1
|
Harbeck N, Wrobel D, Zaiss M, Terhaag J, Guth D, Distelrath A, Zahn MO, Wuerstlein R, Lorenz A, Bartsch R, Breitenstein U, Schwitter M, Balic M, Jackisch C, Müller V, Rinnerthaler G, Schmidt M, Zaman K, Schinköthe T, Resch A, Valenti R, Lüftner D. Neratinib as Extended Adjuvant Treatment of HER2-Positive/HR-Positive Early Breast Cancer Patients in Germany, Austria, and Switzerland: Interim Results of the Prospective, Observational ELEANOR Study. Breast Care (Basel) 2024; 19:1-9. [PMID: 38384488 PMCID: PMC10878708 DOI: 10.1159/000533657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/15/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction Prognosis of patients diagnosed with HER2+ early breast cancer (eBC) has substantially improved, but distant recurrences impacting quality of life and survival still occur. One treatment option for extended adjuvant treatment of patients with HER2+/HR+ eBC is neratinib, available in Europe for patients who completed adjuvant trastuzumab-based therapy within 1 year. The ELEANOR study is investigating the real-world use of neratinib in Germany, Austria, and Switzerland. Results from an interim analysis of the first 200 patients observed for ≥3 months are reported. Methods The primary objective of this prospective, multicenter, observational study is to assess patient adherence to neratinib (defined as the percentage of patients taking neratinib on ≥75% prescribed days). Secondary objectives are patient characteristics and treatment outcomes. Results At cut-off (May 2, 2022), a total of 202 patients had been observed for ≥3 months, with neratinib treatment documented for 187 patients (median age: 53.0 years; 67.9% at increased risk of disease recurrence). In total, 151 (80.7%) patients had received prior neoadjuvant treatment; of these, 82 (54.3%) patients achieved a pathologically complete response. Neratinib was initiated at a median 3.6 months after trastuzumab-based treatment, with 36.4% starting at a dose <240 mg/day. Treatment is ongoing for 46.0% of patients, with median treatment duration of 11.2 (interquartile range 0.9-12.0) months. Diarrhea was the most common adverse event (78.6% any grade, 20.3% grade ≥3); pharmacologic prophylaxis was used in 85.6% of patients. Conclusions The pattern of anti-HER2 pretreatment observed reflected the current treatment for HER2+/HR+ eBC in Germany, Austria, and Switzerland. These interim results suggest that neratinib as an extended adjuvant is a feasible option after various anti-HER2 pretreatments and that its tolerability can be managed and improved with proactive diarrhea management.
Collapse
Affiliation(s)
- Nadia Harbeck
- Department of Obstetrics and Gynecology and CCC Munich, Breast Center, LMU University Hospital, Munich, Germany
| | - Denise Wrobel
- Sozialstiftung Bamberg Klinikum am Bruderwald, Bamberg, Germany
| | - Matthias Zaiss
- Praxis fuer Interdisziplinaere Onkologie, Freiburg, Germany
| | | | - Dagmar Guth
- Gyneco-Oncological Practice Dr. Guth, Plauen, Germany
| | | | | | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology and CCC Munich, Breast Center, LMU University Hospital, Munich, Germany
| | - Andreas Lorenz
- Gyneco-Oncological Practice Dr. Lorenz, Hildburghausen, Germany
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | | | - Marija Balic
- Divison of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Klinikum Offenbach, Offenbach, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Marcus Schmidt
- Department of Gynecology, University Hospital Mainz, Mainz, Germany
| | - Khalil Zaman
- Breast Center, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | - Anna Resch
- Pierre Fabre Pharma GmbH, Freiburg, Germany
| | | | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| |
Collapse
|
2
|
Decker T, Lüdtke-Heckenkamp K, Melnichuk L, Hirmas N, Lübbe K, Zahn MO, Schmidt M, Denkert C, Lorenz R, Müller V, Zahm DM, Mundhenke C, Bauer S, Thill M, Seropian P, Filmann N, Loibl S. Anti-hormonal maintenance treatment with the CDK4/6 inhibitor ribociclib after 1st line chemotherapy in hormone receptor positive / HER2 negative metastatic breast cancer: A phase II trial (AMICA). Breast 2023; 72:103575. [PMID: 37690320 PMCID: PMC10507224 DOI: 10.1016/j.breast.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
PURPOSE This phase II study evaluated the impact of adding ribociclib to maintenance endocrine therapy (ET) treatment of physicians' choice following the first palliative chemotherapy in pre- and post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor 2 negative (HER2-) metastatic breast cancer (mBC). PATIENTS AND METHODS The initial randomized study design was later amended into a single-arm study, and all subsequent patients received ribociclib and ET. The primary end point was locally assessed progression-free survival (PFS). Secondary end points included overall survival (OS), clinical benefit rate (CBR), safety, compliance, and quality of life (QoL). RESULTS A total of 43 patients received ribociclib + ET and 10 patients received ET only. Median PFS was 12.4 months [95% CI 8.7-24.4] for patients who received ribociclib + ET and 4.75 months [95% CI 1.0-10.3] for those who received ET only. Median OS was not reached for patients who received ribociclib + ET, and 28 (65.1%) patients experienced clinical benefit [95% CI 49.1-79.0]. For patients who received ribociclib + ET, grade 3-4 hematological adverse events (AEs) occurred in 25 (58.1%) patients, and grade 3-4 non-hematological AEs occurred in 17 (39.5%) patients. During the study, 15 patients died - 14 of whom due to tumor-related reasons, and one patient due to pneumonia, which was not treatment-related. CONCLUSION The results of the AMICA study show a promising efficacy and safety of maintenance treatment with ribociclib added to ET after at least stable disease following the first metastatic chemotherapy in patients with HR+/HER2-mBC. TRIAL REGISTRATION Anti-hormonal Therapy With Ribociclib in HR-positive/HER2- Negative Metastatic Breast Cancer (AMICA), NCT03555877, https://clinicaltrials.gov/ct2/show/NCT03555877.
Collapse
Affiliation(s)
| | | | | | - Nader Hirmas
- German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany
| | - Kristina Lübbe
- Diakovere Henriettenstift, Breast Center, Hannover, Germany
| | | | | | - Carsten Denkert
- Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Ralf Lorenz
- Frauenärztliche Gemeinschaftspraxis Braunschweig, Germany
| | - Volkmar Müller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Stefan Bauer
- Gemeinschaftspraxis für Hämatologie und Onkologie, Lebach, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus Frankfurt, Germany
| | | | - Natalie Filmann
- German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany
| | - Sibylle Loibl
- German Breast Group (GBG) Forschungs GmbH, Neu-Isenburg, Germany; Centre for Haematology and Oncology/Bethanien Frankfurt/M Freudenstadt, Germany.
| |
Collapse
|
3
|
Bartsch R, Harbeck N, Wrobel D, Zaiss M, Terhaag J, Guth D, Distelrath A, Wuerstlein R, Zahn MO, Lüftner D, Schwitter M, Balic M, Jackisch C, Müller V, Rinnerthaler G, Schmidt M, Zaman K, Schinköthe T, Resch A, Breitenstein U. Abstract P2-01-01: Interim analysis (n=200) from ELEANOR: a multi-national, prospective, non-interventional study among patients with HER2+ and HR+ early breast cancer treated with extended adjuvant neratinib in the clinical routine. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background Recent advances in the treatment of human epidermal growth factor receptor positive (HER2+) early breast cancer (eBC) have led to a reduction in recurrence risk; still a relevant percentage of patients relapses over time, predominantly presenting with distant recurrence. Neratinib is registered in Europe as extended adjuvant treatment for adult patients with HER2+, hormone receptor positive (HR+) eBC, who completed adjuvant trastuzumab-based therapy within one year prior to start of neratinib. In the ExteNET study, neratinib improved the absolute 5-year invasive disease-free survival (iDFS) rate by 5.1% versus placebo in this population (90.8% vs. 85.7%; HR 0.58 [95% CI 0.41-0.82]), mainly by reducing the rate of distant metastases. According to explorative analyses from ExteNET, the effect may be even more pronounced in patients with non-pCR after neoadjuvant trastuzumab treatment and/or in patients completing the full duration of neratinib therapy (i.e. ≥11 months of neratinib treatment). Diarrhea, the most common grade 3 adverse event (neratinib: 39% without primary diarrhea prophylaxis, median cumulative duration 5 days; placebo: 1%; no grade 4 events) can generally be managed through adequate prophylaxis and treatment management. ELEANOR is the first non-interventional study (NIS) of real-world use of neratinib and its management in eBC patients in Germany, Austria and Switzerland. Methods Enrollment of 300 adult female patients with HER2+/HR+ eBC is planned in accordance with the SmPC specifications. Primary endpoint is the rate of patients adherent to neratinib treatment (i.e. neratinib use for ≥75% of treatment days). Secondary objectives include characterization of patients scheduled to receive neratinib, details on neratinib treatment, recurrences, safety/tolerability, and health-related quality of life (HRQoL). CANKADO, an eHealth application developed to support patient/physician communication, is an integral part of the NIS. Here, we report results of the preplanned interim analysis based on 200 enrolled patients. Results At data cut-off (May 2022), 202 patients had been observed for 3 months; patient enrollment is ongoing. Median age was 53.0 years and 66.3% of patients were at increased risk of disease recurrence (defined as non-pCR or AJCC stage > I). Most patients had received prior neoadjuvant treatment (79.7%). Post-neoadjuvant treatment included dual HER2 blockade with trastuzumab and pertuzumab (38.8%/23.9% of pCR/non-pCR patients) and trastuzumab-emtansine (T-DM1, 53.5% of non-pCR patients). Neratinib treatment had been documented for 187 patients, treatment was ongoing for 46.0% of patients. Diarrhea was the most common adverse event (78.6% any grade, 19.3% grade 3, 2 patients grade 4), but was markedly lower when indirectly compared to ExteNET (39% grade 3). The neratinib dose escalation schedule was chosen for 36.4% of patients and led to a decreased incidence of severe diarrhea (16.2% grade 3, no grade 4 events). 93.9% (95% CI: 87.9-97.5%) of 115 evaluable patients adhered to neratinib treatment. Conclusion The results of this preplanned interim analysis reflect the current treatment landscape in Germany, Austria and Switzerland. These results confirm, in line with the observed adherence data, that extended adjuvant neratinib use is feasible in typical clinical practice settings. Furthermore, treatment management strategies such as diarrhea prophylaxis or neratinib dose escalation are routinely used and can increase treatment tolerability markedly. The study is funded by Pierre Fabre Pharma GmbH (Freiburg, Germany), Pierre Fabre Pharma Austria (Wels, Austria) and Pierre Fabre Pharma AG (Allschwil, Switzerland).
Citation Format: Rupert Bartsch, Nadia Harbeck, Denise Wrobel, Matthias Zaiss, Jürgen Terhaag, Dagmar Guth, Andrea Distelrath, Rachel Wuerstlein, Mark-Oliver Zahn, Diana Lüftner, Michael Schwitter, Marija Balic, Christian Jackisch, Volkmar Müller, Gabriel Rinnerthaler, Marcus Schmidt, Khalil Zaman, Timo Schinköthe, Anna Resch, Urs Breitenstein. Interim analysis (n=200) from ELEANOR: a multi-national, prospective, non-interventional study among patients with HER2+ and HR+ early breast cancer treated with extended adjuvant neratinib in the clinical routine [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-01-01.
Collapse
Affiliation(s)
- Rupert Bartsch
- 1Medical University of Vienna, Department of Medicine I, Division of Oncology, Vienna, Austria
| | | | - Denise Wrobel
- 3Sozialstiftung Bamberg Klinikum am Bruderwald, Bamberg, Germany
| | | | | | - Dagmar Guth
- 6Gyneco-oncological practice Dr. Guth, Plauen, Germany
| | | | - Rachel Wuerstlein
- 8Breast Center, Dept. OB&GYN and CCC Munich, LMU University Hospital, Munich, Germany
| | | | - Diana Lüftner
- 10Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Brandenburg, Berlin, Germany
| | | | - Marija Balic
- 12Divison of Oncology, Department of Internal Medicine, Medical University Graz, Austria
| | - Christian Jackisch
- 13Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Germany
| | - Volkmar Müller
- 14Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Rinnerthaler
- 15Department of internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute – Laboratory for Immunological an Molecular Cancer Research (SCI-LIMCR), Paracelsus Medical University, Salzburg Austria, Cancer Cluster Salzburg, Austria
| | - Marcus Schmidt
- 16Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - Khalil Zaman
- 17Breast Center, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | | | | |
Collapse
|
4
|
Grünwald V, Boegemann M, Rafiyan MR, Niegisch G, Schnabel MJ, Flörcken A, Maasberg M, Maintz C, Zahn MO, Wortmann A, Hinkel A, Casper J, Darr C, Hilser T, Schulze M, Sookthai D, Schoenherr C, Ivanyi P. Final analysis of a non-interventional study on cabozantinib in patients with advanced renal cell carcinoma after prior checkpoint inhibitor therapy (CaboCHECK). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
357 Background: Data for cabozantinib after IO-combinations in metastatic renal cell carcinoma (mRCC) remain scarce. We therefore evaluated safety and effectiveness of cabozantinib after failure of IO-based therapies. Methods: Data from patients (pts) with mRCC and cabozantinib treatment after IO-based therapy was retrospectively collected from medical records. Primary endpoint was the incidence of serious adverse events (SAEs). Response rate was assessed clinically (CRR) and/or according to RECIST 1.1. Overall Survival (OS) and Progression Free Survival (PFS) were assessed from start of therapy and data were compared for pts with starting dose of 60 mg (cohort A) vs < 60 mg (cohort B) in a post-hoc analysis. Descriptive statistics and KM-plots were utilized, where appropriate. Results: This final analysis (cut off 08-Oct-21) assessed 56 eligible pts (71.4% male) with median age of 66 yrs. 87.5% (n = 49) had previous nephrectomy. 66.1% (n = 37) had clear cell RCC. 89.3% (n = 50) had ≥2 previous lines. ECOG ≤1 was 33.9% (n = 19). IMDC factors were 0 in 2 (3.6%), ≥1 in 21 (37.5%), missing in 31 pts (55.4%). 62.5% (n = 35) started at reduced dose. 55.4% (n = 31) required dose reductions and 1.8% (n = 1) discontinuation. Median treatment duration was 6.1 months (m). PR was 10.7% (n = 6), SD 19.6% (n = 11), PD 12.5% (n = 7) and missing in 57.1% (n = 32). Median OS and PFS were 15.34 m (95% CI 8.94, 20.93) and 6.34 m (95% CI 5.29, 8.25) in the ITT, 10.48 m (95% CI 6.01, 34.14) and 6.51 m (95% CI 2.99, 10.87) in cohort A and 16.46 m (95% CI 9.56, 23.33) and 6.34 m (95% CI 4.86, 8.71) in cohort B, respectively. All grade AEs and grade 3-5 AEs were 87.5% (n = 49) and 44.6% (n = 25) in the ITT, 95.0% (n = 19) and 55.0% (n = 11) in cohort A and 85.7% (n = 30) and 40.0% (n = 14) in cohort B. SAEs were reported in 21.4% (n = 12) of pts, which were 30.0% (n = 6) of cohort A and 17.1% (n = 6) of cohort B. Treatment related SAEs were reported in 10.7% (n = 6) of pts, which were 15.0% (n = 3) in cohort A and 8.6% (n = 3) in cohort B. Conclusions: Cabozantinib directly after IO therapy was safe and feasible. No new safety signals were reported. A reduced starting dose was frequently utilized and was not associated with adverse outcomes. Our data supports the use of cabozantinib after IO-failure. Major limitation was the retrospective nature of our study.[Table: see text]
Collapse
Affiliation(s)
- Viktor Grünwald
- Universitätsklinikum Essen (AöR), Westdeutsches Tumorzentrum Essen, Innere Klinik (Tumorforschung), Essen, Germany
| | - Martin Boegemann
- Universitätsklinikum Münster, Westdeutsches Tumorzentrum Münster, Klinik für Urologie und Kinderurologie, Münster, Germany
| | - Mohammad-Reza Rafiyan
- Krankenhaus Nordwest gGmbH, Institut für Klinisch-Onkologische Forschung (IKF), Frankfurt, Germany
| | - Guenter Niegisch
- Universitätsklinikum Düsseldorf, Klinik für Urologie, Konservative Urologische Onkologie, Düsseldorf, Germany
| | - Marco Julius Schnabel
- Klinik für Urologie der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg, Germany
| | - Anne Flörcken
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Medizinische Klinik m.S. Hämatologie, Onkologie und Tumorimmunologie, Berlin, Germany
| | | | | | | | - Anke Wortmann
- Onkologiezentrum Soest-Iserlohn, Medizinisches Versorgungszentrum GbR, Soest-Paradiese, Germany
| | - Andreas Hinkel
- Franziskus Hospital Bielefeld, Onkologisches Zentrum, Bielefeld, Germany
| | - Jochen Casper
- Klinikum Oldenburg AöR, Universitätsklinik für Innere Medizin - Onkologie und Hämatologie, Oldenburg, Germany
| | | | - Thomas Hilser
- Universitätsklinikum Essen (AöR), Westdeutsches Tumorzentrum Essen, Innere Klinik (Tumorforschung), Essen, Germany
| | | | - Disorn Sookthai
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Caroline Schoenherr
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Philipp Ivanyi
- Medizinisch Hochschule Hannover, Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Hannover, Germany
| |
Collapse
|
5
|
Zaiss M, Uhlig J, Zahn MO, Decker T, Lehmann HC, Harde J, Hogrefe C, Vannier C, Marschner N. Improving Chemotherapy-Induced Peripheral Neuropathy in Patients with Breast or Colon Cancer after End of (Neo)adjuvant Therapy: Results from the Observational Study STEFANO. Oncol Res Treat 2021; 44:613-621. [PMID: 34496363 DOI: 10.1159/000519000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect persisting after completion of neurotoxic chemotherapies. This observational study was designed to evaluate the effectiveness of the dietary supplement OnLife® (patented mixture of specific fatty acids and palmitoylethanolamide) in improving symptoms of CIPN in breast and colon cancer patients. METHODS Improvement of CIPN was evaluated in adult patients, previously treated with (neo)adjuvant paclitaxel- (breast cancer) or oxaliplatin-based (colon cancer) therapies, receiving OnLife® for 3 months after completion of chemotherapy. The primary endpoint was to compare the severity of peripheral sensory neuropathy (PSN) and peripheral motor neuropathy (PMN) before and at the end of OnLife® treatment. Secondary endpoints included the assessment of patient-reported quality of life and CIPN symptoms as assessed by questionnaires. RESULTS 146 patients (n = 75 breast cancer patients and n = 71 colon cancer patients) qualified for analysis; 31.1% and 37.5% of breast cancer patients had an improvement of PSN and PMN, respectively. In colon cancer patients, PSN and PMN improved in 16.9% and 20.0% of patients, respectively. According to patient-reported outcomes, 45.9% and 37.5% of patients with paclitaxel-induced PSN and PMN, and 23.9% and 22.0% of patients with oxaliplatin-induced PSN and PMN experienced a reduction of CIPN symptoms, respectively. CONCLUSION OnLife® treatment confirmed to be beneficial in reducing CIPN severity and in limiting the progression of neuropathy, more markedly in paclitaxel-treated patients and also in patients with oxaliplatin-induced CIPN.
Collapse
Affiliation(s)
- Matthias Zaiss
- Practice for Interdisciplinary Oncology and Hematology, Freiburg im Breisgau, Germany
| | - Jens Uhlig
- Practice for Internal Medicine, Hematology and Oncology, Naunhof, Germany
| | - Mark-Oliver Zahn
- Outpatient Center for Oncology, MVZ Onkologische Kooperation Harz, Goslar, Germany
| | - Thomas Decker
- Practice for Hematology and Oncology, Ravensburg, Germany
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Köln, Germany
| | - Johanna Harde
- Department of Data Management, Statistics and Medical Informatics, iOMEDICO, Freiburg im Breisgau, Germany
| | - Cathrin Hogrefe
- Department of Clinical Operations, iOMEDICO, Freiburg im Breisgau, Germany
| | - Corinne Vannier
- Medical Department, iOMEDICO, Freiburg im Breisgau, Germany,
| | | |
Collapse
|
6
|
Griesinger F, Eberhardt W, Nusch A, Reiser M, Zahn MO, Maintz C, Bernhardt C, Losem C, Stenzinger A, Heukamp LC, Büttner R, Marschner N, Jänicke M, Fleitz A, Spring L, Sahlmann J, Karatas A, Hipper A, Weichert W, Heilmann M, Sadjadian P, Gleiber W, Grah C, Waller CF, Reck M, Rittmeyer A, Christopoulos P, Sebastian M, Thomas M. Corrigendum to "Biomarker testing in non-small cell lung cancer in routine care: Analysis of the first 3,717 patients in the German prospective, observational, nation-wide CRISP registry (AIO-TRK-0315)" [Lung Cancer 152 (2021) 174-184]. Lung Cancer 2021; 157:167. [PMID: 34049721 DOI: 10.1016/j.lungcan.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Frank Griesinger
- Pius-Hospital Oldenburg, Universitätsklinik für Innere Medizin, Oldenburg, Germany.
| | - Wilfried Eberhardt
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center and Ruhrlandklinik, University Duisburg-Essen, Germany
| | - Arnd Nusch
- Praxis für Hämatologie und internistische Onkologie, Ratingen, Germany
| | - Marcel Reiser
- PIOH - Praxis internistische Onkologie und Hämatologie, Köln, Germany
| | | | | | | | - Christoph Losem
- MVZ für Onkologie und Hämatologie im Rhein-Kreis, Neuss, Germany
| | | | - Lukas C Heukamp
- Hämatopathologie Hamburg, Hamburg, Germany; Lungen Netzwerk NOWEL.org, Oldenburg, Germany
| | - Reinhard Büttner
- Institut für Pathologie des Universitätsklinikums Köln, Köln, Germany
| | - Norbert Marschner
- Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Annette Fleitz
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Lisa Spring
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | | | - Wilko Weichert
- Institut für Pathologie, Technische Universität München und German Cancer Consortium (DKTK), Partner site Munich, München, Germany
| | | | - Parvis Sadjadian
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Germany
| | - Wolfgang Gleiber
- Universitätsklinikum Frankfurt, Medizinische Klinik I, Schwerpunkt Pneumologie/Allergologie, Frankfurt, Germany
| | - Christian Grah
- MVZ Havelhöhe am Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Cornelius F Waller
- Medizinische Klinik I, Hämatologie, Onkologie und Stammzelltransplantation, Fakultät für Medizin, Universitätsklinikum Freiburg, Germany
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | | | - Petros Christopoulos
- Onkologie der Thoraxtumore, Thoraxklinik Heidelberg gGmbH, German Center for Lung Research, Germany
| | - Martin Sebastian
- Medizinische Klinik II, Hämatologie/Onkologie, Universitätsklinikum Frankfurt, Germany
| | - Michael Thomas
- Onkologie der Thoraxtumore, Thoraxklinik Heidelberg gGmbH, German Center for Lung Research, Germany
| | | |
Collapse
|
7
|
Hofheinz RD, Kröning H, Zahn MO, Scholten F, Derigs HG, Pederiva S, Anchisi S, Bohanes PO, Gruenberger B, Windemuth-Kieselbach C, Piringer G, Thaler J, Moos RV. Impact of RAS status and prior targeted therapy on the activity of aflibercept plus FOLFIRI in patients with metastatic colorectal cancer (mCRC) in daily practice. Final results of the QoLiTrap prospective non-interventional study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e15570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15570 Background: The anti-angiogenic fusion protein aflibercept targets VEGF-A, VEGF-B and PIGF. It is approved in combination with FOLFIRI for treatment of mCRC previously treated with an oxaliplatin-containing regimen. We evaluated the influence of RAS status and prior targeted therapy on the efficacy and safety of aflibercept plus FOLFIRI in daily practice. Methods: QoLiTrap is a large international (Germany, Austria, Switzerland), non-interventional study evaluating the quality of life (QoL), efficacy and safety of aflibercept plus FOLFIRI in daily clinical practice. The primary endpoint was QoL assessed by EORTC QLQ-C30 questionnaire. Secondary endpoints included overall survival (OS), progression-free survival (PFS), tumor response and safety. Patients were evaluable for primary and secondary endpoint analysis if they had a QoL questionnaire at baseline and at least 2 post baseline. Safety was analyzed in all patients exposed to at least one dose of study drug. We report here the results by RAS status and prior targeted therapy received. Results: 1277 patients with mCRC were treated (median age 66 years, males 64.8%, right colon tumor 27.6%, liver metastases 53.2% , ECOG 0-1 84.7%) mainly in second-line (50.3%) but also in third-line (23.1%) and fourth-line (11.9%) setting. Median duration of treatment was 12 weeks. Overall, 872 patients were evaluable for the efficacy analysis. At baseline, the global health (mean) score was 58.7 and the mean change from baseline over 12 weeks was -4.6%. A clinically meaningful decline of -10 points was not reached, regardless of RAS status and prior targeted therapy. Secondary endpoints are provided in the Table below. Most common all grade adverse events were diarrhea (34.2%), nausea (17.9%), fatigue (17.2%), stomatitis (17.2%) and hypertension (11.6%). Conclusions: Aflibercept plus FOLFIRI administered in daily practice shows no deleterious effect on QoL and retains its activity irrespective of RAS status and prior targeted therapy. The safety profile was manageable. Clinical trial information: AIO-LQ-0113. [Table: see text]
Collapse
Affiliation(s)
| | - Hendrik Kröning
- Schwerpunktpraxis Hämatologie und Onkologie, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Metz M, Semsek D, Rogmans G, Hutzschenreuter U, Fietz T, Harde J, Zacharias S, Hielscher C, Lorenz A, Zahn MO, Guth D, Liebers S, Berghorn M, Grebhardt S, Matillon CD, Egerer G, Potthoff K. Patient, nurse, and physician preferences: final results of the CONVENIENCE study evaluating pegfilgrastim prophylaxis via pre-filled syringe or on-body injector in cancer patients. Support Care Cancer 2021; 29:6633-6643. [PMID: 33956213 PMCID: PMC8464571 DOI: 10.1007/s00520-021-06230-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
Purpose The on-body injector (OBI) automatically delivers pegfilgrastim the day after chemotherapy (CTx), thus eliminating the need of return visits to the medical office for guideline-compliant pegfilgrastim administration. The CONVENIENCE study aimed to evaluate patient, nurse, and physician preferences as well as health economics for pegfilgrastim administration either with OBI or manually using a pre-filled syringe (PS). Methods Patients with early breast cancer, receiving two or three weekly anthracycline/cyclophosphamide or three weekly taxane-based CTx, and patients with Non-Hodgkin lymphoma (NHL) receiving first-line R-CHOP-14 or -21 were randomized 1:1 to receive both pegfilgrastim application forms for four consecutive CTx cycles in an alternating sequence starting either with OBI or PS. Primary endpoint was patient preference, assessed by questionnaires. Results A total of 308 patients were evaluable in the per-protocol analysis. Patients slightly preferred OBI over PS (OBI, n = 133, 43.2%; vs. PS, n = 111, 36.0%; p-value = 0.159), while study nurses slightly preferred PS (n = 19, 46.3%) over OBI (n = 18, 43.9%) and physicians clearly preferred PS (n = 24, 58.8%) over OBI (n = 15, 36.6%). Among patients with preference for OBI, saving of time was their major reason for preference (53.4%). Pegfilgrastim was administered 24–72 h after each CTx cycle in 97.6% of OBI and 63.1% of PS applications. Conclusion The OBI was slightly preferred by patients and saving time was the major reason for their preference. PS was physicians’ most preferable choice and slightly preferred by nurses. Using OBI, pegfilgrastim was almost always administered within the time period recommended by current guidelines, while it was often not applied as specified using PS. Trial registration No: ClinicalTrials.gov No. NCT03619993. Registered on June 25, 2018
Collapse
Affiliation(s)
| | - Dieter Semsek
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg im Breisgau, Germany
| | - Gunther Rogmans
- ZAGO- Zentrum für ambulante gynäkologische Onkologie, Krefeld, Germany
| | | | - Thomas Fietz
- Schwerpunktpraxis für Hämatologie und Internistische Onkologie, Gastroenterologie, Singen, Germany
| | | | | | | | - Andreas Lorenz
- Gynäkologische Onkologie, Frauenarztpraxis Dr. Lorenz, Hildburghausen, Germany
| | - Mark-Oliver Zahn
- Überörtliche Berufsausübungsgemeinschaft MVZ Onkologische Kooperation Harz, Goslar, Germany
| | - Dagmar Guth
- Gynäkologische Onkologie, Praxis Dr. med. Dagmar Guth, Plauen, Germany
| | | | | | | | | | - Gerlinde Egerer
- Universitätsklinikum Heidelberg, Klinik Für Hämatologie, Onkologie, Rheumatologie, Heidelberg, Germany
| | | |
Collapse
|
9
|
Knauf W, Abenhardt W, Koenigsmann M, Maintz C, Sandner R, Zahn MO, Schnell R, Tech S, Kaiser-Osterhues A, Houet L, Marschner N. Rare lymphomas in routine practice - Treatment and outcome in marginal zone lymphoma in the prospective German Tumour Registry Lymphatic Neoplasms. Hematol Oncol 2021; 39:313-325. [PMID: 33942348 PMCID: PMC8453851 DOI: 10.1002/hon.2868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 12/26/2022]
Abstract
Owing to its heterogeneity and rarity, management of disseminated marginal zone B‐cell lymphoma (MZL) remains largely understudied. We present prospective data on choice of systemic treatment and survival of patients with MZL treated in German routine practice. Of 175 patients with MZL who had been documented in the prospective clinical cohort study Tumour Registry Lymphatic Neoplasms (NCT00889798) collecting data on systemic treatment, 58 were classified as extranodal MZL of mucosa‐associated lymphoid tissue (MALT) and 117 as non‐MALT MZL. We analyzed the most commonly used first‐line and second‐line chemo(immuno)therapies between 2009 and 2016 and examined objective response rate (ORR), progression‐free survival (PFS), overall survival (OS) and prognostic factors for survival. Compared to patients with MALT MZL, those with non‐MALT MZL more often presented with bone marrow involvement (43% vs. 14%), Ann Arbor stage III/IV (72% vs. 57%) and were slightly less often in good general condition (ECOG = 0; 41% vs. 47%). In German routine practice, rituximab‐bendamustine for a median of 6 cycles was the most frequently used first‐line (76%) and second‐line treatment (36%), with no major differences between MZL subtypes. The ORR for patients encompassing any positive response was 81%. For patients with MALT and non‐MALT MZL, respectively, 5‐years PFS was 69% (95% CI 52%–81%) and 66% (95% CI 56%–75%), 5‐years OS 79% (95% CI 65%–89%) and 75% (95% CI 66%–83%). Cox proportional hazards models showed a significantly increased risk of mortality for higher age in all patient groups. Our prospective real world data give valuable insights into the management and outcome of non‐selected patients with MZL requiring systemic treatment and can help optimize therapy recommendations.
Collapse
Affiliation(s)
- Wolfgang Knauf
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt/Main, Germany
| | | | - Michael Koenigsmann
- Onkologisches Ambulanzzentrum am Diakovere Henriettenstift gGmbH, Hannover, Germany
| | - Christoph Maintz
- Medizinisches Versorgungszentrum West GmbH Würselen Hämatologie-Onkologie, Würselen, Germany
| | | | - Mark-Oliver Zahn
- Medizinisches Versorgungszentrum Onkologische Kooperation, Goslar, Germany
| | - Roland Schnell
- Praxis Internistischer Onkologie und Hämatologie (PIOH), Frechen, Germany
| | - Susanne Tech
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | - Norbert Marschner
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | |
Collapse
|
10
|
Griesinger F, Eberhardt W, Nusch A, Reiser M, Zahn MO, Maintz C, Bernhardt C, Losem C, Stenzinger A, Heukamp LC, Büttner R, Marschner N, Jänicke M, Fleitz A, Spring L, Sahlmann J, Karatas A, Hipper A, Weichert W, Heilmann M, Sadjadian P, Gleiber W, Grah C, Waller CF, Reck M, Rittmeyer A, Christopoulos P, Sebastian M, Thomas M. Biomarker testing in non-small cell lung cancer in routine care: Analysis of the first 3,717 patients in the German prospective, observational, nation-wide CRISP Registry (AIO-TRK-0315). Lung Cancer 2020; 152:174-184. [PMID: 33358484 DOI: 10.1016/j.lungcan.2020.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES An increasing number of treatment-determining biomarkers has been identified in non-small cell lung cancer (NSCLC) and molecular testing is recommended to enable optimal individualized treatment. However, data on implementation of these recommendations in the "real-world" setting are scarce. This study presents comprehensive details on the frequency, methodology and results of biomarker testing of advanced NSCLC in Germany. PATIENTS AND METHODS This analysis included 3,717 patients with advanced NSCLC (2,921 non-squamous; 796 squamous), recruited into the CRISP registry at start of systemic therapy by 150 German sites between December 2015 and June 2019. Evaluated were the molecular biomarkers EGFR, ALK, ROS1, BRAF, KRAS, MET, TP53, RET, HER2, as well as expression of PD-L1. RESULTS In total, 90.5 % of the patients were tested for biomarkers. Testing rates were 92.2 % (non-squamous), 70.7 % (squamous) and increased from 83.2 % in 2015/16 to 94.2% in 2019. Overall testing rates for EGFR, ALK, ROS1, and BRAF were 72.5 %, 74.5 %, 66.1 %, and 53.0 %, respectively (non-squamous). Testing rates for PD-L1 expression were 64.5 % (non-squamous), and 58.5 % (squamous). The most common testing methods were immunohistochemistry (68.5 % non-squamous, 58.3 % squamous), and next-generation sequencing (38.7 % non-squamous, 14.4 % squamous). Reasons for not testing were insufficient tumor material or lack of guideline recommendations (squamous). No alteration was found in 37.8 % (non-squamous), and 57.9 % (squamous), respectively. Most common alterations in non-squamous tumors (all patients/all patients tested for the respective biomarker): KRAS (17.3 %/39.2 %), TP53 (14.1 %/51.4 %), and EGFR (11.0 %/15.1 %); in squamous tumors: TP53 (7.0 %/69.1 %), MET (1.5 %/11.1 %), and EGFR (1.1 %/4.4 %). Median PFS (non-squamous) was 8.7 months (95 % CI 7.4-10.4) with druggable EGFR mutation, and 8.0 months (95 % CI 3.9-9.2) with druggable ALK alterations. CONCLUSION Testing rates in Germany are high nationwide and acceptable in international comparison, but still leave out a significant portion of patients, who could potentially benefit. Thus, specific measures are needed to increase implementation.
Collapse
Affiliation(s)
- Frank Griesinger
- Pius-Hospital Oldenburg, Universitätsklinik für Innere Medizin, Oldenburg, Germany.
| | - Wilfried Eberhardt
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätszentrum Essen, Germany
| | - Arnd Nusch
- Praxis für Hämatologie und internistische Onkologie, Ratingen, Germany
| | - Marcel Reiser
- PIOH - Praxis internistische Onkologie und Hämatologie, Köln, Germany
| | | | | | | | - Christoph Losem
- MVZ für Onkologie und Hämatologie im Rhein-Kreis, Neuss, Germany
| | | | - Lukas C Heukamp
- Hämatopathologie Hamburg, Hamburg, Germany; Lungen Netzwerk NOWEL.org, Oldenburg, Germany
| | - Reinhard Büttner
- Institut für Pathologie des Universitätsklinikums Köln, Köln, Germany
| | - Norbert Marschner
- Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Annette Fleitz
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Lisa Spring
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | | | - Wilko Weichert
- Institut für Pathologie, Technische Universität München und German Cancer Consortium (DKTK), partner site Munich, München, Germany
| | | | - Parvis Sadjadian
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Germany
| | - Wolfgang Gleiber
- Universitätsklinikum Frankfurt, Medizinische Klinik I, Schwerpunkt Pneumologie/Allergologie, Frankfurt, Germany
| | - Christian Grah
- MVZ Havelhöhe am Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Cornelius F Waller
- Medizinische Klinik I, Hämatologie, Onkologie und Stammzelltransplantation; Fakultät für Medizin, Universitätsklinikum Freiburg, Germany
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | | | - Petros Christopoulos
- Onkologie der Thoraxtumore, Thoraxklinik Heidelberg gGmbH, German Center for Lung Research (DZL), Germany
| | - Martin Sebastian
- Medizinische Klinik II, Hämatologie/Onkologie, Universitätsklinikum Frankfurt, Germany
| | - Michael Thomas
- Onkologie der Thoraxtumore, Thoraxklinik Heidelberg gGmbH, German Center for Lung Research (DZL), Germany
| | | |
Collapse
|
11
|
Al-Batran SE, Hofheinz RD, Reichart A, Pauligk C, Schönherr C, Schlag R, Siegler G, Dörfel S, Koenigsmann M, Zahn MO, Schubert J, Aldaoud A, Höffkes HG, Schulz H, Hahn L, Uhlig J, Blau W, Stauch M, Weniger J, Wolf M, Jacobasch L, Bildat S, Wehmeyer J, Homann N, Trojan J, Waidmann O, Fietz T, Feustel HP, Groschek M, Wierecky J, Waibel K, Mahlmann S, Schwindel U, Peters U, Schuch G, Pink D, Eschenburg H, Wörns MA, Harich HD, von Weikersthal LF, Däßler KU, Behringer DM, Messmann H, Kretzschmar A, Gallmeier E, Forstbauer H, Kunzmann V, Papke J, Büchner-Steudel P, Vehling-Kaiser U, Springfeld C, Vogel A, Ettrich TJ, Schaaf M, Hausen GZ, Götze TO. Quality of life and outcome of patients with metastatic pancreatic cancer receiving first-line chemotherapy with nab-paclitaxel and gemcitabine: Real-life results from the prospective QOLIXANE trial of the Platform for Outcome, Quality of Life and Translational Research on Pancreatic Cancer registry. Int J Cancer 2020; 148:1478-1488. [PMID: 33038277 DOI: 10.1002/ijc.33336] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 01/05/2023]
Abstract
Few data exist on health-related quality of life (QoL) in patients with metastatic pancreatic cancer (mPC) receiving first-line chemotherapy (Awad L ZE, Mesbah M Boston, MA. Applying survival data methodology to analyze quality of life data, in Mesbah M, Cole BF, Ting Lee M-L (eds): Statistical Methods for Quality of Life Studies: Design, Measurements and Analysis. Kluwer Academic Publishers 2002). The QOLIXANE study is a prospective, noninterventional, multicenter substudy of the Platform for Outcome, Quality of Life and Translational Research on Pancreatic Cancer (PARAGON) registry, which evaluated QoL in patients with mPC receiving first-line gemcitabine and nab-paclitaxel chemotherapy in real-life setting. QoL was prospectively measured via EORTC QLQ-C30 questionnaires at baseline and every month thereafter. Therapy and efficacy parameters were prospectively collected. Main objectives were the rate of patients without deterioration of Global Health Status/QoL (GHS/QoL) at 3 and 6 months. Six hundred patients were enrolled in 95 German study sites. Median progression-free survival was 5.9 months (95% confidence interval [CI], 5.2-6.3). Median overall survival (OS) was 8.9 months (95% CI, 7.9-10.2), while median time to deterioration of GHS/QoL was 4.7 months (95% CI, 4.0-5.6). With a baseline GHS/QoL score of 46 (SD, 22.8), baseline QoL of the patients was severely impaired, in most cases due to loss in role functioning and fatigue. In the Kaplan-Meier analysis, 61% and 41% of patients had maintained GHS/QoL after 3 and 6 months, respectively. However, in the QoL response analysis, 35% and 19% of patients had maintained (improved or stable) GHS/QoL after 3 and 6 months, respectively, while 14% and 9% had deteriorated GHS/QoL with the remaining patients being nonevaluable. In the Cox regression analysis, GHS/QoL scores strongly predicted survival with a hazard ratio of 0.86 (P < .0001). Patients with mPC have poor QoL at baseline that deteriorates within a median of 4.7 months. Treatment with gemcitabine and nab-paclitaxel is associated with maintained QoL in relevant proportions of patients. However, overall, results remain poor, reflecting the aggressive nature of the disease.
Collapse
Affiliation(s)
- Salah-Eddin Al-Batran
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany.,Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Alexander Reichart
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany.,Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Claudia Pauligk
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Caroline Schönherr
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Rudolf Schlag
- Gemeinschaftspraxis Schlag/Schöttker, Würzburg, Germany
| | | | | | | | | | | | - Ali Aldaoud
- HELIOS Park-Klinikum, Pankreaszentrum Leipzig, Leipzig, Germany
| | - Heinz-Gert Höffkes
- Universitätsmedizin Marburg, Klinikum Fulda, Fulda, Germany.,MVZ Osthessen GmbH, Fulda, Germany
| | - Holger Schulz
- Pioh Frechen-Köln Praxis Internistischer Onkologie und Hämatologie, Frechen, Germany
| | - Lars Hahn
- Dokusan Gesellschaft für med. Studien GmbH und Co. KG, Herne, Germany
| | - Jens Uhlig
- Hämatologisch-Onkologische Schwerpunktpraxis, Naunhof, Germany
| | - Wolfgang Blau
- Medizinische Klinik IV/V des Universitätsklinikums Gießen und Marburg, Gießen, Germany
| | - Martina Stauch
- Schwerpunktpraxis für Hämatologie/Onkologie, Kronach, Germany
| | - Jörg Weniger
- Gemeinschaftspraxis für Hämatologie und Onkologie Dres. Weniger/Bittrich/Schütze, Erfurt, Germany
| | - Martin Wolf
- Klinikum Kassel GmbH, Klinik für Hämatologie und Onkologie, Kassel, Germany
| | - Lutz Jacobasch
- Onkologische Gemeinschaftspraxis Dr. med. Lutz Jacobasch, Dresden, Germany
| | - Stephan Bildat
- Klinikum Herford, Medizinische Klinik II & MVZ für Onkologie, Onkologisches Zentrum, Herford, Germany
| | - Jürgen Wehmeyer
- Gemeinschaftspraxis für Hämatologie und Onkologie, Münster, Germany
| | - Nils Homann
- Med. Klinik II Klinikum Wolfsburg, Wolfsburg, Germany
| | - Jörg Trojan
- Klinikum der J. W. Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Oliver Waidmann
- Klinikum der J. W. Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Thomas Fietz
- Schwerpunktpraxis für Hämatologie, Onkologie und Gastroenterologie Dres Banhardt/Fietz/Hertkorn, Singen, Germany
| | | | | | - Jan Wierecky
- Überörtliche Gemeinschaftspraxis, Schwerpunkt Hämatologie, Onkologie und Palliativmedizin, Hamburg, Germany
| | - Karin Waibel
- medius Kliniken gGmbH, medius Klinik Ostfildern-Ruit, Ostfildern-Ruit, Germany
| | | | - Uwe Schwindel
- GPR Gesundheits- und Pflegezentrum gGmbH, I. Medizinische Klinik, Rüsselsheim, Germany
| | - Uwe Peters
- Ambulantes Tumorzentrum Spandau Dres. Peters und Saeuberlich-Knigge, Berlin, Germany
| | - Gunter Schuch
- Hämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany.,Klinik für Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad-Saarow, Brandenburg, Germany
| | | | - Marcus-A Wörns
- I. Med. Klinik und Poliklinik, Universitätsmedizin Mainz, Germany
| | | | | | | | | | - Helmut Messmann
- Universitätsklinikum Augsburg, III. Medizinische Klinik, Augsburg, Germany
| | | | - Eike Gallmeier
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Innere Medizin, Marburg, Germany
| | | | - Volker Kunzmann
- Universitätsklinik Würzburg, Zentrum Innere Medizin, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | - Jens Papke
- Praxis Prof. Dr. med. Jens Papke, Neustadt/Sa, Germany
| | - Petra Büchner-Steudel
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin I, Halle, Germany
| | | | - Christoph Springfeld
- Nationales Centrum für Tumorerkrankungen (NCT), Abt. Medizinische Onkologie Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Arndt Vogel
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Germany
| | - Thomas J Ettrich
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm, Germany
| | - Marina Schaaf
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Gerrit Zur Hausen
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten Oliver Götze
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany.,Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | | |
Collapse
|
12
|
Weide R, Schnell R, Schardt C, Koenigsmann M, Otremba B, Zahn MO, Wierecky J, Braun U, Hensel M, Klausmann M, Fleckenstein D, Ehscheidt P, Feiten S. Health status and infections in patients with symptomatic primary and secondary immunoglobulin G (IgG) deficiencies receiving intravenous IgG replacement. BMC Immunol 2020; 21:39. [PMID: 32600256 PMCID: PMC7325170 DOI: 10.1186/s12865-020-00368-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background The effects of intravenous immunoglobulin G replacement on perceived health and infection susceptibility of patients suffering from immunoglobulin G (IgG) deficiencies should be evaluated in a prospective analysis. Methods Patients with symptomatic primary or secondary IgG deficiencies were interviewed prior to the first IgG infusion (t0) and over the course of their treatment (t1 - t6). The respondents rated their current health using a 100 point scale (EQ-5D-5L), ranging from 0 (‘worst imaginable health’) to 100 (‘best imaginable health’). The patients also provided information on the frequency of infections and of infections requiring antibiotics in the past 8 weeks. A healthy control group (CG) without oncologic diseases answered the questions once. Results One hundred six patients with a median age of 65 years (21–85 years) were investigated. The median serum IgG concentration changed from 500 mg/dl (t0) to 772 mg/dl (t6). The mean number of infections and of infections requiring antibiotics decreased during IgG replacement significantly. Current health according to EQ-5D-5L improved from 57 (t0) to 68 (t6), compared to 73 in the CG. Conclusion During the course of IgG replacement patients reported fewer and less severe infections. Their health assessment improved but still was inferior to the healthy CG.
Collapse
Affiliation(s)
- Rudolf Weide
- Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068, Koblenz, Germany.
| | - Roland Schnell
- pioh - Praxis Internistischer Onkologie und Hämatologie, Frechen, Germany
| | - Christof Schardt
- Onkologische Gemeinschaftspraxis und Tagesklinik, Gelsenkirchen, Germany
| | | | | | | | - Jan Wierecky
- Überörtliche Gemeinschaftspraxis, Dres. Verpoort, Wierecky & Brandl, Schwerpunkt Onkologie & Hämatologie, Hamburg, Germany
| | - Ute Braun
- Gemeinschaftspraxis für Hämatologie und Onkologie, Ludwigshafen, Germany
| | | | | | | | | | - Stefan Feiten
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| |
Collapse
|
13
|
Schilling JP, Busch S, Hielscher C, Holländer M, Klenske J, Zahn MO, Karthaus M. Antiemetic prophylaxis with NEPA: Final results of the German AKYPRO study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12095] [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
12095 Background: NEPA is a fixed combination antiemetic of the NK1-receptor-antagonist (RA) netupitant and the 5-HT3-RA palonosetron. Primary objective of this prospective non-interventional study in Germany was to assess quality of life of cancer patients (pts) undergoing moderately (MEC) or highly (HEC) emetogenic chemotherapy (CT) who received NEPA for prophylaxis of nausea and vomiting (CINV). Secondary objectives were patient reported outcomes as well as effectiveness and safety of NEPA. Here we report final data of the quality of life analysis. Methods: The study included 2.405 pts in 162 centers receiving 3 consecutive cycles of CT as one or two day MEC or HEC. Primary endpoint was impact of quality of life (QoL) due to vomiting or nausea, documented by Functional Living Index–Emesis (FLIE) questionnaires. Effectiveness was reported in patient diaries. Complete response (CR) was defined as no emesis and no rescue medication (RM). Non-significant nausea (NSN) was no or mild nausea. Adverse events (AEs) were reported on d1–21 of each cycle. Results: 2.173 patients were included in the final analysis (full analysis set; FAS). The majority of patients (n = 1976; 91%) received 1-day chemotherapy, 64% HEC, 36% MEC. Median age was 58 years and the majority (85%) was female. Cancer diagnoses: breast 66%, gastrointestinal 10%, ovarian 7% or lung 5%, other 12%. Chemotherapy: AC 57%, carboplatin 19%, cisplatin 8%, oxaliplatin 8% and other 8%. 84% of pts with HEC and 82% with MEC felt no impact on daily life due to vomiting in cycle 1 remaining constant in C2 and C3. 54% HEC patients and 59% MEC patients reported no impact on daily life due to nausea in cycle 1. CR rates ranged between 81-84% and were comparable between different HEC or MEC. NSN rates in MEC ranged from 75% (MEC) to 62% (HEC). Drug-related AEs were rare with constipation, fatigue, insomnia, and nausea as the most common (in > 1% pts). Conclusions: NEPA was highly effective in the prevention of CINV and maintenance of QoL in this real world study. Over 80% of pts reported that their daily live was not influenced by emesis while nausea was more difficult to control. Effectiveness was high and patients and physicians estimate was comparable.
Collapse
Affiliation(s)
| | - Steffi Busch
- Onkologische Schwerpunktpraxis, Mühlhausen, Germany
| | | | | | | | | | - Meinolf Karthaus
- Hematology, Oncology, and Palliative Medicine, Klinikum Neuperlach and Harlaching, Munich, Germany
| |
Collapse
|
14
|
Knauf W, Abenhardt W, Slawik HR, Bückner U, Otremba B, Sauer A, Zahn MO, Wetzel N, Kaiser-Osterhues A, Houet L, Marschner N. Rare lymphomas in routine practice-Treatment and outcome in Waldenström's macroglobulinaemia in the prospective German Tumour Registry Lymphatic Neoplasms. Hematol Oncol 2020; 38:344-352. [PMID: 32383192 PMCID: PMC7497085 DOI: 10.1002/hon.2740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/02/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
Waldenström's macroglobulinaemia (WM) is a rare indolent B‐cell lymphoma for which only little prospective phase III evidence exists. Thus, real world data are important to provide insight into treatment and survival. We present here data on choice and outcome of systemic treatment of patients with WM treated in German routine practice. In total, 139 patients with WM who had been documented in the prospective clinical cohort study Tumour Registry Lymphatic Neoplasms (NCT00889798) were included into this analysis. We analysed the most frequently used first‐line and second‐line treatments between 2009 and 2017 and examined best response, progression‐free survival (PFS) and overall survival (OS). Bendamustine plus rituximab, with a median of six cycles, was by far the most frequently used first‐line treatment (81%). Second‐line treatment was more heterogenous and mainly based on bendamustine, cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP), fludarabine or ibrutinib, the latter approved in 2014. Three‐year PFS from start of first‐line treatment was 83% (95% confidence interval [CI] 74%‐88%), 3‐year OS was 87% (95% CI 80%‐92%). These prospective data give valuable insights into the management and outcome of non‐selected patients with WM treated in German routine practice. In the lack of prospective phase III clinical trials, real world data can help bridging the gap of evidence.
Collapse
Affiliation(s)
- Wolfgang Knauf
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | | | - Ute Bückner
- Hämatologisch-onkologische Schwerpunktpraxis, Bochum, Germany
| | | | - Annette Sauer
- Medizinisches Versorgungszentrum für Blut- und Krebserkrankungen, Potsdam, Germany
| | - Mark-Oliver Zahn
- Medizinisches Versorgungszentrum Onkologische Kooperation, Goslar, Germany
| | - Natalie Wetzel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | - Norbert Marschner
- Praxis für Interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | | |
Collapse
|
15
|
Karthaus M, Oskay-Özcelik G, Wülfing P, Hielscher C, Guth D, Zahn MO, Flahaut E, Schilling J. Real-world evidence of NEPA, netupitant-palonosetron, in chemotherapy-induced nausea and vomiting prevention: effects on quality of life. Future Oncol 2020; 16:939-953. [DOI: 10.2217/fon-2020-0187] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To determine quality of life, effectiveness and safety of oral netupitant-palonosetron (NEPA)–based antiemetic prophylaxis in the real-world setting. Materials & methods: Prospective, noninterventional study in adults receiving highly or moderately emetogenic chemotherapy and NEPA for three cycles. NEPA was administered per summary of product characteristics. Results: A total of 2429 patients enrolled, 2173 were evaluable. ‘No impact on daily life’ due to vomiting was reported by 84%/82% of patients in the highly emetogenic chemotherapy/moderately emetogenic chemotherapy groups in cycle 1, with rates of 54%/59% for nausea. Overall, complete response rate was 89%/87%/83% in the acute/delayed/overall phases. NEPA was well tolerated. Conclusion: NEPA had beneficial effects on the quality of life of a heterogeneous group of cancer patients and was safe and effective in the real-world setting.
Collapse
Affiliation(s)
- Meinolf Karthaus
- Department of Hematology, Oncology & Palliative Care, Klinikum Neuperlach, Munich, Germany
- Department of Hematology, Oncology & Palliative Care, Klinikum Harlaching, Munich, Germany
| | | | - Pia Wülfing
- Mammazentrum Hamburg am Krankenhaus Jerusalem, Hamburg, Germany
| | | | - Dagmar Guth
- Gynecological Oncology Practice, Plauen, Germany
| | | | - Elisa Flahaut
- Department of Medical Affairs, RIEMSER Pharma GmbH, Berlin, Germany
| | | |
Collapse
|
16
|
Stickeler E, Harbeck N, Thill M, Nusch A, Chiabudini M, Kruggel L, Jänicke M, Marschner N, Zahn MO, Welt A, Wöckel A, Decker T. Abstract P2-17-01: Therapy of advanced breast cancer for patients with hormone receptor-positive/HER2-negative and HER2-positive tumors is changing in real life: First results from the prospective, national research platform OPAL for patients with advanced breast cancer in Germany. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction Tumor Registries give insight into routine treatment and complement the knowledge derived from randomized controlled trials (RCT), since characteristics of patients from RCTs often differ from those of patients in routine care. Furthermore, follow-up of patients in registries is generally longer which gives the possibility to analyze sequential treatments. Since 2007 the Tumor Registry Breast Cancer (TMK, NCT01351584) has prospectively collected data on treatment and outcome of patients with breast cancer in Germany. Among other topics, insights into “real-world” treatment and outcome and long-term observation of quality of life have been published. Since 2017 the registry platform OPAL (NCT03417115) has extended the work of the TMK by recruiting patients with advanced breast cancer (ABC) from all specialties (medical and gynecologic oncologists). The main aims are to observe the impact of novel treatments on patient outcome, and to identify areas for improvement of quality of care. Methods OPAL started in December 2017. Patients are prospectively recruited at start of their first systemic treatment for ABC. Follow-up continues until death or up to 5 years. There is no treatment specification. Detailed information on all (sequential) treatments, patient and tumor characteristics, physician-reported factors regarding treatment decision making, biomarker testing, outcomes (e.g. best response, progression-free and overall survival) are collected in a web-based data capture system with implemented checks for completeness and plausibility. Data are monitored by data management and on-site. Patient-reported outcomes (PROs) are collected at start of treatment and every 3 months thereafter. Patients can also give informed consent for their tumor samples to be used in future translational research (virtual biobank). All patient data remain in Germany. Here, first combined data from the TMK and OPAL (database as of 01.04.2019) are presented. Results Since 2007, 5076 patients have been recruited. Patients with ABC (n=2105, 434 since the start of OPAL) have a median age of over 60 years at start of treatment; about 60% have comorbidities. For patients with hormone-receptor positive (HRpos)/HER2 negative (HER2neg) ABC, first-line treatment has changed over the years. From 2007-11 (n=458) 60% of patients started with chemotherapy, decreasing to 48% in 2012-16 (n=528) and to 23% in 2018-19 (n=170) with 58% of patients now being treated with CDK4/6-inhibitor. First-line of HER2pos ABC has also changed from 79% of patients receiving trastuzumab (TRA) between 2007-12 (n=268) to 78% of patients receiving dual-blockade with TRA/pertuzumab in 2018-19 (n=97) and 10% receiving TRA only. About 25% of patients treated with TRA in 2018-19 received a biosimilar. Median overall survival (OS) of patients with start of first-line therapy between 2007-16 is currently 15 months for triple-neg (74% events), 34 months for HRpos/HER2neg (59% events), 40 months for HER2pos (52% events); median OS has not yet been reached for patients in OPAL. Conclusions For patients with HRpos/HER2neg ABC, a shift towards more endocrine therapy in the first-line setting, and a quick implementation of CDK4/6-inhibitors after their approval can be observed. In patients with HER2pos ABC, integration of trastuzumab biosimilars into routine care has started. Prognosis for patients with triple-negative ABC remains poor and new treatment options are urgently needed. OPAL together with TMK will allow to follow changes in treatment of patients with ABC in a “real world” setting in Germany, the application of sequential treatments, and their impact on clinical as well as patient-reported outcome.
Citation Format: Elmar Stickeler, Nadia Harbeck, Marc Thill, Arnd Nusch, Marco Chiabudini, Lisa Kruggel, Martina Jänicke, Norbert Marschner, Mark-Oliver Zahn, Anja Welt, Achim Wöckel, Thomas Decker, OPAL Study Group. Therapy of advanced breast cancer for patients with hormone receptor-positive/HER2-negative and HER2-positive tumors is changing in real life: First results from the prospective, national research platform OPAL for patients with advanced breast cancer in Germany [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-17-01.
Collapse
Affiliation(s)
| | - Nadia Harbeck
- 2Brustzentrum, Klinikum der Universität München (LMU), München, Germany
| | - Marc Thill
- 3Agaplesion Markus Krankenhaus, Frankfurt a.M., Germany
| | - Arnd Nusch
- 4Praxis für Hämatologie und Internistische Onkologie, Ratingen, Germany
| | | | | | | | - Norbert Marschner
- 6Praxis für Interdisziplinäre Onkologie & Hämatologie, Freiburg i. Br., Germany
| | - Mark-Oliver Zahn
- 7Überörtliche Berufsausübungsgemeinschaft MVZ Onkologische Kooperation Harz, Goslar, Germany
| | - Anja Welt
- 8Universitätsklinikum Essen (AöR), Essen, Germany
| | - Achim Wöckel
- 9Universitätsklinikum Würzburg, Würzburg, Germany
| | - Thomas Decker
- 10Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | | |
Collapse
|
17
|
Zaiss MR, Uhlig J, Zahn MO, Decker T, Lehmann HC, Harde J, Vannier C, Hogrefe C, Marschner N. An observational study to evaluate the potential of Onlife to improve chemotherapy-induced peripheral neuropathy: Final results of the STEFANO trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23143] [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
e23143 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, long-term side effect of many antineoplastic agents and has a detrimental impact on patients (pts)’ quality of life and functional activities of daily living. Currently, preventive measures and treatment options for CIPN are quite limited. OnLife is a dietary supplement that contains a patented mixture of fatty acids with anti-inflammatory, neuroprotective and antinociceptive properties. Methods: The STEFANO study – an observational, prospective, two-cohort, multicenter study of dietary supplementation – was designed to evaluate the potential of OnLife to improve CIPN in adult pts with completed neo-/adjuvant chemotherapy and manifest CIPN (grade 1-3) (Cohort A: colon cancer, oxaliplatin-containing therapy; cohort B: breast cancer, paclitaxel therapy). Pts received OnLife for 3 months. The primary objective – assessment of changes in CIPN – was evaluated by comparing the severity of sensory and motor CIPN according to CTCAE v4.03 before, during and after treatment with OnLife. Secondary endpoints included patient-reported experience of symptoms and functional limitations related to CIPN. Descriptive statistics were used to analyze data. Results: In total, 75 breast cancer pts with paclitaxel-induced and 71 colon cancer pts with oxaliplatin-induced peripheral neuropathy, respectively, received OnLife. Based on physician-rated CTCAE grades, 21.3% of breast cancer pts and 12.7% of colon cancer pts had a sustained improvement of sensory CIPN after OnLife treatment. Concerning motor CIPN, the proportions were 12.0% and 9.9%, respectively. According to patient-reported outcomes, 45.3% of breast cancer pts and 23.9% of colon cancer pts had less symptoms and functional limitations related to sensory CIPN after OnLife treatment. Concerning motor CIPN, the proportions were 32.0% and 22.5%, respectively. Conclusions: STEFANO provides indications of the potential of OnLife to reduce severity of objective and subjective CIPN-related symptoms. Therefore, it is a promising agent to meet the unmet medical need of management options for patients with established CIPN. Clinical trial information: NCT03065478.
Collapse
Affiliation(s)
| | - Jens Uhlig
- Medical Practice for Hematology and Oncology Muldental, Naunhof, Germany
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Zahn MO, Linck D, Losem C, Gessner C, Metze H, Gaillard VE, Tessen HW. AVAiLABLE NIS - AVASTIN® in lung cancer treatment in routine oncology practice in Germany. BMC Cancer 2019; 19:433. [PMID: 31077164 PMCID: PMC6511164 DOI: 10.1186/s12885-019-5618-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bevacizumab (Avastin®), a recombinant humanized monoclonal antibody, in combination with platinum-doublet chemotherapy has become a routine treatment for advanced non-small-cell lung cancer (NSCLC). The post-authorization, non-interventional study 'AVAiLABLE' assessed the effectiveness and safety of bevacizumab combined with chemotherapy as first-line treatment. METHODS Nine hundred and eighty-seven adult patients (mean age 61.5 years, 59.8% male) with non-resectable advanced, metastatic or recurrent, predominantly non-squamous NSCLC were evaluated at 185 sites across Germany. 72.8% of the patients had stage IV disease at start of observation, 90.1% had histologically confirmed adenocarcinoma and 80.8% met the bevacizumab label 'NSCLC other than predominantly squamous cell histology'. According to bevacizumab label, chemotherapy plus bevacizumab was recommended, followed by bevacizumab maintenance therapy. Effectiveness endpoints included response rates and progression-free survival (PFS); safety endpoints comprised adverse drug reactions (ADRs). Patients were followed until progression or intolerable toxicity. Data were evaluated by descriptive statistical methods. RESULTS Median PFS was 7.4 months (95% CI: 7.1; 8.4), overall response rate (ORR) 45.6% and disease control rate (DCR) 75%. The majority of patients (72.7%) achieved partial response or stable disease. Complete response was reached by 2.3%. 33.6% of patients experienced an ADR of grade ≥ 3. Bevacizumab-related ADRs of grade ≥ 3 occurred in 5.7% of patients, with the highest incidence for leukopenia, neutropenia, and hypertension. CONCLUSIONS Results of the non-interventional study 'AVAiLABLE' confirmed the effectiveness and safety of bevacizumab in combination with platinum-based chemotherapy as first-line treatment for advanced NSCLC in accordance with previous studies. No new safety signals were identified. Maintenance therapy with bevacizumab was well tolerated and safe even over extended periods (> 20 cycles). TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02596958; registered on 4 November 2015.
Collapse
Affiliation(s)
- Mark-Oliver Zahn
- Onkologische Schwerpunktpraxis Goslar, Kösliner Str. 14, 38642, Goslar, Germany.
| | - Dominik Linck
- Onkologische Schwerpunktpraxis Euskirchen, Gottfried-Disse-Str. 42, 53879, Euskirchen, Germany
| | - Christoph Losem
- MVZ für Onkologie und Hämatologie im Rhein-Kreis Neuss, Am Hasenberg 44, 41462, Neuss, Germany
| | - Christian Gessner
- Pneumologische Schwerpunktpraxis mit pneumologischer Onkologie Leipzig, Tauchaer Str. 12, 04357, Leipzig, Germany
| | - Holger Metze
- Pneumologie des Rhön-Klinikums Frankfurt/Oder, Müllroser Chaussee 7, 15236, Frankfurt/Oder, Germany
| | - Vincent E Gaillard
- F. Hoffmann-La Roche Ltd, Product Development Medical Affairs, Grenzacherstrasse, 4070, Basel, Switzerland
| | - Hans Werner Tessen
- Onkologische Schwerpunktpraxis Goslar, Kösliner Str. 14, 38642, Goslar, Germany
| |
Collapse
|
19
|
Griesinger F, Eberhardt WEE, Nusch A, Reiser M, Zahn MO, Marschner NW, Jänicke M, Fleitz A, Spring L, Sahlmann J, Karatas A, Hipper A, Weichert W, Rittmeyer A, Metzenmacher M, Waller CF, Sebastian M, Thomas M. Molecular testing, frequency of molecular alterations and targeted 1st-line treatment of patients with non-small cell lung carcinoma in Germany: First results from the prospective German Registry CRISP (AIO-TRK-0315). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frank Griesinger
- Pius Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany
| | | | - Arnd Nusch
- Outpatient Center for Hematology and Medical Oncology, Ratingen, Germany
| | - Marcel Reiser
- PIOH - Praxis Internistische Onkologie und Haematologie, Cologne, Germany
| | | | | | | | | | | | | | | | | | - Wilko Weichert
- Institut für Pathologie, Technische Universität München, München, Germany
| | | | | | | | - Martin Sebastian
- Department of Medicine II, University Hospital Goethe, Frankfurt, Germany
| | - Michael Thomas
- Thoraxklinik am Universitätsklinikum Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| |
Collapse
|
20
|
Schoenherr C, Goetze TO, zur Hausen G, Reichart A, Pauligk C, Schlag R, Siegler GM, Doerfel S, Aldaoud A, Hahn L, Schubert JEA, Zahn MO, Hoeffkes HG, Reiser M, Koenigsmann M, Blau W, Uhlig J, Homann N, Trojan J, Al-Batran SE. Real life data of 601 patients from the QoliXane pancreatic cancer study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Gerrit zur Hausen
- IKF Cancer Research GmbH at Krankenhaus Nordwest, Frankfurt, Germany
| | - Alexander Reichart
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis, Würzburg, DE
| | | | | | - Ali Aldaoud
- Gemeinschaftspraxis Aldaoud/Schwarzer, Leipzig, Germany
| | - Lars Hahn
- Praxisklinik – Dialysezentrum Herne, Herne, Germany
| | | | | | | | - Marcel Reiser
- PIOH - Praxis Internistische Onkologie und Haematologie, Cologne, Germany
| | | | | | - Jens Uhlig
- Hämatologie und Onkologie Muldental, Naunhof, Germany
| | - Nils Homann
- Department of Internal Medicine II, Academic Teaching Hospital Wolfsburg, Wolfsburg, Germany
| | - Jorg Trojan
- University Hospital Frankfurt, Frankfurt, Germany
| | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| |
Collapse
|
21
|
Jackisch C, Fasching PA, Grischke EM, Schuetz F, Decker T, Uleer C, Salat C, Foerster F, Schmidt M, Mundhenke C, Tesch H, Wimberger P, Aktas B, Zahn MO, Tome O, Bloch W, Hanson S, Schubert J, Lueftner D. Median progression free survival (PFS) for patients treated with everolimus (EVE) + exemestane (EXE) for HR+ mBC in routine clinical practice: Results of the 3rd interim analysis of the non-interventional trial BRAWO. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12547] [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
e12547 Background: BRAWO is a non-interventional study, which enrolled more than 2400 patients (pts) with advanced/metastatic, hormone-receptor-positive and HER2-negative breast cancer treated with EVE and EXE. Main objectives are a) the impact of physical activity on efficacy and quality of life, b) prophylaxis and management of stomatitis in clinical routine, and c) the sequence of therapy when EVE is used in daily clinical practice. We report updated data of the 3rd interim analysis, including PFS. Methods: This updated analysis (data cut-off 18 Oct 2016) covers data of the first 1345 documented pts with at least one follow up under therapy. Here we describe the baseline characteristics, safety and PFS as well as response rates. PFS was estimated using Kaplan-Meier estimator. Results: At the time point of this data cut-off 1289 pts (93.9%) had discontinued the documentation. The median time for pts since primary diagnosis was 7.1 yrs and 2.2 yrs, since first sign of relapse (local recurrence or metastases). At baseline, 54.1% presented with visceral metastases. 49.2% had an ECOG performance status of 0 and 74.8% of pts started with 10mg EVE, while 24.5% started with 5mg EVE. According to treatment lines we found 27% 1L (359 pts), 32% 2L (426 pts), 19% 3L (253 pts), 11% 4L (153 pts) and 11% 5L (154 pts) in our cohort Additional baseline and safety data will be presented. The Kaplan Meier estimate of the overall PFS is 6.9 months (95%CI 6.3-7.4). 2.2% (18 pts) of the pts experienced a complete and 17.8% (147 pts) a partial remission, while 57.4% (475 pts) remained stable as their best overall responses during the documentation period. 52.3% (718 pts) discontinued the treatment due to a progressive disease and 25.5% (350 pts) due to adverse events. 67.1% (902 pts) continued the antineoplastic treatment with a subsequent therapy. Conclusions: Here we report the PFS of pts treated with EVE + EXE in a real world scenario. The PFS of 6.9 months observed in our series matches somewhat perfect with the PFS of 7.8 months from the randomized Bolero-2 trial suggesting that these findings might be valid and useful for everyday routine. Clinical trial information: EUPAS9462.
Collapse
Affiliation(s)
| | | | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | | | | | - Hans Tesch
- Oncological Practice Bethanien, Frankfurt, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | | | | | - Sven Hanson
- Novartis Pharmaceuticals GmbH, Goettingen, Germany
| | | | - Diana Lueftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
22
|
Fasching PA, Grischke EM, Schuetz F, Decker T, Uleer C, Salat C, Foerster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Wimberger P, Aktas B, Zahn MO, Tome O, Bloch W, Hanson S, Fischer T, Schubert J, Lueftner D. Analysis of everolimus starting dose as prognostic marker in HR+ mBC patients treated with everolimus (EVE) + exemestane (EXE): Results of the 3rd interim analysis of the non-interventional trial BRAWO. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1061] [Citation(s) in RCA: 3] [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
1061 Background: BRAWO is a German non-interventional study, which enrolled more than 2400 patients (pts) with advanced/metastatic, hormone-receptor-positive and HER2-negative breast cancer treated with EVE and EXE. Main objectives are a) the impact of physical activity on efficacy and quality of life, b) prophylaxis and management of stomatitis in clinical routine, and c) the sequence of therapy when EVE is used in daily clinical practice. Methods: In this update on the results of the 3rd interim analysis (data cut-off 18-Oct-2016) we analyzed under real world conditions the first 1.078 patients followed up until disease progression for their progression-free survival (PFS) events. A two-stage process based on a Cox regression model was used to check the relevance of the start dose on PFS. In the first step potentially relevant covariates defined by medical experts were evaluated for relevance. In the second step start dose and all covariates showing a p-value of at most 0.1 in first step including all two-interaction of start dose with these parameters were included into the model. Results: Our multivariate analysis support the evidence that predictive factors, such as body mass index (BMI, p-value: < 0.001), therapeutic line (1st vs. 2nd+3rd vs. ≥4th; p-value: 0.013), presence of visceral metastases (p-value: < 0.001) and ECOG (Eastern Cooperative Oncology Group, p-value: < 0.001) status at the beginning of the therapy correlated significantly with the PFS. 283 patients started with 5mg and 795 Patients started with 10 mg. Starting dose had no significant impact on the PFS (neither as main effect nor within interactions, p-value: 0.44-0.88). Conclusions: Even though the approved and recommended starting dose for treatment with EVE is 10 mg, physicians sometimes start EVE-treatment with a lower starting dose, trying subsequently to increase the dose to the recommended dose of 10mg to allow the patient’s organism to adapt to the therapeutic. As the study was not powered to detect possible differences in PFS by starting dose, the result of showing no detrimental effect of a lower start dose may be the result of limited power. Clinical trial information: EUPAS9462.
Collapse
Affiliation(s)
| | - Eva-Maria Grischke
- Universitӓts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Christoph Uleer
- Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | | | | | | | | | - Hans Tesch
- Oncological Practice Bethanien, Frankfurt, Germany
| | | | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | | | | | - Sven Hanson
- Novartis Pharmaceuticals GmbH, Goettingen, Germany
| | | | | | - Diana Lueftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
23
|
zur Hausen G, Waidmann O, Woerns MA, Hoeffkes HG, Doerfel S, Zahn MO, Aldaoud A, Stauch M, Springfeld C, Haertel N, Reichart A, Pauligk C, Roemmler-Zehrer J, Hofheinz R, Al-Batran SE. Nab-paclitaxel/gemcitabine first-line therapy in patients with metastatic pancreatic carcinoma and high-bilirubin levels: Data from the German QoliXane Pancreatic Cancer Registry. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gerrit zur Hausen
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | | | | | | | | | | | - Ali Aldaoud
- Forschungsgemeinschaft Aldaoud/Schwarzer, Leipzig, Germany
| | - Martina Stauch
- Onkologische Schwerpunktpraxis Kronach, Kronach, Germany
| | | | | | - Alexander Reichart
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt Am Main, Germany
| | | | | | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| |
Collapse
|
24
|
Sahm S, Goehler T, Hering-Schubert C, Janssen J, Neumann UP, Schwittay M, Zahn MO, Stenzel KG, Steinbach-Buechert AK, Overkamp F. Outcome of patients with KRAS exon 2 wildtype (KRAS-wt) metastatic colorectal carcinoma (mCRC) with cetuximab-based first-line treatment in the noninterventional study ERBITAG and impact of comorbidity and age. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.651] [Citation(s) in RCA: 4] [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
651 Background: Cetuximab in combination with irinotecan- or oxaliplatin-based chemotherapy has shown to increase ORR, PFS, OS of KRAS-wt mCRC patients (pts). ERBITAG aimed to evaluate safety and efficacy of cetuximab in combination with various first-line chemotherapy regimens in pts with unresectable KRAS-wt mCRC. Methods: KRAS-wt pts on a cetuximab-based first-line treatment with written informed consent could be enrolled in this prospective, non-interventional study. Primary endpoint was ORR, secondary endpoints were amongst others PFS, OS, TTF, and resection rate of liver metastasis. Comorbidities were documented and evaluated by the Charlson Comorbidity Index (CCI). Results: 817 eligible KRAS-wt mCRC pts were enrolled at 144 sites across Germany, documentations for 456 pts were finalised and evaluated. The median age was 65 [27-87] yrs, with 51.5% ≤65 yrs, 34.0% >65-75 yrs, and 14.5% >75 yrs. ECOG performance status was 0, 1, 2, or missing in 34.4%, 49.6%, 8.8%, and 7.2% of pts, respectively. CCI was 0 in 54.4%, and ≥1 in 45.6%. Resection of liver and/or lung metastases was done in 17.3% of pts, 13.4% were R0 resected. For pts with liver limited disease resection rate and R0-rate were 29.3% and 23.8%, respectively. Pts with CCI 0 had no different outcome regardless of age (table). Pts with CCI ≥1 and >75 yrs had a lower ORR and decreased TTF, pts >65-75 yrs had only a decreased TTF as compared to the ≤ 65 yrs age group (table). Conclusions: In this large observational trial outcomes (ORR and PFS) of KRAS-wt mCRC pts on a cetuximab-based first-line treatment were comparable to those reported in pivotal trials. Pts older than 75 yrs without comorbidities (CCI =0) showed no difference to younger pts in ORR, PFS, and TTF. Pts >75 yrs with CCI ≥ 1 had a significant lower ORR and decreased TTF. Clinical trial information: http://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb/nis-details/_455. [Table: see text]
Collapse
|
25
|
Sahm S, Goehler T, Hering-Schubert C, Janssen J, Schwittay M, Zahn MO, Stenzel KG, Steinbach-Buechert AK, Overkamp F. Impact of prophylactic treatments of cetuximab-based skin reactions in patients with metastatic colorectal carcinoma (mCRC): Interim analysis of the German noninterventional study ERBITAG. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.675] [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
675 Background: Prophylactic treatments are widely used to ameliorate skin reactions induced by EGFR inhibition. Randomised studies have shown a positive impact of prophylactic antibiotics. Methods: Patients (Pts) with KRAS-wt and later RAS-wt mCRC treated with a first-line chemotherapy regimen plus cetuximab with written informed consent were eligible for this prospective, non-interventional study. Physicians were requested to complete a questionnaire and document any applied prophylactic and reactive skin toxicity treatment for every pt. Different prophylactic treatment regimens were categorized in 5 groups: systemic antibiotics (SA), skin care without antibiotics or corticosteroids (SC), other topical treatments (OT) (e.g. antibiotics or corticosteroids), any prophylaxis (P), and no prophylaxis (NP). Results: Data from 497 pts at 178 centers were finally collected and evaluable at data cut off. For all reported skin reactions the maximum NCI-CTCAE grade per patient and prophylactic treatment group was evaluated (table). Although none of the prophylactic regimens were significant different from NP, SA showed a numerically lower rate of all skin reactions by 8.1% (p=0.06) and of rash acneiforme by 5.3% (p=0.134) versus NP. 96.2% of reactive treatments of skin toxicities were done without consultation of a dermatologist and the medication was topical or systemic in 60.9% and 32.3%, respectively. Response to reactive treatment was complete remission or significant improvement of the skin reactions in 68.6% (topical) and 66.0% (systemic). Conclusions: Pts given prophylactic SA showed numerically fewer grade 3-4 skin reactions in comparison to NP (7.6% vs. 15.7%), but without significance. An important reason for failing significance may be the low number of pts receiving prophylactic SA (only in 18.5% of pts). Reactive treatment (systemic or topical) of skin toxicities led to an improvement in the majority of pts. Clinical trial information: http://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb/nis-details/_455. [Table: see text]
Collapse
|
26
|
Schiller H, Bartscht T, Arlt A, Zahn MO, Seifert A, Bruhn T, Bruhn HD, Gieseler F. Thrombin as a survival factor for cancer cells: thrombin activation in malignant effusions in vivo and inhibition of idarubicin-induced cell death in vitro. Int J Clin Pharmacol Ther 2002; 40:329-35. [PMID: 12467301 DOI: 10.5414/cpp40329] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of the experiments shown here, is to demonstrate exemplarily that thrombin can be a survival factor for malignant cells. METHODS Activation of the coagulation system has been examined in patients with acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL) before and after chemotherapy as well as in malignant effusions of heavily pretreated patients with solid tumors. Thrombin receptor expression (PAR-I) has been examined on HL-60 cells; the effect ofthrombin on the proliferation of the cells and inhibition of apoptosis induction by idarubicin has been shown. RESULTS Using fibrinopeptide A as an indirect parameter for thrombin activation, we found elevated levels in patients with AML and NHL before and a significant 2-fold increase after chemotherapy (p < 0.02 for the AML group; p < 0.0006 for the NHL group). Apparently, this does not only affect patients with hematological diseases, but also with solid tumors. In order to find out if the tumor cells directly activate thrombin, we examined malignant effusions of patients with different solid tumors. Comparing prothrombin fragment 1 + 2 in ascites and pleural effusions with the patients' serum levels, we found it significantly increased in all cases (mean of 1.96 +/- 0.5 nmol/l in the serum vs. 12.1 +/- 3.6 nmol/l in effusions; p < 0.001). The majority of patients presented elevated serum levels. Additionally, we incubated HL-60 cells (human promyelocytic leukemia) with thrombin prior to treatment with idarubicin. Expression of thrombin receptor (PAR-1) could be verified by FACS-analysis using a monoclonal antibody. HL-60 cells responded with increased proliferation to thrombin exposure with concentrations between 0.3 and 3 U/ml. This effect could be abolished by the addition of hirudin, demonstrating thrombin specificity. In these concentrations, thrombin was able to abrogate the induction of apoptosis by idarubicin completely (p < 0.005). CONCLUSIONS Here we give evidence for the role of thrombin as a resistance factor for tumor cells towards chemotherapy. In the light of the fact that thrombin is regularly activated in cancer patients, these findings indicate that thrombin is a clinically relevant cellular resistance factor. A number of pre-clinical and clinical studies imply that inhibition of the coagulation system, e.g. by low-molecular weight heparins or warfarin, increases the effect of chemotherapy.
Collapse
Affiliation(s)
- H Schiller
- Department of Internal Medicine, University of Kiel, Germany
| | | | | | | | | | | | | | | |
Collapse
|