institute for Medical Information Processing, Biometry, and Epidemiology University of Munich Marchioninistr. 15 81377 Munich Germany
| | - Andrea Meyer-Lindenberg
- Clinic of Small Animal Surgery and Reproduction LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Rolf D. Issels
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine Klinikum Rechts der Isar Ismaninger Straße 22 81675 Munich Germany
| | - Alexander M. Eggermont
- Princess Máxima Center for Pediatric Oncology University Medical Center Utrecht Heidelberglaan 25 3584 CS Utrecht The Netherlands
| | - Timo L. ten Hagen
- Department of Pathology Laboratory Experimental Oncology and Nanomedicine Innovation Center Erasmus (NICE) Erasmus MC 3015 CE Rotterdam The Netherlands
| | - Lars H. Lindner
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
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Lindner LH. [Deep vein thrombosis - diagnostics and clarification]. Dtsch Med Wochenschr 2021; 146:832-836. [PMID: 34130326 DOI: 10.1055/a-1226-5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Deep vein thrombosis usually manifests as leg or pelvic vein thrombosis (DVT). The causes are either acquired or inherited and can also occur in combination. Early diagnosis and treatment of DVT can reduce the risk of pulmonary embolism and postthrombotic syndrome. The estimation of the clinical probability, if necessary in combination with the D-dimer test, points the way to further imaging diagnostics. After diagnosis, risk factors that led to the occurrence of thrombosis can be identified in many cases. In more than half of the cases, genetic causes play a role. If the cause is not clear, tumor screening should be performed, since up to 20 % of thromboses are due to tumor disease.
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Petrini M, Lokerse WJM, Mach A, Hossann M, Merkel OM, Lindner LH. Effects of Surface Charge, PEGylation and Functionalization with Dipalmitoylphosphatidyldiglycerol on Liposome-Cell Interactions and Local Drug Delivery to Solid Tumors via Thermosensitive Liposomes. Int J Nanomedicine 2021; 16:4045-4061. [PMID: 34163158 PMCID: PMC8214027 DOI: 10.2147/ijn.s305106] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/24/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Previous studies demonstrated the possibility of targeting tumor-angiogenic endothelial cells with positively charged nanocarriers, such as cationic liposomes. We investigated the active targeting potential of positively charged nanoparticles in combination with the heat-induced drug release function of thermosensitive liposomes (TSL). This novel dual-targeted approach via cationic TSL (CTSL) was thoroughly explored using either a novel synthetic phospholipid 1,2-dipalmitoyl-sn-glycero-3-phosphodiglycerol (DPPG2) or a conventional polyethylene glycol (PEG) surface modification. Anionic particles containing either DPPG2 or PEG were also included in the study to highlight difference in tumor enrichment driven by surface charge. With this study, we aim to provide a deep insight into the main differences between DPPG2- and PEG-functionalized liposomes, focusing on the delivery of a well-known cytotoxic drug (doxorubicin; DOX) in combination with local hyperthermia (HT, 41–43°C). Materials and Methods DPPG2- and PEG-based cationic TSLs (PG2-CTSL/PEG-CTSL) were thoroughly analyzed for size, surface charge, and heat-triggered DOX release. Cancer cell targeting and DOX delivery was evaluated by FACS, fluorescence imaging, and HPLC. In vivo particle behavior was analyzed by assessing DOX biodistribution with local HT application in tumor-bearing animals. Results The absence of PEG in PG2-CTSL promoted more efficient liposome–cell interactions, resulting in a higher DOX delivery and cancer cell toxicity compared with PEG-CTSL. By exploiting the dual-targeting function of CTSLs, we were able to selectively trigger DOX release in the intracellular compartment by HT. When tested in vivo, local HT promoted an increase in intratumoral DOX levels for all (C)TSLs tested, with DOX enrichment factors ranging from 3 to 14-fold depending on the type of formulation. Conclusion Cationic particles showed lower hemocompatibility than their anionic counterparts, which was partially mitigated when PEG was grafted on the liposome surface. DPPG2-based anionic TSL showed optimal local drug delivery compared to all other formulations tested, demonstrating the potential advantages of using DPPG2 lipid in designing liposomes for tumor-targeted applications.
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Affiliation(s)
- Matteo Petrini
- Department of Internal Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany.,Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, Ludwig Maximilian University, Munich, Germany
| | - Wouter J M Lokerse
- Department of Internal Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Agnieszka Mach
- Department of Internal Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | | | - Olivia M Merkel
- Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, Ludwig Maximilian University, Munich, Germany
| | - Lars H Lindner
- Department of Internal Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
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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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Hossann M, Hirschberger J, Schmidt R, Baumgartner C, Zimmermann K, Baer S, Ratzlaff C, Peller M, Troedson K, Limmer S, Brühschwein A, Dörfelt R, Kreutzmann N, Wess G, Knösel T, Schagon O, Fischer J, Grüll H, Willerding L, Schmidt M, Meyer-Lindenberg A, Issels RD, Schwaiger M, Eggermont AM, ten Hagen TL, Lindner LH. A Heat‐Activated Drug‐Delivery Platform Based on Phosphatidyl‐(oligo)‐glycerol Nanocarrier for Effective Cancer Treatment. Adv NanoBio Res 2021. [DOI: 10.1002/anbr.202000089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Martin Hossann
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
- Thermosome GmbH 82152 Planegg/Martinsried Germany
| | | | - Rebecca Schmidt
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Christine Baumgartner
- Department of Nuclear Medicine Klinikum Rechts der Isar Ismaninger Straße 22 81675 Munich Germany
| | - Katja Zimmermann
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Silke Baer
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Christina Ratzlaff
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Michael Peller
- Department of Radiology University Hospital LMU Munich Marchioninistr. 15 81377 Munich Germany
| | - Karin Troedson
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Simone Limmer
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Andreas Brühschwein
- Clinic of Small Animal Surgery and Reproduction LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Rene Dörfelt
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Nina Kreutzmann
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Gerhard Wess
- Clinic of Small Animal Medicine LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Thomas Knösel
- Institute of Pathology LMU Munich Thalkirchner Str. 36 80337 Munich Germany
| | - Olaf Schagon
- Phospholipid Research Group Max Planck Institute for Biophysical Chemistry Am Faßberg 11 37073 Göttingen Germany
| | - Johannes Fischer
- Department of Nuclear Medicine Klinikum Rechts der Isar Ismaninger Straße 22 81675 Munich Germany
| | - Holger Grüll
- University of Cologne Faculty of Medicine University Hospital of Cologne Institute of Diagnostic and Interventional Radiology Kerpener Str. 62 50937 Cologne Germany
| | - Linus Willerding
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Michael Schmidt
- Munich Cancer Registry Institute for Medical Information Processing, Biometry, and Epidemiology University of Munich Marchioninistr. 15 81377 Munich Germany
| | - Andrea Meyer-Lindenberg
- Clinic of Small Animal Surgery and Reproduction LMU Munich Veterinärstr. 13 80539 Munich Germany
| | - Rolf D. Issels
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine Klinikum Rechts der Isar Ismaninger Straße 22 81675 Munich Germany
| | - Alexander M. Eggermont
- Princess Máxima Center for Pediatric Oncology University Medical Center Utrecht Heidelberglaan 25 3584 CS Utrecht The Netherlands
| | - Timo L. ten Hagen
- Department of Pathology Laboratory Experimental Oncology and Nanomedicine Innovation Center Erasmus (NICE) Erasmus MC 3015 CE Rotterdam The Netherlands
| | - Lars H. Lindner
- Department of Medicine III & Sarcoma Center (SarKUM) University Hospital LMU Munich Marchioninistraße 15 81377 Munich Germany
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Pink D, Andreou D, Bauer S, Brodowicz T, Kasper B, Reichardt P, Richter S, Lindner LH, Szkandera J, Grünwald V, Kebenko M, Kirchner M, Hohenberger P. Treatment of Angiosarcoma with Pazopanib and Paclitaxel: Results of the EVA (Evaluation of Votrient ® in Angiosarcoma) Phase II Trial of the German Interdisciplinary Sarcoma Group (GISG-06). Cancers (Basel) 2021; 13:cancers13061223. [PMID: 33799576 PMCID: PMC8000466 DOI: 10.3390/cancers13061223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/14/2021] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary There are very few systemic treatment options for patients with advanced angiosarcomas. We therefore examined whether combined treatment with paclitaxel and pazopanib was active and well tolerated. However, we did not meet a preplanned interim target of 6/14 patients without progression of the disease at 6 months, after which finding we stopped recruitment, having enrolled a total of 26 patients. Of the patients enrolled, 46% were progression-free at 6 months. Two patients showed a complete and seven patients a partial tumor response to treatment. The progression-free survival of patients with superficial tumors was significantly longer compared to the patients with visceral tumors. A total of 10 drug-related serious adverse effects were reported in 5 patients, including a fatal hepatic failure. The results in patients with superficial tumors appear promising. Future studies should evaluate the safety and efficacy of vascular endothelial growth factor receptor (VEGFR) and immune checkpoint inhibitors with or without paclitaxel in a randomized, multiarm setting. Abstract We aimed to evaluate the efficacy and toxicity of paclitaxel combined with pazopanib in advanced angiosarcoma (AS). The primary end point was progression-free survival (PFS) rate at six months (PFSR6). Planned accrual was 44 patients in order to detect a PFSR6 of >55%, with an interim futility analysis of the first 14 patients. The study did not meet its predetermined interim target of 6/14 patients progression-free at 6 months. At the time of this finding, 26 patients had been enrolled between July 2014 and April 2016, resulting in an overrunning of 12 patients. After a median follow-up of 9.5 (IQR 7.7–15.4) months, PFSR6 amounted to 46%. Two patients had a complete and seven patients a partial response. Patients with superficial AS had a significantly higher PFSR6 (61% vs. 13%, p = 0.0247) and PFS (11.3 vs. 2.7 months, p < 0.0001) compared to patients with visceral AS. The median overall survival in the entire cohort was 21.6 months. A total of 10 drug-related serious adverse effects were reported in 5 patients, including a fatal hepatic failure. Although our study did not meet its primary endpoint, the median PFS of 11.6 months in patients with superficial AS appears to be promising. Taking recent reports into consideration, future studies should evaluate the safety and efficacy of VEGFR and immune checkpoint inhibitors with or without paclitaxel in a randomized, multiarm setting.
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Affiliation(s)
- Daniel Pink
- Department of Hematology, Oncology and Palliative Medicine, Helios Hospital Bad Saarow, Sarcoma Center Berlin-Brandenburg, 15526 Bad Saarow, Germany
- Department of Internal Medicine C, University Hospital Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-33631-3527
| | - Dimosthenis Andreou
- Division of Orthopedic Oncology and Sarcoma Surgery, Helios Hospital Bad Saarow, Sarcoma Center Berlin-Brandenburg, 15526 Bad Saarow, Germany;
| | - Sebastian Bauer
- Department of Medical Oncology, University Hospital Essen, Sarcoma Center, University of Duisburg-Essen, 45147 Essen, Germany; (S.B.); (V.G.)
| | - Thomas Brodowicz
- Department of Interal Medicine 1/Oncology, Medical University Vienna-General Hospital, 1090 Vienna, Austria;
| | - Bernd Kasper
- Interdisciplinary Tumor Center, Sarcoma Unit, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Peter Reichardt
- Department of Oncology and Palliative Medicine, Helios Hospital Berlin-Buch, Sarcoma Center Berlin-Brandenburg, 13125 Berlin, Germany;
| | - Stephan Richter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, 01307 Dresden, Germany;
| | - Lars H. Lindner
- Department of Medicine III, University Hospital Munich, Ludwig Maximilians University, 81377 Munich, Germany;
| | - Joanna Szkandera
- Clinical Division of Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Viktor Grünwald
- Department of Medical Oncology, University Hospital Essen, Sarcoma Center, University of Duisburg-Essen, 45147 Essen, Germany; (S.B.); (V.G.)
- Department of Hematology, Hemostasis and Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Maxim Kebenko
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, 23538 Lübeck, Germany;
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
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Lindner LH, Blay JY, Eggermont AMM, Issels RD. Perioperative chemotherapy and regional hyperthermia for high-risk adult-type soft tissue sarcomas. Eur J Cancer 2021; 147:164-169. [PMID: 33684876 DOI: 10.1016/j.ejca.2021.02.002] [Citation(s) in RCA: 6] [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: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022]
Abstract
A group of patients with adult-type soft tissue sarcoma is at high risk of local recurrence and distant metastases. Age, tumour site, histological subtype, tumour size and grade have been identified as the most important independent adverse prognostic factors. Macroscopically complete tumour resection is considered as the mainstay of treatment with the addition of preoperative or postoperative radiotherapy for extremity or trunk localisation. Retroperitoneal localisation requires compartmental resection and is associated with a worse prognosis. Here, radiotherapy is of no proven value. Perioperative chemotherapy is considered to treat micrometastatic disease not detectable at the time of diagnosis. The neoadjuvant application gives the risk of distant metastasis the greatest importance as therapy is carried out at the earliest possible time, whereas adjuvant chemotherapy is delayed by surgery and the necessary wound healing. With reported response rates up to 30%, both the operability may be improved and the risk of intraoperative tumour cell dissemination may be reduced, resulting also in reduced local relapse rates. However, the potential risk of early tumour progression may counteract this benefit. Optimised strategies with multimodality approaches including chemotherapy, regional hyperthermia (RHT) and immunotherapeutic agents have been shown to improve survival in high-risk patients. Here, we focus on the data from available randomised studies investigating the use of perioperative chemotherapy in patients with high-risk adult-type soft tissue sarcoma, including the use of RHT for local enhancement of chemotherapy effect and immune induction.
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Affiliation(s)
- Lars H Lindner
- Department of Medicine III, SarKUM, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Jean-Yves Blay
- Department of Medicine, NetSARC and LYRIC, Centre Léon Bérard, 28 rue Laennec l, 69373 Lyon, France.
| | - Alexander M M Eggermont
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - Rolf D Issels
- Department of Medicine III, SarKUM, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Bonvalot S, Wunder J, Gronchi A, Broto JM, Turcotte R, Rastrelli M, Papai Z, Radaelli S, Lindner LH, Shumelinsky F, Cubillo A, Rutkowski P, Demaire C, Strens D, Nalbantov G. Complete pathological response to neoadjuvant treatment is associated with better survival outcomes in patients with soft tissue sarcoma: Results of a retrospective multicenter study. Eur J Surg Oncol 2021; 47:2166-2172. [PMID: 33676792 DOI: 10.1016/j.ejso.2021.02.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/21/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Locally advanced soft tissue sarcoma (STS) management may include neoadjuvant or adjuvant treatment by radiotherapy (RT), chemotherapy (CT) or chemoradiotherapy (CRT) followed by wide surgical excision. While pathological complete response (pCR) to preoperative treatment is prognostic for survival in osteosarcomas, its significance for STS is unclear. We aimed to evaluate the prognostic significance of pCR to pre-operative treatment on 3-year disease-free survival (3y-DFS) in STS patients. METHODS This is an observational, retrospective, international, study of adult patients with primary non-metastatic STS of the extremities and trunk wall, any grade, diagnosed between 2008 and 2012, treated with at least neoadjuvant treatment and surgical resection and observed for a minimum of 3 years after diagnosis. The primary objective was to evaluate the effect of pCR. (≤5% viable tumor cells or ≥95% necrosis/fibrosis) on 3y-DFS. Effect on local recurrence-free survival (LRFS), distant recurrence-free survival (MFS) overall survival (OS) at 3 years was also analyzed. Statistical univariate analysis utilized chi-square independence test and odds ratio confidence interval (CI) estimate, multivariate analysis was performed using LASSO. RESULTS A total of 330 patients (median age 56 years old, range:19-95) treated by preoperative RT (67%), CT (15%) or CRT (18%) followed by surgery were included. pCR was achieved in 74/330 (22%) of patients, of which 56/74 (76%) had received RT. 3-yr DFS was observed in 76% of patients with pCR vs 61% without pCR (p < 0.001). Multivariate analysis showed that pCR is statistically associated with better MFS (95% CI, 1.054-3.417; p = 0.033), LRFS (95% CI, 1.226-5.916; p = 0.014), DFS (95% CI, 1.165-4.040; p = 0.015) and OS at 3 years (95% CI, 1.072-5.210; p = 0.033). CONCLUSIONS In a wide, heterogeneous STS population we showed that pCR to preoperative treatment is prognostic for survival.
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Affiliation(s)
- Sylvie Bonvalot
- Department of Surgery, Institut Curie, Paris University, Paris, France.
| | - Jay Wunder
- Department of Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Javier Martin Broto
- Department of Medical Oncology, Hospital Virgen Del Rocio, And Institute of Biomedicine of Sevilla (IBIS) (HUVR, CSIC, University of Sevilla), Sevilla, Spain
| | - Robert Turcotte
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco Rastrelli
- Department of Surgical Oncology, Istituto Oncologico Veneto, Padova, Italy
| | - Zsuzsanna Papai
- Department of Oncology, Honved Hospital - Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Felix Shumelinsky
- Department of Surgery - Bone and Connective Tissue Tumour Surgery, Jules Bordet Institute, Brussels, Belgium
| | - Antonio Cubillo
- Department of Medical Oncology, Hospital Universitario Sanchinarro, Centro Integral Oncológico Clara Campal HM CIOCC, Madrid, Spain
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Clémentine Demaire
- Health Economics & Outcome Research Team, Monitor Deloitte, Zaventem, Belgium
| | - Daniëlle Strens
- Health Economics & Outcome Research Team, Monitor Deloitte, Zaventem, Belgium
| | - Georgi Nalbantov
- Health Economics & Outcome Research Team, Monitor Deloitte, Zaventem, Belgium
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Holzgreve A, Fabritius MP, Knösel T, Renz BW, Lindner LH, Di Gioia D, Bartenstein P, Rübenthaler J, Tiling R. 18F-FDG PET/CT for Monitoring of Disease Progression in Metastatic Perivascular Epithelioid Cell Tumor. Clin Nucl Med 2021; 46:156-158. [PMID: 33315683 DOI: 10.1097/rlu.0000000000003453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT A 38-year-old woman presented for 18F-FDG PET/CT after multiple intra-abdominal surgical resections of a rare recurrent perivascular epithelioid cell tumor of the gastrointestinal tract. A solitary pelvic metastasis was detected, but surprisingly exhibited neither increased glucose consumption nor contrast enhancement on CT. Follow-up 18F-FDG PET/CT staging in the further disease course revealed multiple abdominal metastases, now, however, with markedly increased 18F-FDG uptake and intraoperatively correlating widespread peritoneal sarcomatosis. This case gives preliminary insight into monitoring of disease progression in metastatic perivascular epithelioid cell tumor, although the underlying pathophysiological bases for varying 18F-FDG uptake in PET/CT are not yet fully understood.
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Affiliation(s)
| | | | | | | | - Lars H Lindner
- Internal Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Dorit Di Gioia
- Internal Medicine III, University Hospital, LMU Munich, Munich, Germany
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Schmoll HJ, Lindner LH, Reichardt P, Heißner K, Kopp HG, Kessler T, Mayer-Steinacker R, Rüssel J, Egerer G, Crysandt M, Kasper B, Niederwieser D, Kunitz A, Eigendorff E, Petersen I, Steighardt J, Cygon F, Meinert F, Stein A. Efficacy of Pazopanib With or Without Gemcitabine in Patients With Anthracycline- and/or Ifosfamide-Refractory Soft Tissue Sarcoma: Final Results of the PAPAGEMO Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:255-262. [PMID: 33355646 DOI: 10.1001/jamaoncol.2020.6564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pazopanib and gemcitabine have shown good tolerability, albeit modest single-agent activity in pretreated soft tissue sarcoma. A combined regimen to improve outcomes is required. Objective To determine the efficacy of gemcitabine and pazopanib compared with pazopanib alone. Design, Setting, and Participants This multicenter, randomized phase 2 clinical trial was conducted in Germany from September 2011 to July 2014 and included patients with an Eastern Cooperative Oncology Group performance status score of 0 to 2, adequate organ function, measurable lesion, and progression after at least 1 prior treatment with anthracyclines and/or ifosfamide. Data analysis was performed during 2019 and 2020. Interventions Patients were randomized to pazopanib with gemcitabine (A) or without gemcitabine (B). Main Outcomes and Measures The primary end point was progression-free survival rate (PFSR) at 12 weeks; secondary end points included toxicity, quality of life, overall survival, and response rates. Results A total of 90 patients were randomized, and 86 eligible patients (43 women [50%]) were evaluable, with a median age of 57 (range, 22-84) years and Eastern Cooperative Oncology Group performance status score of 0/1 in 77 participants (90%). The predominant histological subtypes were leiomyosarcoma (22 [26%]) and liposarcoma (16 [19%]). After a median follow-up of 12.4 (range, 1-48) months, the primary end point was met, with a PFSR at 12 weeks of 74% (A) vs 47% (B) (hazard ratio [HR], 1.60; 90% CI, 1.15-2.23; P = .01). In the combination arm, PFSR was significantly longer, with a median of 5.6 vs 2.0 months (HR, 0.58; 95% CI, 0.36-0.92; P = .02) compared with single-agent pazopanib, whereas overall survival was similar, with 13.1 vs 11.2 months (HR, 0.98; 95% CI, 0.60-1.58; P = .83). The objective response rate was overall low, with 11% (A) vs 5% (B) (P = .10). The toxicity of the combination of pazopanib and gemcitabine was increased, but it was manageable and mainly hematological. Conclusions and Relevance This phase 2 randomized clinical trial of patients with soft tissue sarcoma found that the addition of gemcitabine to pazopanib was tolerable, and PFSR at 12 weeks was significantly higher compared with pazopanib alone. These results suggest clinical activity of the combination, but they should be confirmed in a phase 3 trial in a more homogeneous population (eg, leiomyosarcoma). Trial Registration German Clinical Trials Identifier: DRKS00003139.
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Affiliation(s)
- Hans-Joachim Schmoll
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilians University, Munich, Germany
| | | | | | | | | | | | - Jörn Rüssel
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Gerlinde Egerer
- Department of Internal Medicine V, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen University, Aachen, Germany
| | - Bernd Kasper
- Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, Mannheim, Germany
| | | | | | | | - Iver Petersen
- University Hospital Jena, Jena, Germany.,SRH Wald Klinikum, Gera, Germany
| | - Jörg Steighardt
- Coordination Center for Clinical Trials Halle, Martin Luther University, Halle-Wittenberg, Germany
| | - Franziska Cygon
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Fabian Meinert
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Alexander Stein
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Joensuu H, Eriksson M, Sundby Hall K, Reichardt A, Hermes B, Schütte J, Cameron S, Hohenberger P, Jost PJ, Al-Batran SE, Lindner LH, Bauer S, Wardelmann E, Nilsson B, Kallio R, Jaakkola P, Junnila J, Alvegård T, Reichardt P. Survival Outcomes Associated With 3 Years vs 1 Year of Adjuvant Imatinib for Patients With High-Risk Gastrointestinal Stromal Tumors: An Analysis of a Randomized Clinical Trial After 10-Year Follow-up. JAMA Oncol 2021; 6:1241-1246. [PMID: 32469385 DOI: 10.1001/jamaoncol.2020.2091] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance Adjuvant imatinib is associated with improved recurrence-free survival (RFS) when administered after surgery to patients with operable gastrointestinal stromal tumor (GIST), but its influence on overall survival (OS) has remained uncertain. Objective To evaluate the effect of adjuvant imatinib on OS of patients who have a high estimated risk for GIST recurrence after macroscopically complete surgery. Design, Setting, and Participants In this open-label, randomized (1:1), multicenter phase 3 clinical trial conducted in Finland, Germany, Norway, and Sweden, 400 patients who had undergone macroscopically complete surgery for GIST with a high estimated risk for recurrence according to the modified National Institutes of Health Consensus Criteria were enrolled between February 2004 and September 2008. Data for this follow-up analysis were analyzed from September to November, 2019. Interventions Imatinib 400 mg/d administered orally for either 12 months or 36 months after surgery. Main Outcomes And Measures The primary end point was RFS; the secondary objectives included OS and treatment safety. Results The intention-to-treat cohort consisted of 397 patients (12-month group, 199; 36-month group, 198; 201 men and 196 women; median [IQR] age, 62 (51-69) years and 60 (51-67) years, during a median follow-up time of 119 months after the date of randomization, 194 RFS events and 96 OS events were recorded in the intention-to-treat population. Five-year and 10-year RFS was 71.4% and 52.5%, respectively, in the 36-month group and 53.0% and 41.8% in the 12-month group (hazard ratio [HR], 0.66; 95% CI, 0.49-0.87; P = .003). In the 36-month group, 5-year OS and 10-year OS rates were 92.0% and 79.0%, respectively, and in the 12-month group 85.5% and 65.3% (HR, 0.55; 95% CI, 0.37-0.83; P = .004). The results were similar in the efficacy population, from which 15 patients who did not have GIST in central pathology review and 24 patients who had intra-abdominal metastases removed at surgery were excluded (36-month group, 10-year OS 81.6%; 12-month group, 66.8%; HR, 0.50; 95% CI, 0.32-0.80; P = .003). No new safety signals were detected. Conclusions and Relevance Three years of adjuvant imatinib is superior in efficacy compared with 1 year of imatinib. Approximately 50% of deaths may be avoided during the first 10 years of follow-up after surgery with longer adjuvant imatinib treatment. Trial Registration ClinicalTrials.gov Identifier: NCT00116935.
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Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikael Eriksson
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Kirsten Sundby Hall
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Annette Reichardt
- Helios Klinikum Berlin-Buch, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany
| | | | - Jochen Schütte
- Schwerpunktpraxis Oncology/Hematology, Düsseldorf, Germany
| | - Silke Cameron
- Department of Gastroenterology, University of Göttingen, Göttingen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Philipp J Jost
- Medical Department III, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | | | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University of Münster, Münster, Germany
| | - Bengt Nilsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raija Kallio
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Panu Jaakkola
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Thor Alvegård
- Department of Cancer Epidemiology, Lund University, Lund, Sweden
| | - Peter Reichardt
- Helios Klinikum Berlin-Buch, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany
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van Valenberg FJP, Brummelhuis ISG, Lindner LH, Kuhnle F, Wedmann B, Schweizer P, Hossann M, Witjes JA, Oosterwijk E. DPPG 2-Based Thermosensitive Liposomes with Encapsulated Doxorubicin Combined with Hyperthermia Lead to Higher Doxorubicin Concentrations in the Bladder Compared to Conventional Application in Pigs: A Rationale for the Treatment of Muscle-Invasive Bladder Cancer. Int J Nanomedicine 2021; 16:75-88. [PMID: 33447028 PMCID: PMC7802347 DOI: 10.2147/ijn.s280034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/07/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose Current treatment options for muscle-invasive bladder cancer (MIBC) are associated with substantial morbidity. Local release of doxorubicin (DOX) from phosphatidyldiglycerol-based thermosensitive liposomes (DPPG2-TSL-DOX) potentiated by hyperthermia (HT) in the bladder wall may result in bladder sparing without toxicity of systemic chemotherapy. We investigated whether this approach, compared to conventional DOX application, increases DOX concentrations in the bladder wall while limiting DOX in essential organs. Materials and Methods Twenty-one pigs were anaesthetized, and a urinary catheter equipped with a radiofrequency-emitting antenna for HT (60 minutes) was placed. Experimental groups consisted of iv low or full dose (20 or 60 mg/m2) DPPG2-TSL-DOX with/without HT, iv low dose (20 mg/m2) free DOX with HT, and full dose (50 mg/50 mL) intravesical DOX with/without HT. After the procedure, animals were immediately sacrificed. HPLC was used to measure DOX levels in the bladder, essential organs and serum, and fluorescence microscopy to evaluate DOX distribution in the bladder wall. Results Iv DPPG2-TSL-DOX with HT resulted in a significantly higher bladder wall DOX concentration which was more homogeneous distributed, than iv and intravesical free DOX administration with HT. Specifically in the detrusor, DPPG2-TSL-DOX with HT led to a >7- and 44-fold higher DOX concentration, compared to iv free DOX with HT and intravesical DOX, respectively. Organ DOX concentrations were significantly lower in heart and kidneys, and similar in liver, spleen and lungs, following iv DPPG2-TSL-DOX with HT, compared to iv free DOX. Intravesical DOX led to the lowest organ DOX concentrations. Conclusion Iv DPPG2-TSL-DOX combined with HT achieved higher DOX concentrations in the bladder wall including the detrusor, compared to conventional iv and intravesical DOX application. In combination with lower DOX accumulation in heart and kidneys, compared to iv free chemotherapy, DPPG2-TSL-DOX with HT has great potential to attain a role as a bladder-sparing treatment for MIBC.
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Affiliation(s)
| | - Iris S G Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lars H Lindner
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Felix Kuhnle
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - Barbara Wedmann
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | | | | | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
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Albertsmeier M, Altendorf-Hofmann A, Lindner LH, Issels RD, Kampmann E, Dürr HR, Schubert-Fritschle G, Angele MK, Kirchner T, Jungbluth AA, Knösel T. Cancer Testis Antigens and Immunotherapy: Expression of PRAME Is Associated with Prognosis in Soft Tissue Sarcoma. Cancers (Basel) 2020; 12:E3612. [PMID: 33287125 PMCID: PMC7761656 DOI: 10.3390/cancers12123612] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
(1) Background: PRAME, NY-ESO-1, and SSX2 are cancer testis antigens (CTAs), which are expressed in testicular germ cells with re-expression in numerous cancer types. Their ability to elicit humoral and cellular immune responses have rendered them promising targets for cancer immunotherapy, but they have never been studied in a large and well-characterised cohort of soft tissue sarcomas (STS). (2) Methods: On a protein level, we examined PRAME, NY-ESO-1, and SSX2 expression in tumour tissues of 249 high-risk STS using immunohistochemistry. We correlated expression levels with clinicopathological parameters including tumour-infiltrating lymphocyte (TIL) counts, grading, and long-term survival. (3) Results: Expression of PRAME, NY-ESO-1, and SSX2 was observed in 25 (10%), 19 (8%), and 11 (4%) of 249 specimens with distinct patterns for histo-subtypes. Expression of PRAME was associated with shorter patient survival (p = 0.005) and higher grade (G2 vs. G3, p = 0.001), while NY-ESO-1 expression was correlated with more favourable survival (p = 0.037) and lower grade (G2 vs. G3, p = 0.029). Both PRAME and NY-ESO-1 expression were more frequent in STS with low TIL counts. In multivariate analysis, high PRAME and low SSX2 expression levels as well as metastatic disease and non-radical resections were independent predictors of shorter overall survival. (4) Conclusions: CTAs PRAME, NY-ESO-1, and SSX2 show distinct expression patterns in different STS subtypes. These results demonstrate their prognostic relevance and may guide future immunotherapeutic approaches in STS.
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Affiliation(s)
- Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Annelore Altendorf-Hofmann
- Department of General, Visceral and Vascular Surgery, Friedrich-Schiller Universität Jena, Am Klinikum 1, 07743 Jena, Germany;
| | - Lars H. Lindner
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (L.H.L.); (R.D.I.); (E.K.)
| | - Rolf D. Issels
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (L.H.L.); (R.D.I.); (E.K.)
| | - Eric Kampmann
- Department of Internal Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany; (L.H.L.); (R.D.I.); (E.K.)
| | - Hans-Roland Dürr
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Martin K. Angele
- Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Thomas Kirchner
- Institute of Pathology, Ludwig-Maximilians-Universität (LMU) Munich, Thalkirchner Str. 36, 80337 Munich, Germany;
| | - Achim A. Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 1275, USA;
| | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-Universität (LMU) Munich, Thalkirchner Str. 36, 80337 Munich, Germany;
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Grünwald V, Karch A, Schuler M, Schöffski P, Kopp HG, Bauer S, Kasper B, Lindner LH, Chemnitz JM, Crysandt M, Stein A, Steffen B, Richter S, Egerer G, Ivanyi P, Zimmermann S, Liu X, Kunitz A. Randomized Comparison of Pazopanib and Doxorubicin as First-Line Treatment in Patients With Metastatic Soft Tissue Sarcoma Age 60 Years or Older: Results of a German Intergroup Study. J Clin Oncol 2020; 38:3555-3564. [DOI: 10.1200/jco.20.00714] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Doxorubicin is a standard of care in patients with advanced, inoperable soft tissue sarcoma (STS). We tested whether pazopanib has efficacy comparable to that of doxorubicin in elderly patients with STS and offers superior tolerability for hematologic toxicity. PATIENTS AND METHODS Patients age 60 years or older without previous systemic treatment for progressive advanced or metastatic STS who had Eastern Cooperative Oncology Group performance status of 0 to 2 and adequate organ function were included. Treatment consisted of pazopanib 800 mg once per day or doxorubicin 75 mg/m2 once every 3 weeks (≤ 6 cycles) after being randomly assigned in a 2:1 ratio. Noninferiority was assumed for progression-free survival (PFS), if the upper limit of the 95% CI for the hazard ratio (HR) was less than 1.8. Neutropenia and febrile neutropenia were key secondary end points. The European Organisation for Research and Treatment of Cancer (30-item) Quality of Life Questionnaire and geriatric assessment were used to measure patient-reported outcomes. Cox regression analysis and Kaplan-Meier curves were used for analysis. RESULTS Pazopanib and doxorubicin were given to 81 and 39 patients, respectively. The median age was 71 years (range, 60-88 years). PFS was noninferior (HR, 1.00; 95% CI, 0.65 to 1.53) and the incidence of grade 4 neutropenia and febrile neutropenia favored pazopanib. Objective response rates for pazopanib and doxorubicin were 12.3% and 15.4%, respectively. Overall survival did not differ significantly between arms (HR, 1.08; 95% CI, 0.68 to 1.72; P = .735). Geriatric assessment revealed 2 or more comorbidities in 15.8% of the patients and impairment of activities of daily living in 28.3% of patients. CONCLUSION Pazopanib was noninferior to doxorubicin, rendering pazopanib a putative therapeutic option in the first-line treatment of STS in patients age 60 years or older. The distinct adverse event profile may be used to counsel patients and tailor therapy to individual needs.
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Affiliation(s)
- Viktor Grünwald
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
- Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany
| | - Annika Karch
- Institute for Biostatistics, Medical School Hannover, Hannover, Germany
| | | | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen Stuttgart, Stuttgart, Germany
| | - Sebastian Bauer
- Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Essen, Germany
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, Mannheim, Germany
| | - Lars H. Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jens-Marcus Chemnitz
- Community Hospital Middle Rine, Middle Rine, Germany
- Department of Hematology, Oncology, Clinical Infectious Diseases, Clinical Immunology, Hemostaseology and Medical Intensive Care, University Hospital Cologne, Cologne, Germany
| | | | - Alexander Stein
- University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Stephan Richter
- University Hospital Carl Gustav Carus, University Cancer Center/Medical Department I, Dresden, Germany
| | | | - Philipp Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | | | - Xiaofei Liu
- Institute for Biostatistics, Medical School Hannover, Hannover, Germany
| | - Annegret Kunitz
- Vivantes Clinic Berlin-Spandau, Berlin-Spandau, Germany
- Department of Hematology, Oncology and Tumor Immunology, University Hospital Charite, Berlin, Germany
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Issels RD, Lindner LH, von Bergwelt-Baildon M, Lang P, Rischpler C, Diem H, Mosetter B, Eckl J, Schendel DJ, Salat C, Stötzer O, Burdach S, von Luettichau-Teichert I, Handgretinger R, Neumann J, Kirchner T, Steiger K, Boxberg M, Mansmann U, Multhoff G, Noessner E. Systemic antitumor effect by regional hyperthermia combined with low-dose chemotherapy and immunologic correlates in an adolescent patient with rhabdomyosarcoma - a case report. Int J Hyperthermia 2020; 37:55-65. [PMID: 31918587 DOI: 10.1080/02656736.2019.1709666] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Introduction: An abscopal effect is a clinical observation whereby a local treatment is associated with regression of metastatic cancer at a site distant from the primary location of treatment. Here, we describe the clinical systemic effect induced by regional hyperthermia combined with low-dose chemotherapy and provide immunologic correlates.Case presentation: A 15-year-old patient had been diagnosed with alveolar rhabdomyosarcoma (ARMS). All previous treatment options failed in the patient including haploidentical stem cell transplantation and donor lymphocyte infusion. The patient presented with local and metastatic disease, and upon admission, underwent regional hyperthermia combined with low-dose chemotherapy. Immediately following therapy severe skin reactions were observed. Skin biopsies revealed an intraepithelial lymphocytic infiltration dominated by CD3+/CD8+ T cells with a regular network of dendritic cells. Clinical images compared before and during sequential treatment cycles showed complete metabolic response of the local tumor for more than 10 months of therapy. In addition, metastases completely regressed although they were not direct targets of regional hyperthermia. The systemic effect was associated with enhanced frequency of NK cells and T cells expressing the lectin-like natural-killer group 2 D activating receptor (NKG2D), an increase of the CD56bright subset of NK cells, as well as an increase of effector/memory and effector CD8+ and CD4+ T cells in the blood while the percentage of CD25+FOXP3+ regulatory T cells declined.Conclusions: Regional hyperthermia combined with low-dose chemotherapy had the potential to create a systemic effect which was associated with activation of NK cells and T cells.
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Affiliation(s)
- Rolf D Issels
- Department of Medicine III, University Hospital, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Munich, Germany
| | | | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital, Tuebingenthe, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Heinz Diem
- Laboratory for Hematological Diagnostics, Gauting, Germany
| | - Barbara Mosetter
- Immunoanalytics Research Group - Tissue Control of Immunocytes & Core Facility, Helmholtz Center, Munich, Germany
| | | | | | - Christoph Salat
- Medical Center for Hematology and Oncology Munich, Munich, Germany
| | - Oliver Stötzer
- Medical Center for Hematology and Oncology Munich, Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics and Children's Cancer Research Center, Technical University of Munich, Munich, Germany
| | | | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital, Tuebingenthe, Germany
| | | | | | - Katja Steiger
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Melanie Boxberg
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Ulrich Mansmann
- Institute of Biostatistics and Epidemiology, LMU, Munich, Germany
| | - Gabriele Multhoff
- Radiation Immune-Oncology Group, Center for Translational Cancer Research, Technical University Munich, Munich, Germany
| | - Elfriede Noessner
- Immunoanalytics Research Group - Tissue Control of Immunocytes & Core Facility, Helmholtz Center, Munich, Germany
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Curto S, Mulder HT, Aklan B, Mils O, Schmidt M, Lamprecht U, Peller M, Wessalowski R, Lindner LH, Fietkau R, Zips D, van Holthe N, Franckena M, Paulides MM, van Rhoon GC. A multi-institution study: comparison of the heating patterns of five different MR-guided deep hyperthermia systems using an anthropomorphic phantom. Int J Hyperthermia 2020; 37:1103-1115. [DOI: 10.1080/02656736.2020.1810331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sergio Curto
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hendrik Thijmen Mulder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Bassim Aklan
- Department of Internal Medicine III, Ludwig-Maximilians University Hospital, Munich, Germany
| | - Oliver Mils
- Department of Pediatric Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Manfred Schmidt
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Ulf Lamprecht
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Michael Peller
- Department of Radiology, Ludwig-Maximilians University Hospital, Munich, Germany
| | - Ruediger Wessalowski
- Department of Pediatric Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lars H. Lindner
- Department of Internal Medicine III, Ludwig-Maximilians University Hospital, Munich, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Netteke van Holthe
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martine Franckena
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Margarethus M. Paulides
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerard C. van Rhoon
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Joensuu H, Eriksson M, Sundby Hall K, Reichardt A, Hermes B, Schuette J, Cameron S, Hohenberger P, Jost P, Al-Batran SE, Lindner LH, Bauer S, Wardelmann E, Nilsson BE, Kallio RS, Jaakkola P, Junnila J, Alvegard T, Reichardt P. Three versus one year of adjuvant imatinib for high-risk gastrointestinal stromal tumor (GIST): Survival analysis of a randomized trial after 10 years of follow-up. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11503 Background: Adjuvant imatinib improves recurrence-free survival (RFS) when administered after surgery to selected patients with operable gastrointestinal stromal tumor (GIST). It is uncertain whether overall survival (OS) improves, since imatinib improved OS in only one of the 3 large randomized trials conducted, and in this trial (the Scandinavian Sarcoma Group XVIII/German trial; SSGXVIII/AIO; NCT00116935) the statistical significance for OS remained borderline. The objective of the present analysis was to evaluate long-term OS of patients who participated in the SSGXVIII/AIO trial. Methods: SSGXVIII/AIO is an open-label, randomized (1:1), multicenter phase 3 trial. Four hundred patients who underwent macroscopically complete surgery for GIST with a high estimated risk for recurrence according to the modified National Institutes of Health Consensus Criteria were accrued between February 2004 and September 2008. Imatinib was scheduled to be administered 400 mg/day orally for either 12 months or 36 months after surgery. The patients were scheduled to be followed up for 10 years after study entry. Imaging of the abdomen was carried out periodically. The primary end point was RFS; the secondary objectives included OS and treatment safety. Results: The median follow-up time was 119 months. In the Intention-To-Treat Population 194 RFS events and 96 OS events were recorded. In the 36-month group, 5-year and 10-year RFS was 71.4% and 52.5%, and in the 12-month group, 53.0% and 41.8%, respectively (HR 0.66, 95% CI 0.49-0.87; P = .003). In the 36-month group, the 5-year and 10-year OS rates were 92.0% and 79.0%, and in the 12-month group, 85.5% and 65.3%, respectively (HR 0.55, 95% CI 0.37-0.83; P = .004). In the Efficacy Population, from which 15 patients who did not have GIST in central pathology review and 24 patients who had intra-abdominal metastases removed at surgery were excluded, 10-year OS was 81.6% in the 36-month group and 66.8% in the 12-month group (HR, 0.50, 95% CI 0.32-0.80; P = .003). No new safety signals were detected. Conclusions: About 50% of deaths can be avoided during the first decade of follow-up after surgery with 3-year imatinib treatment as compared to 1-year treatment. Clinical trial information: NCT00116935 .
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Affiliation(s)
- Heikki Joensuu
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | | | - Annette Reichardt
- HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | | | - Jochen Schuette
- Haematoonkologische Schwerpunktpraxis Duesseldorf, Essen, Germany
| | - Silke Cameron
- Department of Gastroenterology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Philipp Jost
- Technische Universitaet Muenchen, Muenchen, Germany
| | - Salah-Eddin Al-Batran
- Institute of Clinical Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | | | - Sebastian Bauer
- West German Cancer Center, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Munster, Muenster, Germany
| | | | | | - Panu Jaakkola
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | | | - Peter Reichardt
- Sarcoma Center, Helios Klinikum Berlin Buch, Berlin, Germany
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Tutter M, Schug C, Schmohl KA, Schwenk N, Petrini M, Lindner LH, Nelson PJ, Spitzweg C. SUN-120 Regional Hyperthermia Enhances Selective Mesenchymal Stem Cell Migration Towards the Tumor Stroma. J Endocr Soc 2020. [PMCID: PMC7207284 DOI: 10.1210/jendso/bvaa046.1029] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The tumor homing characteristics of mesenchymal stem cells (MSCs) make them attractive vehicles for the tumor-specific delivery of therapeutic agents, such as the sodium iodide symporter (NIS). NIS is a theranostic protein that allows non-invasive monitoring of the in vivo biodistribution of functional NIS expression by radioiodine imaging as well as the therapeutic application of 131I. To enhance the actively recruitment of MSCs to growing tumor stroma and thereby trigger targeted delivery of the NIS gene to the tumor, we examined the combination with regional hyperthermia, as heat induces the secretion of immunomodulatory chemokines, cytokines and growth factors, well-known attractants of MSCs. Human hepatocellular carcinoma cells (HuH7) were heat-treated in a water bath at 41 °C for 1h, followed by incubation at 37 °C for 0-48h. mRNA and protein levels of chemokines involved in MSC migration was analyzed by RT-PCR and ELISA. Chemotaxis of MSCs in relation to a gradient of supernatants was tested in a 3D live cell tracking migration assay. In a subcutaneous HuH7 mouse xenograft tumor model, a single systemic injection of CMV-NIS-MSCs was applied 6h, 24h, 48h after or 24h, 48h before hyperthermia treatment and tumoral 123I accumulation was assessed by 123I-scintigraphy. Ex vivo NIS analysis of tumor sections was performed by RT-PCR and immunohistochemistry. The optimal imaging regime was then used for a 131I therapy study. Chemokine mRNA and protein analysis indicated a substantial increase in expression levels of chemokines and growth factors, involved in MSC tumor homing, after heat exposure. In addition, MSCs showed directed migration towards the supernatant of thermo-stimulated cancer cells. In vivo, with the optimal regime, we observed a significantly increased uptake of 123I in tumors of heat-treated animals (41 °C) when thermostimulated 24h after CMV-NIS-MSC injection compared to control animals (37 °C). Immunohistochemical staining of tumor sections showed strong tumoral NIS-specific immunoreactivity and RT-PCR an increased NIS mRNA expression in heat-treated tumors, thereby confirming tumor-selective, temperature-dependent MSC migration. CMV-NIS-MSC-mediated 131I therapy combined with regional hyperthermia resulted in a reduced tumor growth that was associated with prolonged survival of regional heat-treated animals compared to normothermic mice and to the saline control group. In summary, we have demonstrated a significantly increased, selective MSC migration towards the tumor stroma after regional hyperthermia in the 123I imaging study. The combination of MSC-mediated NIS gene therapy with mild regional hyperthermia resulting in stimulated therapeutic efficacy of NIS-mediated 131I therapy.
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Affiliation(s)
- Mariella Tutter
- Department of Internal Medicine IV, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Christina Schug
- Department of Internal Medicine IV, University Hospital of Munich, LMU Munich, Munich, Germany
| | | | - Nathalie Schwenk
- Department of Internal Medicine IV, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Matteo Petrini
- Department of Internal Medicine III, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Lars H Lindner
- Department of Internal Medicine III, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Peter J Nelson
- Department of Internal Medicine IV, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Christine Spitzweg
- Department of Internal Medicine IV, University Hospital of Munich, LMU Munich, Munich, Germany
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Tutter M, Schug C, Schmohl KA, Urnauer S, Schwenk N, Petrini M, Lokerse WJM, Zach C, Ziegler S, Bartenstein P, Weber WA, Wagner E, Lindner LH, Nelson PJ, Spitzweg C. Effective control of tumor growth through spatial and temporal control of theranostic sodium iodide symporter ( NIS) gene expression using a heat-inducible gene promoter in engineered mesenchymal stem cells. Am J Cancer Res 2020; 10:4490-4506. [PMID: 32292510 PMCID: PMC7150485 DOI: 10.7150/thno.41489] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 10/25/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose: The tumor homing characteristics of mesenchymal stem cells (MSCs) make them attractive vehicles for the tumor-specific delivery of therapeutic agents, such as the sodium iodide symporter (NIS). NIS is a theranostic protein that allows non-invasive monitoring of the in vivo biodistribution of functional NIS expression by radioiodine imaging as well as the therapeutic application of 131I. To gain local and temporal control of transgene expression, and thereby improve tumor selectivity, we engineered MSCs to express the NIS gene under control of a heat-inducible HSP70B promoter (HSP70B-NIS-MSCs). Experimental Design: NIS induction in heat-treated HSP70B-NIS-MSCs was verified by 125I uptake assay, RT-PCR, Western blot and immunofluorescence staining. HSP70B-NIS-MSCs were then injected i.v. into mice carrying subcutaneous hepatocellular carcinoma HuH7 xenografts, and hyperthermia (1 h at 41°C) was locally applied to the tumor. 0 - 72 h later radioiodine uptake was assessed by 123I-scintigraphy. The most effective uptake regime was then selected for 131I therapy. Results: The HSP70B promoter showed low basal activity in vitro and was significantly induced in response to heat. In vivo, the highest tumoral iodine accumulation was seen 12 h after application of hyperthermia. HSP70B-NIS-MSC-mediated 131I therapy combined with hyperthermia resulted in a significantly reduced tumor growth with prolonged survival as compared to control groups. Conclusions: The heat-inducible HSP70B promoter allows hyperthermia-induced spatial and temporal control of MSC-mediated theranostic NIS gene radiotherapy with efficient tumor-selective and temperature-dependent accumulation of radioiodine in heat-treated tumors.
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Affiliation(s)
- Ulrich Mansmann
- Institute of Medical Informatics, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Rolf Issels
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
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Issels RD, Lindner LH, Verweij J, Wessalowski R, Reichardt P, Wust P, Ghadjar P, Hohenberger P, Angele M, Salat C, Vujaskovic Z, Daugaard S, Mella O, Mansmann U, Dürr HR, Knösel T, Abdel-Rahman S, Schmidt M, Hiddemann W, Jauch KW, Belka C, Gronchi A. Effect of Neoadjuvant Chemotherapy Plus Regional Hyperthermia on Long-term Outcomes Among Patients With Localized High-Risk Soft Tissue Sarcoma: The EORTC 62961-ESHO 95 Randomized Clinical Trial. JAMA Oncol 2019; 4:483-492. [PMID: 29450452 DOI: 10.1001/jamaoncol.2017.4996] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Patients with soft tissue sarcoma are at risk for local recurrence and distant metastases despite optimal local treatment. Preoperative anthracycline plus ifosfamide chemotherapy improves outcome in common histological subtypes. Objective To analyze whether the previously reported improvement in local progression-free survival by adding regional hyperthermia to neoadjuvant chemotherapy translates into improved survival. Design, Setting, and Participants Open-label, phase 3 randomized clinical trial to evaluate the efficacy and toxic effects of neoadjuvant chemotherapy plus regional hyperthermia. Adult patients (age ≥18 years) with localized soft tissue sarcoma (tumor ≥5 cm, French Federation Nationale des Centers de Lutte Contre le Cancer [FNCLCC] grade 2 or 3, deep) were accrued across 9 centers (6, Germany; 1, Norway; 1, Austria; 1, United States) from July 1997 to November 2006. Follow-up ended December 2014. Interventions After stratification for tumor presentation and site, patients were randomly assigned to either neoadjuvant chemotherapy consisting of doxorubicin, ifosfamide, and etoposide alone, or combined with regional hyperthermia. Main Outcomes and Measures The primary end point was local progression-free survival. Secondary end points included treatment safety and survival, with survival defined from date of randomization to death due to disease or treatment. Patients lost to follow-up were censored at the date of their last follow-up. Results A total of 341 patients were randomized, and 329 (median [range] age, 51 [18-70] years; 147 women, 182 men) were eligible for the intention-to-treat analysis. By December 2014, 220 patients (67%; 95% CI, 62%-72%) had experienced disease relapse, and 188 (57%; 95% CI, 52%-62%) had died. Median follow-up was 11.3 years. Compared with neoadjuvant chemotherapy alone, adding regional hyperthermia improved local progression-free survival (hazard ratio [HR], 0.65; 95% CI, 0.49-0.86; P = .002). Patients randomized to chemotherapy plus hyperthermia had prolonged survival rates compared with those randomized to neoadjuvant chemotherapy alone (HR, 0.73; 95% CI, 0.54-0.98; P = .04) with 5-year survival of 62.7% (95% CI, 55.2%-70.1%) vs 51.3% (95% CI, 43.7%-59.0%), respectively, and 10-year survival of 52.6% (95% CI, 44.7%-60.6%) vs 42.7% (95% CI, 35.0%-50.4%). Conclusions and Relevance Among patients with localized high-risk soft tissue sarcoma the addition of regional hyperthermia to neoadjuvant chemotherapy resulted in increased survival, as well as local progression-free survival. For patients who are candidates for neoadjuvant treatment, adding regional hyperthermia may be warranted. Trial Registration clinicaltrials.gov Identifier: NCT00003052.
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Affiliation(s)
- Rolf D Issels
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Jaap Verweij
- Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | - Peter Wust
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Martin Angele
- Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Salat
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Zeljko Vujaskovic
- Radiation Oncology, University of Maryland, Baltimore, United States
| | - Soeren Daugaard
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Olav Mella
- Haukeland University Hospital, Bergen, Norway
| | - Ulrich Mansmann
- Institute of Medical Informatics, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
| | - Hans Roland Dürr
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | | | - Sultan Abdel-Rahman
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Michael Schmidt
- Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Karl-Walter Jauch
- Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
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Abstract
BACKGROUND Patients with localized high-risk soft tissue sarcoma are at high risk for both local recurrence and distant metastases despite optimal surgical treatment. OBJECTIVE Importance of preoperative or postoperative chemotherapy and hyperthermia. METHODS Evaluation and overview of published study results. RESULTS Preoperative or postoperative radiotherapy is considered as standard for patients with localized high-risk soft tissue sarcoma. The results of two randomized studies on neoadjuvant chemotherapy showed a survival benefit. As both studies did not have a control arm without chemotherapy but in one case the superiority of anthracycline/ifosfamide-based chemotherapy in combination with hyperthermia over chemotherapy alone and in the other case the superiority of anthracycline/ifosfamide-based chemotherapy over histology-specific chemotherapy were shown, the formal proof of the superiority of this treatment is still missing. Stratifying the patients treated in the so far largest randomized adjuvant chemotherapy trial according to current risk criteria ( http://www.sarculator.com ) revealed a significant survival benefit for patients at high risk of recurrence. CONCLUSION For high-risk soft tissue sarcomas, multimodal treatment strategies involving perioperative chemotherapy, radiotherapy and, if possible, hyperthermia should be considered in addition to tumor resection. Preoperative chemotherapy should be given preference over postoperative chemotherapy based on available data.
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Affiliation(s)
- L H Lindner
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Grünwald V, Bauer S, Hermes B, Ivanyi P, Lindner LH, Pink D, Reichardt P, Richter S, Tuchscherer A. A randomized phase II study of durvalumab and tremelimumab compared to doxorubicin in patients with advanced or metastatic soft tissue sarcoma (MEDISARC, AIO-STS 0415). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps11075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS11075 Background: Soft tissue sarcomas (STS) are rare tumors and exhibit substantial histological diversity. Efficacious targeted 1st line treatment for advanced or metastatic STS is not available, and the standard therapy has been anthracycline-based for decades. This strategy shows poor efficacy, as demonstrated by a median Overall Survival (OS) of 12-20 months. Several STS subtypes, however, have been shown to express PD-L1, and immune checkpoint inhibitors (ICI) have demonstrated principle anti-tumor activity in pretreated STS. Our ongoing clinical trial tests the activity and safety of ICI combination therapy in the first-line setting. We hypothesize that the dual checkpoint blockade with Durvalumab (PD-L1) and Tremelimumab (CTLA-4) improves overall survival in STS when compared to the standard of care doxorubicin. Methods: MEDISARC is a multi-center phase II trial that is enrolling adult treatment-naïve patients with histologically confirmed STS of intermediate or high grade (FNCLCC grade 2 or 3) not amenable to surgery with curative intent and ECOG performance status 0-2. Chemosensitive histologic STS are eligible. 100 patients will be randomized 1:1, stratified by ECOG status (0 vs. 1/2). Patients in the experimental arm are treated with fixed doses of durvalumab (1.5 g Q4W) and tremelimumab (75 mg Q4W for 3 cycles, then Q12W) until Progressive Disease (PD) or for a maximum of 12 months. Doxorubicin treatment in the standard arm is at 75 mg/m2 Q3W and limited to 6 cycles. OS is the primary endpoint. Secondary endpoints include 2-year OS rate, PFS, ORR according to conventional and modified RECIST 1.1, safety and tolerability and health-related quality of life (EORTC QLQ-C30). OS analysis may be performed when the required number of events (E=70) has been observed. All randomized and treated subjects will be included in the efficacy and safety analysis. The accompanying translational research aims to identify prognostic and predictive biomarkers in blood and tumor tissue. Enrollment of patients started in April 2018 and is ongoing. As of February 2019, 32 patients have been enrolled. The study is sponsored by AIO-Studien-gGmbH, Berlin, Germany. Clinical trial information: 2016-004750-15.
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Affiliation(s)
- Viktor Grünwald
- Dept. Hematology, Hemostaseology, Oncology & Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Sebastian Bauer
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Philipp Ivanyi
- Dept. Hematology, Hemostaseology, Oncology & Stem Cell Transplantation, Hanover Medical School, Hannover, Germany
| | | | - Daniel Pink
- Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | | | | | - Armin Tuchscherer
- Department I of Internal Medicine, University Hospital Cologne, Köln, Germany
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Schöffski P, Wozniak A, Kasper B, Aamdal S, Leahy MG, Rutkowski P, Bauer S, Gelderblom H, Italiano A, Lindner LH, Hennig I, Strauss S, Zakotnik B, Anthoney A, Albiges L, Blay JY, Reichardt P, Sufliarsky J, van der Graaf WTA, Debiec-Rychter M, Sciot R, Van Cann T, Marréaud S, Raveloarivahy T, Collette S, Stacchiotti S. Activity and safety of crizotinib in patients with alveolar soft part sarcoma with rearrangement of TFE3: European Organization for Research and Treatment of Cancer (EORTC) phase II trial 90101 'CREATE'. Ann Oncol 2019; 29:758-765. [PMID: 29216400 DOI: 10.1093/annonc/mdx774] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Alveolar soft part sarcoma (ASPS) is an orphan malignancy associated with a rearrangement of transcription factor E3 (TFE3), leading to abnormal MET gene expression. We prospectively assessed the efficacy and safety of the MET tyrosine kinase inhibitor crizotinib in patients with advanced or metastatic ASPS. Patients and methods Eligible patients with reference pathology-confirmed ASPS received oral crizotinib 250 mg bd. By assessing the presence or absence of a TFE3 rearrangement, patients were attributed to MET+ and MET- sub-cohorts. The primary end point was the objective response rate (ORR) according to local investigator. Secondary end points included duration of response, disease control rate (DCR), progression-free survival (PFS), progression-free rate, overall survival (OS) and safety. Results Among 53 consenting patients, all had a centrally confirmed ASPS and 48 were treated. A total of 45 were eligible, treated and assessable. Among 40 MET+ patients, 1 achieved a confirmed partial response (PR) that lasted 215 days and 35 had stable disease (SD) as best response (ORR: 2.5%, 95% CI 0.6% to 80.6%). Further efficacy end points in MET+ cases were DCR: 90.0% (95% CI 76.3% to 97.2%), 1-year PFS rate: 37.5% (95% CI 22.9% to 52.1%) and 1-year OS rate: 97.4% (95% CI 82.8% to 99.6%). Among 4 MET- patients, 1 achieved a PR that lasted 801 days and 3 had SD (ORR: 25.0%, 95% CI 0.6% to 80.6%) for a DCR of 100% (95% CI 39.8% to 100.0%). The 1-year PFS rate in MET- cases was 50% (95% CI 5.8% to 84.5%) and the 1-year OS rate was 75% (95% CI 12.8% to 96.1%). One patient with unknown MET status due to technical failure achieved SD but stopped treatment due to progression after 17 cycles. The most common crizotinib-related adverse events were nausea [34/48 (70.8%)], vomiting [22/48 (45.8%)], blurred vision [22/48 (45.8%)], diarrhoea (20/48 (41.7%)] and fatigue [19/48 (39.6%)]. Conclusion According to European Organization for Research and Treatment of Cancer (EORTC) efficacy criteria for soft tissue sarcoma, our study demonstrated that crizotinib has activity in TFE3 rearranged ASPS MET+ patients. Clinical trial number EORTC 90101, NCT01524926.
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Affiliation(s)
- P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium.
| | - A Wozniak
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - B Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, Mannheim, Germany
| | - S Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M G Leahy
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - S Bauer
- Department of Internal Medicine, West German Cancer Center, University Hospital, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Italiano
- Sarcoma Unit, Institut Bergonié, Bordeaux, France
| | - L H Lindner
- Medical Clinic III, University Hospital of Munich, Munich, Germany
| | - I Hennig
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Strauss
- Department of Oncology, University College Hospital, London, UK
| | - B Zakotnik
- Department of Medical Oncology, The Institute of Oncology, Ljubljana, Slovenia
| | - A Anthoney
- Institute of Oncology, Leeds Teaching Hospitals National Health Service Trust, St. James's University Hospital, Leeds, UK
| | - L Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon I, Lyon, France
| | - P Reichardt
- Department of Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | | | - W T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Debiec-Rychter
- Department of Human Genetics, KU Leuven, Leuven, Belgium; University Hospitals Leuven, Leuven, Belgium
| | - R Sciot
- University Hospitals Leuven, Leuven, Belgium; Department of Pathology, KU Leuven; Leuven, Belgium
| | - T Van Cann
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - S Marréaud
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - T Raveloarivahy
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - S Collette
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - S Stacchiotti
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milano, Italy
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Aklan B, Zilles B, Paprottka P, Manz K, Pfirrmann M, Santl M, Abdel-Rahman S, Lindner LH. Regional deep hyperthermia: quantitative evaluation of predicted and direct measured temperature distributions in patients with high-risk extremity soft-tissue sarcoma. Int J Hyperthermia 2019; 36:170-185. [PMID: 30777497 DOI: 10.1080/02656736.2018.1545098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Temperature distributions resulting from hyperthermia treatment of patients with high-risk soft-tissue sarcoma (STS) were quantitatively evaluated and globally compared with thermal simulations performed by a treatment planning system. The aim was to test whether the treatment planning system was able to predict correct temperature distributions. METHODS Five patients underwent computed tomography (CT) fluoroscopy-guided placement of tumor catheters used for the interstitial temperature measurements. For the simulations, five 3 D patient models were reconstructed by segmenting the patient CT datasets into different tissues. The measured and simulated data were evaluated by calculating the temperature change ( ΔT ), T90, T50, T20, Tmean, Tmin and Tmax, as well as the 90th percentile thermal dose (CEM43T90). In order to measure the agreement between both methods quantitatively, the Bland-Altman analysis was applied. RESULTS The absolute difference between measured and simulated temperatures were found to be 2°, 6°, 1°, 4°, 5° and 4 °C on average for Tmin, Tmax, T90, T50, T20 and Tmean, respectively. Furthermore, the thermal simulations exhibited relatively higher thermal dose compared to those that were measured. Finally, the results of the Bland-Altman analysis showed that the mean difference between both methods was above 2 °C which is considered to be clinically unacceptable. CONCLUSION Given the current practical limitations on resolution of calculation grid, tissue properties, and perfusion information, the software SigmaHyperPlan™ is incapable to produce thermal simulations with sufficient correlation to typically heterogeneous tissue temperatures to be useful for clinical treatment planning.
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Affiliation(s)
- B Aklan
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - B Zilles
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - P Paprottka
- b Institute for Clinical Radiology, Ludwig Maximilians University Hospital , Munich, Germany
| | - K Manz
- c Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich , Munich , Germany
| | - M Pfirrmann
- c Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich , Munich , Germany
| | - M Santl
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - S Abdel-Rahman
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - L H Lindner
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
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Schöffski P, Wozniak A, Stacchiotti S, Rutkowski P, Blay JY, Lindner LH, Strauss SJ, Anthoney A, Duffaud F, Richter S, Grünwald V, Leahy MG, Reichardt P, Sufliarsky J, van der Graaf WT, Sciot R, Debiec-Rychter M, van Cann T, Marréaud S, Lia M, Raveloarivahy T, Collette L, Bauer S. Activity and safety of crizotinib in patients with advanced clear-cell sarcoma with MET alterations: European Organization for Research and Treatment of Cancer phase II trial 90101 'CREATE'. Ann Oncol 2019; 30:344. [PMID: 29741569 PMCID: PMC6386024 DOI: 10.1093/annonc/mdx823] [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: 11/14/2022] Open
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