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Saturno G, Lopes F, Niculescu-Duvaz I, Niculescu-Duvaz D, Zambon A, Davies L, Johnson L, Preece N, Lee R, Viros A, Holovanchuk D, Pedersen M, McLeary R, Lorigan P, Dhomen N, Fisher C, Banerji U, Dean E, Krebs MG, Gore M, Larkin J, Marais R, Springer C. The paradox-breaking panRAF plus SRC family kinase inhibitor, CCT3833, is effective in mutant KRAS-driven cancers. Ann Oncol 2021; 32:269-278. [PMID: 33130216 PMCID: PMC7839839 DOI: 10.1016/j.annonc.2020.10.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND KRAS is mutated in ∼90% of pancreatic ductal adenocarcinomas, ∼35% of colorectal cancers and ∼20% of non-small-cell lung cancers. There has been recent progress in targeting G12CKRAS specifically, but therapeutic options for other mutant forms of KRAS are limited, largely because the complexity of downstream signaling and feedback mechanisms mean that targeting individual pathway components is ineffective. DESIGN The protein kinases RAF and SRC are validated therapeutic targets in KRAS-mutant pancreatic ductal adenocarcinomas, colorectal cancers and non-small-cell lung cancers and we show that both must be inhibited to block growth of these cancers. We describe CCT3833, a new drug that inhibits both RAF and SRC, which may be effective in KRAS-mutant cancers. RESULTS We show that CCT3833 inhibits RAF and SRC in KRAS-mutant tumors in vitro and in vivo, and that it inhibits tumor growth at well-tolerated doses in mice. CCT3833 has been evaluated in a phase I clinical trial (NCT02437227) and we report here that it significantly prolongs progression-free survival of a patient with a G12VKRAS spindle cell sarcoma who did not respond to a multikinase inhibitor and therefore had limited treatment options. CONCLUSIONS New drug CCT3833 elicits significant preclinical therapeutic efficacy in KRAS-mutant colorectal, lung and pancreatic tumor xenografts, demonstrating a treatment option for several areas of unmet clinical need. Based on these preclinical data and the phase I clinical unconfirmed response in a patient with KRAS-mutant spindle cell sarcoma, CCT3833 requires further evaluation in patients with other KRAS-mutant cancers.
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Affiliation(s)
- G Saturno
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - F Lopes
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - I Niculescu-Duvaz
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - D Niculescu-Duvaz
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - A Zambon
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Davies
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Johnson
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - N Preece
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - R Lee
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - A Viros
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - D Holovanchuk
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - M Pedersen
- Targeted Therapy Team, the Institute of Cancer Research, London, UK
| | - R McLeary
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - P Lorigan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N Dhomen
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - C Fisher
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U Banerji
- The Royal Marsden NHS Foundation Trust, London, UK
| | - E Dean
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M G Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Gore
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK.
| | - C Springer
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK.
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR, Nathan P, Lorigan P, Dziewulski P, Holikova S, Panwar U, Tahir S, Faust G, Thomas A, Corrie P, Sirohi B, Kelly C, Middleton M, Marples M, Danson S, Lester J, Marshall E, Ajaz M, Houston S, Board R, Eaton D, Waterston A, Nobes J, Loo S, Gray G, Stubbings H, Gore M, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Marsden J, Westwell S, Casasola R, Chao D, Maraveyas A, Marshall E, Patel P, Ottensmeier C, Farrugia D, Humphreys A, Eccles B, Dega R, Herbert C, Price C, Brunt M, Scott-Brown M, Hamilton J, Hayward RL, Smyth J, Woodings P, Nayak N, Burrows L, Wolstenholme V, Wagstaff J, Nicolson M, Wilson A, Barlow C, Scrase C, Podd T, Gonzalez M, Stewart J, Highley M, Wolstenholme V, Grumett S, Goodman A, Talbot T, Nathan K, Coltart R, Gee B, Gore M, Farrugia D, Martin-Clavijo A, Marsden J, Price C, Farrugia D, Nathan K, Coltart R, Nathan K, Coltart R. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 29:1843-1852. [PMID: 30010756 PMCID: PMC6096737 DOI: 10.1093/annonc/mdy229] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor shown to improve survival in advanced solid cancers. We evaluated the role of adjuvant bevacizumab in melanoma patients at high risk of recurrence. Patients and methods Patients with resected AJCC stage IIB, IIC and III cutaneous melanoma were randomised to receive either adjuvant bevacizumab (7.5 mg/kg i.v. 3 weekly for 1 year) or standard observation. The primary end point was detection of an 8% difference in 5-year overall survival (OS) rate; secondary end points included disease-free interval (DFI) and distant metastasis-free interval (DMFI). Tumour and blood were analysed for prognostic and predictive markers. Results Patients (n=1343) recruited between 2007 and 2012 were predominantly stage III (73%), with median age 56 years (range 18–88 years). With 6.4-year median follow-up, 515 (38%) patients had died [254 (38%) bevacizumab; 261 (39%) observation]; 707 (53%) patients had disease recurrence [336 (50%) bevacizumab, 371 (55%) observation]. OS at 5 years was 64% for both groups [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82–1.16, P = 0.78). At 5 years, 51% were disease free on bevacizumab versus 45% on observation (HR 0.85; 95% CI 0.74–0.99, P = 0.03), 58% were distant metastasis free on bevacizumab versus 54% on observation (HR 0.91; 95% CI 0.78–1.07, P = 0.25). Forty four percent of 682 melanomas assessed had a BRAFV600 mutation. In the observation arm, BRAF mutant patients had a trend towards poorer OS compared with BRAF wild-type patients (P = 0.06). BRAF mutation positivity trended towards better OS with bevacizumab (P = 0.21). Conclusions Adjuvant bevacizumab after resection of high-risk melanoma improves DFI, but not OS. BRAF mutation status may predict for poorer OS untreated and potential benefit from bevacizumab. Clinical Trial Information ISRCTN 81261306; EudraCT Number: 2006-005505-64
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Affiliation(s)
- P G Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - P D Nathan
- Medical Oncology, Mount Vernon Hospital, Northwood, UK
| | - P Lorigan
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - M Gore
- Royal Marsden Hospital NHS Trust, London, UK
| | - S Tahir
- Oncology Research, Broomfield Hospital, Chelmsford, UK
| | - G Faust
- Oncology Department, Leicester Royal Infirmary, Leicester, UK
| | - C G Kelly
- Sir Bobby Robson Cancer Trials Research Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Marples
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S J Danson
- Weston Park Hospital, Academic Unit of Clinical Oncology, Sheffield, UK
| | - E Marshall
- Cancer & Palliative Care, St. Helen's Hospital, St. Helens, UK
| | - S J Houston
- Oncology Department, Royal Surrey County Hospital, Guildford, UK
| | - R E Board
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - A M Waterston
- Clinical Trials Unit, Beatson WOS Cancer Centre, Glasgow, UK
| | - J P Nobes
- Department of Clinical Oncology, Norfolk & Norwich University Hospital, Norwich, UK
| | - M Harries
- Guy's & St. Thomas' Hospital, Guy's Cancer Centre, London, UK
| | - S Kumar
- Velindre Cancer Centre, Cardiff, UK
| | - A Goodman
- Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - A Dalgleish
- St George's Hospital, Cancer Centre, London, UK
| | | | - S Westwell
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - R Casasola
- Cancer Centre, Ninewells Hospital, Dundee, UK
| | - D Chao
- Royal Free Hospital, London, UK
| | | | - P M Patel
- Academic Unit of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C H Ottensmeier
- CRUK and NIHR Southampton Experimental Cancer Medicine Centre, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - D Farrugia
- Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
| | - A Humphreys
- Oncology Department, James Cook University Hospital, Middlesbrough, UK
| | - B Eccles
- Oncology Department, Poole Hospital, Dorset, UK
| | - G Young
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E O Barker
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Harman
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Weiss
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K A Myers
- Department of Oncology, University of Oxford, Oxford, UK; Experimental Cancer Medicine Centre, Oxford, UK
| | - A Chhabra
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 30:2013-2014. [PMID: 31430371 PMCID: PMC6938599 DOI: 10.1093/annonc/mdz237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Au L, Litchfield K, Rowan A, Horswell S, Byrne F, Nicol D, Fotiadis N, Salgado R, Hazell S, Lopez J, Hatipoglu E, Del Rosario L, Pickering L, Gore M, Chain B, Quezada S, Larkin J, Swanton C, Turajlic S. ADAPTeR: A phase II study of anti-PD1 (nivolumab) therapy as pre- and post-operative therapy in metastatic renal cell carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.006] [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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Orbegoso Aguilar C, Dumas L, Davies E, Gore M, George A, Banerjee S. Olaparib maintenance treatment, the Royal Marsden experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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Furness A, Arce Vargas F, Litchfield K, Rosenthal R, Gore M, Larkin J, Turajlic S, Swanton C, Peggs K, Quezada S. Mechanism informs precision: In vivo determinants of response to anti-CTLA-4 antibodies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shelley C, Gore M, Tan S, Thomas K, Eeles R. Cervical Spine Fractures in Patients Undergoing Palliative Radiotherapy to the Cervical Spine: Implications for Practice. Clin Oncol (R Coll Radiol) 2018; 30:458. [PMID: 29653748 DOI: 10.1016/j.clon.2018.02.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Affiliation(s)
- C Shelley
- Royal Marsden NHS Foundation Trust, London, UK
| | - M Gore
- Royal Marsden NHS Foundation Trust, London, UK
| | - S Tan
- Royal Marsden NHS Foundation Trust, London, UK
| | - K Thomas
- Royal Marsden NHS Foundation Trust, London, UK
| | - R Eeles
- Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Turajlic S, Gore M, Larkin J. First report of overall survival for ipilimumab plus nivolumab from the phase III Checkmate 067 study in advanced melanoma. Ann Oncol 2018; 29:542-543. [PMID: 29360923 DOI: 10.1093/annonc/mdy020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Turajlic
- Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, UK; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - M Gore
- Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Larkin
- Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, UK.
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Olszanski A, Gonzalez R, Corrie P, Pavlick A, Middleton M, Lorigan P, Plummer R, Skaria S, Herbert C, Gore M, Agarwala S, Daud A, Zhang S, Bahamon B, Rangachari L, Hoberman E, Kneissl M, Rasco D. Phase I study of the investigational, oral pan-RAF kinase inhibitor TAK-580 (MLN2480) in patients with advanced solid tumors (ST) or melanoma (MEL): Final analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Powles T, McDermott D, Rini B, Motzer R, Atkins M, Fong L, Joseph R, Pal S, Ravaud A, Bracarda S, Rodriguez CS, Maio M, Gore M, Grünwald V, Staehler M, Qiu J, Thobhani A, Huseni M, Schiff C, Escudier B. IMmotion150: Novel radiological endpoints and updated data from a randomized phase II trial investigating atezolizumab (atezo) with or without bevacizumab (bev) vs sunitinib (sun) in untreated metastatic renal cell carcinoma (mRCC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Madi A, Gore M, McKay M, Wong H, Cave G, Rao R, Nicholson J, Smart H, Howes N, Wood J. Safety of neoadjuvant/adjuvant chemotherapy for gastroesophageal cancers: A single cancer centre experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morganstein DL, Lai Z, Spain L, Diem S, Levine D, Mace C, Gore M, Larkin J. Thyroid abnormalities following the use of cytotoxic T-lymphocyte antigen-4 and programmed death receptor protein-1 inhibitors in the treatment of melanoma. Clin Endocrinol (Oxf) 2017; 86:614-620. [PMID: 28028828 DOI: 10.1111/cen.13297] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/14/2016] [Accepted: 12/20/2016] [Indexed: 01/21/2023]
Abstract
CONTEXT Checkpoint inhibitors are emerging as important cancer therapies but are associated with a high rate of immune side effects, including endocrinopathy. OBJECTIVE To determine the burden of thyroid dysfunction in patients with melanoma treated with immune checkpoint inhibitors and describe the clinical course. DESIGN AND PATIENTS Consecutive patients with melanoma treated with either ipilimumab, nivolumab, pembrolizumab or the combination of ipilimumab and nivolumab were identified. Baseline thyroid function tests were used to exclude those with pre-existing thyroid abnormalities, and thyroid function tests during treatment used to identify those with thyroid dysfunction. RESULTS Rates of overt thyroid dysfunction were in keeping with the published phase 3 trials. Hypothyroidism occurred in 13·0% treated with a programmed death receptor-1 (PD-1) inhibitor and 22·2% with a combination of PD-1 inhibitor and ipilimumab. Transient subclinical hyperthyroidism was observed in 13·0% treated with a PD-1 inhibitor, 15·9% following a PD-1 inhibitor, and 22·2% following combination treatment with investigations suggesting a thyroiditic mechanism rather than Graves' disease, and a high frequency of subsequent hypothyroidism. Any thyroid abnormality occurred in 23·0% following ipilimumab, 39·1% following a PD-1 inhibitor and 50% following combination treatment. Abnormal thyroid function was more common in female patients. CONCLUSION Thyroid dysfunction occurs commonly in patients with melanoma treated with immune checkpoint inhibitors, with rates, including subclinical dysfunction, occurring in up to 50%.
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Affiliation(s)
- D L Morganstein
- Skin Unit, Royal Marsden Hospital, London, UK
- Department of Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - Z Lai
- Skin Unit, Royal Marsden Hospital, London, UK
- Department of Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - L Spain
- Skin Unit, Royal Marsden Hospital, London, UK
| | - S Diem
- Skin Unit, Royal Marsden Hospital, London, UK
- Department of Oncology/Hematology, Cantonal Hospital St. Gallen, Switzerland, Switzerland
- Department of Oncology/Hematology, Hospital Grabs, Switzerland
| | - D Levine
- Department of Nuclear Medicine, Royal Marsden Hospital, London, UK
| | - C Mace
- Department of Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - M Gore
- Skin Unit, Royal Marsden Hospital, London, UK
| | - J Larkin
- Skin Unit, Royal Marsden Hospital, London, UK
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Spain L, Walls G, Julve M, O'Meara K, Schmid T, Kalaitzaki E, Turajlic S, Gore M, Rees J, Larkin J. Neurotoxicity from immune-checkpoint inhibition in the treatment of melanoma: a single centre experience and review of the literature. Ann Oncol 2017; 28:377-385. [PMID: 28426103 DOI: 10.1093/annonc/mdw558] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [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] [Indexed: 12/18/2022] Open
Abstract
Background Treatment with immune checkpoint inhibitors (ICPi) has greatly improved survival for patients with advanced melanoma in recent years. Anti-CTLA-4 and anti-PD1 antibodies have been approved following large Phase III trials. Immune-related neurological toxicity of varying severity has been reported in the literature. The cumulative incidence of neurotoxicity among ipilimumab, nivolumab and pembrolizumab is reported as <1% in published clinical trials. We aimed to identify the incidence of neurotoxicity in our institution across anti-CTLA4 and anti-PD-1 antibodies, including the combination of ipilimumab with nivolumab. We also review the existing literature and propose an investigation and management algorithm. Methods All patients with advanced melanoma treated with ipilimumab, nivolumab, pembrolizumab or the combination of ipilimumab and nivolumab (ipi + nivo), managed at the Royal Marsden Hospital between September 2010 and December 2015, including patients on (published) clinical trials were included. Medical records for each patient were reviewed and information on neurotoxicity recorded. A systematic search strategy was performed to collate existing reports of neurological toxicity. Results In total, 413 immunotherapy treatment episodes in 352 patients were included, with median follow-up of 26.7 months. Ten cases of neurotoxicity were recorded, affecting 2.8% of patients overall, ranging from grade 1 to 4, affecting both central and peripheral nervous systems. A rate of 14% was noted with ipi + nivo. Three of five patients commenced on corticosteroids responded to these. Six patients had made a full recovery at the time of reporting. A favorable radiological response was found in 7 of the 10 cases. Unusual presentations are described in detail. Conclusions Neurological toxicity is not uncommon, and may be more frequent in patients treated with combination ipi + nivo. Patterns of presentation and response to treatment are varied. A prompt and considered approach is required to optimize outcomes in this group of patients.
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Affiliation(s)
- L Spain
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - G Walls
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - M Julve
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - K O'Meara
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - T Schmid
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - E Kalaitzaki
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - S Turajlic
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
- The Francis Crick Institute, London, UK
| | - M Gore
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - J Rees
- Neurology Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - J Larkin
- Melanoma Unit, Royal Marsden NHS Foundation Trust, London, UK
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McLachlan J, Boussios S, Okines A, Glaessgen D, Bodlar S, Kalaitzaki R, Taylor A, Lalondrelle S, Gore M, Kaye S, Banerjee S. The Impact of Systemic Therapy Beyond First-line Treatment for Advanced Cervical Cancer. Clin Oncol (R Coll Radiol) 2016; 29:153-160. [PMID: 27838135 DOI: 10.1016/j.clon.2016.10.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
AIMS Despite recent advances in the primary and secondary prevention of cervical cancer, a significant number of women present with or develop metastatic disease. There is currently no consensus on the standard of care for second-line systemic treatment of recurrent/metastatic cervical cancer. The purpose of this study was to evaluate the second-line systemic therapy used and the associated outcomes in a single cancer centre. MATERIALS AND METHODS A retrospective review of patients with cervical cancer who received one or more lines of treatment for recurrent or metastatic cervical cancer at the Royal Marsden Hospital between 2004 and 2014 was carried out. The primary objective was to establish the types of second-line systemic treatment used. Secondary end points included objective response rate, progression-free survival and overall survival after second-line therapy. RESULTS In total, 75 patients were included in the study; 53 patients (70.7%) received second-line therapy for recurrent/metastatic disease. The most common second-line therapy was weekly paclitaxel (28.3%). Carboplatin-based chemotherapy (24.5%), targeted agent monotherapy within clinical trials (22.6%), docetaxel-based chemotherapy (13.2%), topotecan (9.4%) and gemcitabine (1.9%) were also used. The objective response rate to second-line therapy was 13.2%, which included three partial responses to carboplatin and paclitaxel, two partial responses to docetaxel-based chemotherapy, one partial response to weekly paclitaxel and one partial response to cediranib. Twenty-two patients (41.5%) achieved stable disease at 4 months. The median progression-free survival for women treated with second-line therapy was 3.2 months (95% confidence interval 2.1-4.3) and median overall survival was 9.3 months (95% confidence interval 6.4-12.5). Thirty-nine per cent of patients received third-line therapy. CONCLUSION Seventy per cent of patients treated with first-line systemic therapy for recurrent/metastatic cervical cancer subsequently received second-line treatment but response rates were poor. There remains no standard of care for second-line systemic therapy for advanced cervical cancer. Patients should be considered for clinical trials whenever feasible, including novel targeted agents and immunotherapy.
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Affiliation(s)
- J McLachlan
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Boussios
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Okines
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Glaessgen
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Bodlar
- Research Data and Statistics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - R Kalaitzaki
- Research Data and Statistics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - A Taylor
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Lalondrelle
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M Gore
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Kaye
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
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15
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McLachlan J, Tunariu N, Lima J, George A, Gore M, Kaye S, Banerjee S. Response to chemotherapy in relapsed low-grade serous ovarian carcinoma: Royal Marsden series of 46 patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Spain L, Diem S, Khabra K, Turajlic S, Gore M, Yousaf N, Larkin J. Patterns of steroid use in diarrhoea and/or colitis (D/C) from immune checkpoint inhibitors (ICPI). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw378.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Banerjee S, Kilburn L, Bowen R, Tovey H, Hall M, Kaye S, Rustin G, Gore M, McLachlan J, Attygalle A, Tunariu N, Lima J, Chatfield P, Jeffs L, Folkerd E, Hills M, Perry S, Attard G, Dowsett M, Bliss J. Principal results of the cancer of the ovary abiraterone trial (CORAL): A phase II study of abiraterone in patients with recurrent epithelial ovarian cancer (CRUKE/12/052). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Gore M, Lester E. Comparison of a Fluorimetric Method and a Competitive Protein Binding Assay Kit for the Determination of Plasma Hydroxycorticosteroids. Ann Clin Biochem 2016; 12:160-2. [PMID: 15637913 DOI: 10.1177/000456327501200138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A new competitive protein binding (C.P.B.) assay kit for the determination of plasma hydroxycorticosteroids which uses a gamma emitting isotope, selenium-75, to label the Cortisol was compared with a fluorimetric method in use in a routine laboratory. The mean plasma corticosteroid level in a group of 54 normal subjects was found to be lower with the C.P.B. kit than with the fluorimetric method. The correlation coefficient between the two methods in 131 specimens from healthy subjects and patients under investigation for pituitary or adrenocortical disorders was + 0.92. The precision of the two methods was similar.
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Affiliation(s)
- M Gore
- Endocrine Laboratory, Department of Chemical Pathology, Royal Free Hospital, London N.W.3
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19
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Spain L, Higgins R, Gopalakrishnan K, Turajlic S, Gore M, Larkin J. Acute renal allograft rejection after immune checkpoint inhibitor therapy for metastatic melanoma. Ann Oncol 2016; 27:1135-1137. [PMID: 26951628 DOI: 10.1093/annonc/mdw130] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [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: 11/01/2015] [Accepted: 03/03/2016] [Indexed: 01/08/2023] Open
Abstract
Immune checkpoint inhibitors such as ipilimumab and nivolumab improve survival in patients with advanced melanoma and are increasingly available to clinicians for use in the clinic. Their safety in organ transplant recipients is not well defined but published case reports describing treatment with ipilimumab have not been complicated by graft rejection. No cases of anti-programmed cell death protein 1 administration are reported in this group. We describe a case of acute graft rejection in a kidney transplant recipient after treatment with nivolumab, after progression on ipilimumab. Potential factors increasing the risk of graft rejection in this case are discussed, in particular the contribution of nivolumab.
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Affiliation(s)
- L Spain
- Royal Marsden NHS Foundation Trust, London
| | - R Higgins
- University Hospitals Coventry and Warwickshire, Coventry
| | | | - S Turajlic
- Royal Marsden NHS Foundation Trust, London; The Francis Crick Institute, Lincoln's Inn Fields Laboratory, London, UK
| | - M Gore
- Royal Marsden NHS Foundation Trust, London
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London.
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20
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Diem S, Kasenda B, Spain L, Martin-Liberal J, Marconcini R, Gore M, Larkin J. Serum lactate dehydrogenase as an early marker for outcome in patients treated with anti-PD-1 therapy in metastatic melanoma. Br J Cancer 2016; 114:256-61. [PMID: 26794281 PMCID: PMC4742588 DOI: 10.1038/bjc.2015.467] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/12/2015] [Accepted: 12/07/2015] [Indexed: 01/20/2023] Open
Abstract
Background: Treatment with programmed death receptor-1 (PD-1) antibodies is associated with high response rates in patients with advanced melanoma. Reliable markers for early response and outcome are still sparse. Methods: We evaluated 66 consecutive patients with advanced/metastatic melanoma treated with nivolumab or pembrolizumab between 2013 and 2014. The main objectives of this study were to investigate whether, first, serum lactate dehydrogenase (LDH) at baseline (normal vs above the upper limit of normal) correlates with overall survival (OS), and, second, whether the change of LDH during treatment predicts response before the first scan and OS in patients with an elevated baseline LDH. Results: After a median follow-up of 9 months, patients with an elevated baseline LDH (N=34) had a significantly shorter OS compared with patients with normal LDH (N=32; 6-month OS: 60.8% vs 81.6% and 12-month OS: 44.2% vs 71.5% (log-rank P=0.0292). In those 34 patients with elevated baseline LDH, the relative change during treatment was significantly associated with an objective response on the first scan: the 11 (32%) patients with partial remission had a mean reduction of −27.3% from elevated baseline LDH. In contrast, patients with progressive disease (N=15) had a mean increase of +39%. Patients with a relative increase over 10% from elevated baseline LDH had a significantly shorter OS compared with patients with ⩽10% change (4.3 vs 15.7 months, log-rank P<0.00623). Conclusions: LDH could be a useful marker at baseline and during treatment to predict early response or progression in patients with advanced melanoma who receive anti-PD-1 therapy.
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Affiliation(s)
- S Diem
- Department of Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - B Kasenda
- Department of Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - L Spain
- Department of Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - J Martin-Liberal
- Department of Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW36JJ, UK.,Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - R Marconcini
- Department of Medical Oncology, Santa Chiara Hospital, via Roma 67, 56100 Pisa, Italy
| | - M Gore
- Department of Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW36JJ, UK
| | - J Larkin
- Department of Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW36JJ, UK
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21
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Sinha R, Larkin J, Gore M, Fearfield L. Cutaneous toxicities associated with vemurafenib therapy in 107 patients with BRAF V600E mutation-positive metastatic melanoma, including recognition and management of rare presentations. Br J Dermatol 2015; 173:1024-31. [PMID: 26109403 DOI: 10.1111/bjd.13958] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Vemurafenib significantly improved overall survival compared with dacarbazine in patients with metastatic or unresectable BRAF V600E-positive melanoma in the BRIM-3 trial. However, vemurafenib was associated with a number of skin-related adverse events (AEs). OBJECTIVES To investigate the incidence and management of vemurafenib-associated skin AEs. METHODS This retrospective, observational study included adult patients with stage IIIC or IV melanoma who received vemurafenib between March 2010 and August 2013. Patients received oral vemurafenib 960 mg twice daily, with dose interruptions and reductions allowed for AE management. RESULTS In total 107 patients were treated with vemurafenib during the study period. The most frequent clinically important skin-related AEs were rash (64%), squamoproliferative growths (41%), photosensitivity (40%) and squamous cell carcinoma (SCC) or keratoacanthoma (KA; 20%). Rare cases of granulomatous dermatitis and cutaneous T-cell lymphoma were also found. Rash was manageable with corticosteroids and dose modifications; squamoproliferative growths and SCCs/KAs were treated with cryotherapy and surgical excision, respectively. Patients were counselled regarding phototoxicity. The uncontrolled nature and retrospective design of the study, and the small patient numbers are limitations. CONCLUSIONS Vemurafenib appears to have a predictable and manageable AE profile. Proactive management can limit the impact of AEs on patients, allowing treatment to continue despite toxicities.
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Affiliation(s)
- R Sinha
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, U.K.,Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
| | - J Larkin
- Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
| | - M Gore
- Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
| | - L Fearfield
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, U.K.,Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
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Rasco D, Middleton M, Gonzalez R, Corrie P, Pavlick A, Lorigan P, Plummer R, Gore M, Herbert C, Agarwala S, Logan T, Khleif S, Papadopoulos K, Rangachari L, Suri A, Xu Q, Kneissl M, Bozón V, Olszanski A. 300 Phase I study of two dosing schedules of the investigational oral pan-RAF kinase inhibitor MLN2480 in patients (pts) with advanced solid tumors or melanoma. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(15)30005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Kolomainen D, Butler J, Barton DP, Taylor A, Stanley K, Gore M, Banerjee S. 2758 Is there a survival benefit for patients who receive post-operative adjuvant chemotherapy following secondary cytoreductive surgery (SCRS) for recurrent epithelial ovarian cancer (EOC)? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Seifert H, Georgiou A, Alexander H, Bodla S, Kaye S, Nobbenhuis M, Gore M, Banerjee S. 2763 Poor performance status (PS) is an indication for an aggressive approach to neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer (EOC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Turajlic S, Furney SJ, Stamp G, Rana S, Ricken G, Oduko Y, Saturno G, Springer C, Hayes A, Gore M, Larkin J, Marais R. Whole-genome sequencing reveals complex mechanisms of intrinsic resistance to BRAF inhibition. Ann Oncol 2014; 25:959-67. [PMID: 24504448 PMCID: PMC3999800 DOI: 10.1093/annonc/mdu049] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND BRAF is mutated in ∼42% of human melanomas (COSMIC. http://www.sanger.ac.uk/genetics/CGP/cosmic/) and pharmacological BRAF inhibitors such as vemurafenib and dabrafenib achieve dramatic responses in patients whose tumours harbour BRAF(V600) mutations. Objective responses occur in ∼50% of patients and disease stabilisation in a further ∼30%, but ∼20% of patients present primary or innate resistance and do not respond. Here, we investigated the underlying cause of treatment failure in a patient with BRAF mutant melanoma who presented primary resistance. METHODS We carried out whole-genome sequencing and single nucleotide polymorphism (SNP) array analysis of five metastatic tumours from the patient. We validated mechanisms of resistance in a cell line derived from the patient's tumour. RESULTS We observed that the majority of the single-nucleotide variants identified were shared across all tumour sites, but also saw site-specific copy-number alterations in discrete cell populations at different sites. We found that two ubiquitous mutations mediated resistance to BRAF inhibition in these tumours. A mutation in GNAQ sustained mitogen-activated protein kinase (MAPK) signalling, whereas a mutation in PTEN activated the PI3 K/AKT pathway. Inhibition of both pathways synergised to block the growth of the cells. CONCLUSIONS Our analyses show that the five metastases arose from a common progenitor and acquired additional alterations after disease dissemination. We demonstrate that a distinct combination of mutations mediated primary resistance to BRAF inhibition in this patient. These mutations were present in all five tumours and in a tumour sample taken before BRAF inhibitor treatment was administered. Inhibition of both pathways was required to block tumour cell growth, suggesting that combined targeting of these pathways could have been a valid therapeutic approach for this patient.
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Affiliation(s)
| | - S. J. Furney
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - G. Stamp
- Experimental Pathology Laboratory, Cancer Research UK London Research Institute, London
| | - S. Rana
- The Institute of Cancer Research, London
| | - G. Ricken
- The Institute of Cancer Research, London
| | - Y. Oduko
- The Institute of Cancer Research, London
| | - G. Saturno
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
| | - C. Springer
- Division of Cancer Therapeutics, The Institute of Cancer Research, London
| | | | - M. Gore
- Melanoma Unit, Royal Marsden Hospital, London, UK
| | - J. Larkin
- Melanoma Unit, Royal Marsden Hospital, London, UK
| | - R. Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, Manchester
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Fotopoulou C, Vergote I, Mainwaring P, Bidzinski M, Vermorken J, Ghamande S, Harnett P, Del Prete S, Green J, Spaczynski M, Blagden S, Gore M, Ledermann J, Kaye S, Gabra H. Weekly AUC2 carboplatin in acquired platinum-resistant ovarian cancer with or without oral phenoxodiol, a sensitizer of platinum cytotoxicity: the phase III OVATURE multicenter randomized study. Ann Oncol 2014; 25:160-5. [DOI: 10.1093/annonc/mdt515] [Citation(s) in RCA: 20] [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] [Indexed: 01/09/2023] Open
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Ambady P, Holdhoff M, Ferrigno C, Grossman S, Anderson MD, Liu D, Conrad C, Penas-Prado M, Gilbert MR, Yung AWK, de Groot J, Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, Apok V, Mills S, Soh C, Karabatsou K, Arimappamagan A, Arya S, Majaid M, Somanna S, Santosh V, Schaff L, Armentano F, Harrison C, Lassman A, McKhann G, Iwamoto F, Armstrong T, Yuan Y, Liu D, Acquaye A, Vera-Bolanos E, Diefes K, Heathcock L, Cahill D, Gilbert M, Aldape K, Arrillaga-Romany I, Ruddy K, Greenberg S, Nayak L, Avgeropoulos N, Avgeropoulos G, Riggs G, Reilly C, Banerji N, Bruns P, Hoag M, Gilliland K, Trusheim J, Bekaert L, Borha A, Emery E, Busson A, Guillamo JS, Bell M, Harrison C, Armentano F, Lassman A, Connolly ES, Khandji A, Iwamoto F, Blakeley J, Ye X, Bergner A, Dombi E, Zalewski C, Follmer K, Halpin C, Fayad L, Jacobs M, Baldwin A, Langmead S, Whitcomb T, Jennings D, Widemann B, Plotkin S, Brandes AA, Mason W, Pichler J, Nowak AK, Gil M, Saran F, Revil C, Lutiger B, Carpentier AF, Milojkovic-Kerklaan B, Aftimos P, Altintas S, Jager A, Gladdines W, Lonnqvist F, Soetekouw P, van Linde M, Awada A, Schellens J, Brandsma D, Brenner A, Sun J, Floyd J, Hart C, Eng C, Fichtel L, Gruslova A, Lodi A, Tiziani S, Bridge CA, Baldock A, Kumthekar P, Dilfer P, Johnston SK, Jacobs J, Corwin D, Guyman L, Rockne R, Sonabend A, Cloney M, Canoll P, Swanson KR, Bromberg J, Schouten H, Schaafsma R, Baars J, Brandsma D, Lugtenburg P, van Montfort C, van den Bent M, Doorduijn J, Spalding A, LaRocca R, Haninger D, Saaraswat T, Coombs L, Rai S, Burton E, Burzynski G, Burzynski S, Janicki T, Marszalek A, Burzynski S, Janicki T, Burzynski G, Marszalek A, Cachia D, Smith T, Cardona AF, Mayor LC, Jimenez E, Hakim F, Yepes C, Bermudez S, Useche N, Asencio JL, Mejia JA, Vargas C, Otero JM, Carranza H, Ortiz LD, Cardona AF, Ortiz LD, Jimenez E, Hakim F, Yepes C, Useche N, Bermudez S, Asencio JL, Carranza H, Vargas C, Otero JM, Bartels C, Quintero A, Restrepo CE, Gomez S, Bernal-Vaca L, Lema M, Cardona AF, Ortiz LD, Useche N, Bermudez S, Jimenez E, Hakim F, Yepes C, Mejia JA, Bernal-Vaca L, Restrepo CE, Gomez S, Quintero A, Bartels C, Carranza H, Vargas C, Otero JM, Carlo M, Omuro A, Grommes C, Kris M, Nolan C, Pentsova E, Pietanza M, Kaley T, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba G, Bertani G, Cogiamanian F, Ardolino G, Zarino B, Locatelli M, Caroli M, Rampini P, Chamberlain M, Raizer J, Soffetti R, Ruda R, Brandsma D, Boogerd W, Taillibert S, Le Rhun E, Jaeckle K, van den Bent M, Wen P, Chamberlain M, Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Kerloeguen Y, Guijarro A, Cloughsey T, Choi JH, Hong YK, Conrad C, Yung WKA, deGroot J, Gilbert M, Loghin M, Penas-Prado M, Tremont I, Silberman S, Picker D, Costa R, Lycette J, Gancher S, Cullen J, Winer E, Hochberg F, Sachs G, Jeyapalan S, Dahiya S, Stevens G, Peereboom D, Ahluwalia M, Daras M, Hsu M, Kaley T, Panageas K, Curry R, Avila E, Fuente MDL, Omuro A, DeAngelis L, Desjardins A, Sampson J, Peters K, Ranjan T, Vlahovic G, Threatt S, Herndon J, Boulton S, Lally-Goss D, McSherry F, Friedman A, Friedman H, Bigner D, Gromeier M, Prust M, Kalpathy-Cramer J, Poloskova P, Jafari-Khouzani K, Gerstner E, Dietrich J, Fabi A, Villani V, Vaccaro V, Vidiri A, Giannarelli D, Piludu F, Anelli V, Carapella C, Cognetti F, Pace A, Flowers A, Flowers A, Killory B, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Garciarena P, Anderson MD, Hamilton J, Schellingerhout D, Fuller GN, Sawaya R, Gilbert MR, Gilbert M, Pugh S, Won M, Blumenthal D, Vogelbaum M, Aldape K, Colman H, Chakravarti A, Jeraj R, Dignam J, Armstrong T, Wefel J, Brown P, Jaeckle K, Schiff D, Brachman D, Werner-Wasik M, Tremont-Lukats I, Sulman E, Mehta M, Gill B, Yun J, Goldstein H, Malone H, Pisapia D, Sonabend AM, Mckhann GK, Sisti MB, Sims P, Canoll P, Bruce JN, Girvan A, Carter G, Li L, Kaltenboeck A, Chawla A, Ivanova J, Koh M, Stevens J, Lahn M, Gore M, Hariharan S, Porta C, Bjarnason G, Bracarda S, Hawkins R, Oudard S, Zhang K, Fly K, Matczak E, Szczylik C, Grossman R, Ram Z, Hamza M, O'Brien B, Mandel J, DeGroot J, Han S, Molinaro A, Berger M, Prados M, Chang S, Clarke J, Butowski N, Hashimoto N, Chiba Y, Tsuboi A, Kinoshita M, Hirayama R, Kagawa N, Oka Y, Oji Y, Sugiyama H, Yoshimine T, Hawkins-Daarud A, Jackson PR, Swanson KR, Sarmiento JM, Ly D, Jutla J, Ortega A, Carico C, Dickinson H, Phuphanich S, Rudnick J, Patil C, Hu J, Iglseder S, Nowosielski M, Nevinny-Stickel M, Stockhammer G, Jain R, Poisson L, Scarpace L, Mikkelsen T, Kirby J, Freymann J, Hwang S, Gutman D, Jaffe C, Brat D, Flanders A, Janicki T, Burzynski S, Burzynski G, Marszalek A, Jiang C, Wang H, Jo J, Williams B, Smolkin M, Wintermark M, Shaffrey M, Schiff D, Juratli T, Soucek S, Kirsch M, Schackert G, Kakkar A, Kumar S, Bhagat U, Kumar A, Suri A, Singh M, Sharma M, Sarkar C, Suri V, Kaley T, Barani I, Chamberlain M, McDermott M, Raizer J, Rogers L, Schiff D, Vogelbaum M, Weber D, Wen P, Kalita O, Vaverka M, Hrabalek L, Zlevorova M, Trojanec R, Hajduch M, Kneblova M, Ehrmann J, Kanner AA, Wong ET, Villano JL, Ram Z, Khatua S, Fuller G, Dasgupta S, Rytting M, Vats T, Zaky W, Khatua S, Sandberg D, Foresman L, Zaky W, Kieran M, Geoerger B, Casanova M, Chisholm J, Aerts I, Bouffet E, Brandes AA, Leary SES, Sullivan M, Bailey S, Cohen K, Mason W, Kalambakas S, Deshpande P, Tai F, Hurh E, McDonald TJ, Kieran M, Hargrave D, Wen PY, Goldman S, Amakye D, Patton M, Tai F, Moreno L, Kim CY, Kim T, Han JH, Kim YJ, Kim IA, Yun CH, Jung HW, Koekkoek JAF, Reijneveld JC, Dirven L, Postma TJ, Vos MJ, Heimans JJ, Taphoorn MJB, Koeppen S, Hense J, Kong XT, Davidson T, Lai A, Cloughesy T, Nghiemphu PL, Kong DS, Choi YL, Seol HJ, Lee JI, Nam DH, Kool M, Jones DTW, Jager N, Northcott PA, Pugh T, Hovestadt V, Markant S, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schuller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Krel R, Krutoshinskaya Y, Rosiello A, Seidman R, Kowalska A, Kudo T, Hata Y, Maehara T, Kumthekar P, Bridge C, Patel V, Rademaker A, Helenowski I, Mrugala M, Rockhill J, Swanson K, Grimm S, Raizer J, Meletath S, Bennett M, Nestor VA, Fink KL, Lee E, Reardon D, Schiff D, Drappatz J, Muzikansky A, Hammond S, Grimm S, Norden A, Beroukhim R, McCluskey C, Chi A, Batchelor T, Smith K, Gaffey S, Gerard M, Snodgras S, Raizer J, Wen P, Leeper H, Johnson D, Lima J, Porensky E, Cavaliere R, Lin A, Liu J, Evans J, Leuthardt E, Dacey R, Dowling J, Kim A, Zipfel G, Grubb R, Huang J, Robinson C, Simpson J, Linette G, Chicoine M, Tran D, Liubinas SV, D'Abaco GM, Moffat B, Gonzales M, Feleppa F, Nowell CJ, Gorelick A, Drummond KJ, Morokoff AP, O'Brien TJ, Kaye AH, Loghin M, Melhem-Bertrandt A, Penas-Prado M, Zaidi T, Katz R, Lupica K, Stevens G, Ly I, Hamilton S, Rostomily R, Rockhill J, Mrugala M, Mandel J, Yust-Katz S, de Groot J, Yung A, Gilbert M, Burzynski S, Janicki T, Burzynski G, Marszalek A, Pachow D, Kliese N, Kirches E, Mawrin C, McNamara MG, Lwin Z, Jiang H, Chung C, Millar BA, Sahgal A, Laperriere N, Mason WP, Megyesi J, Salehi F, Merker V, Slusarz K, Muzikansky A, Francis S, Plotkin S, Mishima K, Adachi JI, Suzuki T, Uchida E, Yanagawa T, Watanabe Y, Fukuoka K, Yanagisawa T, Wakiya K, Fujimaki T, Nishikawa R, Moiyadi A, Kannan S, Sridhar E, Gupta T, Shetty P, Jalali R, Alshami J, Lecavalier-Barsoum M, Guiot MC, Tampieri D, Kavan P, Muanza T, Nagane M, Kobayashi K, Takayama N, Shiokawa Y, Nakamura H, Makino K, Hideo T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Nambudiri N, Arrilaga I, Dunn I, Folkerth R, Chi S, Reardon D, Nayak L, Omuro A, DeAngelis L, Robins HI, Govindan R, Gadgeel S, Kelly K, Rigas J, Reimers HJ, Peereboom D, Rosenfeld S, Garst J, Ramnath N, Wing P, Zheng M, Urban P, Abrey L, Wen P, Nayak L, DeAngelis LM, Wen PY, Brandes AA, Soffietti R, Peereboom DM, Lin NU, Chamberlain M, Macdonald D, Galanis E, Perry J, Jaeckle K, Mehta M, Stupp R, van den Bent M, Reardon DA, Norden A, Hammond S, Drappatz J, Phuphanich S, Reardon D, Wong E, Plotkin S, Lesser G, Raizer J, Batchelor T, Lee E, Kaley T, Muzikansky A, Doherty L, LaFrankie D, Ruland S, Smith K, Gerard M, McCluskey C, Wen P, Norden A, Schiff D, Ahluwalia M, Lesser G, Nayak L, Lee E, Muzikansky A, Dietrich J, Smith K, Gaffey S, McCluskey C, Ligon K, Reardon D, Wen P, Bush NAO, Kesari S, Scott B, Ohno M, Narita Y, Miyakita Y, Arita H, Matsushita Y, Yoshida A, Fukushima S, Ichimura K, Shibui S, Okamura T, Kaneko S, Omuro A, Chinot O, Taillandier L, Ghesquieres H, Soussain C, Delwail V, Lamy T, Gressin R, Choquet S, Soubeyran P, Maire JP, Benouaich-Amiel A, Lebouvier-Sadot S, Gyan E, Barrie M, del Rio MS, Gonzalez-Aguilar A, Houllier C, Tanguy ML, Hoang-Xuan K, Omuro A, Abrey L, Raizer J, Paleologos N, Forsyth P, DeAngelis L, Kaley T, Louis D, Cairncross JG, Matasar M, Mehta J, Grimm S, Moskowitz C, Sauter C, Opinaldo P, Torcuator R, Ortiz LD, Cardona AF, Hakim F, Jimenez E, Yepes C, Useche N, Bermudez S, Mejia JA, Asencio JL, Carranza H, Vargas C, Otero JM, Lema M, Pace A, Villani V, Fabi A, Carapella CM, Patel A, Allen J, Dicker D, Sheehan J, El-Deiry W, Glantz M, Tsyvkin E, Rauschkolb P, Pentsova E, Lee M, Perez A, Norton J, Uschmann H, Chamczuck A, Khan M, Fratkin J, Rahman R, Hempfling K, Norden A, Reardon DA, Nayak L, Rinne M, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Wen P, Lee E, Ranjan T, Peters K, Vlahovic G, Friedman H, Desjardins A, Reveles I, Brenner A, Ruda R, Bello L, Castellano A, Bertero L, Bosa C, Trevisan E, Riva M, Donativi M, Falini A, Soffietti R, Saran F, Chinot OL, Henriksson R, Mason W, Wick W, Nishikawa R, Dahr S, Hilton M, Garcia J, Cloughesy T, Sasaki H, Nishiyama Y, Yoshida K, Hirose Y, Schwartz M, Grimm S, Kumthekar P, Fralin S, Rice L, Drawz A, Helenowski I, Rademaker A, Raizer J, Schwartz K, Chang H, Nikolai M, Kurniali P, Olson K, Pernicone J, Sweeley C, Noel M, Sharma M, Gupta R, Suri V, Singh M, Sarkar C, Shibahara I, Sonoda Y, Saito R, Kanamori M, Yamashita Y, Kumabe T, Watanabe M, Suzuki H, Watanabe T, Ishioka C, Tominaga T, Shih K, Chowdhary S, Rosenblatt P, Weir AB, Shepard G, Williams JT, Shastry M, Hainsworth JD, Singer S, Riely GJ, Kris MG, Grommes C, Sanders MWCB, Arik Y, Seute T, Robe PAJT, Leijten FSS, Snijders TJ, Sturla L, Culhane JJ, Donahue J, Jeyapalan S, Suchorska B, Jansen N, Wenter V, Eigenbrod S, Schmid-Tannwald C, Zwergal A, Niyazi M, Bartenstein P, Schnell O, Kreth FW, LaFougere C, Tonn JC, Taillandier L, Wittwer B, Blonski M, Faure G, De Carvalho M, Le Rhun E, Tanaka K, Sasayama T, Nishihara M, Mizukawa K, Kohmura E, Taylor S, Newell K, Graves L, Timmer M, Cramer C, Rohn G, Goldbrunner R, Turner S, Gergel T, Lacroix M, Toms S, Ueki K, Higuchi F, Sakamoto S, Kim P, Salgado MAV, Rueda AG, Urzaiz LL, Villanueva MG, Millan JMS, Cervantes ER, Pampliega RA, de Pedro MDA, Berrocal VR, Mena AC, van Zanten SV, Jansen M, van Vuurden D, Huisman M, Hoekstra O, van Dongen G, Kaspers GJ, Schlamann A, von Bueren AO, Hagel C, Kramm C, Kortmann RD, Muller K, Friedrich C, Muller K, von Hoff K, Kwiecien R, Pietsch T, Warmuth-Metz M, Gerber NU, Hau P, Kuehl J, Kortmann RD, von Bueren AO, Rutkowski S, von Bueren AO, Friedrich C, von Hoff K, Kwiecien R, Muller K, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Walker J, Tremont I, Armstrong T, Wang H, Jiang C, Wang H, Jiang C, Warren P, Robert S, Lahti A, White D, Reid M, Nabors L, Sontheimer H, Wen P, Yung A, Mellinghoff I, Lamborn K, Ramkissoon S, Cloughesy T, Rinne M, Omuro A, DeAngelis L, Gilbert M, Chi A, Batchelor T, Colman H, Chang S, Nayak L, Massacesi C, DiTomaso E, Prados M, Reardon D, Ligon K, Wong ET, Elzinga G, Chung A, Barron L, Bloom J, Swanson KD, Elzinga G, Chung A, Wong ET, Wu W, Galanis E, Wen P, Das A, Fine H, Cloughesy T, Sargent D, Yoon WS, Yang SH, Chung DS, Jeun SS, Hong YK, Yust-Katz S, Milbourne A, Diane L, Gilbert M, Armstrong T, Zaky W, Weinberg J, Fuller G, Ketonen L, McAleer MF, Ahmed N, Khatua S, Zaky W, Olar A, Stewart J, Sandberg D, Foresman L, Ketonen L, Khatua S. NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
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Melichar B, Bracarda S, Matveev V, Alekseev B, Ivanov S, Zyryanov A, Janciauskiene R, Fernebro E, Mulders P, Osborne S, Jethwa S, Mickisch G, Gore M, van Moorselaar RJA, Staehler M, Magne N, Bellmunt J. A multinational phase II trial of bevacizumab with low-dose interferon-α2a as first-line treatment of metastatic renal cell carcinoma: BEVLiN. Ann Oncol 2013; 24:2396-402. [PMID: 23803225 DOI: 10.1093/annonc/mdt228] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 11/12/2022] Open
Abstract
BACKGROUND Avastin and Roferon in Renal Cell Carcinoma (AVOREN) demonstrated efficacy for bevacizumab plus interferon-α2a (IFN; 9 MIU tiw) in first-line metastatic renal cell carcinoma (mRCC). We evaluated bevacizumab with low-dose IFN in mRCC to determine whether clinical benefit could be maintained with reduced toxicity. METHODS BEVLiN was an open-label, single-arm, multinational, phase II trial. Nephrectomized patients with treatment-naive, clear cell mRCC and favourable/intermediate Memorial Sloan-Kettering Cancer Center scores received bevacizumab (10 mg/kg every 2 weeks) and IFN (3 MIU thrice weekly) until disease progression. Descriptive comparisons with AVOREN patients having favourable/intermediate MSKCC scores treated with bevacizumab plus IFN (9 MIU) were made. Primary end points were grade ≥3 IFN-associated adverse events (AEs) and progression-free survival (PFS). All grade ≥3 AEs and bevacizumab/IFN-related grade 1-2 AEs occurring from first administration until 28 days after last treatment were reported. RESULTS A total of 146 patients were treated; the median follow-up was 29.4 months. Any-grade and grade ≥3 IFN-associated AEs occurred in 53.4% and 10.3% of patients, respectively. The median PFS and overall survival were 15.3 [95% confidence interval (CI): 11.7-18.0] and 30.7 months (95% CI: 25.7-not reached), respectively. The ORR was 28.8%. CONCLUSIONS Compared with a historical control AVOREN subgroup, low-dose IFN with bevacizumab resulted in a reduction in incidence rates of IFN-related AEs, without compromising efficacy [NCT00796757].
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Affiliation(s)
- B Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic.
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Hall M, Gourley C, McNeish I, Ledermann J, Gore M, Jayson G, Perren T, Rustin G, Kaye S. Targeted anti-vascular therapies for ovarian cancer: current evidence. Br J Cancer 2013; 108:250-8. [PMID: 23385789 PMCID: PMC3566823 DOI: 10.1038/bjc.2012.541] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 10/10/2012] [Accepted: 11/02/2012] [Indexed: 12/21/2022] Open
Abstract
Ovarian cancer presents at advanced stage in around 75% of women, and despite improvements in treatments such as chemotherapy, the 5-year survival from the disease in women diagnosed between 1996 and 1999 in England and Wales was only 36%. Over 80% of patients with advanced ovarian cancer will relapse and despite a good chance of remission from further chemotherapy, they will usually die from their disease. Sequential treatment strategies are employed to maximise quality and length of life but patients eventually become resistant to cytotoxic agents. The expansion in understanding of the molecular biology that characterises cancer cells has led to the rapid development of new agents to target important pathways but the heterogeneity of ovarian cancer biology means that there is no predominant defect. This review attempts to discuss progress to date in tackling a more general target applicable to ovary cancer-angiogenesis.
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Affiliation(s)
- M Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK.
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Abstract
Cancer rates are increased in people with diabetes. There is also recent evidence that outcomes from cancer treatment are worse in those with diabetes. There is a need to assess the prevalence of diabetes in cancer patients in order to tailor resources and improve clinical outcomes. This study examined the prevalence of diabetes and hyperglycaemia and specific referrals amongst hospitalised patients in a specialist cancer hospital. In a cancer hospital 11% of in-patients had either identified diabetes or hyperglycaemia (random blood glucose >11mmol/l.) Consecutive referrals to a diabetes consultant confirmed that over half of patients had gastro-intestinal tract primary cancers, over 20% had poor glycaemic control whilst on steroids, and 18% had poor glycaemic control during artificial nutrition. Referrals came from both medical and surgical teams. Thus diabetes and hyperglycaemia are common problems amongst in-patients with cancer, and these patients have complex diabetes requirement. Patients with cancer and diabetes need access to specialist diabetes care.
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Affiliation(s)
- DL Morganstein
- Beta Cell Diabetes Centre, Chelsea and Westminster Hospital Foundation Trust, London, UK
- Royal Marsden Hospital, Fulham Road, London, UK
| | - S Tan
- Royal Marsden Hospital, Fulham Road, London, UK
| | - M Gore
- Royal Marsden Hospital, Fulham Road, London, UK
| | - MD Feher
- Beta Cell Diabetes Centre, Chelsea and Westminster Hospital Foundation Trust, London, UK
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Escudier B, Rini B, Hutson T, Gore M, Oudard S, Tarazi J, Rosbrook B, Williams J, Kim S, Motzer R. 81 Updated results of the phase 3 AXIS trial: Axitinib vs sorafenib as second-line therapy for metastatic renal cell carcinoma (mRCC). ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1569-9056(12)60080-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gore M, Bellmunt J, Eisen T, Mickisch G, Patard J, Porta C, Ravaud A, Schmidinger M, Sternberg C, Szczylik C, De Nigris E, Kirpekar S, Wheeler C. 7114 POSTER DISCUSSION Appropriateness of Treatment Options for the Management of Patients With Advanced Renal Cell Carcinoma (RCC) Using the Validated Semi Quantitative RAND Corporation/University of California, Los Angeles (RAND/UCLA) Methodology. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gonzalez-Martin A, Gladieff L, Stroyakovskiy D, Tholander B, Gore M, Scambia G, Kristensen G, Diz M, Bollag D, Pignata S. 8002 ORAL Front-line Bevacizumab (BEV) Combined With Weekly Paclitaxel (wPAC) and Carboplatin (C) for Ovarian Cancer (OC): Safety Results From the Concurrent Chemotherapy (CT) Phase of the OCTAVIa Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72090-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Gore M, Vergote I, Vasanthan S, Chan S, Arranz J, Colombo N, Arranz J, Fischer M, San Andres BG, Nieto A. 8050 POSTER Cost-effectiveness of Trabectedin in Combination With Pegylated Liposomal Doxorubicin Hydrochloride for the Treatment of Women With Relapsed Platinum-sensitive Ovarian Cancer in the UK -Analysis Based on the Final Survival Data. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72138-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rustin G, Reed N, Jayson GC, Ledermann JA, Adams M, Perren T, Poole C, Lind M, Persic M, Essapen S, Gore M, Calvert H, Stredder C, Wagner A, Giurescu M, Kaye S. A phase II trial evaluating two schedules of sagopilone (ZK-EPO), a novel epothilone, in patients with platinum-resistant ovarian cancer. Ann Oncol 2011; 22:2411-2416. [PMID: 21372124 DOI: 10.1093/annonc/mdq780] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sagopilone, the first fully synthetic epothilone, has shown promising preclinical activity in tumour models. This open-label randomised phase II study investigated two infusion schedules of sagopilone in women with ovarian cancer. PATIENTS AND METHODS Women with ovarian cancer recurring within 6 months of end of last platinum-containing treatment received sagopilone 16 mg/m(2) as a 3- or 0.5-h i.v. infusion every 21 days for up to 6 weeks. RESULTS Sixty-three patients received sagopilone as a 3-h (n=38) or 0.5-h (n=25) infusion. There were nine confirmed tumour responses [by modified RECIST (n=8) and by Gynecologic Cancer Intergroup CA-125 criteria (n=1)] in 57 patients assessable for efficacy overall [three (13%) with 0.5-h and six (18%) with 3-h infusions]. The 0.5-h arm was closed when it failed to meet its target efficacy. Main drug-related adverse events were peripheral sensory neuropathy (73%; 16% grade 3), nausea (37%; 2% grade 3), fatigue (35%; 3% grade 3) and arthralgia (30%; 5% grade 3). Overall incidence of peripheral sensory neuropathy was similar in both treatment arms, with no grade 4 neuropathy events. No acute allergic infusion reactions were observed. CONCLUSION Sagopilone is effective, with balanced tolerability, in patients with recurrent platinum-resistant ovarian cancer.
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Affiliation(s)
- G Rustin
- Medical Oncology, Mount Vernon Cancer Centre, Northwood.
| | - N Reed
- Department of Clinical Oncology, Beatson Oncology Centre, Gartnavel General Hospital, Glasgow
| | - G C Jayson
- School of Cancer and Enabling Sciences, University of Manchester and Christie Hospital, Manchester
| | - J A Ledermann
- Department of Oncology, UCL Hospitals and UCL Cancer Institute, London
| | - M Adams
- Clinical Oncology, Velindre NHS Trust, Cardiff
| | - T Perren
- Department of Medical Oncology, St James's Institute of Oncology, St James's University Hospital, Leeds
| | - C Poole
- Arden Cancer Research Centre, University Hospitals Coventry and Warwickshire, Coventry
| | - M Lind
- Department of Oncology, Princess Royal Hospital, Hull
| | - M Persic
- Clinical Oncology, Derbyshire Royal Infirmary, Derby
| | - S Essapen
- Clinical Oncology, The Royal Surrey County Hospital, Guildford
| | - M Gore
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London
| | | | | | - A Wagner
- Global Medical Development Oncology, Bayer Schering Pharma AG, Berlin, Germany
| | - M Giurescu
- Global Medical Development Oncology, Bayer Schering Pharma AG, Berlin, Germany
| | - S Kaye
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London
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Khan OA, Gore M, Lorigan P, Stone J, Greystoke A, Burke W, Carmichael J, Watson AJ, McGown G, Thorncroft M, Margison GP, Califano R, Larkin J, Wellman S, Middleton MR. A phase I study of the safety and tolerability of olaparib (AZD2281, KU0059436) and dacarbazine in patients with advanced solid tumours. Br J Cancer 2011; 104:750-5. [PMID: 21326243 PMCID: PMC3048218 DOI: 10.1038/bjc.2011.8] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Poly adenosine diphosphate (ADP)-ribose polymerase (PARP) is essential in cellular processing of DNA damage via the base excision repair pathway (BER). The PARP inhibition can be directly cytotoxic to tumour cells and augments the anti-tumour effects of DNA-damaging agents. This study evaluated the optimally tolerated dose of olaparib (4-(3--4-fluorophenyl) methyl-1(2H)-one; AZD2281, KU0059436), a potent PARP inhibitor, with dacarbazine and assessed safety, toxicity, clinical pharmacokinetics and efficacy of combination treatment. Patients and methods: Patients with advanced cancer received olaparib (20–200 mg PO) on days 1–7 with dacarbazine (600–800 mg m−2 IV) on day 1 (cycle 2, day 2) of a 21-day cycle. An expansion cohort of chemonaive melanoma patients was treated at an optimally tolerated dose. The BER enzyme, methylpurine-DNA glycosylase and its substrate 7-methylguanine were quantified in peripheral blood mononuclear cells. Results: The optimal combination to proceed to phase II was defined as 100 mg bd olaparib with 600 mg m−2 dacarbazine. Dose-limiting toxicities were neutropaenia and thrombocytopaenia. There were two partial responses, both in patients with melanoma. Conclusion: This study defined a tolerable dose of olaparib in combination with dacarbazine, but there were no responses in chemonaive melanoma patients, demonstrating no clinical advantage over single-agent dacarbazine at these doses.
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Affiliation(s)
- O A Khan
- University of Oxford Department of Oncology, Churchill Hospital, Old Road, Oxford OX3 7LJ, UK
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Mickisch G, Gore M, Escudier B, Procopio G, Walzer S, Nuijten M. Costs of managing adverse events in the treatment of first-line metastatic renal cell carcinoma: bevacizumab in combination with interferon-alpha2a compared with sunitinib. Br J Cancer 2009; 102:80-6. [PMID: 19920817 PMCID: PMC2813739 DOI: 10.1038/sj.bjc.6605417] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bevacizumab plus interferon-alpha2a (IFN) prolongs progression-free survival to >10 months, which is comparable with sunitinib as first-line treatment of metastatic renal cell carcinoma (RCC). The two regimens have different tolerability profiles; therefore, costs for managing adverse events may be an important factor in selecting therapy. METHODS Costs of managing adverse events affecting patients with metastatic RCC eligible for treatment with bevacizumab plus IFN or sunitinib were evaluated using a linear decision analytical model. Management costs were calculated from the published incidence of adverse events and health-care costs for treating adverse events in the United Kingdom, Germany, France and Italy. RESULTS Adverse event management costs were higher for sunitinib than for bevacizumab plus IFN. The average cost per patient for the management of grade 3-4 adverse events was markedly lower with bevacizumab plus IFN compared with sunitinib in the United Kingdom (euro1475 vs euro804), Germany (euro1785 vs euro1367), France (euro2590 vs euro1618) and Italy (euro891 vs euro402). The main cost drivers were lymphopaenia, neutropaenia, thrombocytopaenia, leucopaenia and fatigue/asthaenia for sunitinib; and proteinuria, fatigue/asthaenia, bleeding, anaemia and gastrointestinal perforation for bevacizumab plus IFN. CONCLUSION The costs of managing adverse events are lower for bevacizumab plus IFN than for sunitinib. The potential for cost savings should be considered when selecting treatments for RCC.
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Affiliation(s)
- G Mickisch
- Center of Operative Urology, Bremen 28277, Germany.
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Powell-Tuck J, Gosling P, Lobo DN, Carlson GL, Allison SP, Gore M, Lewington AJ, Pearse RL, Mythen MG. Authors of guideline respond. West J Med 2009. [DOI: 10.1136/bmj.b3030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Glasspool RM, Gore M, Rustin G, McNeish I, Wilson R, Pledge S, Paul J, Mackean M, Halford S, Kaye S. Randomized phase II study of decitabine in combination with carboplatin compared with carboplatin alone in patients with recurrent advanced ovarian cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5562] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
5562 Background: Experimental and clinical data (Gifford et al, Clin Cancer Res. 2004) indicate the potential importance of methylation in mediating resistance to carboplatin in ovarian cancer. A previous phase I trial (Appleton et al, J Clin Oncol. 2007) established the feasibility of combining carboplatin with the demethylating agent decitabine on a day 1 + 8 q4 weekly (w) schedule and PD data provided evidence of target cell demethylation. Methods: Patients (pt) with ovarian cancer relapsing 6–12 months following first line treatment were randomised to receive either 6 cycles of carboplatin AUC 6 q4 w (Arm A), or 90 mg/m2 decitabine as a 6 hour infusion on day 1 and carboplatin AUC 6 on day 8 q4 w (Arm B). The primary endpoint was response rate. An interim analysis was planned after 11 patients were enrolled into Arm B. Results: 29 pt were enrolled. After the first 4 pt had been treated (at 90 mg/m2 decitabine) the frequency of dose delays due to neutropenia was considered unacceptable, and therefore the starting dose of decitabine was reduced to 45 mg/m2 for the subsequent 11 pt. 7 out of 14 pt in Arm A completed 6 cycles compared with 0 of 11 in Arm B (at 45 mg/m2 decitabine). Grade 2/3 hypersensitivity reactions were more common in Arm B than Arm A (64% vs. 21%), as were prolonged treatment delays due to neutropenia (36% vs. 10%). At the interim analysis, in the 11 pt treated with 45mg/m2 (Arm B), there were no RECIST responses, while 2 pt had short-lived CA125 responses (59 and 63 days). In contrast 6 of 14 patients in Arm A had RECIST responses consistent with the expected efficacy of carboplatin in this population. Conclusions: The lack of efficacy, as well as the difficulties in treatment delivery in Arm B, led the project team to conclude that the study should be closed. With this dose and schedule, decitabine is ineffective in reversing carboplatin resistance. Further investigations are ongoing to understand (a) the apparent increased incidence of hypersensitivity and (b) the trend towards reduced efficacy in Arm B. [Table: see text]
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Affiliation(s)
- R. M. Glasspool
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - M. Gore
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - G. Rustin
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - I. McNeish
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - R. Wilson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - S. Pledge
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - J. Paul
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - M. Mackean
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - S. Halford
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - S. Kaye
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
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Montes A, Sandhu SK, Rothermundt C, Coombes I, A'Hern R, Keyzor C, Thomas A, Kaye S, Gore M. Phase I feasibility study of carboplatin plus capecitabine followed by maintenance capecitabine in patients (pts) with recurrent platinum-sensitive epithelial ovarian cancer (EOC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5564 Background: In a previous study, we noted a response rate (RR) of 61% for the 3 drug combination of carboplatin, epirubicin and capecitabine in platinum-sensitive recurrent EOC. This combination however resulted in excessive grade (G) 3–4 haematological toxicity (55%) (BJC 2006; 94:74). The current trial therefore assessed the feasibility and efficacy of the 2 drugs, carboplatin and capecitabine as second- or third-line treatment. Methods: Pts were administered carboplatin (AUC5) day 1 and capecitabine at a starting dose of 750 mg/m2 bd, days 1–21, q21 (dose level 1). The capecitabine dose was deescalated to 625 mg/m2 (dose level -1) and 500 mg/m2 (dose level -2) according to toxicity. Pts with an objective response or stable disease received maintenance capecitabine (at the same dose level) for up to 12 months or until progression. Responses were assessed with RECIST criteria and CA-125. Results: 19 of the 20 pts enrolled were evaluable for toxicity and response. Dose-limiting toxicity was observed at dose level 1 (G3 fatigue, G3 diarrhoea, G3 neutropenia of > 14 days; n = 3/5), dose level -1 (G3 angina (n = 2), G3 vomiting, G3 palmar plantar erythema; n = 4/7) and dose level-2 (diarrhoea / fatigue; n = 1/7). One patient had a G3 carboplatin hypersensivity reaction. 8 pts received maintenance capecitabine which was well tolerated. The overall RR was 53% with 10 partial responses and 5 stable diseases. The median progression free survival (PFS) was 6.5 months (m) and the 6mPFS was 63% with 2 pts currently ongoing treatment. The median PFS on maintenance was 3.2 m. Conclusions: The combination was well tolerated at the recommended phase II dose of carboplatin (AUC 5) and capecitabine (500 mg/m2 bd) with partial responses in over half of the cases. [Table: see text]
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Affiliation(s)
- A. Montes
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - S. K. Sandhu
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - C. Rothermundt
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - I. Coombes
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - R. A'Hern
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - C. Keyzor
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - A. Thomas
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - S. Kaye
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - M. Gore
- Guy's and St Thomas’ Hospital, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
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Gahrton G, Tura S, Belanger C, Cavo M, Chapvis B, Ferrant A, Flesch M, Gore M, Gratwohl A, Gravett PJ. Allogeneic bone marrow transplantation in patients with multiple myeloma. Eur J Haematol Suppl 2009; 51:182-5. [PMID: 2697589 DOI: 10.1111/j.1600-0609.1989.tb01514.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
50 patients with a median age of 41 years (range 29-54) underwent allogenic bone marrow transplantation for multiple myeloma. 35 patients were on second-line treatment, and 15 on first-line treatment. 24 patients were considered refractory to previous treatment. 45 patients received marrow from HLA-matched sibling donors (3 of these from twin donors), and 5 from unrelated or related non-sibling donors. 21 patients entered complete remission, while 15 had persistent disease following repopulation of the marrow. 14 patients were not evaluable for remission status because of early transplantation-related death. The overall median survival from bone marrow transplantation was 27 months, with a projected long-term survival of 34%. Patients who were 40 yr of age or older had a survival that was not different from that of patients between 29 and 40 yr of age. The median disease-free survival of patients who entered complete remissions was 41 months. These patients tended to have a longer survival than patients with persistent disease following repopulation of the marrow. Allogeneic bone marrow transplantation appears to be a promising method for treatment of certain patients with multiple myeloma.
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Sohaib SA, Cook G, Allen SD, Hughes M, Eisen T, Gore M. Comparison of whole-body MRI and bone scintigraphy in the detection of bone metastases in renal cancer. Br J Radiol 2009; 82:632-9. [PMID: 19221182 DOI: 10.1259/bjr/52773262] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study aims to compare the sensitivity of whole-body MRI with bone scintigraphy in the detection of bone metastases in patients with renal cancer. A prospective study was carried out in 47 patients with renal cancer (mean age 62 years, range 29-79 years). All patients had assessment of the skeleton with whole-body bone scintigraphy (with technetium-99m methylene diphosphonate) and whole-body MRI (coronal T(1) weighted and short tau inversion recovery sequences). The number and sites of bony metastases were assessed on each imaging investigation independently. Sites of extra-osseous metastasis on MRI were also noted. The imaging findings were correlated with other imaging modalities and follow-up. 15 patients (32%) had bone metastases at 34 different sites. Both scintigraphy and MRI were highly specific (94% and 97%, respectively), but the sensitivity of MRI (94%) was superior (p = 0.007) to that of scintigraphy (62%). MRI identified more metastases in the spine and appendicular skeleton, whereas scintigraphy showed more lesions in the skull/facial and thoracic bones. MRI identified extra-osseous metastases in 33 patients (70%), these were mainly lung and retroperitoneal in site. Whole-body MRI is a more sensitive method for detection of bone metastases in renal cancer than bone scintigraphy, and also allows the assessment of soft-tissue disease.
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Affiliation(s)
- S A Sohaib
- Department of Imaging, Royal Marsden Hospital, London, UK.
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Linch M, Stavridi F, Hook J, Barbachano Y, Gore M, Kaye S. Experience in a UK cancer centre of weekly paclitaxel in the treatment of relapsed ovarian and primary peritoneal cancer. Gynecol Oncol 2008; 109:27-32. [DOI: 10.1016/j.ygyno.2008.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 12/21/2007] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
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Agarwal R, Paul J, Carty K, Perren T, Reed N, Gourley C, Parkin D, Gore M, Kaye S. A phase II study of the feasibility of sequential carboplatin (C) followed by paclitaxel (P) and gemcitabine (G) as first-line chemotherapy for stage Ic-IV ovarian (OC), fallopian tube (FTC), and primary peritoneal carcinoma (PPC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5578 Background: We previously explored the feasibility of adding G to C + P in a phase II study, in which 4 cycles of C followed by 4 cycles of concurrent weekly P and G were given (BJC (2004) 91:627–32). Although highly active (med PFS 19.5m), the feasibility of this 1st-line regimen was limited by dyspnea during the weekly P+G phase. The current trial assessed whether the dyspnoea could be ameliorated by altering the schedule. Methods: Untreated FIGO stage Ic-IV OC, FTC and PPC patients (pts) were eligible. Chemotherapy (CTX) consisted of 4 cycles of C (AUC 7) q21 days, followed by 4 cycles of concurrent P (175 mg/m2) d1 and G (1,000 mg/m2) d1 and d8 q21 days. The primary endpoint of the study was the percentage of pts completing the planned 8 cycles of CTX. The planned sample size was 54 pts, based on a one stage single arm study design with 95% power to reject the null hypothesis (completion rate less than 60%), assuming a true completion rate of 80% using one-sided alpha=0.05. Results: All 54 pts were recruited between June 05 and June 06. Details for 44 pts are currently available for the C phase. 38% of these pts had one or more dose reduction (DR), and 68% had dose delays (DD). The commonest reason for DR and DD was neutropenia. Details for 33 pts are currently available for the P+G phase. 27% of these pts had a DR of P and 51% had a DR of G. 71% of pts omitted G on D8, and 64% had a DD. The commonest reasons for DR and DD were neutropenia and thrombocytopenia. Overall, the KM estimate of the percentage completing 8 cycles is 75% (95% CI 61%-89%) based on the current data. Dyspnoea (Grade 2 only) was observed in 4.5% and 3% pts during the C and P+G phases respectively. No significant treatment related CXR changes were observed. The overall response rate was 68% (95% CI 45–86%; 36% CR, 32%PR, 14% SD, 5%PD, 14% NE; n=22). The median follow-up is 7.5 months and the PFS at 8 months is 92% (95% CI 77–97%). Conclusion: This schedule appears to ameliorate the previously observed dyspnoea, while retaining comparable efficacy. The feasibility of this regimen is limited by myelosuppression which could potentially be overcome by: a) reducing the dose of gemcitabine to 750 mg/m2, or b) using prophylactic Peg-GCSF. [Table: see text]
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Affiliation(s)
- R. Agarwal
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - J. Paul
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - K. Carty
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - T. Perren
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - N. Reed
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - C. Gourley
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - D. Parkin
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - M. Gore
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - S. Kaye
- Royal Marsden Hospital, London, United Kingdom; CRUK Clinical Trials Unit, Beatson Oncolgy Centre, Glasgow, United Kingdom; St James’s Hospital, Leeds, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom; University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
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Eisen T, Marais R, Affolter A, Lorigan P, Ottensmeier C, Robert C, Corrie P, Chevreau C, Erlandsson F, Gore M. An open-label phase II study of sorafenib and dacarbazine as first-line therapy in patients with advanced melanoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8529] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8529 Background: Sorafenib (SOR) exerts anti-tumor and anti-angiogenic effects via inhibition of VEGFR-1,-2,-3, PDGFR-a, -β and Raf. In a phase I, study SOR + dacarbazine (DTIC) as first-line therapy for advanced melanoma patients (pts) was well-tolerated and had activity. Methods: In this multicenter, phase II, open-label, uncontrolled, 2-stage study, eligibility criteria included: measurable disease by RECIST, ECOG performance status 0 or 1, no prior chemotherapy. Prior immunotherapy was allowed. Planned sample size was 82 pts based on a Simon 2-stage optimal design. Pts were treated with oral SOR 400 mg bid daily combined with repeated 21-day cycles of iv DTIC 1,000 mg/m2 given on day 1 of each cycle until occurrence of progressive disease or intolerable toxicity. The primary endpoint was overall tumor response rate using RECIST. Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety and toxicity. Results: 30 and 53 pts were treated in Stages I and II, respectively. Baseline characteristics were as follows: median age 56 yrs; 60% male, 34% ECOG 1, 80% AJCC Stage IV M1c; 31% elevated LDH. Eight (10%) pts had partial responses, 34 (41%) had stable disease, 32 (39%) had progressive disease and 9 (11%) were not evaluable. The median PFS was 14 wks (95% CI 12, 19; 28% censored). PFS rates at 3 & 6 mos were 56% (45%, 67%; 13% censored) and 33% (22%, 45%; 24% censored), respectively. Median OS was 41 wks (28, 59, 63% censored). Grade 3/4 drug-related adverse events included: neutrophils 33%, platelets 22%, hand-foot skin reaction 8%, fatigue 7% and abdominal pain 6%. 1 patient had febrile neutropenia. To correlate treatment response with mutational status, melanoma samples from 20 pts were analyzed for mutations in B-RAF (exon 15) and PI3Kinase (exons 9 & 20). 3 of 20 samples had V600E mutations in B- RAF; no PI3Kinase alterations were detected. Conclusions: Addition of SOR to DTIC was well-tolerated and resulted in encouraging PFS and OS rates in this poor prognostic cohort of patients. The data are promising as compared with published results of DTIC alone in metastatic melanoma (RR 7.5%, PFS 6 wks; Bedikian et al. 2006). A recently completed randomized Phase II trial will provide additional information on the efficacy of this combination regimen. [Table: see text]
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Affiliation(s)
- T. Eisen
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - R. Marais
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - A. Affolter
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - P. Lorigan
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - C. Ottensmeier
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - C. Robert
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - P. Corrie
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - C. Chevreau
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - F. Erlandsson
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
| | - M. Gore
- Addenbrooke's Hospital, Cambridge, United Kingdom; Royal Marsden Hospital & Inst of Cancer Research, London, United Kingdom; Christie Hospital, Manchester, United Kingdom; Southampton General Hospital, Hampshire, United Kingdom; Institut Gustave-Roussy, Villejuif, France; Institut Claudius Regaud, Toulouse, France; Bayer AB, Gothenburg, Sweden
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Keilholz U, Suciu S, Bedikian AY, Punt CJ, Gore M, Kruit W, Pavlick AC, Spatz A, Gilles E, Eggermont AM. LDH is a prognostic factor in stage IV melanoma patients (pts) but is a predictive factor only for bcl2 antisense treatment efficacy: Re-analysis of GM301 and EORTC18951 randomized trials. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8552 Background: Two large studies with identical eligibility criteria and using serum LDH as stratification for randomization were re-analyzed in order to 1) confirm the prognostic importance of LDH in advanced melanoma; 2) to assess whether an interaction between LDH and treatment efficacy exists. Methodology: Oblimersen (OBL) trial GM301 randomized 771 pts between DTIC vs. DTIC+OBL, whereas EORTC trial 18951 randomized 365 pts between biochemotherapy vs biochemotherapy+IL2 (JCO, 2004). LDH was divided into 5 groups: 5 UNL. Cox model was used to asses the prognostic importance of LDH, treatment difference and LDH-treatment interaction regarding the main endpoint, overall survival (OS). Results: In each study LDH appeared to be of strong and incremental prognostic importance (p<0.0001): the higher the LDH the shorter the OS. Median OS in pts with LDH<0.8 UNL was ±1 yr vs. 5 UNL. In both trials, pts with LDH 0.8–1.1 UNL had already a shorter median OS (± 9 months) as compared to the <0.8 group. In each study, overall, treatment differences were not significant. However, an interaction between LDH and treatment difference was observed in GM301 (p=0.01), but not in 18951 (p=0.51). In GM301, the largest benefit in favor of OBL was confined to the LDH <0.8 UNL subgroup (see table ), whereas in EORTC18951 the trend for an IL2 advantage was spread over several LDH groups. The observation was consistent also for response and PFS, and was not related to known confounding variables including metastatic disease site and PS. Conclusion: LDH is a biomarker with remarkable prognostic value for OS in advanced melanoma, and our analysis provides evidence for its prognostic value already below the UNL. Furthermore, OBL only had an effect in pts with low pretreatment LDH levels representing more favorable biology. No significant financial relationships to disclose. [Table: see text]
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Affiliation(s)
- U. Keilholz
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - S. Suciu
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - A. Y. Bedikian
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - C. J. Punt
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - M. Gore
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - W. Kruit
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - A. C. Pavlick
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - A. Spatz
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - E. Gilles
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
| | - A. M. Eggermont
- Charite, Berlin, Germany; EORTC Data Center, Brussels, Belgium; MD Anderson Cancer Center, Houston, TX; University Medical Center, Nijmegen, The Netherlands; Royal Marsden Hospital, London, United Kingdom; Erasmus Medical Center, Rotterdam, The Netherlands; Kaplan Cancer Center, New York, NY; Institute Gustave Roussy, Villejuif, France; Genta, Inc., New Jersey, NJ
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Eggermont AM, Suciu S, Santinami M, Kruit W, Testori A, Marsden J, Punt C, Hauschild A, Gore M, Keilholz U. EORTC 18991: Long-term adjuvant pegylated interferon-alpha2b (PEG-IFN) compared to observation in resected stage III melanoma, final results of a randomized phase III trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8504] [Citation(s) in RCA: 14] [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
8504 Background: EORTC 18991 is the largest adjuvant trial ever conducted in stage III melanoma. It assessed the efficacy and toxicity of long term PEG-IFN vs Observation (Obs.). Methods: PEG-IFN (Induction at 6μg/Kg/wk, sc, 8 weeks; followed by Maintenance at 3μg/Kg/wk, sc) for a total treatment duration of 5 years was compared to Obs. in 1256 patients (pts) with stage III melanoma (anyTN1–2M0 without in-transit metastases). Randomization was stratified for nodal involvement N1 (microscopic) vs N2 (palpable nodes), # of nodes, Breslow and ulceration of primary, sex and center. Distant Metastasis-Free Survival (DMFS) was the primary endpoint. Relapse-Free Survival (RFS) was the pre-specified regulatory primary endpoint. Overall survival (OS) was the secondary endpoint. Intent-to-treat analysis was performed. Results: Median follow-up was 3.8 yrs: HR = Hazard Ratio; NR = Not Reached In N1-pts (n=543) the benefit of PEG-IFN seemed more pronounced than in N2-pts (n=713): RFS (HR 0.73 p=0.02 and HR 0.86 p=0.12 for N1 and N2, respectively), DMFS (HR 0.75 p=0.03 and HR 0.94 p=0.53) and OS (HR 0.88 p=0.43 and HR 1.01 p=0.91). PEG-IFN therapy relative dose intensity (actual/planned dose while treated) reached median 88% (induction) and 83% (maintenance). 251 pts (40 %) stopped PEG-IFN because of toxicity. Grade 3–4 - mostly grade 3 - toxicities were reported in 45% (PEG-IFN), vs 12% (Obs.), including most frequently fatigue (15%), hepatotoxicity (10%) and depression (6%) with ECOG 0–1 Performance Status maintained in 83% of pts during maintenance. Conclusions: Long term PEG-IFN therapy in stage III melanoma had a significant and sustained impact on RFS, but not on DMFS and OS. Pts with only microscopic nodal involvement (Sentinel Node positive) seemed to have greater benefit in terms of both RFS and DMFS. Similar better effects of adjuvant IFN therapy in pts with lower disease burden are observed in 2 consecutive EORTC trials (18952 and 18991) involving 2644 pts. [Table: see text] [Table: see text]
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Affiliation(s)
- A. M. Eggermont
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - S. Suciu
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - M. Santinami
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - W. Kruit
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - A. Testori
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - J. Marsden
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - C. Punt
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - A. Hauschild
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - M. Gore
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
| | - U. Keilholz
- Erasmus University Medical Center, Rotterdam, The Netherlands; EORTC Data Center, Brussels, Belgium; National Cancer Institute Milan, Milan, Italy; European Institute of Oncology, Milan, Italy; University of Birmingham, Birmingham, United Kingdom; Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; University of Kiel, Kiel, Germany; Royal Marsden Hospital, London, United Kingdom; Charite, Berlin, Germany
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Parsons SL, Kutarska E, Koralewski P, Gore M, Wimberger P, Burges A, Stroehlein MA, Lahr A, Jaeger M, Heiss MM. Treatment of ovarian cancer patients with malignant ascites using the trifunctional antibody catumaxomab: Results of a phase II/III study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
5520 Background: Malignant ascites in ovarian carcinoma patients (pts.) is associated with a poor prognosis and reduced quality of life. Catumaxomab (anti-EpCAM × anti-CD3) is known to effectively eliminate tumor cells within ascites by simultaneously activating T cells and Fc gamma-receptor positive cells and redirecting them against the tumor. Methods: A total of 129 ovarian cancer pts. with recurrent symptomatic malignant ascites containing EpCAM+ tumor cells were enrolled in the study; 85 were randomized to treatment with catumaxomab (paracentesis plus intraperitoneal infusions of 10, 20, 50 and 150 μg for 11 days), and 44 to the control arm (paracentesis alone). The primary endpoint was puncture free survival (time to first need for paracentesis after treatment or time to death, which ever occurred first). Results: Pts. characteristics were well balanced in both arms. Median puncture free survival was 52 days for catumaxomab vs. 11 days for control (p<0.0001) whereas the median time to first need for paracentesis was 71 days vs. 11 days l (p<0.0001). There was a pronounced decrease of tumor cell load accompanied by a distinct increase of leukocyte count during catumaxomab treatment within the ascites fluid. Overall and progression free survival data suggest longer survival for catumaxomab-treated pts. compared to control. Follow-up data will be presented. The most frequent AEs were symptoms related to cytokine release (pyrexia, nausea, vomiting). These were generally mild to moderate in intensity, and fully reversible. Transient increases in liver enzymes and bilirubin, and transient WBC abnormalities such as leukocytosis, neutrophilia and a decrease in peripheral lymphocyte were regularly observed as abnormal laboratory values but rarely considered clinically significant. Conclusions: Intraperitoneal therapy with catumaxomab resulted in a significant and clinically relevant improvement of puncture-free survival time, tumor cell load, and time to first need for puncture compared to the control group of best available treatment. The safety profile reflects catumaxomabs mode of action and reveals a low and acceptable toxicity. No significant financial relationships to disclose.
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Affiliation(s)
- S. L. Parsons
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - E. Kutarska
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - P. Koralewski
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - M. Gore
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - P. Wimberger
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - A. Burges
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - M. A. Stroehlein
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - A. Lahr
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - M. Jaeger
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
| | - M. M. Heiss
- Nottingham University Hospitals, Nottingham, United Kingdom; Centre of Oncology of Lubelska Land, Lublin, Poland; L. Rydygier’s Voievodship Specialistic Hospital, Krakow, Poland; The Royal Marsden Hospital, London, United Kingdom; University of Duisburg-Essen, Essen, Germany; Ludwig-Maximilians University, Munich Groβhadern, Munich, Germany; Klinikum Cologne-Merheim, Cologne, Germany; Fresenius Biotech GmbH, Munich, Germany; TRION Research GmbH, Martinsried, Germany
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Vasey PA, Paul J, Rustin G, Wilson R, Guastalla J, Pujade-Lauraine E, Gore M, Gabra H, Carty K, Kaye S. Maintenance erlotinib (E) following first-line treatment with docetaxel, carboplatin and erlotinib in patients with ovarian carcinoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5560] [Citation(s) in RCA: 4] [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
5560 Background: We previously reported on the feasibility of a combination of erlotinib (E; a HER1/EGFR tyrosine-kinase inhibitor) with platinum and taxane chemotherapy (Agarwal et al, Ann Oncol 2004) and reported that almost 1/3rd patients (pts) stopped E during treatment due to toxicities which included intolerable rash, diarrhea and neutropenic sepsis. This update reports on those pts who then received E at 150mg daily as maintenance treatment. Methods: 48 pts initially received docetaxel (75 mg/m2) and carboplatin (AUC 5) following surgery q21d for 6 cycles in combination with daily oral E (50–100 mg) in dose-escalating cohorts. After 6 cycles, pts could continue with E alone (150mg/d) until progression. Results: 27 pts (56%) continued E beyond chemotherapy for a median of 8.6 months (mo) (range 2.3–32.5 mos), and 23/27 were escalated as planned to daily. Subsequently, 12/27 (44%) pts had their dose either reduced or interrupted for toxicity, which was cutaneous in 10/12 (83%) pts. However, the incidence of = grade 2 toxicity was low apart from alopecia (24%), rash (18%) and fatigue (15%). During follow-up (36 mo) 22/27 (81%) pts stopped E due to progressive disease and 3/27 (11%) stopped E due to cutaneous toxicity. Only 2/27 (7%) pts continue to receive E without evidence of progression, both at doses less than 150mg, again due to cutaneous toxicity. Pts receiving maintenance E had a median progression-free survival of 14.8 mo (95% CI 12.6–17.1 mo) and median overall survival 37.0 mo (95% ci 31.6–42.4 mo); for all pts these figures were 12.5 mo (95% CI 9.1–15.9 mo) respectively, and 37.0 mo (95% ci 27.3–46.7 mo). Conclusions: Maintenance E at 150mg daily following initial treatment with E plus docetaxel-carboplatin for ovarian carcinoma is associated with cutaneous toxicity which limits the dose and duration of treatment in a proportion of pts. The potential benefit of this approach can only be addressed in a randomized trial, and this is now underway under the auspices of the EORTC. A parallel translational study will examine the possibility that patients most likely to benefit can be predicted by molecular tumor analysis. [Table: see text]
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Affiliation(s)
- P. A. Vasey
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - J. Paul
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - G. Rustin
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - R. Wilson
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - J. Guastalla
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - E. Pujade-Lauraine
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - M. Gore
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - H. Gabra
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - K. Carty
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
| | - S. Kaye
- HOCA, Brisbane, Australia; Beatson Oncology Centre, Glasgow, United Kingdom; Mount Vernon Hospital, London, United Kingdom; Queen’s University, Belfast, United Kingdom; Centre Leon Berard, Lyon, France; Hôpital Hôtel-Dieu, Paris, France; Royal Marsden Hospital, London, United Kingdom; Hammersmith Hospital, London, United Kingdom
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King L, Nelson R, Hudson R, Gore M, He Q, Marcelpoil R, Morel D, Whitehead C, Fischer T, Malinowski D. P49 Molecular characterization of E2F1 and PSMB9 expression in breast cancer and correlation with poor prognosis and disease recurrence. Breast 2007. [DOI: 10.1016/s0960-9776(07)70114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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