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Mark M, Rusakiewicz S, Früh M, Hayoz S, Grosso F, Pless M, Zucali P, Ceresoli G, Maconi A, Schneider M, Froesch P, Tarussio D, Benedetti F, Dagher J, Kandalaft L, von Moos R, Tissot-Renaud S, Schmid S, Metaxas Y. Long-term benefit of lurbinectedin as palliative chemotherapy in progressive malignant pleural mesothelioma (MPM): final efficacy and translational data of the SAKK 17/16 study. ESMO Open 2022; 7:100446. [PMID: 35427834 PMCID: PMC9271468 DOI: 10.1016/j.esmoop.2022.100446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 01/01/2023] Open
Abstract
Background The SAKK 17/16 study showed promising efficacy data with lurbinectedin as second- or third-line palliative therapy in malignant pleural mesothelioma. Here, we evaluated long-term outcome and analyzed the impact of lurbinectedin monotherapy on the tumor microenvironment at the cellular and molecular level to predict outcomes. Material and methods Forty-two patients were treated with lurbinectedin in this single-arm study. Twenty-nine samples were available at baseline, and seven additional matched samples at day one of cycle two of treatment. Survival curves and rates between groups were compared using the log-rank test and Kaplan–Meier method. Statistical significance was set at P value <0.05. Results Updated median overall survival (OS) was slightly increased to 11.5 months [95% confidence interval (CI) 8.8-13.8 months]. Thirty-six patients (85%) had died. The OS rate at 12 and 18 months was 47% (95% CI 32.1% to 61.6%) and 31% (95% CI 17.8% to 45.0%), respectively. Median progression-free survival was 4.1 months (95% CI 2.6-5.5 months). No new safety signals were observed. Patients with lower frequencies of regulatory T cells, as well as lower tumor-associated macrophages (TAMs) at baseline, had a better OS. Comparing matched biopsies, a decrease of M2 macrophages was observed in five out of seven patients after exposure to lurbinectedin, and two out of four patients showed increased CD8+ T-cell infiltrates in tumor. Discussion Lurbinectedin continues to be active in patients with progressing malignant pleural mesothelioma. According to our very small sample size, we hypothesize that baseline TAMs and regulatory T cells are associated with survival. Lurbinectedin seems to inhibit conversion of TAMs to M2 phenotype in humans. Lurbinectedin continues to be active in patients with progressing MPM with a median OS of 11.5 months (95% CI 8.8-13.8 months). TAMs and regulatory T cells are associated with survival. Lurbinectedin seems to inhibit conversion of TAMs to M2 phenotype in humans.
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Wicki A, Mamot C, Hasler-Strub U, Riniker S, Li Q, Holer L, Baertschi D, Zaman K, von Moos R, Dedes K, Novak U, Bodmer A, Ritschard R, Obermann E, Ackermann C, Membrez-Antonioli V, Zuerrer U, Caspar C, Rochlitz C, Winterhalder R. 268P Anti-EGFR-immunoliposomes loaded with doxorubicin in patients with advanced triple-negative, EGFR positive breast cancer: A multicenter single arm phase II trial [SAKK 24/14]. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.551] [Citation(s) in RCA: 1] [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: 10/20/2022] Open
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von Moos R, Thaler J, Kröning H, Zahn M, Scholten F, Pederiva S, Anchisi S, Bohanes P, Grünberger B, Windemuth-Kieselbach C, Piringer G, Hofheinz R. PD-3 Impact of RAS status, prior targeted therapy, age, and gender on the activity of aflibercept plus FOLFIRI in patients with metastatic colorectal cancer: Real-world data from the QoLiTrap study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.021] [Citation(s) in RCA: 1] [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: 11/26/2022] Open
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Joerger M, Metaxas Y, Schmitt A, Koeberle D, Zaman K, Betticher D, Mach N, Renner C, Mark M, Petrausch U, Caspar C, Britschgi C, Taverna C, Zenger F, Mingrone W, Schulz J, Kopp C, Hayoz S, Stathis A, von Moos R. LBA80 Outcome and prognostic factors of SARS CoV-2 infection in cancer patients: A cross-sectional study (SAKK 80/20 CaSA). Ann Oncol 2020. [PMCID: PMC7506361 DOI: 10.1016/j.annonc.2020.08.2321] [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: 11/24/2022] Open
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Ribi K, Thuerlimann B, Schär C, Dietrich D, Cathomas R, Zuerrer U, Von Briel T, Anchisi S, Bohanes P, Blum V, von Burg P, Mannhart M, Caspar C, von Moos R, Mark M. 1867P Quality of life and pain in patients with metastatic bone disease from solid tumors treated with bone-targeted agents: A real-world cross-sectional study from Switzerland (SAKK 95/16). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1514] [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: 11/16/2022] Open
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Metaxas Y, Früh M, Eboulet EI, Grosso F, Pless M, Zucali PA, Ceresoli GL, Mark M, Schneider M, Maconi A, Perrino M, Biaggi-Rudolf C, Froesch P, Schmid S, Waibel C, Appenzeller C, Rauch D, von Moos R. Lurbinectedin as second- or third-line palliative therapy in malignant pleural mesothelioma: an international, multi-centre, single-arm, phase II trial (SAKK 17/16). Ann Oncol 2020; 31:495-500. [PMID: 32085891 DOI: 10.1016/j.annonc.2019.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 10/29/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Systemic second- and third-line therapies for malignant pleural mesothelioma (MPM) result in a median progression-free survival (mPFS) of <2 months and median overall survival (mOS) of 6-9 months. Lurbinectedin binds to the DNA of the regulatory region while inhibiting tumour-associated macrophage transcription. In early trials, encouraging outcomes occurred in patients (pts) with MPM treated with lurbinectedin. We aimed to generate lurbinectedin efficacy and safety data among pts with progressive MPM. PATIENTS AND METHODS Pts with progressing MPM treated with first-line platinum-pemetrexed chemotherapy with or without immunotherapy received lurbinectedin monotherapy. Treatment was given intravenously at 3.2 mg/m2 dose every 3 weeks until progression or unacceptable toxicity. Using Simon's two-stage design, the primary endpoint, progression-free survival (PFS) at 12 weeks (PFS12wks), was met if achieved by ≥21 pts (p0 ≤35% versus p1 ≥55%). RESULTS Forty-two pts from nine centres across Switzerland and Italy were recruited. Histology was epithelioid in 33 cases, sarcomatoid in 5, and biphasic in 4. Overall 10/42 (23.8%) underwent prior immunotherapy and 14/42 (33.3%) had progressed ≤6 months after first-line chemotherapy. At data cut-off PFS12wks was met by 22/42 pts (52.4%; 90% confidence interval (CI): 38.7% to 63.5%; P = 0.015) with an mPFS of 4.1 months and mOS of 11.1 months. The best response was complete and partial remission observed in one patient each and stable disease in 20 pts. The duration of disease control was 6.6 months (95% CI: 5.2-7.4). No significant difference in PFS12wks, mPFS, and mOS was recorded in epithelioid versus non-epithelioid cases and pts with prior immunotherapy versus those without. Similar mPFS but shorter mOS were observed among pts who progressed within ≤6 months after first-line chemotherapy. Lurbinectedin-related grade 3-4 toxicity was seen in 21 pts, mostly being neutropenia (23.8%) and fatigue (16.7%). CONCLUSIONS The primary efficacy endpoint was reached with acceptable toxicity. Lurbinectedin showed promising activity regardless of histology, prior immunotherapy, or outcome on prior treatment. CLINICALTRIALS. GOV IDENTIFIER NCT03213301.
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Affiliation(s)
- Y Metaxas
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland.
| | - M Früh
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland; University of Bern, Bern, Switzerland
| | | | - F Grosso
- Mesothelioma Unit - Oncology, SS. Antonio and C. Arrigo Hospital, Alessandria, Italy
| | - M Pless
- Department of Medical Oncology and Haematology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - P A Zucali
- Humanitas Cancer Centre, Humanitas Research Hospital, Rozzano, Italy
| | - G L Ceresoli
- Oncology Unit, Humanitas Clinic Gavazzeni, Bergamo, Italy
| | - M Mark
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
| | | | - A Maconi
- Scientific Research and Development Department, SS Antonio e Biagio e Cesare Arrigo, General Hospital, Alessandria, Italy
| | - M Perrino
- Humanitas Cancer Centre, Humanitas Research Hospital, Rozzano, Italy
| | | | - P Froesch
- Department of Oncology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - S Schmid
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - C Waibel
- Division of Haematology and Oncology, Kantonsspital Baden, Baden, Switzerland
| | - C Appenzeller
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - D Rauch
- Oncology Centre, Hospital STS AG, Thun, Switzerland
| | - R von Moos
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
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Wirsching HG, Tabatabai G, Roelcke U, Hottinger AF, Jörger F, Schmid A, Plasswilm L, Schrimpf D, Mancao C, Capper D, Conen K, Hundsberger T, Caparrotti F, von Moos R, Riklin C, Felsberg J, Roth P, Jones DTW, Pfister S, Rushing EJ, Abrey L, Reifenberger G, Held L, von Deimling A, Ochsenbein A, Weller M. Bevacizumab plus hypofractionated radiotherapy versus radiotherapy alone in elderly patients with glioblastoma: the randomized, open-label, phase II ARTE trial. Ann Oncol 2019; 29:1423-1430. [PMID: 29648580 DOI: 10.1093/annonc/mdy120] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The addition of bevacizumab to temozolomide-based chemoradiotherapy (TMZ/RT → TMZ) did not prolong overall survival (OS) in patients with newly diagnosed glioblastoma in phase III trials. Elderly and frail patients are underrepresented in clinical trials, but early reports suggested preferential benefit in this population. Patients and methods ARTE was a 2 : 1 randomized, multi-center, open-label, non-comparative phase II trial of hypofractionated RT (40 Gy in 15 fractions) with bevacizumab (10 mg/kg×14 days) (arm A, N = 50) or without bevacizumab (arm B, N = 25) in patients with newly diagnosed glioblastoma aged ≥65 years. The primary objective was to obtain evidence for prolongation of median OS by the addition of bevacizumab to RT. Response was assessed by RANO criteria. Quality of life (QoL) was monitored by the EORTC QLQ-C30/BN20 modules. Exploratory studies included molecular subtyping by 450k whole methylome and gene expression analyses. Results Median PFS was longer in arm A than in arm B (7.6 and 4.8 months, P = 0.003), but OS was similar (12.1 and 12.2 months, P = 0.77). Clinical deterioration was delayed and more patients came off steroids in arm A. Prolonged PFS in arm A was confined to tumors with the receptor tyrosine kinase (RTK) I methylation subtype (HR 0.25, P = 0.014) and proneural gene expression (HR 0.29, P = 0.025). In a Cox model of OS controlling for established prognostic factors, associations with more favorable outcome were identified for age <70 years (HR 0.52, P = 0.018) and Karnofsky performance score 90%-100% (HR 0.51, P = 0.026). Including molecular subtypes into that model identified an association of the RTK II gene methylation subtype with inferior OS (HR 1.73, P = 0.076). Conclusion Efficacy outcomes and exploratory analyses of ARTE do not support the hypothesis that the addition of bevacizumab to RT generally prolongs survival in elderly glioblastoma patients. Molecular biomarkers may identify patients with preferential benefit from bevacizumab. Clinical trial registration number NCT01443676.
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Affiliation(s)
- H-G Wirsching
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - G Tabatabai
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - U Roelcke
- Department of Neurology, Brain Tumor Center Aarau, Cantonal Hospital Aarau, Aarau, Switzerland
| | - A F Hottinger
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland; Department of Medical Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - F Jörger
- Department of Clinical Trials Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - A Schmid
- Department of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - L Plasswilm
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - D Schrimpf
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Mancao
- Genentech, Oncology Biomarker Development, Basel, Switzerland
| | - D Capper
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Conen
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - T Hundsberger
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - F Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - R von Moos
- Department of Medical Oncology, Cantonal Hospital Chur, Chur, Switzerland
| | - C Riklin
- Department of Medical Oncology, Cantonal Hospital Lucerne, Lucerne Switzerland
| | - J Felsberg
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Roth
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - D T W Jones
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - S Pfister
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - E J Rushing
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - L Abrey
- F. Hoffmann-La Roche, Pharma Division, Product Development Oncology, Basel, Switzerland
| | - G Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Cancer Research Center, Essen/Düsseldorf, Germany
| | - L Held
- Biostatistics Department, University of Zurich, Zurich, Switzerland
| | - A von Deimling
- Department of Neuropathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Ochsenbein
- Department of Medical Oncology, University Hospital Bern, Bern, Switzerland
| | - M Weller
- Brain Tumor Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
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Mark M, Thuerlimann B, Ribi K, Schaer C, Dietrich D, Zuerrer U, von Moos R. Patterns of care for patients with metastatic bone disease in solid tumors: A cross-sectional study (SAKK 95/16). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Metaxas Y, Frueh M, Eboulet E, Grosso F, Pless M, Zucali P, Ceresoli G, Mark M, Schneider M, Roveta A, Perrino M, Biaggi Rudolf C, Froesch P, Schmidt S, Waibel C, Appenzeller C, Rauch D, von Moos R. SAKK 17/16 - Lurbinectedin as second or third line palliative chemotherapy in malignant pleural mesothelioma (MPM): A multi-center, single-arm phase II trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz266.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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von Moos R, Scholten F, Derigs HG, Grünberger B, Thaler J, Hofheinz R. Quality of life (QoL) in patients with aflibercept (AFL) and FOLFIRI for metastatic colorectal cancer (mCRC): Interim analysis with focus on mutational status of the non-interventional study QoLiTrap (AIO-LQ-0113). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.072] [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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Hofheinz R, Scholten F, Derigs H, Thaler J, von Moos R. Quality of life in patients treated with aflibercept and FOLFIRI for metastatic colorectal cancer: interim analysis with focus on therapy lines of the non-interventional study QoLiTrap (AIO-LQ-0113). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vetter M, Rothgiesser K, Li Q, Hawle H, Schönfeld W, Ribi K, Riniker S, von Moos R, Müller A, Thürlimann B. SAKK 21/12: A stratified, multicenter phase II trial of transdermal CR1447 in endocrine responsive-HER2 negative and triple negative-androgen receptor positive metastatic or locally advanced breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz100.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Müller A, Templeton AJ, Hayoz S, Hawle H, Hasler-Strub U, Schwitter M, Pestalozzi BC, Pagani O, Bützberger P, Wehrhahn T, Rauch D, Inauen R, Betticher D, Zaman K, Bodmer A, Popescu RA, Rothschild S, Schardt J, Borner M, Fuhrer A, Schär C, Gillessen S, von Moos R. Abstract P1-18-01: Incidence of hypocalcemia in patients with metastatic breast cancer under treatment with denosumab: A non-inferiority phase III trial assessing prevention of symptomatic skeletal events (SSE) with denosumab administered every 4 weeks versus every 12 weeks: SAKK 96/12 (REDUSE). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-18-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Monthly Denosumab (DN) has shown superiority over zoledronic acid (ZA) in delaying skeletal related events. Randomized trials have shown that ZA given every 12 weeks (q12w) is non-inferior to ZA given every 4 weeks (q4w). The primary endpoint of the REDUSE-trial is non-inferiority for SSE for DN q12w versus q4w. Here we present early data for hypocalcemia (HC), a secondary endpoint.
Methods
Patients with bone metastasis from breast cancer (BC) not pretreated with DN or Bisphosphonates were randomized 1:1 to receive DN q4w (Arm A) versus q12w (Arm B) after a 3-month induction phase with q4w therapy for both arms. All patients received vitamin D 400 U (VitD) and calcium (Ca) 500 mg daily. Measurement of albumin-corrected serum-Ca was mandatory before each DN injection (HC defined as <2.0 mmol/l like in CTCAE V4.0). This safety interim analysis was performed after 3.5 years of accrual. Patients who received at least 1 dose of DN were considered evaluable.
Results
351 BC-patients are currently included (177 in Arm A, 174 in Arm B). HC was the most common side effect with a rate of 20% in the first 16 weeks (during the induction phase with DN q4w for both Arms) and 19% afterwards (combined for Arms A and B). After week 16 HC-prevalence differed between the two arms: while HC was present in 25% in Arm A (q4w), the rate was only 12% in Arm B (q12w). Grade 3 HC (i.e. corrected Ca 1.5 - 1.74 mmol/l or hospitalisation indicated) was rare (0.3%), no grade 4 HC occurred. After 1 year of treatment, the rate of HC compared to the induction phase had decreased in Arm B but not in Arm A (A: 25%, B: 12%). Since HC improved in more patients in Arm B than in Arm A whereas it worsened in more patients in Arm A than in Arm B, a remarkable difference for HC resulted between the two arms.
Rates of hypocalcemia and change of severity after week 16* Arm A (N = 177)Arm B (N = 174)Rates of hypocalcemian (%)n (%)Patients with hypocalcemia at any time49 (28%)46 (26%)Patients with hypocalcemia after week 16*44 (25%)21 (12%) Change in hypocalcemia grade after week 16*for the 49 patients with hypocalcemiafor the 46 patients with hypocalcemiaWorsening25 (51%)8 (17%)Stable10 (20%)9 (20%)Improving14 (29%)29 (63%) *week 16: i.e. the time where the schedules of DN begin to differ between Arm A and Arm BArm A: DN q4w for weeks 1 - 12 and likewise thereafter / Arm B: DN q4w for weeks 1 - 12 and q12w thereafter
Conclusions
In our trial up to 20% of all BC patients treated with DN experienced HC in the q4w induction phase despite mandatory supplementation of VitD and Ca. This rate is considerably higher than the numbers reported in the registration trials of DN (where it was 5.5% for BC). After the induction phase, HC is markedly reduced in the q12w arm compared to q4w. This suggests that DN given q12w has a more favorable long-term safety profile in terms of HC compared to DN q4w.
Citation Format: Müller A, Templeton AJ, Hayoz S, Hawle H, Hasler-Strub U, Schwitter M, Pestalozzi BC, Pagani O, Bützberger P, Wehrhahn T, Rauch D, Inauen R, Betticher D, Zaman K, Bodmer A, Popescu RA, Rothschild S, Schardt J, Borner M, Fuhrer A, Schär C, Gillessen S, von Moos R, For the Swiss Group for Clinical Cancer Research (SAKK). Incidence of hypocalcemia in patients with metastatic breast cancer under treatment with denosumab: A non-inferiority phase III trial assessing prevention of symptomatic skeletal events (SSE) with denosumab administered every 4 weeks versus every 12 weeks: SAKK 96/12 (REDUSE) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-18-01.
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Affiliation(s)
- A Müller
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - AJ Templeton
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - S Hayoz
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - H Hawle
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - U Hasler-Strub
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - M Schwitter
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - BC Pestalozzi
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - O Pagani
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - P Bützberger
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - T Wehrhahn
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - D Rauch
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - R Inauen
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - D Betticher
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - K Zaman
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - A Bodmer
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - RA Popescu
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - S Rothschild
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - J Schardt
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - M Borner
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - A Fuhrer
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - C Schär
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - S Gillessen
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
| | - R von Moos
- Kantonsspital Winterthur, Winterthur, Switzerland; St. Claraspital, Basel, Switzerland; SAKK Coordinating Center, Bern, Switzerland; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Graubünden, Chur, Switzerland; Universitätsspital Zürich, Zürich, Switzerland; Ente Ospedaliero Cantonale Ticino, Bellinzona, Switzerland; Kantonsspital Baden, Baden, Switzerland; Kantonsspital Aarau, Aarau, Switzerland; Spital STS, Thun, Switzerland; Spital Thurgau, Münsterlingen, Switzerland; HFR Freiburg – Kantonsspital, Freiburg, Switzerland; Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland; Hospitaux Universitaires de Geneve HUG, Geneve, Switzerland; Hirslanden Medical Center, Aarau, Switzerland; Universitätsspital Basel, Basel, Switzerland; Inselspital, Universitätsspital Bern, Bern, Switzerland; Engeried & Lindenhofspital, Bern, Switzerland
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Hofheinz R, Derigs HG, Piringer G, von Moos R. Interim analysis of the non-interventional study QoLiTrap (AIO-LQ-0113) in patients with metastatic colorectal cancer (mCRC) treated with aflibercept (AFL) + FOLFIRI: Efficacy according to age group ≤65 and >65 years. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Peters S, Danson S, Hasan B, Reinmuth N, Majem M, Tournoy K, Mark M, Pless M, Cobo M, Rodriguez-Abreu D, Falchero L, Massutí B, Coate L, von Moos R, Zielinski C, De Maio E, O’Brien M, Roschitzki-Voser H, Dafni U, Stahel R. A randomised phase III trial evaluating the addition of denosumab to standard first-line treatment in advanced NSCLC: The ETOP and EORTC SPLENDOUR trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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Metaxas Y, Xyrafas A, Mark M, Pless M, Frueh M, Froesch P, Schneider M, Biaggi Rudolf C, Grosso F, von Moos R. SAKK 17/16 - Lurbinectedin monotherapy in patients with progressive malignant pleural mesothelioma: A multicenter, single-arm phase II trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy301.011] [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: 11/14/2022] Open
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von Moos R, Hawle H, Hayoz S, Cathomas R, Müller A, Schmid S, Pagani O, Wehrhahn T, Rauch D, Anchisi S, Hermanns T, Fehr M, Stoll S, Bützberger P, Zweifel M, Huber U, Fuhrer A, Schär C, Gillessen S, Templeton A. Incidence of hypocalcemia in a non-inferiority phase III trial assessing prevention of symptomatic skeletal events (SSE) with denosumab (DN) administered every 4 weeks (q4w) versus every 12 weeks (q12w): SAKK 96/12 (REDUSE). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.020] [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: 11/14/2022] Open
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Zahn M, Scholten F, von Moos R, Thaler J, Hofheinz R. Quality-of-life in patients with metastatic colorectal cancer (mCRC) treated with aflibercept and FOLFIRI: Interim results of the non-interventional AIO study QoLiTrap. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.259] [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: 11/14/2022] Open
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Ribi K, Sun Z, Jerusalem G, Hasler-Strub U, Colleoni M, von Moos R, Cortés J, Vidal M, Hennessy B, Walshe J, Amillano Parraga K, Morales Muriilo S, Pagani O, Barbeaux A, Bortsnar S, Maibach R, Regan MM, Gennari A, Bernhard J. Abstract P5-18-02: Nab-Paclitaxel-based therapy in the first line treatment of metastatic breast cancer (IBCSG 42-12/BIG 2-12 SNAP): Impact of different schedules on quality of life. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-18-02] [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: The randomized phase II SNAP trial assessed three alternative reduced maintenance chemotherapy regimens using nab-Paclitaxel after a short term induction phase at conventional doses as first line treatment in patients (pts) with metastatic breast cancer (MBC). For all three regimens median progression-free survival was greater than achieved with full dose docetaxel (historical reference). Symptom palliation and quality of life (QoL) are important when deciding on therapeutic agents and schedules in MBC pts.
Methods: Of the 258 pts with MBC enrolled from April 2013 to August 2015 in the SNAP trial, 255 were included in the QoL analysis. Pts were randomized to three arms, each receiving the same induction chemotherapy based on 3 cycles of nab-Paclitaxel 150 mg/m2 dd 1, 8, 15 Q28, which was reduced to 125 mg/m2 after a safety review. The schedules of nab-Paclitaxel in maintenance therapy differed in each arm: Arm A) 150 mg/m2 dd 1,15 Q28; Arm B) 100 mg/m2 dd 1,8,15 Q28; Arm C) 75 mg/m2 dd 1,8,15,22 Q28. Pts completed a QoL form to assess global and symptom-specific indicators (range 0-100) at baseline, and at day 1 of every cycle for the first 12 cycles on treatment, or until treatment discontinuation. Changes in QoL scores during induction (day 1 cycle 4 − baseline) and maintenance (day 1 cycle 12 – day 1 cycle 4) therapy were summarized descriptively per arm. Treatment effects on changes in QoL during maintenance therapy were analyzed by repeated measurement models including timepoints (from day 1 of cycle 4 to day 1 of cycle 12), induction start dose, age, and treatment arms as covariates.
Results: During induction therapy, mean changes [SD] in hair loss (Arm A:−70.2 [41.9]; Arm B: −77.3 [34.5]; Arm C: −72.6 [32.8]), sensory neuropathy (Arm A: −19.0 [25.2]; Arm B: −20.6 [22.7]; Arm C: −18.8 [23.8]), and treatment burden (Arm A: −12.9 [33.4]; Arm B: −13.4 [33.5]; Arm C: −11.4 [34.8]) showed the most pronounced worsening. During maintenance therapy, scores for sensory neuropathy remained impaired without worsening. No significant differences in changes for sensory neuropathy or the other symptoms were seen between arms, except for hair loss, with pts in arm C (mean difference 10.91; 95% CI [0.35, 21.48]; p=0.04) ] and B (mean difference 18.55; 95% CI [7.52, 29.59]; p=0.001) reporting a greater improvement compared to those in arm A. Pts in arm C reported a significantly greater improvement in mood compared to arm A (mean difference 13.34; 95% CI [6.08, 20.60]; p<0.001) and arm B (mean difference 9.62; 95% CI [2.84, 16.40]; p=0.01)].
Conclusion: The effectiveness of alternative maintenance chemotherapy schedules with reduced doses after a short term induction phase at conventional doses must be weighed against a substantial worsening in sensory neuropathy during induction therapy, and scores continuing to be impaired without worsening with prolonged administration. During maintenance therapy, improvements were seen in the perception of hair loss and in mood, particularly in Arm B and C, with a similar tendency seen for some other QoL domains. A more frequent administration of reduced dose chemotherapy agents is favorable with respect to QoL in this setting.
Citation Format: Ribi K, Sun Z, Jerusalem G, Hasler-Strub U, Colleoni M, von Moos R, Cortés J, Vidal M, Hennessy B, Walshe J, Amillano Parraga K, Morales Muriilo S, Pagani O, Barbeaux A, Bortsnar S, Maibach R, Regan MM, Gennari A, Bernhard J. Nab-Paclitaxel-based therapy in the first line treatment of metastatic breast cancer (IBCSG 42-12/BIG 2-12 SNAP): Impact of different schedules on quality of life [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-18-02.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - Z Sun
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - G Jerusalem
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - U Hasler-Strub
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - M Colleoni
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - R von Moos
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - J Cortés
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - M Vidal
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - B Hennessy
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - J Walshe
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - K Amillano Parraga
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - S Morales Muriilo
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - O Pagani
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - A Barbeaux
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - S Bortsnar
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - R Maibach
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - MM Regan
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - A Gennari
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
| | - J Bernhard
- International Breast Cancer Study Group, Cancer Trials Ireland, and SOLTI
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Mauti L, Rivalland G, Klingbiel D, Kao S, Schmid S, Nowak A, Gautschi O, Hughes B, Bartnick T, Pavlakis N, Bouchaab H, O'Byrne K, Rothschild S, Russell P, Savic Prince S, Thapa B, Pless M, von Moos R, Metaxas Y, John T. Pembrolizumab (pembro) for relapsed malignant pleural mesothelioma (MPM): Outcomes in real-life setting in Australia (AUS) and Switzerland (CH). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx711.007] [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: 11/15/2022] Open
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Klingbiel D, Thürlimann B, Brauchli P, von Moos R. Absence of evidence is not evidence of absence: the case of non-inferiority. Ann Oncol 2017; 28:3100-3101. [PMID: 28945840 DOI: 10.1093/annonc/mdx498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Klingbiel
- SAKK Coordinating Center, Swiss Group for Clinical Cancer Research, Bern
| | - B Thürlimann
- Breast Center St. Gallen, Kantonsspital, St. Gallen
| | - P Brauchli
- SAKK Coordinating Center, Swiss Group for Clinical Cancer Research, Bern
| | - R von Moos
- Department of Oncology/Hematology, Kantonsspital, Chur, Switzerland
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Schmid S, Klingbiel D, Goldhirsch A, Oehlschlegel C, Munzone E, Nolè F, Pestalozzi B, Aebi S, Rochlitz C, von Moos R, Zaman K, Mamot C, Weder P, Thuerlimann B, Pagani O, Ruhstaller T. Long-term responders to trastuzumab monotherapy in the first-line metastatic setting: characteristics and survival data (SAKK 22/99 Trial). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.063] [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: 11/14/2022] Open
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Hartmann B, Oberaigner W, Frick H, Weiss L, Winder T, Philipp-Abbrederis K, Herrmann C, Huynh M, Spizzo G, Lang C, Seeber A, Schneider J, Wöll E, Mosler P, Greil R, Rössle M, Rumpold H, Gastl G, von Moos R, Lang A. Real life registry data of primary localisation of a well-defined colon cancer population of western Austria (Salzburg, Tyrol and Vorarlberg), eastern Switzerland (St. Gallen and Graubünden) and Liechtenstein. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.124] [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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von Moos R, Derigs G, Scholten F, Thaler J, Losem C, Kroening H, Windemuth-Kieselbach C, Hofheinz R. Quality-of-life in patients with metastatic colorectal cancer (mCRC) treated with aflibercept and FOLFIRI – Interim results of the non-interventional AIO study QoLiTrap. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.120] [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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Mauti L, Klingbiel D, Schmid S, Bouchaab H, Bartnick T, Gautschi O, Rothschild S, Loeffler M, Froesch P, Petrausch U, Wolleb Schild S, Mingrone W, Pratsch Peter S, Savic Prince S, Pless M, von Moos R, Metaxas Y. Pembrolizumab as second or further line treatment in relapsed malignant pleural mesothelioma: A Swiss registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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Mark M, Klingbiel D, Mey U, Winterhalder R, Rothermundt C, Gillessen S, von Moos R, Manetsch G, Cathomas R. Impact of the addition of metformin (Met) to abiraterone (Abi) in metastatic castration-resistant prostate cancer (mCRPC) patients (pts) progressing on Abi treatment: A phase II pilot study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370.015] [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: 11/15/2022] Open
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Gennari A, Sun Z, Hasler-Strub U, Colleoni M, Kennedy J, von Moos R, Cortes J, Vidal M, Hennessy B, Walshe J, Amillano Parraga K, Morales Murrillo S, Pagani O, Barbeaux A, Borstnar S, Rabaglio M, Maibach R, Regan MM, Jerusalem G. Abstract P5-15-05: Randomized phase II study evaluating different schedules of nab-paclitaxel in metastatic breast cancer (MBC): Results of the SNAP study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-15-05] [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
Longer chemotherapy (CT) duration is associated with a significant improvement in progression-free survival (PFS) and a moderate, but significant improvement in overall survival (OS) in MBC patients (pts). Prolonged CT administration, however, must be weighed against the side effects of continuous CT delivery. The SNAP trial was designed to improve the tolerability of prolonged CT by studying alternative treatment schedules.
Methods
The SNAP trial enrolled 258 women from April 2013 to Aug 2015. Eligibility criteria included HER2- MBC, no prior CT for advanced disease, measurable and/or non-measurable disease.
All eligible pts were randomized to one of three arms. Pts received the same induction chemotherapy consisting of 3 cycles of nab-Paclitaxel given days 1,8,15 Q28, followed by one of the three maintenance therapy schedules. Originally, the dose of the induction chemotherapy was 150 mg/m2, but this was reduced to 125 mg/m2 following the first safety review of 48 treated pts. The three schedules of nab-Paclitaxel used as maintenance therapy were (Arm A) nab-Paclitaxel 150 mg/m2 d 1,15 Q28; (Arm B) nab-Paclitaxel 100 mg/m2 d 1,8,15 Q28; (Arm C) nab-Paclitaxel 75 mg/m2 d 1,8,15,22 Q28.
The primary objective is to evaluate the efficacy of three nab-Paclitaxel regimens as measured by progression-free survival (PFS), using the historical reference of PFS (based on AVADO study) of docetaxel for first-line treatment of metastatic breast cancer. Each of the three regimens is compared to the historic 7-month median PFS to determine whether any of the three regimens are worthy of further investigation. Secondary endpoints include tolerability, feasibility, response rate, OS and QoL.
Results
Two-hundred-fifty-eight pts have been randomised and 255 are available for primary endpoint evaluation. At 18.2 months' median follow-up, 182 PFS events and 85 deaths have been observed. Median PFS was 7.9 months (90%CI 6.8-8.4) in Arm A, 9.0 months (90%CI 8.1-10.9) in Arm B and 8.5 (90%CI 6.7-9.5) in Arm C. PFS in Arm B was significantly longer than the historic PFS of first-line docetaxel (one-sided log-rank p=0.03).
As expected, neurotoxicity was the most frequent adverse event. In the induction phase, grade≥2 sensory neuropathy was reported in 14.8% of pts at the starting dose of 150 mg/m2 and 7.5% at the starting dose of 125 mg/m2; grade≥3 sensory neuropathy occurred in 2.5% and 0% of the pts, respectively. In the maintenance phase, grade≥2 sensory neuropathy was reported in 37.9% of pts in Arm A, 36.1% in Arm B and 31.2% in Arm C; grade≥3 sensory neuropathy occurred in 9.1%, 5.6% and 6.6% of the pts, respectively.
199 pts started the maintenance phase. The median number of maintenance cycles was 3, 4, and 5, respectively. Stopping maintenance for reasons other than objective progression occurred in 41%, 58%, and 53%, respectively.
Conclusion
The SNAP trial indicates that alternative maintenance chemotherapy schedules with reduced doses after a short term induction phase at conventional doses are feasible and significantly more active than the historical PFS of docetaxel in the first line treatment of advanced breast cancer.
Citation Format: Gennari A, Sun Z, Hasler-Strub U, Colleoni M, Kennedy J, von Moos R, Cortes J, Vidal M, Hennessy B, Walshe J, Amillano Parraga K, Morales Murrillo S, Pagani O, Barbeaux A, Borstnar S, Rabaglio M, Maibach R, Regan MM, Jerusalem G. Randomized phase II study evaluating different schedules of nab-paclitaxel in metastatic breast cancer (MBC): Results of the SNAP study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-15-05.
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Affiliation(s)
- A Gennari
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - Z Sun
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - U Hasler-Strub
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - M Colleoni
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - J Kennedy
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - R von Moos
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - J Cortes
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - M Vidal
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - B Hennessy
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - J Walshe
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - K Amillano Parraga
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - S Morales Murrillo
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - O Pagani
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - A Barbeaux
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - S Borstnar
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - M Rabaglio
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - R Maibach
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - MM Regan
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
| | - G Jerusalem
- International Breast Cancer Study Group (Bern, Switzerland), Cancer Trials Ireland (Dublin, Ireland), and SOLTI (Barcelona, Spain)
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Pagani O, Klingbiel D, Ruhstaller T, Nolè F, Eppenberger S, Oehlschlegel C, Bernhard J, Brauchli P, Hess D, Mamot C, Munzone E, Pestalozzi B, Rabaglio M, Aebi S, Ribi K, Rochlitz C, Rothgiesser K, Thürlimann B, von Moos R, Zaman K, Goldhirsch A. Do all patients with advanced HER2 positive breast cancer need upfront-chemo when receiving trastuzumab? Randomized phase III trial SAKK 22/99. Ann Oncol 2017; 28:305-312. [DOI: 10.1093/annonc/mdw622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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von Moos R, Costa L, Scagliotti G, Sleeboom H, Goldwasser F, Hirsh V, Spencer A, Radcliffe HS, Niepel D, Henry D. Symptomatic skeletal events (SSEs) versus skeletal-related events (SREs) in patients with advanced cancer and bone metastases treated with denosumab or zoledronic acid. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Body JJ, von Moos R, Lipton A, Martin M, Diel I, Steger G, Tonkin K, de Boer R, Radcliffe HS, Niepel D, Stopeck A. Denosumab for the prevention of symptomatic skeletal events (SSEs) in patients with bone-metastatic breast cancer: A comparison with skeletal-related events (SREs). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.31] [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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Pereira J, Body JJ, Gunther O, Sleeboom H, Hechmati G, Maniadakis N, Terpos E, Acklin YP, Finek J, von Moos R. Cost of skeletal complications from bone metastases in six European countries. J Med Econ 2016; 19:611-8. [PMID: 26849381 DOI: 10.3111/13696998.2016.1150852] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Patients with bone metastases or lesions secondary to solid tumors or multiple myeloma often experience bone complications (skeletal-related events [SREs]-radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression); however, recent data that can be used to assess the value of treatments to prevent SREs across European countries are limited. This study aimed to provide estimates of health resource utilization (HRU) and cost associated with all SRE types in Europe. HRU data were reported previously; cost data are reported herein. Methods Eligible patients from 49 centers across Austria (n = 57), the Czech Republic (n = 59), Finland (n = 60), Greece (n = 59), Portugal (n = 59), and Sweden (n = 62) had bone metastases or lesions secondary to breast, lung, or prostate cancer, or multiple myeloma, and ≥1 index SRE (a SRE preceded by a SRE-free period of ≥ 6.5 months). SRE-related costs were estimated from a payer perspective using health resource utilization data from patient charts (before and after the index SRE diagnosis). Country-specific unit costs were from 2010 and local currencies were converted to 2010 euros. Results The mean costs across countries were €7043, €5242, €11,101, and €11,509 per radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression event, respectively. Purchasing power parity (PPP)-adjusted mean cost ratios were similar in most countries, with the exception of radiation to bone. Limitations The overall burden of SREs may have been under-estimated owing to home visits and evaluations outside the hospital setting not being reported here. Conclusions All SREs were associated with substantial costs. Variation in SRE-associated costs between countries was most likely driven by differences in treatment practices and unit costs.
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Affiliation(s)
- J Pereira
- a Universidade NOVA de Lisboa, National School of Public Health, Public Health Research Centre (CISP) , Lisbon , Portugal
| | - J-J Body
- b C.H.U. Brugmann, Université Libre de Bruxelles , Brussels , Belgium
| | - O Gunther
- c Centre for Observational Research, Amgen Ltd , Uxbridge , UK
| | - H Sleeboom
- d HAGA Hospital , The Hague , The Netherlands
| | - G Hechmati
- e Health Economics, Amgen (Europe) GmbH , Zug , Switzerland
| | - N Maniadakis
- f Department of Health Services Management , National School of Public Health , Athens , Greece
| | - E Terpos
- g University of Athens School of Medicine, Alexandra University Hospital , Athens , Greece
| | - Y P Acklin
- h Kantonsspital Graubünden , Chur , Switzerland
| | - J Finek
- i University Hospital , Plzen , Czech Republic
| | - R von Moos
- j Kantonsspital Graubünden , Chur , Switzerland
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Strasser F, Blum D, von Moos R, Cathomas R, Ribi K, Aebi S, Betticher D, Hayoz S, Klingbiel D, Brauchli P, Haefner M, Mauri S, Kaasa S, Koeberle D. The effect of real-time electronic monitoring of patient-reported symptoms and clinical syndromes in outpatient workflow of medical oncologists: E-MOSAIC, a multicenter cluster-randomized phase III study (SAKK 95/06). Ann Oncol 2015; 27:324-32. [PMID: 26646758 DOI: 10.1093/annonc/mdv576] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with advanced, incurable cancer receiving anticancer treatment often experience multidimensional symptoms. We hypothesize that real-time monitoring of both symptoms and clinical syndromes will improve symptom management by oncologists and patient outcomes. PATIENTS AND METHODS In this prospective multicenter cluster-randomized phase-III trial, patients with incurable, symptomatic, solid tumors, who received new outpatient chemotherapy with palliative intention, were eligible. Immediately before the weekly oncologists' visit, patients completed the palm-based E-MOSAIC assessment (Edmonton-Symptom-Assessment-Scale, ≤3 additional symptoms, estimated nutritional intake, body weight change, Karnofsky Performance Status, medications for pain, fatigue, nutrition). A cumulative, longitudinal monitoring sheet (LoMoS) was printed immediately. Eligible experienced oncologists were defined as one cluster each and randomized to receive the immediate print-out LoMoS (intervention) or not (control). Primary analysis limited to patients having uninterrupted (>4/6 visits with same oncologist) patient-oncologist sequences was a mixed model for the difference in patients global quality of life (G-QoL; items 29/30 of EORTC-QlQ-c30) between baseline (BL) and week 6. Intention-to-treat (ITT) analysis included all eligible patients. RESULTS In 8 centers, 82 oncologists treated 264 patients (median 66 years; overall survival intervention 6.3, control 5.4 months) with various tumors. The between-arm difference in G-QoL of 102 uninterrupted patients (intervention: 55; control: 47) was 6.8 (P = 0.11) in favor of the intervention; in a sensitivity analysis (oncologists treating ≥2 patients; 50, 39), it was 9.0 (P = 0.07). ITT analysis revealed improvement in symptoms (difference last study visit-BL: intervention -5.4 versus control 2.1, P = 0.003) and favored the intervention for communication and coping. More patients with high symptom load received immediate symptom management (chart review, nurse-patient interview) by oncologists getting the LoMoS. CONCLUSION Monitoring of patient symptoms, clinical syndromes and their management clearly reduced patients' symptoms, but not QoL. Our results encourage the implementation of real-time monitoring in the routine workflow of oncologist with a computer solution.
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Affiliation(s)
- F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - D Blum
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine and Palliative Center, Cantonal Hospital St Gallen, St Gallen, Switzerland European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - R von Moos
- Department of Oncology, Cantonal Hospital Chur, Chur
| | - R Cathomas
- Department of Oncology, Cantonal Hospital Chur, Chur
| | | | - S Aebi
- Department of Oncology, University Hospital Bern, Bern
| | - D Betticher
- Department of Oncology, Cantonal Hospital Fribourg, Fribourg
| | - S Hayoz
- SAKK Coordinating Center, Bern
| | | | | | | | - S Mauri
- Department of Oncology, Cantonal Hospital Lugano, Lugano
| | - S Kaasa
- European Palliative Research Centre, NTNU, and St Olavs University Hospital Trondheim, Trondheim, Norway
| | - D Koeberle
- Clinic Oncology/Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Mark M, Volk V, Mey U, Brossart P, von Moos R, Cathomas R. Weekly Carboplatin and Paclitaxel in Advanced Non-Small Cell Lung Cancer: Good Response Rate But Poor Overall Survival in a “Real World” Population. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv050.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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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Templeton A, Stalder L, Albiges Sauvin L, Bernhard J, Brauchli P, Gillessen S, Hayoz S, Klingbiel D, Matter-Walstra K, Thürlimann B, von Moos R. Prevention of Symptomatic Skeletal Events with Denosumab Administered Every 4 Weeks Versus Every 12 Weeks–A Non-Inferiority Phase III Trial: Sakk 96/12 - Reduse. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Montemurro M, Cioffi A, Domont J, Rutkowski P, Roth A, von Moos R, Inauen R, Bui B, Burkhard R, Knuesli C, Bauer S, Cassier P, Schwarb H, Le Cesne A, Koeberle D, Baertschi D, Dietrich D, Biaggi C, Prior J, Leyvraz S. Long-Term Outcome of Dasatinib First-Line Treatment in Gastrointestinal Stromal Tumors: a Multicenter Two Stage Phase Ii Trial Sakk 56/07. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gomez-Roca C, Delord J, Robert C, Hidalgo M, von Moos R, Arance A, Elez E, Michel D, Seroutou A, Demuth T, Tabernero J. Encorafenib (Lgx818), an Oral Braf Inhibitor, in Patients (Pts) with Braf V600E Metastatic Colorectal Cancer (Mcrc): Results of Dose Expansion in an Open-Label, Phase 1 Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.38] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Cathomas R, Klingbiel D, Geldart T, Mead G, Ellis S, Wheater M, Simmonds P, Nagaraj N, von Moos R, Fehr M. Relevant risk of carboplatin underdosing in cancer patients with normal renal function using estimated GFR: lessons from a stage I seminoma cohort. Ann Oncol 2014; 25:1591-7. [DOI: 10.1093/annonc/mdu129] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Joerger M, Baty F, Früh M, Droege C, Stahel RA, Betticher DC, von Moos R, Ochsenbein A, Pless M, Gautschi O, Rothschild S, Brauchli P, Klingbiel D, Zappa F, Brutsche M. Circulating microRNA profiling in patients with advanced non-squamous NSCLC receiving bevacizumab/erlotinib followed by platinum-based chemotherapy at progression (SAKK 19/05). Lung Cancer 2014; 85:306-13. [PMID: 24928469 DOI: 10.1016/j.lungcan.2014.04.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 04/23/2014] [Accepted: 04/26/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Molecular subclassification of non small-cell lung cancer (NSCLC) is essential to improve clinical outcome. This study assessed the prognostic and predictive value of circulating micro-RNA (miRNA) in patients with non-squamous NSCLC enrolled in the phase II SAKK (Swiss Group for Clinical Cancer Research) trial 19/05, receiving uniform treatment with first-line bevacizumab and erlotinib followed by platinum-based chemotherapy at progression. MATERIALS AND METHODS Fifty patients with baseline and 24 h blood samples were included from SAKK 19/05. The primary study endpoint was to identify prognostic (overall survival, OS) miRNA's. Patient samples were analyzed with Agilent human miRNA 8x60K microarrays, each glass slide formatted with eight high-definition 60K arrays. Each array contained 40 probes targeting each of the 1347 miRNA. Data preprocessing included quantile normalization using robust multi-array average (RMA) algorithm. Prognostic and predictive miRNA expression profiles were identified by Spearman's rank correlation test (percentage tumor shrinkage) or log-rank testing (for time-to-event endpoints). RESULTS Data preprocessing kept 49 patients and 424 miRNA for further analysis. Ten miRNA's were significantly associated with OS, with hsa-miR-29a being the strongest prognostic marker (HR=6.44, 95%-CI 2.39-17.33). Patients with high has-miR-29a expression had a significantly lower survival at 10 months compared to patients with a low expression (54% versus 83%). Six out of the 10 miRNA's (hsa-miRN-29a, hsa-miR-542-5p, hsa-miR-502-3p, hsa-miR-376a, hsa-miR-500a, hsa-miR-424) were insensitive to perturbations according to jackknife cross-validation on their HR for OS. The respective principal component analysis (PCA) defined a meta-miRNA signature including the same 6 miRNA's, resulting in a HR of 0.66 (95%-CI 0.53-0.82). CONCLUSION Cell-free circulating miRNA-profiling successfully identified a highly prognostic 6-gene signature in patients with advanced non-squamous NSCLC. Circulating miRNA profiling should further be validated in external cohorts for the selection and monitoring of systemic treatment in patients with advanced NSCLC.
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Affiliation(s)
- M Joerger
- Department of Medical Oncology & Hematology, Cantonal Hospital, St. Gallen, Switzerland.
| | - F Baty
- Department of Pneumology, Cantonal Hospital, St. Gallen, Switzerland
| | - M Früh
- Department of Medical Oncology & Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - C Droege
- Department of Medical Oncology, University Hospital Basel, Switzerland
| | - R A Stahel
- Department of Medical Oncology, University Hospital Zurich, Switzerland
| | - D C Betticher
- Department of Medical Oncology, Cantonal Hospital, Fribourg, Switzerland
| | - R von Moos
- Department of Medical Oncology, Cantonal Hospital, Chur, Switzerland
| | - A Ochsenbein
- Department of Medical Oncology, University Hospital, Bern, Switzerland
| | - M Pless
- Department of Medical Oncology, Cantonal Hospital, Winterthur, Switzerland
| | - O Gautschi
- Department of Medical Oncology, Cantonal Hospital, Luzern, Switzerland
| | - S Rothschild
- Department of Medical Oncology, Cantonal Hospital, Luzern, Switzerland
| | - P Brauchli
- SAKK Coordinating Center, Bern, Switzerland
| | | | - F Zappa
- Oncology Department, Clinica Luganese, Lugano, Switzerland
| | - M Brutsche
- Department of Pneumology, Cantonal Hospital, St. Gallen, Switzerland
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40
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Cleeland C, von Moos R, Walker M, Wang Y, Gao J, Liede A, Arellano J, Balakumaran A, Qian Y. Abstract P3-10-01: Burden of symptoms associated with development of metastatic bone disease in patients with breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-10-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Bone is the most common site of distant metastasis in advanced breast cancer patients (pts). Development of bone metastases (mets) is associated with substantial morbidity including skeletal complications, decreased quality of life, increased pain, and shortened lifespan. Pt burden of symptoms associated with bone mets has been assessed in tumor types other than breast or in metastatic disease not specific to bone. This study characterizes patterns of pt-reported symptoms over time among breast cancer pts with bone mets.
Methods: The Oncology Services Comprehensive Electronic Records (OSCER) database was used to retrospectively identify women with breast cancer who developed bone mets during their care and had ≥1 ACORN Patient Care Monitor (PCM) assessment. The PCM summarizes symptoms on an 11-point scale (0 = not a problem to 10 = as bad as possible). Moderate/severe symptoms were defined by a PCM score ≥4. PCM items relevant to metastatic disease (fatigue, physical pain, trouble sleeping, numbness/tingling, anxious, loss of interest in others) were assessed. A generalized linear mixed model was used to evaluate symptom progression before and after bone mets diagnosis (dx). Kaplan-Meier methods were used to estimate time to development of and proportion of pts with moderate/severe symptoms after bone mets dx.
Results: 1105 pts with breast cancer and bone mets were included. In general, the proportion of pts with moderate/severe symptom burden increased in the months (mos) before bone mets dx (Table 1). The odds (risk) of pts experiencing moderate/severe symptom burden increased in the mos leading up to bone mets dx, with a 9% increase per mo for both fatigue and physical pain, and a 19% increase per mo for numbness/tingling (P<0.001 for all). Non-significant changes were observed in the risk of pts experiencing trouble sleeping (3%), anxiousness (0%), or loss of interest in others (16%). After bone mets dx, the cumulative proportion of pts with moderate/severe symptom burden increased with time (Table 2). Median time to moderate/severe symptoms after bone mets dx was 1.4 mos for fatigue, 1.9 mos for physical pain, 3.9 mos for trouble sleeping, 9.3 mos for numbness/tingling, 20.6 mos for anxious, and was not reached for loss of interest in others.
Table 1. Unadjusted proportion of pts with moderate/severe symptom burden before or at time of bone mets dxSymptom12 mos before dx6 mos before dxAt bone mets dxFatigue35%37%52%Physical pain29%34%47%Trouble sleeping22%25%28%Numbness/tingling16%18%19%Anxious14%16%23%Loss of interest in others4%6%6%
Conclusions: These data from a large number of breast cancer pts treated at community oncology practices show that pts experience increasing symptom burden for a substantial period of time before bone mets dx. Most pts continue to experience burdensome symptoms after bone mets dx. These findings reinforce the need for multiple symptoms to be proactively monitored and managed in these pts.
Table 2. KM estimate: cumulative proportion of pts with moderate/severe symptom burden after bone mets dxSymptom2 mos after dx12 mos after dxFatigue58%82%Physical pain51%74%Trouble sleeping39%64%Numbness/tingling26%53%Anxious27%46%Loss of interest in others9%22%
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-10-01.
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Affiliation(s)
- C Cleeland
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - R von Moos
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - M Walker
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - Y Wang
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - J Gao
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - A Liede
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - J Arellano
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - A Balakumaran
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
| | - Y Qian
- University of Texas MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; ACORN Research LLC, Memphis, TN; IMS Health, Plymouth Meeting, PA; Amgen Inc., Thousand Oaks, CA
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Kubicka S, Greil R, André T, Bennouna J, Sastre J, Van Cutsem E, von Moos R, Osterlund P, Reyes-Rivera I, Müller T, Makrutzki M, Arnold D. Bevacizumab plus chemotherapy continued beyond first progression in patients with metastatic colorectal cancer previously treated with bevacizumab plus chemotherapy: ML18147 study KRAS subgroup findings. Ann Oncol 2013; 24:2342-9. [PMID: 23852309 DOI: 10.1093/annonc/mdt231] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND ML18147 evaluated continued bevacizumab with second-line chemotherapy for patients with metastatic colorectal cancer (mCRC) progressing after the standard first-line bevacizumab-containing therapy. PATIENTS AND METHODS Evaluating outcomes according to tumor Kirsten rat sarcoma virus oncogene (KRAS) status was an exploratory analysis. KRAS data were collected from local laboratories (using their established methods) and/or from a central laboratory (mutation-specific Scorpion amplification-refractory mutation system). No adjustment was made for multiplicity; analyses were not powered to detect statistically significant differences. RESULTS Of 820 patients, 616 (75%) had unambiguous KRAS data; 316 (51%) had KRAS wild-type tumors and 300 (49%) had mutant KRAS tumors. The median progression-free survival (PFS) was 6.4 months for bevacizumab plus chemotherapy and 4.5 months for chemotherapy [P < 0.0001; HR = 0.61; 95% confidence interval (CI): 0.49-0.77] for wild-type KRAS and 5.5 and 4.1 months, respectively (P = 0.0027; HR = 0.70; 95% CI: 0.56-0.89) for mutant KRAS. The median overall survival (OS) was 15.4 and 11.1 months, respectively (P = 0.0052; HR = 0.69; 95% CI: 0.53-0.90) for wild-type KRAS and 10.4 versus 10.0 months, respectively (P = 0.4969; HR = 0.92; 95% CI: 0.71-1.18) for mutant KRAS. In both analyses, no treatment interaction by KRAS status was observed (PFS, P = 0.4436; OS, P = 0.1266). CONCLUSIONS Bevacizumab beyond first progression represents an option for patients with mCRC treated with bevacizumab plus standard first-line chemotherapy, independent of KRAS status.
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Affiliation(s)
- S Kubicka
- Cancer Center Reutlingen, Reutlingen, Germany.
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Joerger M, Baty F, Stahel R, Betticher D, von Moos R, Pless M, Gautschi O, Brauchli P, Zappa F, Brutsche M. 25PD CIRCULATING MICRO-RNA PROFILING IN PATIENTS WITH ADVANCED NON-SQUAMOUS NON SMALL-CELL LUNG CANCER RECEIVING BEVACIZUMAB/ERLOTINIB FIRST-LINE TREATMENT FOLLOWED BY PLATINUM-BASED CHEMOTHERAPY AT DISEASE PROGRESSION (SAKK 19/05). Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70246-0] [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: 11/27/2022]
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43
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Vadhan-Raj S, von Moos R, Fallowfield LJ, Patrick DL, Goldwasser F, Cleeland CS, Henry DH, Novello S, Hungria V, Qian Y, Feng A, Yeh H, Chung K. Clinical benefit in patients with metastatic bone disease: results of a phase 3 study of denosumab versus zoledronic acid. Ann Oncol 2012; 23:3045-3051. [PMID: 22851406 DOI: 10.1093/annonc/mds175] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patients with metastatic bone disease are living longer in the metastatic stage due to improvements in cancer therapy, making strategies to prevent the aggravation of bone disease and its complications, such as skeletal-related events (SREs) and pain, increasingly important. PATIENTS AND RESULTS In this phase 3 trial in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma, denosumab reduced the risk of radiation to bone by 22% relative to zoledronic acid (P = 0.026), prevented worsening of pain and pain interference (2-point increase in Brief Pain Inventory score; P < 0.05 versus zoledronic acid), and reduced the frequency of a shift from no/weak opioid analgesic use to strong opioids (P < 0.05 versus zoledronic acid at months 3-5). Denosumab delayed the time to moderate-to-severe pain compared with zoledronic acid in patients with mild or no pain at the baseline (P = 0.04), supporting early treatment. Health-related quality-of-life scores were similar in both groups. The number needed to treat to avoid one SRE for denosumab was 3 patient-years versus placebo and 10 patient-years versus zoledronic acid. CONCLUSION The use of denosumab was associated with better prevention of the complications of metastatic bone disease secondary to solid tumors or multiple myeloma versus zoledronic acid.
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Affiliation(s)
- S Vadhan-Raj
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology and Lymphoma/Myeloma, Section of Cytokines and Supportive Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - R von Moos
- Department of Medical Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - L J Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Brighton, UK
| | - D L Patrick
- Department of Health Services, School of Public Health, University of Washington, Seattle, USA
| | - F Goldwasser
- Department of Medical Oncology, Paris Descartes University, AP-HP, Paris, France
| | - C S Cleeland
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - D H Henry
- Department of Hematology-Oncology, Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, USA
| | - S Novello
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - V Hungria
- Department of Hematology, Irmandade da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Y Qian
- Global Biostatistical Sciences, USA
| | - A Feng
- Global Biostatistical Sciences, USA
| | - H Yeh
- Clinical Development, USA
| | - K Chung
- Global Health Economics, Amgen Inc., Thousand Oaks, USA
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von Moos R, Cathomas R, Mark M, Hitz F. [Treatment of metastatic melanoma: are we entering the era of targeted treatment?]. Praxis (Bern 1994) 2012; 101:1423-1429. [PMID: 23117962 DOI: 10.1024/1661-8157/a001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The treatment of metastatic melanoma has progressed greatly during the last two years. Nowadays melanomas can be divided into molecular subgroups, this being therapeutically relevant. Around 60% of melanomas show a BRAF mutation and can be treated with selected tyrokinase inhibitors. In addition a CTLA-4-antibody was developed which shuts off the natural immune breaking system resulting in a continuous anti-tumor reaction. Angiogenesis inhibitors have shown there importance in different phase II trials. We hope that this represents only the first step of an individualized treatment for metastatic melanoma.
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Affiliation(s)
- R von Moos
- Abteilung Medizinische Onkologie/Hämatologie, Kantonsspital Graubünden
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45
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Dirix L, Schuler M, Machiels J, Hess D, Awada A, Steeghs N, Paz-Ares L, von Moos R, Rabault B, Rodon J. Phase IB Dose-Escalation Study of BEZ235 or BKM120 in Combination with Paclitaxel (PTX) in Patients With Advanced Solid Tumors. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33012-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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46
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Blum D, Koeberle D, von Moos R, Ribi K, Aebi S, Betticher D, Hayoz S, Nadig J, Mauri S, Strasser F. Real-Time Electronic Monitoring of Patient-Reported Symptoms and Syndromes (PRS): E-Mosaic, a Multicenter Phase iii Study (Sakk 95/06). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33977-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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47
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Bouche O, Steffens C, André T, Bennouna J, Sastre J, Österlund P, von Moos R, Reyes-Rivera I, Sersch M, Arnold D. Efficacy and Safety of Treatment with Bevacizumab (BEV) + Chemotherapy (CT) Beyond First Progression in Patients (PTS) with Metastatic Colorectal Cancer (MCRC) Previously Treated with BEV + CT: Age Subgroup Analysis From a Randomised Phase III Intergroup Study (ML18147). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33169-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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48
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Peduzzi M, Schwitter M, Cathomas R, von Moos R, Wieland T, Mey U. [Persistent Eosinophilia--differential diagnosis and work-up]. Praxis (Bern 1994) 2012; 101:483-487. [PMID: 22454311 DOI: 10.1024/1661-8157/a000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The differential diagnosis of eosinophilia is broad and constitutes a major challenge for both, the general practitioner and the hematologist. Whereas in developing countries secondary eosinophilia is commonly caused by parasitic infections, in Western and European countries eosinophilia is more often associated with atopic diseases or drug-related. This case-report presents an asymptomatic patient with marked persisting eosinophilia caused by Strongyloidiasis in whom parasitic stool examinations were repeatedly negative and infection could only be established by serologic testing.
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Affiliation(s)
- M Peduzzi
- Departement Innere Medizin, Medizinische Onkologie, Kantonsspital Graubünden, Chur
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Dummer R, Guggenheim M, Arnold AW, Braun R, von Moos R. Updated Swiss guidelines for the treatment and follow-up of cutaneous melanoma. Swiss Med Wkly 2011; 141:w13320. [PMID: 22180245 DOI: 10.4414/smw.2011.13320] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Melanoma is the most common lethal cutaneous neoplasm. In order to harmonise treatment and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland were inaugurated in 2001 and revised in 2006. A new classification and recent results in randomised trials necessitated changes concerning staging and modifications of the recommendations of therapy and follow-up.
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Affiliation(s)
- R Dummer
- Department of Dermatology, University Hospital of Zurich, Switzerland.
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50
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Reinhart WH, Fehr M, von Moos R. Reply to the letter to the editor "Assessing the role of platelet activation in bevacizumab associated thrombosis". Swiss Med Wkly 2011. [DOI: 10.4414/smw.2011.13279] [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: 11/18/2022] Open
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