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De Dosso S, Nucifora M, Sahnane N, Epistolio S, Riveiro ME, Bertolini V, Bucci E, Boldorini R, Freguia S, Frattini M, Saletti P. Influence of KRAS mutations on clinical outcome in patients with curatively resected stage III colon cancer treated with adjuvant chemotherapy. Eur Rev Med Pharmacol Sci 2020; 24:2994-3003. [PMID: 32271417 DOI: 10.26355/eurrev_202003_20664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To profile and correlate KRAS mutations with outcome in stage III colon cancer (CC) patients who underwent adjuvant chemotherapy following curative resection surgery. PATIENTS AND METHODS In this retrospective study, eligible patients were those with resected stage III CC who underwent 6-months adjuvant chemotherapy, either with fluoropyrimidine monotherapy (FP) or with oxaliplatin-based regimens (O-FP). Disease-free survival (DFS) and overall survival (OS) were analyzed and computed using the Kaplan-Meier method and the log-rank test. RESULTS The study population included 148 patients (n=65 FP and n=83 O-FP). We identified KRAS mutations in 41/148 (27%) patients, of which 18 (44%) received FP and 23 (56%) O-FP. Five-year DFS and OS were significantly higher in patients with KRAS wild-type vs. mutant [DFS: 78 vs. 56%, HR: 0.47 (95% CI: 0.25; 0.87), p=0.01; OS: 73 vs. 68%, HR: 0.44 (95% CI: 0.21; 0.88), p=0.01]. In patients treated with FP, the 5-year DFS and OS was significantly improved in the KRAS wild-type vs. mutant group, respectively [DFS: 80 vs. 43%, HR: 2.88 (95% CI: 0.67; 3.76), p=0.014; OS: 85 vs. 68%, HR: 0.27 (95% CI: 0.10; 0.73), p=0.005]. Conversely, 5-year DFS and OS were not statistically different for patients with KRAS wild-type vs. mutations treated with O-FP, respectively [DFS: 78 vs. 65%, HR: 1.59 (95% CI: 0.67; 3.76), p=0.281; OS: 80 vs. 75%, HR: 0.73 (95% CI: 0.55; 2.12), p=0.57)]. CONCLUSIONS Our results suggest that curatively resected stage III CC patients exhibiting wild-type KRAS status might benefit from FP alone. Conversely, an oxaliplatin-containing regimen should be recommended in KRAS mutated patients.
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Affiliation(s)
- S De Dosso
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Cefalì M, Efstathopoulou A, De Dosso S, Saletti P. Lymphocyte count and lymphocyte-to-white blood cells ratio as indicators of survival in specific cancer subtypes. Int Immunopharmacol 2019; 77:105982. [PMID: 31677993 DOI: 10.1016/j.intimp.2019.105982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Cefalì
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland.
| | - A Efstathopoulou
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland
| | - S De Dosso
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland
| | - P Saletti
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland
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Koeberle D, Dufour JF, Demeter G, Li Q, Ribi K, Samaras P, Saletti P, Roth AD, Horber D, Buehlmann M, Wagner AD, Montemurro M, Lakatos G, Feilchenfeldt J, Peck-Radosavljevic M, Rauch D, Tschanz B, Bodoky G. Sorafenib with or without everolimus in patients with advanced hepatocellular carcinoma (HCC): a randomized multicenter, multinational phase II trial (SAKK 77/08 and SASL 29). Ann Oncol 2016; 27:856-61. [PMID: 26884590 DOI: 10.1093/annonc/mdw054] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/29/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sorafenib (S), a multitargeted tyrosine kinase inhibitor, is the standard of care for first-line systemic treatment of advanced hepatocellular carcinoma (HCC). Everolimus (E) is a potent inhibitor of mTOR, a pathway frequently activated in HCC. Preclinical data suggest that the combination S + E has additive effects compared with single-agent S. PATIENTS AND METHODS Patients with unresectable or metastatic HCC and Child-Pugh ≤7 liver dysfunction were randomized to receive daily S 800 mg alone or with E 5 mg until progression or unacceptable toxicity. The primary end point was progression-free survival at 12 weeks (PFS12). The secondary end points included response rate, PFS, time to progression (TTP), overall survival (OS), duration of disease stabilization (DDS), safety, and quality-of-life (QoL) assessments. RESULTS A total of 106 patients were randomized: 46 patients received S and 60 patients received S + E. Ninety-three patients were assessable for the primary end point and 105 patients for the safety analysis. The PFS12 rate was 70% [95% confidence interval (CI) 54-83] and 68% (95% CI 53-81) in patients randomized to S and S + E, respectively. The RECIST (mRECIST) response rate was 0% (23%) in the S arm and 10% (35%) in the S + E arm. Median PFS (6.6 versus 5.7 months), TTP (7.6 versus 6.3 months), DDS (6.7 versus 6.7 months), and OS (10 versus 12 months) were similar in the S and S + E arms, respectively. Grade 3/4 adverse events occurred in 72% and 86% of patients in arm S and arm S + E, respectively. Patients had similar QoL scores over time, except for a greater worsening in physical well-being and mood in the arm S + E. CONCLUSIONS No evidence was found that S + E improves the efficacy compared with S alone. Combining 5 mg E with full-dose S is feasible, but more toxic than S alone. Further testing of this drug combination in molecularly unselected HCCs appears unwarranted. CLINICALTRIALSGOV NCT01005199.
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Affiliation(s)
- D Koeberle
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen
| | - J-F Dufour
- Department of Hepatology, University Hospital Bern, Bern, Switzerland
| | - G Demeter
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
| | - Q Li
- SAKK Coordinating Center, Berne
| | - K Ribi
- Quality of life Office, International Breast Cancer Study Group, Bern
| | - P Samaras
- Department of Medical Oncology, University Hospital Zurich, Zürich
| | - P Saletti
- Department of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona
| | - A D Roth
- Department of Medical Oncology, University Hospital of Geneva, Geneva
| | - D Horber
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen
| | - M Buehlmann
- Department of Medical Oncology, University Hospital Bern, Bern
| | - A D Wagner
- Department of Medical Oncology, University Hospital Lausanne, Lausanne
| | - M Montemurro
- Department of Medical Oncology, University Hospital Lausanne, Lausanne
| | - G Lakatos
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
| | - J Feilchenfeldt
- Department of Medical Oncology, Hôpital du Valais (RSV)-CHCVs, Lausanne, Switzerland
| | - M Peck-Radosavljevic
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - D Rauch
- Department of Medical Oncology, Spital STS AG, Bern, Switzerland
| | | | - G Bodoky
- Department of Medical Oncology, St László Teaching Hospital, Budapest, Hungary
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Fedeli L, Busoni S, Fedi M, Saletti P, Taddeucci A. Temporal stability QA in functional magnetic resonance imaging. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kienle D, Winterhalder R, Koeberle D, Horber D, Kueng M, Saletti P, Helbling D, Bastian S, Dietrich D, Baertschi D, Pilop C, Von Moos R. 1322 Cetuximab monotherapy and cetuximab plus capecitabine as first-line treatment in elderly patients with RAS- and BRAF wild-type metastatic colorectal cancer. Results of the multicenter phase II trial SAKK 41/10. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koeberle D, Betticher DC, von Moos R, Dietrich D, Brauchli P, Baertschi D, Matter K, Winterhalder R, Borner M, Anchisi S, Moosmann P, Kollar A, Saletti P, Roth A, Frueh M, Kueng M, Popescu RA, Schacher S, Hess V, Herrmann R. Bevacizumab continuation versus no continuation after first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer: a randomized phase III non-inferiority trial (SAKK 41/06). Ann Oncol 2015; 26:709-714. [PMID: 25605741 DOI: 10.1093/annonc/mdv011] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chemotherapy plus bevacizumab is a standard option for first-line treatment in metastatic colorectal cancer (mCRC) patients. We assessed whether no continuation is non-inferior to continuation of bevacizumab after completing first-line chemotherapy. PATIENTS AND METHODS In an open-label, phase III multicentre trial, patients with mCRC without disease progression after 4-6 months of standard first-line chemotherapy plus bevacizumab were randomly assigned to continuing bevacizumab at a standard dose or no treatment. CT scans were done every 6 weeks until disease progression. The primary end point was time to progression (TTP). A non-inferiority limit for hazard ratio (HR) of 0.727 was chosen to detect a difference in TTP of 6 weeks or less, with a one-sided significance level of 10% and a statistical power of 85%. RESULTS The intention-to-treat population comprised 262 patients: median follow-up was 36.7 months. The median TTP was 4.1 [95% confidence interval (CI) 3.1-5.4] months for bevacizumab continuation versus 2.9 (95% CI 2.8-3.8) months for no continuation; HR 0.74 (95% CI 0.58-0.96). Non-inferiority could not be demonstrated. The median overall survival was 25.4 months for bevacizumab continuation versus 23.8 months (HR 0.83; 95% CI 0.63-1.1; P = 0.2) for no continuation. Severe adverse events were uncommon in the bevacizumab continuation arm. Costs for bevacizumab continuation were estimated to be ∼30,000 USD per patient. CONCLUSIONS Non-inferiority could not be demonstrated for treatment holidays versus continuing bevacizumab monotheray, after 4-6 months of standard first-line chemotherapy plus bevacizumab. Based on no impact on overall survival and increased treatment costs, bevacizumab as a single agent is of no meaningful therapeutic value. More efficient treatment approaches are needed to maintain control of stabilized disease following induction therapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, number NCT00544700.
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Affiliation(s)
- D Koeberle
- Department of Oncology, Kantonsspital St Gallen, St Gallen.
| | - D C Betticher
- Department of Oncology, Hôpital Fribourgeois, Fribourg
| | - R von Moos
- Department of Oncology, Kantonsspital Chur, Chur
| | | | | | | | - K Matter
- Institute of Pharmaceutical Medicine/ECPM, Basel
| | | | - M Borner
- Department of Oncology, Spitalzentrum Biel, Biel
| | - S Anchisi
- Department of Oncology, Hôpital de Sion, Sion
| | - P Moosmann
- Department of Oncology, Kantonsspital Aarau, Aarau
| | - A Kollar
- Department of Oncology, Inselspital Bern, Bern
| | - P Saletti
- Department of Oncology, IOSI, Bellinzona
| | - A Roth
- Department of Oncology, HCUG, Geneva
| | - M Frueh
- Department of Oncology, Kantonsspital St Gallen, St Gallen
| | - M Kueng
- Department of Oncology, Hôpital Fribourgeois, Fribourg
| | - R A Popescu
- Department of Oncology, Hirslanden Klinik Aarau, Aarau
| | - S Schacher
- Department of Oncology, Kantonsspital Winterthur, Winterthur
| | - V Hess
- Department of Oncology, Universitätsspital Basel, Basel, Switzerland
| | - R Herrmann
- Department of Oncology, Universitätsspital Basel, Basel, Switzerland
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Matter-Walstra K, Schwenkglenks M, Li Q, Cvijetic I, Tschanz B, Samaras P, Saletti P, Roth A, Horber D, Koeberle D. Health Economic Analysis of the Randomized Multicenter Phase Ii Trial Sakk 77/08: Sorafenib with or Without Everolimus in Patients with Unresectable Hepatocellular Carcinoma (Hcc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu341.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Helbling D, Bodoky G, Gautschi O, Sun H, Bosman F, Gloor B, Burkhard R, Winterhalder R, Madlung A, Rauch D, Saletti P, Widmer L, Borner M, Baertschi D, Yan P, Benhattar J, Leibundgut EO, Bougel S, Koeberle D. Neoadjuvant chemoradiotherapy with or without panitumumab in patients with wild-type KRAS, locally advanced rectal cancer (LARC): a randomized, multicenter, phase II trial SAKK 41/07. Ann Oncol 2012; 24:718-25. [PMID: 23139259 DOI: 10.1093/annonc/mds519] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We conducted a randomized, phase II, multicenter study to evaluate the anti-epidermal growth factor receptor (EGFR) mAb panitumumab (P) in combination with chemoradiotherapy (CRT) with standard-dose capecitabine as neoadjuvant treatment for wild-type KRAS locally advanced rectal cancer (LARC). PATIENTS AND METHODS Patients with wild-type KRAS, T3-4 and/or N+ LARC were randomly assigned to receive CRT with or without P (6 mg/kg). The primary end-point was pathological near-complete or complete tumor response (pNC/CR), defined as grade 3 (pNCR) or 4 (pCR) histological regression by Dworak classification (DC). RESULTS Forty of 68 patients were randomly assigned to P + CRT and 28 to CRT. pNC/CR was achieved in 21 patients (53%) treated with P + CRT [95% confidence interval (CI) 36%-69%] versus 9 patients (32%) treated with CRT alone (95% CI: 16%-52%). pCR was achieved in 4 (10%) and 5 (18%) patients, and pNCR in 17 (43%) and 4 (14%) patients. In immunohistochemical analysis, most DC 3 cells were not apoptotic. The most common grade ≥3 toxic effects in the P + CRT/CRT arm were diarrhea (10%/6%) and anastomotic leakage (15%/4%). CONCLUSIONS The addition of panitumumab to neoadjuvant CRT in patients with KRAS wild-type LARC resulted in a high pNC/CR rate, mostly grade 3 DC. The results of both treatment arms exceeded prespecified thresholds. The addition of panitumumab increased toxicity.
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Affiliation(s)
- D Helbling
- Department of Medical Oncology, Gastrointestinal Tumorcenter Zurich, Zurich 8038, Switzerland.
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Frigeri M, De Dosso S, Castillo-Fernandez O, Feuerlein K, Neuenschwander H, Saletti P. Chemotherapy in patients with advanced pancreatic cancer: too close to death? Support Care Cancer 2012; 21:157-63. [PMID: 22648205 DOI: 10.1007/s00520-012-1505-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/20/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE We evaluated the attitude in using chemotherapy near the end of life in advanced pancreatic adenocarcinoma (PAC). Clinical and laboratory parameters recorded at last chemotherapy administration were analyzed, in order to identify risk factors for imminent death. METHODS Retrospective analysis of patients who underwent at least one line of palliative chemotherapy was made. Data concerning chemotherapy (regimens, lines, and date of last administration) were collected. Clinical and laboratory factors recorded at last chemotherapy administration were: performance status, presence of ascites, hemoglobin, white blood cell (WBC), platelets, total bilirubin, albumin, LDH, C-reactive protein (C-rp), and Ca 19.9. RESULTS We analyzed 231 patients: males/females, 53/47 %; metastatic/locally advanced disease, 80/20 %; and median age, 66 years (range 32-85). All patients died due to disease progression. Median overall survival was 6.1 months (95 % CI 5.1-7.2). At the last chemotherapy delivery, performance status was 0-1 in 37 % and 2 in 63 %. Fifty-nine percent of patients received one chemotherapy line, while 32, 8, and 1 % had second-, third-, and fourth line, respectively. The interval between last chemotherapy administration and death was <4 weeks in 24 %, ≥4-12 in 47 %, and >12 in 29 %. Median survival from last chemotherapy to death was 7.5 weeks (95 % CI 6.7-8.4). In a univariate analysis, ascites, elevated WBC, bilirubin, LDH, C-rp and Ca 19.9, and reduced albumin were found to predict shorter survival; however, none of them remained significant in a multivariate analysis. CONCLUSIONS A significant proportion of patients with advanced PAC received chemotherapy within the last month of life. The clinical and laboratory parameters recorded at last chemotherapy delivery did not predict shorter survival.
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Affiliation(s)
- M Frigeri
- Centre Pluridisciplinaire d'Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Martin V, Sacconi A, Landi L, Riva A, Saletti P, Geva R, Tejpar S, Kalogeras K, Frattini M, Cappuzzo F. 6015 POSTER DISCUSSION An International Consortium in Chemo-refractory Metastatic Colorectal Cancer Patients Shows Cetuximab Efficacy in Patients Harboring HER2 Gene Copy Number Gain. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Helbling D, Bodoky G, Gautschi O, Sun H, Bosman F, Gloor B, Burkhard R, Winterhalder RC, Madlung A, Rauch D, Saletti P, Widmer LA, Borner MM, Baertschi D, Yan P, Koeberle D. Neoadjuvant chemoradiation (CRT) with or without panitumumab (Pan) in patients with K-ras-unmutated, locally advanced rectal cancer (LARC): A randomized multicenter phase II trial (SAKK 41/07). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lugli A, Molinari F, Saletti P, de Dosso S, Mazzucchelli L, Frattini M, Zlobec I. Use of tumor budding with K-RAS gene analysis to identify potentially responsive metastatic colorectal cancer patients treated with anti-EGFR therapies. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Frattini M, Molinari F, Saletti P, Mazzucchelli L. Reply: Do we need biopsies of metastases for colorectal cancer patients? Br J Cancer 2009. [PMCID: PMC2720196 DOI: 10.1038/sj.bjc.6605170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Koeberle D, Montemurro M, Samaras P, Majno P, Simcock M, Kovacs K, Inauen R, Hess V, Saletti P, Bodoky G. Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4591] [Citation(s) in RCA: 7] [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
4591 Background: Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenetic activity. Evidence for clinical activity in HCC was reported in 2 phase II trials [Zhu et al and Faivre et al, ASCO 2007] using either a 37.5 or a 50 mg daily dose in a 4 weeks on, 2 weeks off regimen. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients (pts) with HCC. Methods: Key eligibility criteria included unresectable or metastatic HCC, no prior systemic anticancer treatment, measurable disease and Child-Pugh A or B liver dysfunction. Pts received 37.5 mg SU daily until progression or unacceptable toxicity. The primary endpoint was progression free survival at 12 weeks (PFS12) defined as ‘success’ if the patient was alive and without tumor progression assessed by 12 weeks (± 7 days) after registration. A PFS12 of ≤ 20% was considered uninteresting and promising if ≥ 40%. Using the Simon-two minimax stage design with 90% power and 5% significance the sample size was 45 pts. Secondary endpoints included safety assessments, measurement of serum cobalamin levels and tumor density. Results: From September 2007 to August 2008 45 pts, mostly male (87%), were enrolled in 10 centers. Median age was 63 years, 89% had Child-Pugh A and 47% had distant metastases. Median largest lesion diameter was 84 mm (range: 18 - 280) and 18% had prior TACE. Reasons for stopping therapy were: PD 60%, symptomatic deterioration 16%, toxicity 11%, death 2% (due to tumor), and other reasons 4%; 7% remain on therapy. PFS12 was rated as success in 15 pts (33%) (95% CI: 20%, 49%) and failure in 27 (60%); 3 were not evaluable (due to refusal). Over the whole trial period 1 CR and 40% SD as best response were achieved. Median PFS, duration of disease stabilization, TTP and OS were 2.8, 3.2, 2.8 and 9.3 months, respectively. Grade 3 and 4 adverse events were infrequent and all deaths due to the tumor. Conclusions: Continuous SU treatment with 37.5 mg/d daily is feasible and demonstrates moderate activity in pts with advanced HCC and mild to moderately impaired liver dysfunction. Under this trial design the therapy is considered promising (> 13 PFS12 successes). No significant financial relationships to disclose.
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Affiliation(s)
- D. Koeberle
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Montemurro
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Samaras
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Majno
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Simcock
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - K. Kovacs
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - R. Inauen
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - V. Hess
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Saletti
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - G. Bodoky
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
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Molinari F, Martin V, Saletti P, De Dosso S, Spitale A, Camponovo A, Bordoni A, Crippa S, Mazzucchelli L, Frattini M. Differing deregulation of EGFR and downstream proteins in primary colorectal cancer and related metastatic sites may be clinically relevant. Br J Cancer 2009; 100:1087-94. [PMID: 19293803 PMCID: PMC2669991 DOI: 10.1038/sj.bjc.6604848] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 11/24/2008] [Accepted: 12/01/2008] [Indexed: 02/08/2023] Open
Abstract
Cetuximab and panitumumab efficacy in metastatic colorectal cancer (mCRC) may be influenced by EGFR gene status and/or deregulation of its downstream signalling proteins detected in primary tumour. However, metastasis might have different molecular patterns with respect to primary tumour, possibly affecting the prediction of EGFR-targeted therapy efficacy. We analysed primary tumour and metastasis in 38 mCRC patients. Twelve cases were cetuximab/panitumumab treated. EGFR gene status and protein expression were investigated through fluorescent in situ hybridisation and immunohistochemistry (IHC), K-Ras/BRAF mutations by sequencing and PTEN expression by IHC. We observed EGFR gene deregulation in 25 out of 36 primary tumours and 29 out of 36 metastases, K-Ras mutations in 16 out of 37 cancers and in 15 out of 37 metastases, BRAF mutations in 2 out of 36 cancers and 2 out of 36 metastases and PTEN loss in 8 out of 38 cancers and 12 out of 38 metastases. For the first time in literature, we show that primary colorectal cancer and paired metastasis may exhibit difference with respect to EGFR pathway deregulation mechanisms possibly implying a different response to cetuximab or panitumumab treatment. The investigation of treated patients confirms this hypothesis. We therefore suggest that the analysis of metastatic lesion should be considered in patient management as well as in designing future clinical trials aimed to investigate the effect of anti-EGFR monoclonal antibodies in the treatment of mCRC.
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Affiliation(s)
- F Molinari
- Institute of Pathology, Locarno, Switzerland
| | - V Martin
- Institute of Pathology, Locarno, Switzerland
| | - P Saletti
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - S De Dosso
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A Spitale
- Ticino Cancer Registry, Locarno, Switzerland
| | - A Camponovo
- Institute of Pathology, Locarno, Switzerland
| | - A Bordoni
- Ticino Cancer Registry, Locarno, Switzerland
| | - S Crippa
- Institute of Pathology, Locarno, Switzerland
| | | | - M Frattini
- Institute of Pathology, Locarno, Switzerland
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16
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De Dosso S, Sessa C, Saletti P. Adjuvant therapy for colon cancer: Present and perspectives. Cancer Treat Rev 2009; 35:160-6. [DOI: 10.1016/j.ctrv.2008.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 10/02/2008] [Accepted: 10/04/2008] [Indexed: 01/14/2023]
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Di Nicolantonio F, Martini M, Molinari F, Sartore Bianchi A, Arena S, Saletti P, Mazzucchelli L, Frattini M, Siena S, Bardelli A. 247 ORAL BRAF V600E confers resistance to cetuximab or panitumumab in metastatic colorectal cancer. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72181-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Saletti P, Molinari F, Martin V, Bordoni A, Crippa S, Mazzucchelli L, Frattini M. Analysis of epidermal growth factor receptor (EGFR) downstream proteins in metastatic colorectal cancer patients: Comparison between primary tumor and related metastatic sites. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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De Dosso S, Ghielmini M, Saletti P. Advanced pancreatic cancer: A single institution experience. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Gerber D, Dietrich D, Koeberle D, Saletti P, Borner M, Caspar CB, Mingrone W, Beretta K, Herrmann R. Clinical benefit and quality of life in patients with advanced biliary tract cancer receiving gemcitabine plus capecitabine (GemCap): Results from a multicenter phase II trial (SAKK 44/02). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Borner M, Koeberle D, Von Moos R, Saletti P, Rauch D, Hess V, Trojan A, Helbling D, Pestalozzi B, Caspar C, Ruhstaller T, Roth A, Kappeler A, Dietrich D, Lanz D, Mingrone W. Adding cetuximab to capecitabine plus oxaliplatin (XELOX) in first-line treatment of metastatic colorectal cancer: a randomized phase II trial of the Swiss Group for Clinical Cancer Research SAKK. Ann Oncol 2008; 19:1288-1292. [PMID: 18349029 DOI: 10.1093/annonc/mdn058] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To determine the activity and tolerability of adding cetuximab to the oxaliplatin and capecitabine (XELOX) combination in first-line treatment of metastatic colorectal cancer (MCC). PATIENTS AND METHODS In a multicenter two-arm phase II trial, patients were randomized to receive oxaliplatin 130 mg/m(2) on day 1 and capecitabine 1000 mg/m(2) twice daily on days 1-14 every 3 weeks alone or in combination with standard dose cetuximab. Treatment was limited to a maximum of six cycles. RESULTS Seventy-four patients with good performance status entered the trial. Objective partial response rates after external review and radiological confirmation were 14% and 41% in the XELOX and in the XELOX + Cetuximab arm, respectively. Stable disease has been observed in 62% and 35% of the patients, with 76% disease control in both arms. Cetuximab led to skin rash in 65% of the patients. The median overall survival was 16.5 months for arm A and 20.5 months for arm B. The median time to progression was 5.8 months for arm A and 7.2 months for arm B. CONCLUSION Differences in response rates between the treatment arms indicate that cetuximab may improve outcome with XELOX. The correct place of the cetuximab, oxaliplatin and fluoropyrimidine combinations in first-line treatment of MCC has to be assessed in phase III trials.
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Affiliation(s)
- M Borner
- Institute of Medical Oncology, Inselspital, Bern, Switzerland.
| | - D Koeberle
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - R Von Moos
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - P Saletti
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Rauch
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - V Hess
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Trojan
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Helbling
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - B Pestalozzi
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - C Caspar
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - T Ruhstaller
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Roth
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Kappeler
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Dietrich
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Lanz
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - W Mingrone
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
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- Institute of Medical Oncology, Inselspital, Bern, Switzerland
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22
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Frattini M, Saletti P, Romagnani E, Martin V, Molinari F, Ghisletta M, Camponovo A, Etienne LL, Cavalli F, Mazzucchelli L. PTEN loss of expression predicts cetuximab efficacy in metastatic colorectal cancer patients. Br J Cancer 2007; 97:1139-45. [PMID: 17940504 PMCID: PMC2360431 DOI: 10.1038/sj.bjc.6604009] [Citation(s) in RCA: 429] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 09/01/2007] [Indexed: 12/12/2022] Open
Abstract
To evaluate whether the epidermal growth factor receptor (EGFR), K-Ras and PTEN, all members of the EGFR signalling pathway, may affect the clinical response in cetuximab-treated metastatic colorectal cancer (mCRC) patients. Twenty-seven cetuximab-treated mCRC patients were evaluated for drug response and investigated for EGFR protein expression and gene status, K-Ras mutational status and PTEN protein expression. Ten patients achieved a partial response (PR) to cetuximab-based therapy. All 27 patients showed EGFR protein overexpression. Epidermal growth factor receptor gene amplification was observed in eight out of 27 (30%) and chromosome 7 marked polysomy in 16 (59%) patients. Partial response was observed in six out of eight patients with EGFR gene amplification, four out of 16 with marked polysomy and none out of three with eusomy (P<0.05). The K-Ras wild-type sequence was observed in 17 patients, and nine of them experienced a PR. Conversely, K-Ras was mutated in 10 cases, of which one patient experienced a PR (P<0.05). The PTEN protein was normally expressed in 16 patients, and 10 of them achieved a PR. In contrast, no benefit was documented in 11 patients with loss of PTEN activity (P<0.001). Patients with EGFR gene amplification or chromosome 7 marked polysomy respond to cetuximab. In addition to K-Ras mutations, we demonstrate for the first time that the loss of PTEN protein expression is associated with nonresponsiveness to cetuximab.
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Affiliation(s)
- M Frattini
- Institute of Pathology, via in Selva 24, CH-6600 Locarno, Switzerland.
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Koeberle D, Saletti P, Borner M, Caspar C, Strasser F, Ruhstaller T, Mora O, Dietrich D, Gerber D, Herrmann R. 3524 POSTER High rate of clinical benefit response in patients with advanced biliary tract cancer receiving gemcitabine plus capecitabine. A prospective, multicenter phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 44/02). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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24
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Mancuso A, Sacchetta S, Saletti P, Tronconi C, Milesi L, Garassino M, Martelli O, Labianca R, Cavalli F, Sternberg CN. Clinical and molecular determinants of survival in pancreatic cancer patients treated with second line chemotherapy: results of an Italian/Swiss multicenter survey. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4622 Background: The impact on survival of palliative second-line therapy in pancreatic cancer has not been clarified and clinical/molecular predictive factors are needed in order to decide which therapeutic regimens may be effective. Methods: Clinical records of 160 Gemcitabine resistant/refractory pancreatic cancer patients (pts) treated in 11 medical oncology departments in Italy and Switzerland were reviewed. All pts received a second line regimen from June 1997 to February 2006. There were 99 males, 61 females, median age 62 years (range 34–78) and median ECOG performance status (PS): 1 (range 0–2). 16 different salvage regimens were administered consisting of monotherapy with fluoropyrimidines in 59% of cases and combinations of platinum- salts/fluoropyrimidines in 36%. Fluoropyrimidines combinations with bevacizumab, irinotecan and mitomycin C were administered in the remaining 5%. ERCC-1 expression was examined by performing immunohistochemical staining in pts treated with platinum-salts. Results: Second line chemotherapy produced partial responses (PR) in 16 (10%) and stable disease (SD) in 40 pts (25%) by RECIST criteria. The median progression free survival (PFS) was 2.65 months. Multivariate analysis revealed that the most important prognostic factor for PFS was PS at the beginning of second line therapy (Second line PFS PS=0–1 vs PS=2: 78 days vs 48 days, p<0.05, log-rank test). Pts who had responded (PR) to first-line Gemcitabine were more likely to respond or attain stable disease after second-line treatment, with a PFS of 2.6 vs 1.6 months (p<0.05, log-rank test). The overall survival (OS) for all evaluable pts was 11.5 months and 1-year survival was 45%. Among 57 pts treated with platinum-containing doublets, a low ERCC1 level (28/57 pts) was highly predictive of longer survival (11.9 versus 9.9 months, p<0.05 log-rank test). Conclusions: These results suggest that fluoropyrimidine-based salvage regimens have marginal activity and should be considered only in pts with a good PS who have responded to first line chemotherapy. ERCC-1 expression should be further evaluated as a predictive test to select patients who may benefit from platinum/fluoropyrimidine salvage regimens. No significant financial relationships to disclose.
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Affiliation(s)
- A. Mancuso
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - S. Sacchetta
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - P. Saletti
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - C. Tronconi
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - L. Milesi
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - M. Garassino
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - O. Martelli
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - R. Labianca
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - F. Cavalli
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
| | - C. N. Sternberg
- S. Camillo-Forlanini Hospital, Rome, Italy; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Humanitas Clinical Institute, Milano, Italy; Ospedali Riuniti, Bergamo, Bergamo, Italy; Ospedale Fatebenefratelli e Oftalmico, Milano, Italy; San Giovanni Hospital, Rome, Italy; San Camillo and Forlanini Hospitals, Rome, Italy
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25
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Mancuso A, Saletti P, Sacchetta S, Romagnani E, Cavalli F, Sternberg CN. Treatment outcomes with first and second line chemotherapy in advanced and metastatic pancreatic cancer patients. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14107] [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
14107 Background: Recent advances in the treatment of pancreatic cancer might influence the management of locally advanced and metastatic disease, nonetheless prognosis remains dismal (1-year survival rates: 24%). The impact on survival of palliative second-line therapy is hotly debated. Methods: We retrospectively reviewed the clinical records of 103 pancreatic cancer patients admitted to San Camillo/Forlanini Hospital (Rome, Italy) and the Oncology Institute of Southern Switzerland during the period June, 1997 to August, 2005 [60 males, 43 females, median age 65 years (range 43–80); median ECOG performance status (PS): 1]. All patients received Gemcitabine as single agent (90%) or in combination with Oxaliplatin (10%) as upfront therapy. A total of 12 fluoropyrimidine-based salvage regimens were administered to 46 patients in the second line setting. Best supportive care was selected in 57 patients after failing first line therapy. Results: Of 103 evaluable patients, first line chemotherapy produced overall tumor growth control of partial response (PR) and stable disease(SD) by RECIST criteria of 52.4% with a median progression free survival (PFS) of 4.6 months. Multivariate analysis revealed that the most important prognostic factor for PFS was the patient’s PS, as patients with PS of 1–2 at diagnosis had significantly worse results than patients with PS = 0 (First line PFS: 110 days vs 193 days, p<0.05). Baseline CA19–9 and number of metastatic sites were not independent prognostic factors for better first-line PFS. PR was observed in 8/46 patients (17.3%) who received second line chemotherapy, SD in 10 (21.7%), and 28 patients progressed (61%). Median overall second line PFS was 3.2 months. Patients who had responded to first-line Gemcitabine were more likely to respond or attain stable disease with second-line treatment, with a PFS of 5.6 vs 2.85 months (p<0.05). The overall survival for all evaluable patients was 8.4 months. 1-year survival was 52% for patients treated with second line therapy. Conclusions: These results are consistent with historical studies and suggest that fluoropyrimidine-based salvage regimens have marginal but definite activity and should be considered in patients who have responded to first line chemotherapy with an optimal PS. No significant financial relationships to disclose.
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Affiliation(s)
- A. Mancuso
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; San Camillo/Forlanini Hospital, Rome, Italy
| | - P. Saletti
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; San Camillo/Forlanini Hospital, Rome, Italy
| | - S. Sacchetta
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; San Camillo/Forlanini Hospital, Rome, Italy
| | - E. Romagnani
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; San Camillo/Forlanini Hospital, Rome, Italy
| | - F. Cavalli
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; San Camillo/Forlanini Hospital, Rome, Italy
| | - C. N. Sternberg
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; San Camillo/Forlanini Hospital, Rome, Italy
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Borner M, Mingrone W, Koeberle D, Von Moos R, Rauch D, Saletti P, Herrmann R, Dietrich D, Lanz D, Roth A. The impact of cetuximab on the capecitabine plus oxaliplatin (XELOX) combination in first-line treatment of metastatic colorectal cancer (MCC): A randomized phase II trial of the Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3551] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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
3551 Background: XELOX is a valuable alternative to continuous infusion FOLFOX type regimens in the treatment of MCC (Borner et al, JCO 2002, 1759). Cetuximab is an EGFR antibody, which has been shown to improve the efficacy of chemotherapy. A phase II study in first-line treatment of MCC has demonstrated a high response rate combining cetuximab with FOLFOX (Tabernero et al, Proc ASCO 2004, 3512). Methods: Multicenter, randomized two-arm phase II trial: OXA 130 mg/m2 day 1 and oral CAP 1000 mg/m2 bid days 1–14 every 21 days alone or in combination with cetuximab 250 mg/m2 weekly after a loading dose of 400 mg/m2. Treatment was limited to a maximum of 6 cycles. With 37 patients in each arm, the power was 90% to select the truly better arm if the true between-arm difference in response rate (RECIST) is at least 15%. The study was open for accrual until October 2005. Results: We present here the results of 74 patients included in the study. In 67 patients the first response data are available (investigators’ assessment after 3 cycles). The two arms are well balanced for relevant patient, disease and treatment characteristics. The study treatment was well tolerated with grade 3/4 toxicities in < 10% of the cycles in each arm. The frequency of side effects was balanced, but with more frequent skin toxicity in the cetuximab arm (6% versus 0% grade 3/4). Conclusions: Cetuximab seems to positively interact with XELOX in terms of efficacy but not toxicity. The cetuximab/XELOX combination appears to be a valuable option in first-line treatment of MCC especially if high response rates are a primary objective. This trial was supported in part by Merck KGaA and Sanofi-Aventis Switzerland. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Borner
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - W. Mingrone
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Koeberle
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - R. Von Moos
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Rauch
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - P. Saletti
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - R. Herrmann
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Dietrich
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Lanz
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - A. Roth
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
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Herrmann R, Bodoky G, Ruhstaller T, Glimelius B, Saletti P, Bajetta E, Schueller J, Bernhard J, Dietrich D, Scheithauer W. Gemcitabine (G) plus capecitabine (C) versus G alone in locally advanced or metastatic pancreatic cancer. A randomized phase III study of the Swiss Group for Clinical Cancer Research (SAKK) and the Central European Cooperative Oncology Group (CECOG). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba4010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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)
- R. Herrmann
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - G. Bodoky
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - T. Ruhstaller
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - B. Glimelius
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - P. Saletti
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - E. Bajetta
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - J. Schueller
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - J. Bernhard
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - D. Dietrich
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - W. Scheithauer
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
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Borner MM, Bernhard J, Dietrich D, Popescu R, Wernli M, Saletti P, Rauch D, Herrmann R, Koeberle D, Honegger H, Brauchli P, Lanz D, Roth AD. A randomized phase II trial of capecitabine and two different schedules of irinotecan in first-line treatment of metastatic colorectal cancer: efficacy, quality-of-life and toxicity. Ann Oncol 2005; 16:282-8. [PMID: 15668285 DOI: 10.1093/annonc/mdi047] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [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: 11/12/2022] Open
Abstract
BACKGROUND To determine the efficacy, impact on quality-of-life (QoL) and tolerability of two different irinotecan administration schedules in combination with capecitabine as first-line treatment of metastatic colorectal cancer. PATIENTS AND METHODS We carried out a randomized phase II trial to select one of the following treatment regimens for further investigation: weekly irinotecan at a dose of 70 mg/m(2) days 1, 8, 15, 22, 29 (arm A) or 3-weekly irinotecan at a dose of 300/240 mg/m(2) day 1 and days 22 (arm B) in combination with capecitabine 1000 mg/m(2) twice daily days 1-14 and days 22-35 every 6 weeks. RESULTS Seventy-five patients with good performance status entered the trial. The two arms were well balanced for relevant patient and disease characteristics. The most frequent toxic effects were grade 3/4 diarrhea (arm A: 34%, B: 19%), grade 3/4 neutropenia (A: 5%, B: 19%) and grade 2/3 alopecia (A: 26%, B: 65%). Other grade 3/4 toxic effects were rare (<5%). Response rates were 34% [95% confidence interval (CI) 20% to 51%] in arm A and 35% (95% CI: 20% to 53%) in arm B. Median time to progression was 6.9 (4.6-10.1) and 9.2 (7.9-11.5) months and median overall survival was 17.4 (12.6-23.0+) and 24.7 (16.3-26.4+) months. Patients with an objective tumor response reported better physical well-being (P < 0.01), mood (P < 0.05), functional performance (P < 0.05) and less effort to cope (P < 0.05) compared with the non-responders and stable disease patients. CONCLUSIONS The primary end point of this study was the objective response rate and based on the statistical design of the trial, the 3-weekly irinotecan schedule was selected over weekly irinotecan administration. The 3-weekly irinotecan schedule also seemed advantageous in terms of grade 3/4 diarrhea, time to progression, overall survival and patient convenience, but the study was not designed to detect differences in these parameters. In addition, tumor response was shown to have a beneficial effect on QoL indicators.
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Affiliation(s)
- M M Borner
- Institute of Medical Oncology, Inselspital, 3101 Berne, Switzerland.
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Borner MM, Bernhard J, Dietrich D, Popescu R, Wernli M, Saletti P, Rauch D, Herrmann R, Roth A. The impact of the irinotecan (IRI) schedule on quality of life in combination with capecitabine (CAP) in first-line treatment of metastatic colorectal cancer (MCC): A randomized phase II trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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)
- M. M. Borner
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - J. Bernhard
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Dietrich
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - R. Popescu
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - M. Wernli
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - P. Saletti
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - D. Rauch
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - R. Herrmann
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - A. Roth
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
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Roth AD, Maibach R, Falk S, Stupp R, Saletti P, Kãberle D, Borner MM, Honegger HP, Leslie M, Fazio N. Docetaxel-cisplatin-5FU (TCF) versus docetaxel-cisplatin (TC) versus epirubicin-cisplatin-5FU (ECF) as systemic treatment for advanced gastric carcinoma (AGC): A randomized phase II trial of the Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4020] [Citation(s) in RCA: 10] [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)
- A. D. Roth
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - R. Maibach
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - S. Falk
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - R. Stupp
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - P. Saletti
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - D. Kãberle
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - M. M. Borner
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - H.-P. Honegger
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - M. Leslie
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - N. Fazio
- Oncosurgery, Geneva University Hospital, Geneva, Switzerland; SIAK Coordinating Center, Bern, Switzerland; Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Multidisciplinary Oncology Center, CHUV, Lausanne, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Division of Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland; Institute of Medical Oncology, Inselspital, Bern, Switzerland; Institute of Oncology, Stadtspital Triemli, Zurich, Switzerland
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Saletti P, Ghielmini M, Martinoli S, Goldhirsch A. Sustained complete remission of metastatic oesophageal adenocarcinoma using long-term therapy with 5-fluorouracil. Ann Oncol 2004; 15:1145-6. [PMID: 15205212 DOI: 10.1093/annonc/mdh269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Colorectal cancer (CRC) is a significant cause of mortality in Western populations. About 15% of CRC patients report a family history of the disease. Studies on individuals with a genetic predisposition to CRC have been responsible for significant advances in the understanding of this disease. Thus, although developments in molecular biology have been mainly restricted to a minority of individuals with a hereditary background, information obtained from this group may affect the diagnosis and therapy of sporadic CRCs as well. Deficiency in the DNA mismatch repair (MMR) system results in microsatellite instability (MSI). Individuals from hereditary non-polyposis colorectal cancer (HNPCC) kindreds with germline mutations in genes involved in MMR may benefit from clinical screening programs. The higher frequency of MSI in HNPCC than in sporadic tumours suggests that involvement of MMR genes in sporadic adenomas may be uncommon. Consequently
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Affiliation(s)
- P Saletti
- Istituto Oncologico della Svizzera Italiana, Oncologia medica, Ospedale S. Giovanni, Bellinzona, Switzerland.
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Saletti P, Zucca E, Gueneau M, Peccatori F, Cavalli F, Martinelli G. ChlVPP/ABV-VP16 hybrid regimen for advanced Hodgkin's disease: a study in 36 patients. Leuk Lymphoma 1999; 33:313-9. [PMID: 10221511 DOI: 10.3109/10428199909058431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prolonged remission can now be induced in the majority of patients with advanced Hodgkin's disease (HD) by the use of non-cross-resistant regimens. The aim of this retrospective analysis was to evaluate the efficacy and tolerability of a hybrid chemotherapy regimen (ChlVPP/ABV-VP16) in this unfavorable subset of patients. From 1982 to 1997 thirty-six previously untreated patients with advanced HD, Stages IIB to IV according to the Ann Arbor classification, were treated with the ChlVPP/ABV-VP16 regimen. The median age of the group was 29 years (range, 18 to 74), and 50% of them had bulky disease. Complete remission (CR) was induced in 31 patients (86%); 3 patients achieved partial responses and 2 had progressive disease. The median follow-up duration is 5.7 years, with a 5-year overall survival rate of 80%. At 5 years, the time to progression (TTP) and event-free survival (EFS) were 71% and 64%, respectively. Acute toxicity was quite acceptable, and there were no treatment-related deaths. A total of 3 second malignancies (8%) were documented. In conclusion, the ChlVPP/ABV-VP16 hybrid is an active regimen for use in advanced HD. Its overall survival, TTP and CR rates make this regimen an attractive alternative to MOPP/ABVD. However, the possibility of the development of second tumors is worrisome, although the relatively brief interval between the end of treatment and tumor detection may imply caution about the possible relationship.
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Affiliation(s)
- P Saletti
- Servizio Oncologico Cantonale, Ospedale San Giovanni, Bellinzona, Switzerland
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Abstract
Systemic mastocytosis is a rare condition characterized clinically by the local consequences of vasoactive peptides released from infiltrating mast cells in the reticuloendothelial tissues. Mast cells originate from the pluripotent bone marrow stem cells; it is therefore not surprising that myeloproliferative and myelodysplastic disorders commonly coexist or terminate the clinical phase of mastocytosis. We report here, to our knowledge, the first case of Hodgkin's and Castleman's disease occurring in a patient with co-existent systemic mastocytosis, which remained unchanged after combination chemotherapy for Hodgkin's disease.
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Affiliation(s)
- P Saletti
- Department of Oncology, Ospedale S. Giovanni, Bellinzona, Switzerland
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Pinotti G, Zucca E, Roggero E, Pascarella A, Bertoni F, Savio A, Savio E, Capella C, Pedrinis E, Saletti P, Morandi E, Santandrea G, Cavalli F. Clinical features, treatment and outcome in a series of 93 patients with low-grade gastric MALT lymphoma. Leuk Lymphoma 1997; 26:527-37. [PMID: 9389360 DOI: 10.3109/10428199709050889] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.4] [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: 02/05/2023]
Abstract
The purpose of this paper is to report the clinical characteristics and treatment outcome following different therapeutic approaches in a large series of patients with primary low-grade MALT lymphoma of the stomach. A total of ninety-three patients (median age 63 years) were reviewed. The patients were treated by different modalities (local treatment alone, combined treatment, chemotherapy, antibiotics alone); seven patients refused any treatment. The antibiotic-treated group of patients was prospectively followed with regular endoscopic biopsies, and their responses were histologically evaluated. The 5-years projected overall survival is 82% (95% C.I.; 67%-91%) in the series as a whole. Second tumors were observed in 21.5% of the patients in this series (95% CI 14%v to 31%). There was no apparent difference in overall survival and event-free survival between patients who received different treatments. In the antibiotic-treated group histologic regression of MALT lymphoma was documented in 67% of patients (95% CI 51% to 80%). In conclusion the indolent nature of the disease justifies a conservative approach. The use of antibiotics as first-line therapy may avert or at least postpone the indication for surgical resection in the majority of patients.
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Affiliation(s)
- G Pinotti
- Divisione Clinica Medica, Ospedale Multizonale, Varese, Italy
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