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Shagera QA, Karfis I, Kristanto P, Spyridon S, Diamand R, Santapau A, Peltier A, Roumeguère T, Flamen P, Artigas C. PSMA PET/CT for Response Assessment and Overall Survival Prediction in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors. J Nucl Med 2023; 64:1869-1875. [PMID: 37770114 DOI: 10.2967/jnumed.123.265874] [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: 04/14/2023] [Revised: 09/07/2023] [Indexed: 10/02/2023] Open
Abstract
We aimed to evaluate the role of prostate-specific membrane antigen (PSMA) PET/CT for response assessment and outcome prediction in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with androgen receptor pathway inhibitors (ARPIs), including abiraterone acetate or enzalutamide. Methods: We retrospectively analyzed 30 ARPI-treated mCRPC patients who underwent 68Ga-PSMA-11 PET/CT within 8 wk before (baseline) and 12 ± 4 wk after treatment initiation. Total PSMA tumor volume was calculated using the fixed threshold method (SUV ≥ 3). Patients were categorized as PSMA responders (PSMA-Rs) or PSMA nonresponders (PSMA-NRs) on the basis of both European Association of Urology/European Association of Nuclear Medicine (EAU/EANM) criteria and Response Evaluation Criteria in PSMA PET/CT (RECIP) 1.0. PSMA-R included patients with a complete response, a partial response, or stable disease, and PSMA-NR included those with progressive disease. On the basis of prostate-specific antigen (PSA), patients were classified as biochemical responders if PSA decreased by at least 50% and as nonresponders if it did not. The Φ-coefficient was used to evaluate the correlation of PSMA- and PSA-based responses. Survival analysis was performed using the Cox regression hazard model and the Kaplan-Meier method. Predictive accuracy was tested for both response criteria. Results: On the basis of PSMA PET/CT, 13 (43%) patients were PSMA-NR according to the EAU/EANM criteria and 11 (37%) patients were PSMA-NR according to RECIP 1.0. Significant correlations were observed between PSMA- and PSA-based responses for both criteria (Φ = 0.79 and 0.66, respectively). After a median follow-up of 25 mo (interquartile range, 21-43 mo), the median overall survival was significantly longer for PSMA-R than PSMA-NR (54 vs. 22 mo) for both the EAU/EANM criteria and RECIP 1.0, with hazard ratios of 6.9 (95% CI, 1.9-26; P = 0.004) and 5.6 (95% CI, 1.69-18.26, P = 0.005), respectively. No significant difference in predictive accuracy was found between the 2 criteria (C-index, 0.79 vs. 0.76, respectively, P = 0.54). Flare phenomena at the second PSMA PET study were not observed in our cohort. Conclusion: Our results demonstrate that PSMA PET/CT is a valuable imaging biomarker for response assessment and overall survival prediction when performed at 3 mo after ARPI treatment initiation in mCRPC patients. Both proposed PSMA response criteria (EAU/EANM and RECIP 1.0) seem to perform equally well. No PSMA flare was observed. Prospective validation of these findings is strongly needed.
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Affiliation(s)
- Qaid Ahmed Shagera
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Ioannis Karfis
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Paulus Kristanto
- Data Centre, Unité de Gestion de l'Information, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Sideris Spyridon
- Department of Oncology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Albert Santapau
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Roumeguère
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Flamen
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Artigas
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium;
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Buisseret L, Loirat D, Aftimos P, Maurer C, Punie K, Debien V, Kristanto P, Eiger D, Goncalves A, Ghiringhelli F, Taylor D, Clatot F, Van den Mooter T, Ferrero JM, Bonnefoi H, Canon JL, Duhoux FP, Mansi L, Poncin R, Barthélémy P, Isambert N, Denis Z, Catteau X, Salgado R, Agostinetto E, de Azambuja E, Rothé F, Craciun L, Venet D, Romano E, Stagg J, Paesmans M, Larsimont D, Sotiriou C, Ignatiadis M, Piccart-Gebhart M. Paclitaxel plus carboplatin and durvalumab with or without oleclumab for women with previously untreated locally advanced or metastatic triple-negative breast cancer: the randomized SYNERGY phase I/II trial. Nat Commun 2023; 14:7018. [PMID: 37919269 PMCID: PMC10622534 DOI: 10.1038/s41467-023-42744-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
Chemo-immunotherapy is the first-line standard of care for patients with PD-L1 positive metastatic triple-negative breast cancer (mTNBC). SYNERGY (NCT03616886) is a dose-finding phase I and a randomized phase II, open-label trial evaluating if targeting the immunosuppressive adenosine pathway can enhance the antitumor activity of chemo-immunotherapy. The phase I part included 6 patients with untreated locally-advanced or mTNBC to determine the safety and recommended phase II dose of the anti-CD73 antibody oleclumab in combination with the anti-PD-L1 durvalumab and 12 cycles of weekly carboplatin and paclitaxel. In the phase II part, 127 women were randomized 1:1 to receive chemo-immunotherapy, with (arm A) or without (arm B) oleclumab. The primary endpoint was the clinical benefit rate at week 24, defined as stable disease, partial or complete response per RECIST v1.1. Secondary endpoints included objective response rate, duration of response, survival outcomes (progression-free survival and overall survival), and safety. The trial did not meet its primary endpoint, as the 24-week clinical benefit rate was not significantly improved by adding oleclumab (43% vs. 44%, p = 0.61). Exploratory median progression-free survival was 5.9 months in arm A as compared to 7.0 months in arm B (p = 0.90). The safety profile was manageable in both arms.
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Affiliation(s)
- Laurence Buisseret
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium.
| | - Delphine Loirat
- Medical Oncology Department, Institut Curie, 75005, Paris, France
| | - Philippe Aftimos
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Christian Maurer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, 52074, Cologne, Germany
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Unit, Leuven Cancer Institute, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Véronique Debien
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Paulus Kristanto
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Daniel Eiger
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Anthony Goncalves
- Medical Oncology Department, Institut Paoli-Calmettes, 13274, Marseille, France
| | | | - Donatienne Taylor
- Department of Oncology, CHU-UCL-Namur - Site Sainte-Elisabeth, 5000, Namur, Belgium
| | - Florent Clatot
- Medical Oncology Department, Centre Henri Becquerel, 76038, Rouen, France
| | - Tom Van den Mooter
- Department of Oncology, GZA Ziekenhuizen Campus Sint-Augustinus, 2610, Antwerp, Belgium
| | - Jean-Marc Ferrero
- Department of Oncology, Centre Antoine Lacassagne, 06189, Nice, France
| | - Hervé Bonnefoi
- Medical Oncology Department, Institut Bergonié, 33000, Bordeaux, France
| | - Jean-Luc Canon
- Department of Oncology-Hematology, Grand Hôpital de Charleroi - Site Notre Dame, 6000, Charleroi, Belgium
| | - Francois P Duhoux
- Medical Oncology Department, Cliniques Universitaires Saint-Luc (UCLouvain), 1200, Brussels, Belgium
| | - Laura Mansi
- Department of Oncology, CHU Besançon - Hôpital Jean Minjoz, 25030, Besancon, France
| | - Renaud Poncin
- Medical Oncology Department, Clinique Saint-Pierre, 1340, Ottignies-Louvain-la-Neuve, Belgium
| | - Philippe Barthélémy
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe (ICANS), 67000, Strasbourg, France
| | - Nicolas Isambert
- Medical Oncology Department, CHU Poitiers, 86000, Poitiers, France
| | - Zoë Denis
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Xavier Catteau
- CurePath Laboratory (CHU Tivoli, CHIREC), 6040, Jumet, Belgium
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, 2610, Antwerp, Belgium
| | - Elisa Agostinetto
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Evandro de Azambuja
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Françoise Rothé
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Ligia Craciun
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - David Venet
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Emanuela Romano
- Centre for Cancer Immunotherapy, Medical Oncology Department, INSERM U932, Institut Curie, PSL Research University, 75005, Paris, France
| | - John Stagg
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Faculté de Pharmacie et Institut du Cancer de Montréal, Montréal, QC, 11290, Canada
| | - Marianne Paesmans
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Denis Larsimont
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Christos Sotiriou
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Michail Ignatiadis
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
| | - Martine Piccart-Gebhart
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, 1070, Brussels, Belgium
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Lytrivi M, Gomes Da Silveira Cauduro C, Kibanda J, Kristanto P, Paesmans M, Cnop M. Impact of saturated compared with unsaturated dietary fat on insulin sensitivity, pancreatic β-cell function and glucose tolerance: a systematic review and meta-analysis of randomized, controlled trials. Am J Clin Nutr 2023; 118:739-753. [PMID: 37500058 DOI: 10.1016/j.ajcnut.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The impact of the dietary fat type on type 2 diabetes (T2D) remains unclear. OBJECTIVES We aimed to evaluate the effects of replacing dietary saturated fatty acids (SFA) with mono- or poly-unsaturated fatty acids (MUFA and PUFA, respectively) on insulin sensitivity, pancreatic β-cell function, and glucose tolerance, as surrogate endpoints for T2D. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials that replaced ≥5% of total energy intake provided by SFA with MUFA or PUFA and reported indexes of insulin sensitivity, β-cell function, and/or glucose tolerance. We searched MEDLINE, Scopus, and the Cochrane Library (CENTRAL) up to 9 January, 2023. Eligible interventions had to be isocaloric, with no significant difference in other macronutrients. Data were synthesized using random-effects model meta-analysis. RESULTS Of 6355 records identified, 10 parallel and 20 crossover trials with 1586 participants were included. The mean age of the participants was 42 years, 47% were male, mean body mass index (BMI; in kg/m2) was 26.8, median baseline fasting glucose was 5.13 mmol/L, and the median duration of interventions was 5 weeks. Replacing SFA with MUFA or PUFA had no significant effects on insulin sensitivity [standardized mean difference (SMD) SFA compared with MUFA: 0.01, 95% confidence interval (CI): -0.06 to 0.09, I2 = 0% and SMD SFA compared with PUFA: 0, 95% CI: -0.15 to 0.14, I2 = 0%]. Replacing SFA with MUFA did not significantly impact the β-cell function, evaluated by the disposition index (mean difference: -12, 95% CI: -158 to 133, I2=0%). Evidence on glucose tolerance (SFA compared with MUFA or PUFA) and on β-cell function when SFA were replaced with PUFA was scant. CONCLUSIONS Short-term substitution of saturated with unsaturated fat does not significantly affect insulin sensitivity nor β-cell function (the latter in the SFA compared with MUFA comparison). Future studies are needed to elucidate longer term effects of dietary fat saturation on glucose homeostasis. This trial was registered at PROSPERO as CRD42020178382.
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Affiliation(s)
- Maria Lytrivi
- ULB Center for Diabetes Research, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Division of Endocrinology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Carolina Gomes Da Silveira Cauduro
- ULB Center for Diabetes Research, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Radiotherapy Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jésabelle Kibanda
- ULB Center for Diabetes Research, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Miriam Cnop
- ULB Center for Diabetes Research, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Division of Endocrinology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Merckaert I, Waroquier P, Caillier M, Verkaeren O, Righes S, Liénard A, Libert Y, Kristanto P, Razavi D. Improving emotion regulation in breast cancer patients in the early survivorship period: Efficacy of a brief ecologically boosted group intervention. Psychooncology 2023; 32:597-609. [PMID: 36703250 DOI: 10.1002/pon.6105] [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: 05/11/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE This study reports the short- and mid-term benefits of an eight-session emotion and self-regulation group intervention ecologically boosted through daily app-based prompts. The intervention was designed for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. METHODS Patients were randomly assigned to the immediate intervention arm (n = 61; intervention received immediately) or to the delayed intervention arm (n = 59; intervention received 5 months later). Psychological symptoms, including anxiety, depressive symptoms, emotional distress, fear of cancer recurrence (FCR), worry, and intrusive thoughts were assessed through questionnaires. Emotion regulation was assessed in a dynamic emotion regulation task and in everyday life. Assessments were completed at baseline (T1), 5 months (T2) and 10 months (T3) later. RESULTS Treated patients reported lower levels of worry and intrusive thoughts. They improved their ability to down-regulate the intensity of their negative emotions when exposed to cancer-related triggers in the dynamic emotion regulation task. They reported fewer and less intense negative emotions and more positive emotions in their everyday life. Benefits were maintained 5 months later, except for positive emotions in everyday life. CONCLUSIONS The results showed that focusing on emotion regulation is a relevant approach in the treatment of psychological symptoms for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. The intervention led to changes in patients' dynamic and everyday life emotion regulation. Consolidation sessions may be needed to sustain benefits in positive emotions and to increase the effect sizes.
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Affiliation(s)
- Isabelle Merckaert
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | - Pauline Waroquier
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | | | | | - Sadio Righes
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium
| | - Aurore Liénard
- Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | - Yves Libert
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | - Paulus Kristanto
- Institut Jules Bordet, Data Center, Unité de Gestion de l'Information (UGI), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Darius Razavi
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
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Polastro L, Kotecki N, Martins-Branco D, Delaroche D, Barthelemy P, Holbrechts S, Vergauwe P, Goemine JC, Demolin G, Prenen H, Clatot F, Roca CG, Kristanto P, Peasmans M, Awada A, hendlisz A, Carnot A, Sclafani F, Aftimos P. Abstract CT530: Multiorgan metabolic imaging response assessment of abemaciclib (MiMe-A): Oncodistinct 002. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Abemaciclib (A) activity against breast cancer as monotherapy or combined with endocrine therapy warrants further investigations in other cancer types. However, its significant toxicity profile illustrates the challenge of defining more precisely the patients unlikely to benefit from it, sparing them from useless toxicities. FDG-PET/CT can identify treatment-refractory disease with high negative predictive value, soon after the treatment onset and before morphological changes are observed. MiMe-A was built on the assumption that a therapy that does not induce tumoral metabolic changes 14 days after its onset is unlikely to achieve a significant clinical benefit.
Methods: A multicenter phase II basket trial assessed the efficacy of A in 5 cancers types (cholangiocarcinoma, endometrial, urothelial carcinomas, oesophagal adeno- and squamous cell carcinomas). The primary endpoint is the ‘treatment success’, defined as metabolic response according to PERCIST at FDG-PET/CT performed during the first cycle (D14) and absence of disease progression per RECIST 1.1 after two cycles of A. A Simon’s 2-stage design was used in each cohort based on the null hypothesis that the treatment success rate will be ≤20%. An interim analysis for futility was performed on each cohort after accrual of 17 patients during the first stage.
Results: The baseline characteristics and the metabolic and morphologic evaluation of eligible patients are shown below.
*: stop treatment before the two months (due to progression or toxicities) IQR: interquartile range, PR: partial response, SD: stable disease, PD: progressive disease
The treatment success rate was 0% for each cancer type except for urothelial carcinoma (5,9% (1/17 treatment success). Toxicities were mainly graded 1 or 2, including diarrhea, nausea, fatigue and haematological.
Conclusion: A did not show significant anti-tumour activity in any of the five cohorts. But early metabolic response was noted in 29% of the oesophageal squamous cell carcinoma population, this finding did not translate in disease control at two months. This could be explained by an initial response rapidly followed by tumoral escape. A combination of A with other drugs should be explored in this cancer type.
Esophageal adenocarcinomaN=17 Esophageal Squamous cell carcinomaN=17 CholangiocarcinomaN=17 Endometrial carcinomaN=17 Urothelial CarcinomaN=17 Baselinecharacteristics Age range 36-83 56-77 50-85 57-84 46-80 Median age (IQR) 65 (55-68) 67 (63-71) 70 (67-74) 68(64-73) 67 (63-71) Median number of lines of prior treatments (IQR) 3 (2-4) 3 (2-4) 2 (1-2) 3 (2-3) 3 (2-3) Metabolic response (PERCIST) assessment Complete metabolic response 0/17 0/17 0/17 0/17 0/17 Partial metabolic response 2/17 5/17 1/17 0/17 2/17 Stable metabolic disease 8/17 4/17 5/17 8/17 7/17 Progressive metabolic disease 4/17 7/17 9/17 6/17 4/17 Not evaluable 3/17 1/17 2/17 3/17 4/17 % Complete or partial metabolic response (95% CI) 12% (2%-36%) 29% (10%-56%) 6% (0%-29%) 0% (0%-20%) 12% (1%-36%) Response by RECIST (after 2 cycles) PR 1/17 1/17 0/17 0/17 0/17 SD 3/17 2/17 5/17 5/17 8/17 PD 6/17 10/17 7/17 9/17 8/17 Not available* 7/17 4/17 5/17 3/17 1/17
Citation Format: Laura Polastro, Nuria Kotecki, Diogo Martins-Branco, Diane Delaroche, Philippe Barthelemy, Stephane Holbrechts, Philippe Vergauwe, JC Goemine, Gauthier Demolin, Hans Prenen, Florian Clatot, Carlos Gomez Roca, Paulus Kristanto, Marianne Peasmans, Ahmad Awada, Alain hendlisz, Aurélien Carnot, Fransceco Sclafani, Philippe Aftimos. Multiorgan metabolic imaging response assessment of abemaciclib (MiMe-A): Oncodistinct 002 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT530.
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Affiliation(s)
| | | | | | | | | | | | | | - JC Goemine
- 5Clinique Saint Elisabeth, Namur, Belgium
| | | | | | | | | | | | | | - Ahmad Awada
- 1Jules Bordet Institute, Anderlecht, Belgium
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Dobbels F, De Bleser L, Berben L, Kristanto P, Dupont L, Nevens F, Vanhaecke J, Verleden G, De Geest S. Efficacy of a medication adherence enhancing intervention in transplantation: The MAESTRO-Tx trial. J Heart Lung Transplant 2017; 36:499-508. [PMID: 28162931 DOI: 10.1016/j.healun.2017.01.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [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: 06/10/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Well-designed randomized controlled trials (RCTs) testing efficacy of post-transplant medication adherence enhancing interventions and clinical outcomes are scarce. METHODS This randomized controlled trial enrolled adult heart, liver, and lung transplant recipients who were >1 year post-transplant and on tacrolimus twice daily (convenience sample) (visit 1). After a 3-month run-in period, patients were randomly assigned 1:1 to intervention group (IG) or control group (CG) (visit 2), followed by a 6-month intervention (visits 2-4) and a 6-month adherence follow-up period (visit 5). All patients used electronic monitoring for 15 months for adherence measurement, generating a daily binary adherence score per patient. Post-intervention 5-year clinical event-free survival (mortality or retransplantation) was evaluated. The IG received staged multicomponent tailored behavioral interventions (visits 2-4) building on social cognitive theory and trans-theoretical model (e.g., electronic monitoring feedback, motivational interviewing). The CG received usual care and attended visits 1-5 only. Intention-to-treat analysis used generalized estimating equation modeling and Kaplan-Meier survival analysis. RESULTS Of 247 patients, 205 were randomly assigned (103 IG, 102 CG). At baseline, average daily proportions of patients with correct dosing (82.6% IG, 78.4% CG) and timing adherence (75.8% IG, 72.2% CG) were comparable. The IG had a 16% higher dosing adherence post-intervention (95.1% IG, 79.1% CG; p < 0.001), resulting in odds of adherence being 5 times higher in the IG than in the CG (odds ratio 5.17, 95% confidence interval 2.86-9.38). This effect was sustained at end of follow-up (similar results for timing adherence). In the IG, 5-year clinical event-free survival was 82.5% vs 72.5% in the CG (p = 0.18). CONCLUSION Our intervention was efficacious in improving adherence and sustainable. Further research should investigate clinical impact, cost-effectiveness, and scalability.
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Affiliation(s)
- Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, University of Basel, Basel, Switzerland.
| | - Leentje De Bleser
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Lut Berben
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | | | - Lieven Dupont
- Lung Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Frederik Nevens
- Liver Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Johan Vanhaecke
- Heart Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Geert Verleden
- Lung Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Sabina De Geest
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, University of Basel, Basel, Switzerland
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Dobbels F, De Bleser L, Berben L, Kristanto P, Dupont L, Nevens F, Vanhaecke J, Verleden G, De Geest S. Testing the Efficacy of a Multicomponent Theory-Based Tailored Behavioral Medication Adherence Intervention in Transplantation: The MAESTRO-TX RCT. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Braun M, Young J, Reiner CS, Poster D, Krauer F, Kistler AD, Kristanto P, Wang X, Liu Y, Loffing J, Andreisek G, von Eckardstein A, Senn O, Wüthrich RP, Serra AL. Low-dose oral sirolimus and the risk of menstrual-cycle disturbances and ovarian cysts: analysis of the randomized controlled SUISSE ADPKD trial. PLoS One 2012; 7:e45868. [PMID: 23071528 PMCID: PMC3468602 DOI: 10.1371/journal.pone.0045868] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/22/2012] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED Sirolimus has been approved for clinical use in non proliferative and proliferative disorders. It inhibits the mammalian target of rapamycin (mTOR) signaling pathway which is also known to regulate ovarian morphology and function. Preliminary observational data suggest the potential for ovarian toxicity but this issue has not been studied in randomized controlled trials. We reviewed the self-reported occurrence of menstrual cycle disturbances and the appearance of ovarian cysts post hoc in an open label randomized controlled phase II trial conducted at the University Hospital Zürich between March 2006 and March 2010. Adult females with autosomal dominant polycystic kidney disease, an inherited kidney disease not known to affect ovarian morphology and function, were treated with 1.3 to 1.5 mg sirolimus per day for a median of 19 months (N = 21) or standard care (N = 18). Sirolimus increased the risk of both oligoamenorrhea (hazard ratio [HR] 4.3, 95% confidence interval [CI] 1.1 to 29) and ovarian cysts (HR 4.4, CI 1.1 to 26); one patient was cystectomized five months after starting treatment with sirolimus. We also studied mechanisms of sirolimus-associated ovarian toxicity in rats. Sirolimus amplified signaling in rat ovarian follicles through the pro-proliferative phosphatidylinositol 3-kinase pathway. Low dose oral sirolimus increases the risk of menstrual cycle disturbances and ovarian cysts and monitoring of sirolimus-associated ovarian toxicity is warranted and might guide clinical practice with mammalian target of rapamycin inhibitors. TRIAL REGISTRATION ClinicalTrials.gov NCT00346918.
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Affiliation(s)
- Matthias Braun
- Division of Nephrology, University Hospital, Zürich, Switzerland
| | - James Young
- Biometrical Practice BIOP AG, Basel, Switzerland
| | - Cäcilia S. Reiner
- Division of Diagnostic and Interventional Radiology, University Hospital, Zürich, Switzerland
| | - Diane Poster
- Division of Nephrology, University Hospital, Zürich, Switzerland
| | - Fabienne Krauer
- Division of Nephrology, University Hospital, Zürich, Switzerland
| | | | - Paulus Kristanto
- Medication Adherence Research Centre, AARDEX Group, Visé, Belgium
| | - Xueqi Wang
- Department of Nephrology, Changzheng Hospital, Shanghai, China
| | - Yang Liu
- Center for Integrative Human Research, University of Zürich, Zürich, Switzerland
| | | | - Gustav Andreisek
- Division of Diagnostic and Interventional Radiology, University Hospital, Zürich, Switzerland
| | | | - Oliver Senn
- Institute of General Practice and Health Services Research, University Hospital, Zürich, Switzerland
| | | | - Andreas L. Serra
- Division of Nephrology, University Hospital, Zürich, Switzerland
- * E-mail:
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Serra AL, Poster D, Kistler AD, Krauer F, Raina S, Young J, Rentsch KM, Spanaus KS, Senn O, Kristanto P, Scheffel H, Weishaupt D, Wüthrich RP. Sirolimus and kidney growth in autosomal dominant polycystic kidney disease. N Engl J Med 2010; 363:820-9. [PMID: 20581391 DOI: 10.1056/nejmoa0907419] [Citation(s) in RCA: 405] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In autosomal dominant polycystic kidney disease (ADPKD), aberrant activation of the mammalian target of rapamycin (mTOR) pathway is associated with progressive kidney enlargement. The drug sirolimus suppresses mTOR signaling. METHODS In this 18-month, open-label, randomized, controlled trial, we sought to determine whether sirolimus halts the growth in kidney volume among patients with ADPKD. We randomly assigned 100 patients between the ages of 18 and 40 years to receive either sirolimus (target dose, 2 mg daily) or standard care. All patients had an estimated creatinine clearance of at least 70 ml per minute. Serial magnetic resonance imaging was performed to measure the volume of polycystic kidneys. The primary outcome was total kidney volume at 18 months on blinded assessment. Secondary outcomes were the glomerular filtration rate and urinary albumin excretion rate at 18 months. RESULTS At randomization, the median total kidney volume was 907 cm3 (interquartile range, 577 to 1330) in the sirolimus group and 1003 cm3 (interquartile range, 574 to 1422) in the control group. The median increase over the 18-month period was 99 cm3 (interquartile range, 43 to 173) in the sirolimus group and 97 cm3 (interquartile range, 37 to 181) in the control group. At 18 months, the median total kidney volume in the sirolimus group was 102% of that in the control group (95% confidence interval, 99 to 105; P=0.26). The glomerular filtration rate did not differ significantly between the two groups; however, the urinary albumin excretion rate was higher in the sirolimus group. CONCLUSIONS In adults with ADPKD and early chronic kidney disease, 18 months of treatment with sirolimus did not halt polycystic kidney growth. (Funded by Wyeth and others; ClinicalTrials.gov number, NCT00346918.)
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Affiliation(s)
- Andreas L Serra
- Division of Nephrology, University Hospital and the University of Zurich, Zurich, Switzerland
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Abstract
OBJECTIVE To describe characteristics of dosing history in patients prescribed a once a day antihypertensive medication. DESIGN Longitudinal database study. SETTING Clinical studies archived in database for 1989-2006. PARTICIPANTS Patients who participated in the studies whose dosing histories were available through electronic monitoring. MAIN OUTCOME MEASURES Persistence with prescribed antihypertensive treatment and execution of their once a day drug dosing regimens. RESULTS The database contained dosing histories of 4783 patients with hypertension. The data came from 21 phase IV clinical studies, with lengths ranging from 30 to 330 days and involving 43 different antihypertensive drugs, including angiotensin II receptor blockers (n=2088), calcium channel blockers (n=937), angiotensin converting enzyme inhibitors (n=665), beta blockers (n=195), and diuretics (n=155). About half of the patients who were prescribed an antihypertensive drug had stopped taking it within one year. On any day, patients who were still engaged with the drug dosing regimen omitted about 10% of the scheduled doses: 42% of these omissions were of a single day's dose, whereas 43% were part of a sequence of several days (three or more days-that is, drug "holidays"). Almost half of the patients had at least one drug holiday a year. The likelihood that a patient would discontinue treatment early was inversely related to the quality of his or her daily execution of the dosing regimen. CONCLUSIONS Early discontinuation of treatment and suboptimal daily execution of the prescribed regimens are the most common facets of poor adherence with once a day antihypertensive drug treatments. The shortfalls in drug exposure that these dosing errors create might be a common cause of low rates of blood pressure control and high variability in responses to prescribed antihypertensive drugs.
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Affiliation(s)
- Bernard Vrijens
- Pharmionic Research Center, Rue des Cyclistes Frontière 24, 4600 Visé, Belgium.
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Vriesendorp R, Cohen A, Kristanto P, Vrijens B, Rakesh P, Anand B, Iwebor HU, Stiekema J. Adherence to HAART therapy measured by electronic monitoring in newly diagnosed HIV patients in Botswana. Eur J Clin Pharmacol 2007; 63:1115-21. [PMID: 17882408 PMCID: PMC2071959 DOI: 10.1007/s00228-007-0369-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 08/07/2007] [Indexed: 11/21/2022]
Abstract
Aims This pilot study was designed to evaluate the feasibility and benefits of electronic adherence monitoring of antiretroviral medications in HIV patients who recently started Highly Active Anti Retroviral Therapy (HAART) in Francistown, Botswana and to compare this with self-reporting. Methods Dosing histories were compiled electronically using Micro Electro Mechanical Systems (MEMS) monitors to evaluate adherence to prescribed therapies. Thirty patients enrolled in the antiretroviral treatment program were monitored over 6 weeks. These patients were all antiretroviral (ARV) naïve. After each visit (mean three times) to the pharmacy, the data compiled by the monitors were downloaded. Electronic monitoring of adherence was compared to patient self-reports of adherence. Results The mean individual medication adherence level measured with the electronic device was 85% (range 21–100%). The mean adherence level measured by means of self-reporting was 98% (range 70–100%). Medication prescribed on a once-a-day dose base was associated with a higher adherence level (97.9% for efavirenz) compared with a twice-a-day regimen (88.4% for Lamivudine/Zidovudine). Conclusions It is feasible to assess treatment adherence of patients living in a low resource setting on HAART by using electronic monitors. Adherence, even in the early stages of treatment, appears to be insufficient in some patients and may be below the level required for continuous inhibition of viral replication. This approach may lead to improved targeting of counselling about their medication intake of such patients in order to prevent occurrence of resistant viral strains due to inadequate inhibition of viral replication. In this pilot study a significant difference between the data recorded through the electronic monitors and those provided by self-reporting was observed.
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Affiliation(s)
- Reinout Vriesendorp
- Centre for Human Drug Research and Department of Clinical Pharmacology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Adam Cohen
- Centre for Human Drug Research and Department of Clinical Pharmacology, Leiden University Medical Centre, Leiden, The Netherlands
- CHDR, Zernikedreef 10, 2333CL Leiden, The Netherlands
| | - Paulus Kristanto
- Pharmionic Systems Ltd., Visé, Belgium
- Aardex Ltd, Zug, Switzerland
| | - Bernard Vrijens
- Pharmionic Systems Ltd., Visé, Belgium
- Aardex Ltd, Zug, Switzerland
| | - Pande Rakesh
- Department of Pharmacy, Nyangabgwe Hospital, Francistown, Botswana
| | - Bene Anand
- Department of Pharmacy, Nyangabgwe Hospital, Francistown, Botswana
| | | | - Jacobus Stiekema
- Department of Medicine, Nyangabgwe Hospital, Francistown, Botswana
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