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Gronchi A, Palmerini E, Quagliuolo V, Martin Broto J, Lopez Pousa A, Grignani G, Brunello A, Blay JY, Tendero O, Diaz Beveridge R, Ferraresi V, Lugowska I, Pizzamiglio S, Verderio P, Fontana V, Donati DM, Palassini E, Sanfilippo R, Bianchi G, Bertuzzi A, Morosi C, Pasquali S, Stacchiotti S, Bagué S, Coindre JM, Miceli R, Dei Tos AP, Casali PG. Neoadjuvant Chemotherapy in High-Grade Myxoid Liposarcoma: Results of the Expanded Cohort of a Randomized Trial From Italian (ISG), Spanish (GEIS), French (FSG), and Polish Sarcoma Groups (PSG). J Clin Oncol 2024; 42:898-906. [PMID: 38232337 DOI: 10.1200/jco.23.00908] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/20/2023] [Accepted: 11/08/2023] [Indexed: 01/19/2024] Open
Abstract
PURPOSE A randomized trial was conducted to compare neoadjuvant standard (S) anthracycline + ifosfamide (AI) regimen with histology-tailored (HT) regimen in selected localized high-risk soft tissue sarcoma (STS). The results of the trial demonstrated the superiority of S in all STS histologies except for high-grade myxoid liposarcoma (HG-MLPS) where S and HT appeared to be equivalent. To further evaluate the noninferiority of HT compared with S, the HG-MLPS cohort was expanded. PATIENTS AND METHODS Patients had localized high-grade (cellular component >5%; size ≥5 cm; deeply seated) MLPS of extremities or trunk wall. The primary end point was disease-free survival (DFS). The secondary end point was overall survival (OS). The trial used a noninferiority Bayesian design, wherein HT would be considered not inferior to S if the posterior probability of the true hazard ratio (HR) being >1.25 was <5%. RESULTS From May 2011 to June 2020, 101 patients with HG-MLPS were randomly assigned, 45 to the HT arm and 56 to the S arm. The median follow-up was 66 months (IQR, 37-89). Median size was 107 mm (IQR, 84-143), 106 mm (IQR, 75-135) in the HT arm and 108 mm (IQR, 86-150) in the S arm. At 60 months, the DFS and OS probabilities were 0.86 and 0.73 (HR, 0.60 [95% CI, 0.24 to 1.46]; log-rank P = .26 for DFS) and 0.88 and 0.90 (HR, 1.20 [95% CI, 0.37 to 3.93]; log-rank P = .77 for OS) in the HT and S arms, respectively. The posterior probability of HR being >1.25 for DFS met the Bayesian monitoring cutoff of <5% (4.93%). This result confirmed the noninferiority of trabectedin to AI suggested in the original study cohort. CONCLUSION Trabectedin may be an alternative to standard AI in HG-MLPS of the extremities or trunk when neoadjuvant treatment is a consideration.
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Affiliation(s)
- Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuela Palmerini
- Osteoncologia, Sarcomi dell'osso e dei tessuti molli, e Terapie Innovative, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Javier Martin Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain
- University Hospital General de Villalba, Madrid, Spain
- Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD, UAM), Madrid, Spain
| | - Antonio Lopez Pousa
- Department of Cancer Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Giovanni Grignani
- Department of Cancer Medicine, Ospedale Città della Scienza e della Salute, Torino, Italy
| | - Antonella Brunello
- Department of Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV, IRCCS, Padova, Italy
| | - Jean-Yves Blay
- Department of Cancer Medicine, Centre Léon Bérard Cancer Center, UNICANCER & Université Claude Bernard, Lyon, France
| | - Oscar Tendero
- Department of Surgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Robert Diaz Beveridge
- Department of Cancer Medicine, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Centrum Onkologii, Instytutim, Marii Sklodowskiej-Curie, Warszawa, Poland
| | - Sara Pizzamiglio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Fontana
- Department of Epidemiology, Clinical Trial Center, IRCCS Ospedale Policlinico San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Davide Maria Donati
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Palassini
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Sanfilippo
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Bianchi
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alexia Bertuzzi
- Department of Cancer Medicine, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Bagué
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Rosalba Miceli
- Unit of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Frezza AM, Stacchiotti S, Chibon F, Coindre J, Italiano A, Romagnosa C, Bagué S, Dei Tos AP, Braglia L, Palmerini E, Quagliuolo V, Broto JM, Lopez Pousa A, Grignani G, Brunello A, Blay J, Beveridge RD, Lugowska I, Lesluyes T, Maestro R, Merlo FD, Casali PG, Gronchi A. CINSARC in high-risk soft tissue sarcoma patients treated with neoadjuvant chemotherapy: Results from the ISG-STS 1001 study. Cancer Med 2022; 12:1350-1357. [PMID: 35848358 PMCID: PMC9883440 DOI: 10.1002/cam4.5015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Complexity INdex in SARComas (CINSARC) is a transcriptional signature derived from the expression of 67 genes involved in mitosis control and chromosome integrity. This study aims to assess CINSARC value of in an independent series of high-risk patients with localized soft tissue sarcoma (STS) treated with preoperative chemotherapy within a prospective, randomized, phase III study (ISG-STS 1001). PATIENTS AND METHODS Patients with available pre-treatment samples, treated with 3 cycles of either standard (ST) preoperative or histotype-tailored (HT) chemotherapy, were scored according to CINSARC (low-risk, C1; high-risk, C2). The 10-year overall survival probability (pr-OS) according to SARCULATOR was calculated, and patients were classified accordingly (low-risk, Sarc-LR, 10-year pr-OS>60%; high-risk, Sarc-HR, 10-year pr-OS<60%). Survival functions were estimated using the Kaplan-Meier method and compared using log-rank test. RESULTS Eighty-six patients were included, 30 C1 and 56 C2, 49 Sarc-LR and 37 Sarc-HR. A low level of agreement between CINSARC and SARCULATOR was observed (Cohen's Kappa = 0.174). The 5-year relapse-free survival in C1 and C2 were 0.57 and 0.55 (p = 0.481); 5-year metastases-free survival 0.63 and 0.64 (p = 0.740); 5-year OS 0.80 and 0.72 (p = 0.460). The 5-year OS in C1 treated with ST and HT chemotherapy was 0.84 and 0.76 (p = 0.251) respectively; in C2 treated it was 0.72 and 0.70 (p = 0.349). The 5-year OS in Sarc-LR treated with S and HT chemotherapy was 0.80 and 0.82 (p = 0.502) respectively; in Sarc-HR it was 0.70 and 0.61 (p = 0.233). CONCLUSIONS Our results, although constrained by the small size of the series, suggest that CINSARC has weak prognostic power in high-risk, localized STS treated with neoadjuvant chemotherapy.
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Affiliation(s)
- Anna Maria Frezza
- Department of Medical OncologyFondazione IRCCS Istituto Nazionale TumoriMilanoItaly
| | - Silvia Stacchiotti
- Department of Medical OncologyFondazione IRCCS Istituto Nazionale TumoriMilanoItaly
| | - Frederic Chibon
- Institut Claudius Régaud, Cancer Research Center of Toulouse (CRCT)IUCT‐ OncopoleToulouseFrance
| | | | - Antoine Italiano
- Early Phase Trials and Sarcoma UnitsInstitut BergoniéBordeauxFrance
| | - Cleofe Romagnosa
- Clinical Genetics and Genetic Counseling ProgramGermans Trias i Pujol HospitalBarcelonaSpain
| | - Silvia Bagué
- Department of PathologyHospital de la Santa Creu i Sant PauBarcelonaSpain
| | | | - Luca Braglia
- Department Infrastructure Research and StatisticsAzienda USL‐IRCCS Reggio EmiliaReggio EmiliaItaly
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative TherapiesIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery UnitIRCCS Humanitas Research HospitalMilanItaly
| | - Javier Martin Broto
- Medical Oncology Department, University Hospital Fundación Jimenez Diaz, Madrid, SpainUniversity Hospital General de Villalba, Madrid, Spain. Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM)MadridSpain
| | - Antonio Lopez Pousa
- Fundacio de Gestio Sanitaria de L'Hospital de la Santa Creu I Sant PauBarcelonaSpain
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer InstituteFPO – IRCCSCandioloItaly
| | | | - Jean‐Yves Blay
- Department of Medicine, Centre Leon BerardUNICANCER & University Lyon ILyonFrance
| | | | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Centrum OnkologiiInstytut im. Marii Sklodowskiej‐CurieWarsawPoland
| | - Tom Lesluyes
- Institut Claudius Régaud, Cancer Research Center of Toulouse (CRCT)IUCT‐ OncopoleToulouseFrance
| | - Roberta Maestro
- Oncogenetics and Oncogenomics UnitCentro di Riferimento Oncologico di Aviano IRCCSAvianoItaly
| | | | | | - Alessandro Gronchi
- Department of SurgeryFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
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Martin Broto J, Martinez Garcia J, Moura DS, Redondo A, Gutierrez A, Lopez-Pousa A, Martinez-Trufero J, Sevilla I, Diaz Beveridge R, Solis-Hernandez MP, Carnero A, Perez M, Marcilla D, Lopez-Martin JA, Casado Herraez A, Alvarez Alvarez RM, Cruz Jurado J, Estival-Gonzalez A, Ledesma P, Hindi N. Phase II trial of palbociclib in advanced sarcoma overexpressing CDK4 gene excluding dedifferentiated liposarcoma (DD LPS): A study from the Spanish Group for Research on Sarcoma (GEIS). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11511 Background: CDK4/6 inhibitors showed a favorable progression-free survival (PFS) in DD LPS, a sarcoma bearing 12q 13-15 amplicon that implies CDK4 amplification. The median PFS was 4 and 7 months (m) for palbociclib and abemaciclib, respectively. Preclinical experiments in 10 sarcoma cell lines and 6 PDX models, including only one DD LPS, showed higher efficacy of anti-CDK4 in cases with high expression of CDK4 and low expression of p16. This rationale supported the design of a phase II trial exploring palbociclib in a wide range of sarcomas, excluding DD LPS. Methods: Progressing pretreated advanced soft tissue sarcoma, excluding DD LPS, or osteosarcoma adult patients (pts), whose tumors overexpressed CDK4 and underexpressed CDKN2A mRNA in a baseline mandatory biopsy, were enrolled. CDK4 and CDKN2A expression were assessed by qRT-PCR, using an external control as reference (Universal human reference RNA; Agilent Technologies). The primary endpoint was 6-m PFS rate. Minimax Simon’s two-stage with type 1 and 2 errors of 10%, and null and alternative hypothesis of H0 15%, H1 40%, 6-month PFS rates were specified. The study will warrant further investigation if 6 or more pts had a PFS > 6 m from 21 evaluable pts. Palbociclib was administered orally at 125 mg/ day 21 out of 28 days. Pre-screening intended to increase the probability of positive profile in the baseline biopsy. Results: A total of 214 pts with 236 CDK4/ CDKN2A determinations were assessed for enrolment; 141 for prescreening, in archive tumor sample, and 95 for screening, in a baseline biopsy. There were 38/141 (27%) and 28/95 (29%) pts with favorable mRNA profile from pre and screening, respectively. Twenty-two pts were enrolled with a median of previous systemic lines of 3 (1-5). There were 9 different sarcoma subtypes, including 2 osteosarcomas. With a median FU of 10 m (0.4-23.3), the median PFS was 4.2 m (95% CI 0.9-7.4), while the 6- and 12-m PFS rates were 30% (95% CI 9-51) and 18% (95% CI 12-48) respectively. From 19 evaluable pts (1 early death by COVID, 1 withdrew consent and for 1 it was too early to be assessed) 11 had stable disease (58%) and 8 progressed (42%) as the best response. Patients with CDK4 expression above the median value had significantly longer mPFS in the univariate analysis: 5.9 m (95% CI 1.4-10.4) vs 1.9 m (95% CI 0.6-3.2), p = 0.046; and longer OS: 15.5 m (95% CI 6.8-24.3) vs 10.6 m (95% CI 0-23.2), p = 0.047, respectively. The probability to find a positive profile in the screening was 29%, but this proportion increased up to 41% if in pre-screening had been positive. Conclusions: Palbociclib showed to be effective in a wide variety of sarcoma subtypes, other than DD LPS, selected by CDK4/CDKN2A biomarkers. Clinical trial information: NCT03242382.
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Affiliation(s)
- Javier Martin Broto
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Autonomous University of Madrid (IIS-FJD, UAM), Madrid, Spain
| | | | - David Silva Moura
- Group of Advanced Therapies and Biomarkers in Sarcomas, Health Research Institute-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | | | | | - Isabel Sevilla
- Hospital Universitario Regional y Virgen de la Victoria, Málaga, Spain
| | | | | | - Amancio Carnero
- IBIS (HUVR/CSIC/Universidad de Sevilla); CIBERONC, Sevilla, Spain
| | - Marco Perez
- IBIS (HUVR/CSIC/Universidad de Sevilla); CIBERONC, Sevilla, Spain
| | - David Marcilla
- Pathology Department, Universitary Hospital Virgen del Rocio, Seville, Spain
| | | | | | | | | | | | | | - Nadia Hindi
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Autonomous University of Madrid (IIS-FJD, UAM), Madrid, Spain
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Ochenduszko S, García J, Juan-Fita MJ, Gonzalez-Barrallo I, Herrero Colomina J, Diaz Beveridge R, Ros Martinez S, Sanchez Lafuente B, Cunquero Tomas AJ, Berrocal A, Cerezuela-Fuentes P, Luna Fra P, Gervás Peeters A, Sanchez Gonzalez JL, Meana Garcia A, Algarra Garcia M, Palomares García E, Perez Altozano J, Tallón Guerola M, Maestu I. Real-world study on characteristics of advanced melanoma patients with sustained complete response (CR) after elective 1 st line anti-programmed death-1 (anti-PD1) monotherapy discontinuation. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21529 Background: Previous reports proved the feasibility of immunotherapy (IT) discontinuation in advanced melanoma (MEL) patients (pts) in case of CR. We aimed to investigate clinical characteristics of pts with sustained CR after elective discontinuation of the 1st line anti-PD1 monotherapy in the real world setting. Methods: This is a multicenter retrospective cohort study. Eligible pts ≥ 18 years with unresectable locally advanced or metastatic primary cutaneous (PC) or unknown primary (UP) MEL with at least one measurable lesion per RECIST version 1.1 at baseline, treated with nivolumab (NIVO) o pembrolizumab (PEMBRO) monotherapy with no previous IT were included. All pts achieved CR to the treatment confirmed by computed tomography (CT) or positron emission tomography (PET-CT) and had at least one imaging study in the follow-up (FU). IT discontinuation was at the discretion of the treating physician. Pts with CR who stopped IT due to toxicity grade (G) 3 and/or 4 were excluded. Information regarding baseline characteristics, survival and immune related adverse events (irAEs) was obtained from patients´ charts. Data cut-off was February 10th 2022. Results: 36 pts treated in 12 hospitals in Spain between October 8th 2015 and October 27th 2021 were identified. Mean age was 66.8 years and mean BMI was 27.4. Twenty eight (77.8%) pts were males and 35 (97.2%) had ECOG PS 0-1. PC melanoma was observed in 33 (91.7%) pts, UP in 3 (8.3%). 35 pts (97.2%) had metastatic disease, with 11 (30.6%) pts with ≥3 metastatic sites. There were 21 (58.4%) pts with stage M1a-M1b disease; only 3 (8.3%) had liver and 2 (5.6%) had brain metastases. Baseline LDH was within normal limits in 28 (77.8%) pts and 31 (86.1%) pts had baseline neutrophil to lymphocyte ratio ≤3. Treatment received: PEMBRO 21 (58.3%), NIVO 15 (41.7%) pts. CR to treatment was confirmed by PET-CT in 27 (75.0%) pts. Median duration of anti-PD1 IT was 23.5 months (range 1.3 - 50.5) and median time to CR was 12.0 months (range 2.2 - 50.2). With the median FU time off treatment of 24.1 months (95% CI 19.4 – 28.8), median progression free survival (PFS) after IT discontinuation has not been reached: estimated PFS at 1 and 2 years were 94.1% and 89.2%, respectively. Estimated overall survival from start of IT at 3 and 4 years were 97.2% and 93.5%, respectively. irAEs G 1-2 were observed in 30 (83.3%) pts and the most common were: vitiligo 8 (22.2%), pruritis 4 (11.1%), other skin toxicity 8 (22.2%), hypothyroidism 5 (13.9%), pneumonitis 3 (8.3%), colitis 5 (13.9%), hepatitis 3 (8.3%), arthralgia 5 (13.9%) and nephritis 3 (8.3%). Conclusions: Our study confirms sustained CR after elective 1st line anti-PD1 monotherapy discontinuation in a cohort of advanced PC and UP MEL pts with favorable established prognostic factors for MEL at baseline. Frequency of irAEs was concordant with previous reports on IT.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alfonso Berrocal
- Medical Oncology, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Pablo Luna Fra
- Hospital Universitari Son Espases, Palma De Mallorca, Spain
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Gronchi A, Palmerini E, Quagliuolo V, Martin Broto J, Lopez-Pousa A, Grignani G, Brunello A, Blay JY, Diaz Beveridge R, Ferraresi V, Lugowska I, Pizzamiglio S, Verderio P, Fontana V, Donati DM, Palassini E, Stacchiotti S, Miceli R, Dei Tos AP, Casali PG. Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: Results of the expanded cohort of myxoid liposarcoma of the randomized clinical trial from the Italian Sarcoma Group (ISG), the Spanish Sarcoma Group (GEIS), the French Sarcoma Group (FSG), and the Polish Sarcoma Group (PSG). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11508 Background: An ISG, GEIS, FSG and PSG randomized trial on 3 cycles of neoadjuvant epirubicine+ifosfamide (EI) versus a histology-tailored (HT) regimen in selected localized high-risk STS showed some superiority of EI in all histologies with the exception of Myxoid Liposarcoma (MLPS) where EI and HT regimens seemed equivalent (J Clin Oncol 2020; 38:2178-86). This MLPS cohort was expanded with the aim to assess the non-inferiority of the HT regimen compared to EI. Methods: This was a multicenter European randomized trial comparing EI versus a HT regimen. Patients (pts) had localized high-risk (grade = 3; size >5 cm; deeply seated) undifferentiated pleomorphic sarcoma, leiomyosarcoma, malignant peripheral nerve sheath tumor, synovial sarcoma or MLPS of extremities or trunk wall. Primary end-point was Disease Free Survival (DFS). Secondary end-point was Overall Survival (OS). The MLPS cohort was expanded after the results of the 3rd interim analysis (Lancet Oncol 2017; 18:812-22) in order to reject the hypothesis that HT regimen trabectedin is associated with a HR of relapse = 1.25 with a non-inferiority design. To this aim, a Bayesian monitoring approach was used until the probability that the true HR is higher than 1.25 was greater than 80% or smaller than 5%. Results: From May 2011 to June 2020, 101 pts affected by high-risk MLPS were randomized, 56 to EI and 45 to HT regimen. The median follow-up was 66 months (IQ range 37-89). Median size was 107 mm (IQ range 84-143), 108 mm (IQ range 86-150) in the EI and 106 mm (IQ range75-135) in the HT arm. The DFS and OS probabilities at 60 months were 0.86 and 0.73 (HR:0.60; 95%CI: 0.24-1.46; log rank p = 0.26 for DFS) and 0.88 and 0.90 (HR:1.20; 95%CI:0.37-3.93; log rank p = 0.77 for OS), in the HT and EI arm, respectively. 5-yr observed and Sarculator-predicted OS were 0.89 (95% CI 0.82-0.97) and 0.80 in all patients (p = 0.020), 0.90 (95% CI 0.81-1.00) and 0.79 in the EI arm (p = 0.049) and 0.88 (95% CI 0.77-1.00) and 0.81 in the HT arm (p = 0.204) respectively. Conclusions: In the expanded cohort of MLPS, the HT neoadjuvant therapy trabectedin was not inferior to EI. While survival in both arms was better than predicted by Sarculator, it is left to understand whether this patient population, who had on average a lower Sarculator-predicted risk of death compared with the rest of the trial population, may benefit from a neoadjuvant therapy. Clinical trial information: NCT01710176.
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Affiliation(s)
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, Orthopaedic Institute Rizzoli, Bologna, Italy
| | | | - Javier Martin Broto
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Autonomous University of Madrid (IIS-FJD, UAM), Madrid, Spain
| | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - Antonella Brunello
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | | | | | - Iwona Lugowska
- Early Phase Clinial Trials Unit,, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Paolo Verderio
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Fontana
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | - Elena Palassini
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Rosalba Miceli
- Department of Medical Statistics, Biometry, and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Paolo Giovanni Casali
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Mora J, Suñol M, Hindi N, Castañeda A, Redondo A, Sirvent FJB, Diaz Beveridge R, Lopez-Pousa A, Lopez-Martin JA, Martin Broto J. GEIS 39: Phase II trial of nabpaclitaxel for the treatment of patient with multiply relapsed/refractory desmoplastic small round cell tumor (DSRCT) and Ewing sarcoma (EwS). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11529 Background: Nab-paclitaxel (albumin-bound paclitaxel) has shown preclinical activity against pediatric solid tumors. Preclinical data in EwS PDX models suggested high activity of nab-paclitaxel in tumors expressing high-levels of SPARC. Tumoral SPARC facilitates the accumulation of albumin in the tumor and increases the effectiveness of albumin-bound paclitaxel. Nab-paclitaxel utilizes albumin to deliver paclitaxel via caveolin-mediated endocytosis which is expressed in the EwS cells surface. We hypothesized that SPARC can be a predictive biomarker for nab-paclitaxel in EwS and DSRCT that could potentially be relevant for a better design of clinical trials and personalized treatments using nab-paclitaxel. Methods: Main endpoint of GEIS-39 was the overall response rate (ORR) assessed by RECIST 1.1 criteria with centralized pathology and imaging review. Secondary objectives included safety according to the CTCAE 4.0 criteria. Patients aged ≥ 6 months and ≤ 40 years, with relapsed/refractory DSRCT were eligible after having received at least one previous poly-chemotherapy line; EwS must have received at least two standard chemotherapy lines. Prior taxane therapy was accepted. Central pathology review selected for tumors with > Grade 3 (intense and diffuse) expression of SPARC by immunohistochemistry to be eligible. Nab-paclitaxel was administered as follows: age ≥ 21 and ≤ 40 years: 125 mg/m2 days 1, 8 and 15 in cycles of 28 days; age ≥ 6 months and ≤ 20 years: 240 mg/m2 days 1, 8 and 15 in cycles of 28 days. A 30% ORR was anticipated with a sample size of 25 patients needed to test the hypothesis. Stopping rule was set at 1 response within the first 16 treated pts. If 5 or more successes were observed in 25 pts, the results of the trial will warrant further investigation. Results: Twenty-nine patients were enrolled from June 2017 until October 2019, 11 DSRCT and 18 EwS. Median age was 32 years (range 14-69), and 5 females and 24 males were included, having received a median of 3 previous systemic treatment lines. Patients received a median of 3 cycles of nab-paclitaxel (range 1-17). In the EwS cohort an ORR of 33.3% (all partial responses, median duration 2 months) and 16.7% of stabilizations were achieved. No objective responses were observed among DSRCT pts, but 27.3% of pts achieved a stabilization. Overall, median progression free survival was 2.8 months and median overall survival 12.1 months, with no significant differences between DSRCT and EwS cohorts. Most common grade 3 toxicities were neutropenia (20.7%) and diarrhea (10.3%). Conclusions: Single agent nab-paclitaxel in biomarker selected EwS patients, but not in DSRCT, provided clinically meaningful activity that deserves further development. Nab-paclitaxel had a manageable adverse event profile. Clinical trial information: 2016-002464-14.
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Affiliation(s)
- Jaume Mora
- Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
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Gonzalez-Cao M, Mayo de las Casas C, Oramas J, Berciano-Guerrero MA, De la Cruz L, Cerezuela-Fuentes P, Arance AM, Muñoz-Couselo E, Espinosa E, Puértolas T, Diaz Beveridge R, Ochenduszko S, Villanueva Silva MJ, Basterretxea L, Bellido L, Rodriguez-Abreu D, Drozdowskyj A, Molina Vila MA, Lopez-Martin JA, Berrocal A. Results of phase II randomized study of intermittent versus continuous schedule of vemurafenib plus cobimetinib in BRAF-mutated advanced melanoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9528 Background: Combination of vemurafenib plus cobimetinib is approved for the treatment of BRAF-mutated advanced melanoma. Although patients initially respond to treatment, resistance emerges before 18 months in most cases. One of the key pre-clinical observations that supported an intermittent schedule was that resistant tumors suffer a fitness deficit in the absence of the drug, so modulation of the drug pressure through an intermittent dosing could delay the emergence of resistance. Methods: GEM1501 is a randomized phase 2 study comparing the activity of the combination of vemurafenib 960 mg every 12 h/d plus cobimetinib 60 mg/d in a standard (arm A) versus intermittent schedule (arm B). Arm A: four-week (w) cycles of daily vemurafenib for 4w plus cobimetinib for 3w-on and 1w-off-treatment. Arm B: first three cycles according to the standard schedule, followed by 6w-cycle with 2w-off vemurafenib & 3w-off cobimetinib. Primary endpoint was progression free survival (PFS) and secondary were objective response (OR) and treatment-related adverse events (TAEs). Results: 70 treatment-naïve patients were included. Results in arms A and B: median PFS 16.2 (95%CI 9.5, 24.1) vs 6.9 months (95%CI 5.2, 9.3) (p = 0.079); OR in 25 (71.4%) (8 complete -23%-) vs 21 (60%) patients (5 complete -14%-); G3-4 TAEs 42.8% vs 40.0%, respectively. Analysis of BRAFV600 mutation in tumoral cell free DNA (cfDNA) was performed in serial plasma samples in 41 patients. Twenty-one (51%) patients had detectable BRAFV600 mutation in pretreatment cfDNA (preBRAF+). Significant differences in PFS were found according to preBRAF V600: 8.2 months (95%CI 5.2, 13.6) in preBRAF+ vs non-reached (NR) (95%CI 2.8, NR) in preBRAF- (p = 0.017). In arm A, median PFS was 13.3 months (95% CI 4.6, NR) in preBRAF+ vs NR (95% CI 2.3, NR) in preBRAF-. In arm B, median PFS was 6.2 months (95% CI 0.3-8.3) in preBRAF+ vs NR (95%CI 2.8, NR) in preBRAF- (p = 0.003). BRAFV600 mutation became undetectable in cfDNA after treatment initiation in all preBRAF+ patients. Different kinetic of BRAFV600 mutation in cfDNA was found according to treatment arm. At progression, BRAFV600 reappeared in cfDNA in all (5/5) cases treated in arm B, but only in 50% (3/6) of cases in arm A. NGS analysis of cfDNA at progression suggested different resistance mechanisms. Conclusions: The results of this study do not support the use of an intermittent schedule of vemurafenib plus cobimetinib in advanced melanoma. BRAFV600 detection in pretreatment cfDNA is a prognostic factor of poor survival that it is independent of treatment schedule, although most striking differences favoring continuous arm vs intermittent arm were found in patients with detectable BRAFV600 mutation on pretreatment cfDNA. Further research is required to determine the clinical value of the analysis of resistance mechanisms in cfDNA. Clinical trial information: 2014-005277-36.
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Affiliation(s)
| | | | - Juana Oramas
- Hospital Universitario de Canarias, Tenerife, Spain
| | - Miguel-Angel Berciano-Guerrero
- Unidad Intercentros de Oncología. HURyVV (Hospitales Universitarios Regional y Virgen de la Victoria de Málaga), IBIMA (Instituto de Investigación Biomédica de Málaga), Málaga, Spain
| | | | | | - Ana Maria Arance
- Department of Medical Oncology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Eva Muñoz-Couselo
- Vall d'Hebron Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Enrique Espinosa
- Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
| | - Teresa Puértolas
- Medical Oncology. Hospital Miguel Servet, Zaragoza, Spain, Zaragoza, Spain
| | | | | | | | | | | | | | - Ana Drozdowskyj
- Oncology Department, Instituto Oncologico Dr Rosell, Hospital Universitari Dexeus, Barcelona, Spain
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8
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Pasquali S, Castelli C, Collini P, Barisella M, Romagosa C, Bague S, Coindre JM, De Tos P, Braglia L, Palmerini E, Quagliuolo V, Martin Broto J, Lopez-Pousa A, Grignani G, Blay JY, Diaz Beveridge R, Merlo DF, Stacchiotti S, Casali PG, Gronchi A. Immune contexture in high-risk soft tissue sarcomas (STS): A planned analysis of the ISG-STS-1001 randomized trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11572 Background: The characteristics of immune contexture and its prognostic and predictive value in STS is left to be understood. This planned analysis of the ISG-STS-1001 trial, which compared neoadjuvant anthracycline + ifosfamide (AI) vs a histology-tailored (HT) chemotherapy (ChT), was aimed at characterizing the immune contexture after neoadjuvant ChT and investigating any association with the risk of recurrence. Methods: Patients registered in the ISG-STS-1001 study (ID: NCT01710176) were included if they had tumor tissue available for Tissue MicroArray (TMA), which was performed in the area of the surgical specimen with the highest lymphocyte infiltrate. The following markers were analyzed with IHC and measured quantitatively: CD3, CD8, PD1, GranzymeB, Foxp3, CD20, CD163, and PDL1. The T-Distributed Stochastic Neighboring Entities (t-SNE) analysis was used to account for the co-expression of IHC markers in each tumor. The prognostic value of each marker for disease-free survival (DFS) was assessed. Results: This analysis was conducted in 256 of 435 study patients. AI and HT neoadjuvant ChT did not result in any different distribution of immune contexture. Conversely, differences were observed between ‘complex’ karyotype STS (ck-STS: LMS, MPNST, UPS, MFS, pleomorphic liposarcoma, and pleomorphic rhabdomyosarcoma) and ‘simple’ karyotype STS (sk-STS: MLPS and SS). Ck-STS were enriched in both CD3+ and CD8+ cells compared to sk-STS. These cells displayed an heterogeneous distribution and were dispersed inside the tumor nest, keeping direct contact with sarcoma cells. Ck-STS also displayed an enrichment in Granzyme B+, and CD163+ cells. PDL1+ cells were occasionally identified and were more frequent in ck-STS, suggesting an immune-related expression. Most STS were negative for CD20+ cells, however, when present these cells were highly represented and organized in tertiary lymphoid-like structure. The t-SNE generated plot clustered tumors, the ‘cold’ mainly including sk-STS and the ‘hot’ mainly composed by ck-STS. In the ‘hot’ group, a cluster of tumors displayed an immune infiltrate enriched with a high number of CD3, CD8, GranzymeB, PD-1, and PDL-1+ cells. When the prognostic value of the immune markers was investigated, the presence of CD20+ cells was the only independent prognostic factor for DFS (HR=0.68, 95%CI 0.52-0.91) in a histology-stratified estimate adjusting for tumor size in cm (HR=1.07, 95%CI 1.03-1.12) and patient age (HR=1.0, 95%CI 0.97-1.02). Conclusions: Immune contexture differed across sarcoma histologies after neoadjuvant ChT, rather than across the two study arms, with ck-STS being marked by a rich immune contexture. While a CD20+ infiltrate was found to be an independent prognostic factor for a better outcome, further analyses are in progress on the prognosis of patients with the richest immune contexture. Clinical trial information: NCT01710176.
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Affiliation(s)
- Sandro Pasquali
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Castelli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Soft Tissue and Bone Pathology, Histopathology and Pediatric Pathology Unit, Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Silvia Bague
- Pathology Department, Hospital De Sant Pau i la Santa Creu, Barcelona, Spain
| | | | - Paolo De Tos
- University of Padua School of Medicine, Treviso, Italy
| | - Luca Braglia
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | | | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | | | | | - Domenico F Merlo
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | | | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Istituto Nazionale Dei Tumori, Milan, Italy
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Pasquali S, Braglia L, Chibon F, Coindre JM, Italiano A, Romagosa C, Bague S, Dei Tos AP, Palmerini E, Quagliuolo V, Martin Broto J, Lopez-Pousa A, Grignani G, Brunello A, Blay JY, Diaz Beveridge R, Stacchiotti S, Merlo DF, Casali PG, Gronchi A. The prognostic value of CINSARC in a randomised trial comparing histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23531 Background: The Complexity INdex in SARComas (CINSARC) is a gene expression signature related to mitosis and chromosome integrity that stratifies risk for recurrence of soft tissue sarcoma (STS) patients. The aim of this study was to validate the prognostic value of CINSARC in patients enrolled in a randomised trial that compared histotype-tailored neoadjuvant chemotherapy with standard chemotherapy in patients with high-risk STS (ISG-STS 1001). Methods: CINSARC is 67-gene-expression-based signature that has been previously tested in retrospective series. The ISG-STS 1001 was a phase 3 RCT comparing histotype-tailored and anthracycline-based chemotherapy in localised, high-risk STS of the extremities or trunk wall, with one of five histological STS subtypes: high-grade myxoid liposarcoma, leiomyosarcoma, synovial sarcoma, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma. Outcome variables were disease-free survival (DFS), overall survival (OS) and tumour response according to RECIST v1.1. Results: CINSARC was assessed in pre-treatment biopsies of 87 in 435 patients participating in the study. Thirty and 57 patients segregated in the lower (C1) and higher (C2) CINSARC risk group, respectively. Incidence of local recurrences (LR) and distant metastasis (DM) did not differ between C1 and C2 CINSARC groups [2 (6.6%) and 11 (19.3%) patients had a LR, respectively, and 10 (33.3%) and 14 (24.5%) patients had DM, respectively, P = 0.800]. Consistently, we did not observe statistically significant differences for DFS and OS between patients in the CINSARC C1 and C2 groups (log-rank test, P = 0.522 and P = 0.480, respectively). RECIST tumour response was analysed in a subset of patients (N = 39), showing that a RECIST SD was more likely in C1 (N = 12/14, 85.6%) compared to C2 (N = 18/25, 72%) group, while both RECIST PD and PR were more commonly detected in C2 [3/25 (12%) and 4/25 (16%), respectively] compared to C1 [0/14 (0%) and 1/14 (7.1%), respectively] group. Conclusions: In high-risk STS patients treated with preoperative chemotherapy within a RCT, CINSARC did not correlate with different DFS and OS. While this may well be due to a failure of this gene signature in this patient population, an alternative hypothesis is that preoperative chemotherapy may improve the prognosis of higher-risk patients. Clinical trial information: NCT01710176 .
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Affiliation(s)
- Sandro Pasquali
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Braglia
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | | | | | | | - Silvia Bague
- Pathology Department, Hospital De Sant Pau i la Santa Creu, Barcelona, Spain
| | | | | | | | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Antonella Brunello
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | | | | | - Domenico F Merlo
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Paolo Giovanni Casali
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Stacchiotti S, Morosi C, Braglia L, Palmerini E, Quagliuolo V, Martin Broto J, Lopez-Pousa A, Grignani G, Brunello A, Blay JY, Tendero O, Diaz Beveridge R, Lugowska I, Fontana V, Marchesi E, Palassini E, Bruzzi P, Merlo FD, Casali PG, Gronchi A. Prognostic role of % changes in longest tumor diameter (LTD) in localized high-risk soft tissue sarcoma (STS) treated with neoadjuvant chemotherapy in a randomized clinical trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11558 Background: We investigated the prognostic relevance of % change in LTD in patients (pts) with localized high-risk STS treated with neoadjuvant chemotherapy in a phase 3 randomized trial (NCT01710176), aimed at comparing 3 cycles of a neoadjuvant histology-tailored (HT) over 3 cycles of standard anthracycline + ifosfamide chemotherapy (S). Methods: Pts with localized high-risk STS of extremities or trunk wall, and a diagnosis of myxoid liposarcoma, leiomyosarcoma, synovial sarcoma, malignant peripheral nerve sheath tumors, undifferentiated pleomorphic sarcoma were randomly assigned to receive 3 cycles of S or HT. Pts affected by myxofibrosarcoma, pleomorphic liposarcoma, pleomorphic rhabomyosarcoma unclassified spindle cell sarcoma were prospectively registered and treated by S. Change of LTD was assessed comparing baseline dimension with that measured after 3 cycles of S or HT, before surgery. Only pts treated with neodjuvant chemotherapy alone were selected for the analysis. We first investigated Overall Survival (OS) from surgery of the groups identified by “any % reduction”, “no-change” or “increase” in LTD by Kaplan-Meier estimates and log-rank tests. Then we searched for cutoffs able to separate prognosis among pts with a LTD reduction applying the change-point method proposed by Contal - O’Quigley. Results: Of 325 pts who entered the study and evaluable for response, 181 received neoadjuvant chemotherapy alone (92 S and 89 HT group respectively) and were analyzed, while 144 received concurrent chemo-radiotherapy and were excluded. In the whole population, % changes in LTD were significantly associated (log rank p = 0.032) to OS. “Any % reduction in LTD (101/181pts) displayed a better prognosis compared to “no-change” (28/181 pts) or “any % increase” (52/181). The change-point analysis was applied to all, S and HT groups separately; a cutoff of = / > 18.75% decrease in LTD was the optimal predictor of outcome for the S group (p = 0.031), while no size cut-off could be identified for the HT group. Conclusions: In our study, % change in LTD of pts treated with neoadjuvant chemotherapy for localized high-risk STS correlated with OS. However, a % decrease in LTD cut-off able to predict the best outcome could be identified only for pts treated in the S group, while no differences in outcome were found by any % LTD change in the HT group. Interestingly, the LTD cut-off identified in the S group was lower than the one selected to define a response by RECIST ( = / > 18.75% decrease in LTD vs = / > 30%). Clinical trial information: NCT01710176 .
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Affiliation(s)
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Braglia
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | | | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Antonella Brunello
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Oscar Tendero
- Hospital Universitari Son Espases, Palma De Mallorca, Spain
| | | | - Iwona Lugowska
- Early Phase Clinial Trials Unit,, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Valeria Fontana
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | - Elena Palassini
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Milan, Italy
| | - Paolo Bruzzi
- IRCCS Azienda Ospedaliera Universitaria San Martino—Ist-Istituto Nazionale Per La Ricerca Sul Cancro, Genoa, Italy
| | | | - Paolo Giovanni Casali
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Gronchi A, Palmerini E, Quagliuolo V, Martin Broto J, Lopez Pousa A, Grignani G, Brunello A, Blay JY, Tendero O, Diaz Beveridge R, Ferraresi V, Lugowska I, Merlo DF, Fontana V, Marchesi E, Braglia L, Donati DM, Palassini E, Bianchi G, Marrari A, Morosi C, Stacchiotti S, Bagué S, Coindre JM, Dei Tos AP, Picci P, Bruzzi P, Casali PG. Neoadjuvant Chemotherapy in High-Risk Soft Tissue Sarcomas: Final Results of a Randomized Trial From Italian (ISG), Spanish (GEIS), French (FSG), and Polish (PSG) Sarcoma Groups. J Clin Oncol 2020; 38:2178-2186. [PMID: 32421444 DOI: 10.1200/jco.19.03289] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To determine whether the administration of histology-tailored neoadjuvant chemotherapy (HT) was superior to the administration of standard anthracycline plus ifosfamide neoadjuvant chemotherapy (A+I) in high-risk soft tissue sarcoma (STS) of an extremity or the trunk wall. PATIENTS AND METHODS This was a randomized, open-label, phase III trial. Patients had localized high-risk STS (grade 3; size, ≥ 5 cm) of an extremity or trunk wall, belonging to one of the following five histologic subtypes: high-grade myxoid liposarcoma (HG-MLPS); leiomyosarcoma (LMS), synovial sarcoma (SS), malignant peripheral nerve sheath tumor (MPNST), and undifferentiated pleomorphic sarcoma (UPS). Patients were randomly assigned in a 1:1 ratio to receive three cycles of A+I or HT. The HT regimens were as follows: trabectedin in HG-MLPS; gemcitabine plus dacarbazine in LMS; high-dose prolonged-infusion ifosfamide in SS; etoposide plus ifosfamide in MPNST; and gemcitabine plus docetaxel in UPS. Primary and secondary end points were disease-free survival (DFS) and overall survival (OS), estimated using the Kaplan-Meier method and compared using Cox models adjusted for treatment and stratification factors. The study is registered at ClinicalTrials.gov (identifier NCT01710176). RESULTS Between May 2011 and May 2016, 287 patients (UPS: n = 97 [33.8%]; HG-MLPS: n = 65 [22.6%]; SS: n = 70 [24.4%]; MPNST: n = 27 [9.4%]; and LMS: n = 28 [9.8%]) were randomly assigned to either A+I or HT. At the final analysis, with a median follow-up of 52 months, the projected DFS and OS probabilities were 0.55 and 0.47 (log-rank P = .323) and 0.76 and 0.66 (log-rank P = .018) at 60 months in the A+I arm and HT arm, respectively. No treatment-related deaths were observed. CONCLUSION In a population of patients with localized high-risk STS, HT was not associated with a better DFS or OS, suggesting that A+I should remain the regimen to choose whenever neoadjuvant chemotherapy is used in patients with high-risk STS.
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Affiliation(s)
- Alessandro Gronchi
- Department of Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Javier Martin Broto
- Medical Oncology Department, University Hospital Virgen del Rocio, Sevilla, Spain.,Institute of Biomedicine of Sevilla, University of Sevilla, Sevilla, Spain
| | - Antonio Lopez Pousa
- Department of Cancer Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Giovanni Grignani
- Department of Cancer Medicine, Fondazione del Piemonte per l'Oncologia, IRCCS, Candiolo, Turin, Italy
| | - Antonella Brunello
- Department of Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Jean-Yves Blay
- Department of Cancer Medicine, Centre Léon Bérard Cancer Center, Lyon, France.,Université Claude Beranrd Lyon I, Lyon, France
| | - Oscar Tendero
- Department of Surgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Robert Diaz Beveridge
- Department of Cancer Medicine, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Centrum Onkologii, Instytutim, Marii Sklodowskiej-Curie, Warszawa, Poland
| | - Domenico Franco Merlo
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale, IRCCS, Reggio Emilia, Italy
| | - Valeria Fontana
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | | | - Luca Braglia
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale, IRCCS, Reggio Emilia, Italy
| | - Davide Maria Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Palassini
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Marrari
- Department of Cancer Medicine, Istituto Clinico Humanitas, Rozzano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Bagué
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Angelo Paolo Dei Tos
- Department of Pathology, Treviso General Hospital Treviso, Padova, Italy.,University of Padua, Padova, Italy
| | - Piero Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Bruzzi
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Gronchi A, Palmerini E, Quagliuolo V, Martin Broto J, Lopez Pousa A, Grignani G, Brunello A, Blay JY, Diaz Beveridge R, Ferraresi V, Lugowska I, Merlo FD, Fontana V, Palassini E, Morosi C, Stacchiotti S, Dei Tos AP, Picci P, Bruzzi P, Casali PG. Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: Final results of a randomized clinical trial from the Italian Sarcoma Group, the Spanish Sarcoma Group (GEIS), the French Sarcoma Group (FSG), and the Polish Sarcoma Group (PSG). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11000 Background: A ISG randomized trial on 5 cycles of adjuvant epirubicin+ifosfamide (EI) versus no chemotherapy suggested an OS benefit in localized high-risk STS (JCO 2001;19:1238). A subsequent trial showed no difference between 3 vs 5 cycles of the same neoadjuvant regimen (JCO 2012;30:850). The aim of this trial was to compare 3 cycles of EI versus a histology-tailored (HT) neoadjuvant regimen in selected localized high-risk STS. Methods: This is a multicenter European randomized trial comparing EI versus a HT regimen: gemcitabine+docetaxel in undifferentiated pleomorphic sarcoma (UPS); trabectedin in high-grade myxoid liposarcoma; high-dose prolonged-infusion ifosfamide in synovial sarcoma (SS); etoposide+ifosfamide in malignant peripheral nerve sheath tumors (MPNST); gemcitabine+dacarbazine in leiomyosarcoma (LMS). Patients had localized high-risk (grade = 3; size ≥5 cm) STS of extremities or trunk wall. Primary end-point was Disease Free Survival (DFS). The final analysis was planned after the observation of 130 events. This allows an 80% power to detect a significant difference at the 5% 2-sided level, if the true HR is 0.6 in favor of EI, as shown by the interim analysis (Lancet Oncol 2017;18:812-822). Results: From May 2011 to May 2016, 287 patients were randomized (97 = UPS; 65 = myxoid liposarcoma; 70 = SS; 27 = MPNST; 28 = LMS). The median follow-up was 51.75 months for the alive patients (IQ 28.03) The DFS and OS probability at 60 months were 0.48 and 0.55 (HR:1.232; 95%CI: 0.875-1.733; log rank p=0.323) and 0.66 and 0.76 (HR:1.766; 95%CI:1.101-2.831; log rank p=0.018), in the HT and EI arm, respectively. Conclusions: The final analysis shows a non-statistically significant DFS difference in favor of EI over HT chemotherapy with a larger and statistically significant OS difference. The outcome of patients on EI overlapped previous ISG trials. EI should remain the regimen of choice when neoadjuvant chemotherapy is used in high-risk localized STS. However this trial cannot be used as a formal proof of efficacy of (neo)adjuvant chemotherapy per se. EUDRACT 2010 – 023484 – 17. Funding source: Eurosarc FP7 278472. Clinical trial information: NCT01710176.
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Affiliation(s)
- Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Giovanni Grignani
- Medical Oncology-Sarcoma Unit, Istituto di Candiolo-Fondazione del Piemonte per l'Oncologia IRCCS Candiolo, Turin, Italy
| | - Antonella Brunello
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | | | | | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | | | - Valeria Fontana
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Elena Palassini
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Milan, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Piero Picci
- Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - Paolo Bruzzi
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Paolo Giovanni Casali
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Hindi N, Ramos R, Martinez-Trufero J, Alvarez Alvarez RM, Cordeiro M, Gonzalez de Sande LM, Marquina G, Cano JM, Cruz J, Valverde Morales CM, Vaz Salgado MÁ, Lavernia J, Lopez-Pousa A, Diaz Beveridge R, Sevilla I, Gutierrez A, Marcilla D, Taron M, Moura DS, Martin Broto J. Prognostic role of HMG proteins in a series of 301 advanced soft tissue sarcoma patients: A Spanish Group for Sarcoma Research Study (GEIS). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nadia Hindi
- Institute of Biomedicine Research (IBIS)- Universitary Hospital Virgen del Rocio/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Rafael Ramos
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | | | | | - Josefina Cruz
- Hospital Universitario de Canarias, Santa Cruz De Tenerife, Spain
| | | | | | - Javier Lavernia
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | | | - Isabel Sevilla
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - David Marcilla
- Pathology Department, Universitary Hospital Virgen del Rocio, Sevilla, Sevilla, Spain
| | - Miquel Taron
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - David Silva Moura
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
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Mielgo X, Diaz Beveridge R, Pineda E, Sepúlveda JM, López Castro R, Lecumberri-Biurrun MJ, Vaz Salgado MÁ, De Las Penas R, López-López C, Rodriguez Salas N, virizuela JA, Lopez R, Medina J, Valverde C, Beato C, Lainez N, Rodríguez-Antona C, Berraondo P, Herrador A, GarcÃa-Donas J. A multicenter phase 2 study of nivolumab combined with ipilimumab in patients with pediatric solid tumors in adulthood (GETHI021). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps3123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Xabier Mielgo
- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | | | | | | | | | | | | | | | | | | | - Rafael Lopez
- Hospital Clinico Santiago, Santiago De Compostela, Spain
| | - Javier Medina
- Virgen de la Salud Hospital, Medical Oncology Department, Toledo, Spain
| | | | | | - Nuria Lainez
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Pedro Berraondo
- Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain
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Martin Broto J, Marcilla D, Ramos R, Moura DS, Alvarez R, Hernandez N, Agra Pujol C, Mayordomo E, Romagosa C, Bague S, Reguero E, Cruz J, Martin FJ, Gutierrez A, Cruz J, Alvarez Alvarez RM, Diaz Beveridge R, Valverde Morales CM, Lopez-Pousa A, Martinez-Trufero J. Predictive role of FAS for trabectedin in second lines of advanced soft tissue sarcoma (ASTS): A Spanish group for research on sarcoma (GEIS) study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.11071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11071 Background: There are currently several second-line options for the treatment of ASTS as gemcitabine combinations, trabectedin, pazopanib, eribulin or olaratumab plus doxorubicin in cases where anthracyclins are still possible. There is an unmet need for predictive biomarkers which hinders the rational selection of the best sequence in second line. We already published the prognostic value of FAS in first line of ASTS while this study analyzes its predictive role in different second line schemes. Methods: Most relevant selection criteria for this study were having received trabectedin in 2nd line or beyond for ASTS, progressive disease after at least one previous line for ASTS and signed CI. A TMA was set up for FAS staining (Cell Signaling) with blocks from diagnostic time. Two expert blinded pathologists reviewed and classified the cases as negative, weak or strong. Kaplan–Meier estimations were used for time-to-event variables and the log-rank test was used to compare groups. Results: A series of 198 patients accomplished selection criteria. Metastases at diagnosis occurred in 46 (24%) and median time to metastases was 18.8 months (CI 16,3; 21.3). Previous line to trabectedin consisted of gemcitabine combination 83 (42%), Doxorubicin-based 65 (33%) and others 50 (25%). Median PFS for previous and trabectedin lines were 3.5 (2.8-4.2) and 3.4 (2.8-4) months respectively. FAS positive entailed significantly better PFS for the previous trabectedin line: 4.1 (1.5-6.7) vs 3.0 (2.5-3.5) months, p = 0.01 whereas FAS positive was related with worse PFS for the trabectedin line 2.5 (2.2-2.8) vs 3.7 (2.7-4.8) months, p = 0.028. These results were more notorious for L-sarcoma cases: 7.0 (3.6-10.5) vs 4.3 (1.9-6.6) months, p = 0.017 in previous line and 2.4 (2.2-2.6) vs 6.5 (3.8-9.3) months, p < 0.001 in trabectedin. From trabectedin administration, FAS+ had significantly worse OS especially in L-sarcomas: 11.9 (5.2-18.7) vs 21.7 (12.7-30.8) months, p = 0.002. Conclusions: FAS showed predictive value in PFS and OS for trabectedin administration in ASTS. The different prognostic role of FAS across distinct lines and its relevance in L-sarcomas deserve further attention.
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Affiliation(s)
- Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS), Seville, Spain
| | - David Marcilla
- Pathology Department, Universitary Hospital Virgen del Rocio, Sevilla, Sevilla, Spain
| | - Rafael Ramos
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | - Empar Mayordomo
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | | | - Silvia Bague
- Pathology Department, Hospital De Sant Pau i la Santa Creu, Barcelona, Spain
| | | | - Julia Cruz
- Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - Josefina Cruz
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Diaz Beveridge R, Akhoundova D, Bruixola G, Mendez JA, Medina ME, Garcia E, Torres A, Navarro E, Melian M, Gimenez A, Segura A, Aparicio J. Long-term experience with oral fluoropyrimidines and oxaliplatin-based long-course chemoradiotherapy in locally advanced rectal cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15159 Background: Neoadjuvant radiotherapy (RT) previous to surgery (S), both as short-course RT (SCRT) and as long-course RT with 5-FU-based chemotherapy (LCRCT), is used in locally advanced rectal cancer (LARC), with consistent benefits in the local relapse (LR) risk. However, survival benefits have been elusive to find, especially with the use of total mesorectal excision (TME). Concerns about over-treating patients (pts) and long-term side effects have also cast more doubts in a blanket approach of treating all pts with neoadjuvant RT, especially with LCRCT. Methods: Retrospective review of cT3-T4 and/or N+ rectal cancer pts (1999-2014) treated with LCRCT and oral 5-FU and oxaliplatin (65% of pts), followed by TME and 5-FU-based CT. Clinical, radiological and pathological prognostic factors for LR, distant metastases (DM), disease-free survival (DFS) and overall survival (OS) are shown. Results: 203 pts. 98.5% proceeded to S; TME done in 89.7%. Downstaging rate: 70.4% (mainly N staging); pathological complete responses: 14.9%. LR and DM rate was 8.3% and 27%. TNM pathological data (ypTN) were better prognostic factors than tumour regression grades. Prognostic factors (multivariate): circumferential margin (CRM) and perineural invasion. No benefit seen with the addition of oxaliplatin. Compliance to adjuvant CT was poor; < 50% received the full dose. 5- and 10-year DFS and OS: 71.4% and 54.9% and 75.4% and 62.4%. Elderly pts had a worse OS, due to higher unexpected toxicity and lower treatment compliance. Mucinous tumours showed a poor response to LCRCT. Prognostic factors (multivariate) for OS and DFS: older age, CRM invasion, an unsuccessful TME and a heavy lymph node burden. Conclusions: The identification of pts with a low risk of LR where RT could be avoided is based on the premise of an exquisite imaging staging and a surgical team specialized in TME. A free CRM and a successful TME are pivotal for success. Clinical lymph node staging is problematic. The role of adjuvant CT remains undefined, and compliance rates are poor. Neoadjuvant CT is an option, especially if there is a high risk of DM. Better tolerated options, such as SCRT, should be used in elderly or frail pts.
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Affiliation(s)
| | | | - Gema Bruixola
- Medical Oncology Department, University Hospital La FE, Valencia, Spain
| | | | | | - Esther Garcia
- Medical Oncology Department, University Hospital La FE, Valencia, Spain
| | - Alba Torres
- Medical Oncology Department, University Hospital La FE, Valencia, Spain
| | - Edwin Navarro
- Medical Oncology Department, University Hospital La FE, Valencia, Spain
| | - Marcos Melian
- Medical Oncology Department, University Hospital La FE, Valencia, Spain
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17
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Gronchi A, Ferrari S, Quagliuolo V, Broto JM, Pousa AL, Grignani G, Basso U, Blay JY, Tendero O, Beveridge RD, Ferraresi V, Lugowska I, Merlo DF, Fontana V, Marchesi E, Donati DM, Palassini E, Palmerini E, De Sanctis R, Morosi C, Stacchiotti S, Bagué S, Coindre JM, Dei Tos AP, Picci P, Bruzzi P, Casali PG. Histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001): an international, open-label, randomised, controlled, phase 3, multicentre trial. Lancet Oncol 2017; 18:812-822. [PMID: 28499583 DOI: 10.1016/s1470-2045(17)30334-0] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/21/2017] [Accepted: 03/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous trials from our group suggested an overall survival benefit with five cycles of adjuvant full-dose epirubicin plus ifosfamide in localised high-risk soft-tissue sarcoma of the extremities or trunk wall, and no difference in overall survival benefit between three cycles versus five cycles of the same neoadjuvant regimen. We aimed to show the superiority of the neoadjuvant administration of histotype-tailored regimen to standard chemotherapy. METHODS For this international, open-label, randomised, controlled, phase 3, multicentre trial, patients were enrolled from 32 hospitals in Italy, Spain, France, and Poland. Eligible patients were aged 18 years or older with localised, high-risk (high malignancy grade, 5 cm or longer in diameter, and deeply located according to the investing fascia), soft-tissue sarcoma of the extremities or trunk wall and belonging to one of five histological subtypes: high-grade myxoid liposarcoma, leiomyosarcoma, synovial sarcoma, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma. Patients were randomly assigned (1:1) to receive three cycles of full-dose standard chemotherapy (epirubicin 60 mg/m2 per day [short infusion, days 1 and 2] plus ifosfamide 3 g/m2 per day [days 1, 2, and 3], repeated every 21 days) or histotype-tailored chemotherapy: for high-grade myxoid liposarcoma, trabectedin 1·3 mg/m2 via 24-h continuous infusion, repeated every 21 days; for leiomyosarcoma, gemcitabine 1800 mg/m2 on day 1 intravenously over 180 min plus dacarbazine 500 mg/m2 on day 1 intravenously over 20 min, repeated every 14 days; for synovial sarcoma, high-dose ifosfamide 14 g/m2, given over 14 days via an external infusion pump, every 28 days; for malignant peripheral nerve sheath tumour, intravenous etoposide 150 mg/m2 per day (days 1, 2, and 3) plus intravenous ifosfamide 3 g/m2 per day (days 1, 2, and 3), repeated every 21 days; and for undifferentiated pleomorphic sarcoma, gemcitabine 900 mg/m2 on days 1 and 8 intravenously over 90 min plus docetaxel 75 mg/m2 on day 8 intravenously over 1 h, repeated every 21 days. Randomisation was stratified by administration of preoperative radiotherapy and by country of enrolment. Computer-generated random lists were prepared by use of permuted balanced blocks of size 4 and 6 in random sequence. An internet-based randomisation system ensured concealment of the treatment assignment until the patient had been registered into the system. No masking of treatment assignments was done. The primary endpoint was disease-free survival. The primary and safety analyses were planned in the intention-to-treat population. We did yearly futility analyses on an intention-to-treat basis. The study was registered with ClinicalTrials.gov, number NCT01710176, and with the European Union Drug Regulating Authorities Clinical Trials, number EUDRACT 2010-023484-17, and is closed to patient entry. FINDINGS Between May 19, 2011, and May 13, 2016, 287 patients were randomly assigned to a group (145 to standard chemotherapy and 142 to histotype-tailored chemotherapy), all of whom, except one patient assigned to standard chemotherapy, were included in the efficacy analysis (97 [34%] with undifferentiated pleomorphic sarcoma; 64 [22%] with high-grade myxoid liposarcoma; 70 [24%] with synovial sarcoma; 27 [9%] with malignant peripheral nerve sheath tumour; and 28 [10%] with leiomyosarcoma). At the third futility analysis, with a median follow-up of 12·3 months (IQR 2·75-28·20), the projected disease-free survival at 46 months was 62% (95% CI 48-77) in the standard chemotherapy group and 38% (22-55) in the histotype-tailored chemotherapy group (stratified log-rank p=0·004; hazard ratio 2·00, 95% CI 1·22-3·26; p=0·006). The most common grade 3 or higher adverse events in the standard chemotherapy group (n=125) were neutropenia (107 [86%]), anaemia (24 [19%]), and thrombocytopenia (21 [17%]); the most common grade 3 or higher adverse event in the histotype-tailored chemotherapy group (n=114) was neutropenia (30 [26%]). No treatment-related deaths were reported in both groups. In agreement with the Independent Data Monitoring Committee, the study was closed to patient entry after the third futility analysis. INTERPRETATION In a population of patients with high-risk soft-tissue sarcoma, we did not show any benefit of a neoadjuvant histotype-tailored chemotherapy regimen over the standard chemotherapy regimen. The benefit seen with the standard chemotherapy regimen suggests that this benefit might be the added value of neoadjuvant chemotherapy itself in patients with high-risk soft-tissue sarcoma. FUNDING European Union grant (Eurosarc FP7 278472).
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Affiliation(s)
- Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Stefano Ferrari
- Department of Cancer Medicine, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Javier Martin Broto
- Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Antonio Lopez Pousa
- Department of Cancer Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Giovanni Grignani
- Department of Cancer Medicine, Fondazione del Piemonte per l'Oncologia IRCCS Candiolo, Turin, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Jean-Yves Blay
- Department of Cancer Medicine, Centre Léon Bérard Cancer Center, Lyon, France
| | - Oscar Tendero
- Department of Surgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Robert Diaz Beveridge
- Department of Cancer Medicine, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Centrum Onkologii, Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland
| | - Domenico Franco Merlo
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Valeria Fontana
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | - Davide Maria Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Palassini
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuela Palmerini
- Department of Cancer Medicine, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rita De Sanctis
- Department of Cancer Medicine, Istituto Clinico Humanitas, Rozzano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Bagué
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Angelo Paolo Dei Tos
- Department of Pathology, Treviso General Hospital Treviso, Italy; University of Padua, Padova, Italy
| | - Piero Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Bruzzi
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Martin Broto J, Redondo A, Valverde CM, Vaz Salgado MÁ, Mora J, Garcia del Muro X, Sancho Marquez MP, Martinez-Trufero J, Diaz Beveridge R, Gutierrez A, Blay P, Tous C, Luna Fra P, Lopez-Pousa A. Phase II trial of gemcitabine plus rapamycin as second line in advanced osteosarcoma: A Spanish Group for Sarcoma Research (GEIS) Study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Jaume Mora
- Hospital Sant Joan de Deu, Barcelona, Spain
| | - Xavier Garcia del Muro
- Medical Oncology Department, Institut Català d’Oncologia, l’Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Pilar Blay
- Hospital Central de Asturias, Oviedo, Spain
| | | | - Pablo Luna Fra
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Diaz Beveridge R, Alcolea V, Aparicio J, Segura Á, García J, Corbellas M, Fonfría M, Giménez A, Montalar J. Management of advanced pancreatic cancer with gemcitabine plus erlotinib: efficacy and safety results in clinical practice. JOP 2014; 15:19-24. [PMID: 24413779 DOI: 10.6092/1590-8577/1570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/26/2013] [Accepted: 10/12/2013] [Indexed: 01/24/2023]
Abstract
CONTEXT The combination of gemcitabine and erlotinib is a standard first-line treatment for unresectable, locally advanced or metastatic pancreatic cancer. We reviewed our single centre experience to assess its efficacy and toxicity in clinical practice. METHODS Clinical records of patients with unresectable, locally advanced or metastatic pancreatic cancer who were treated with the combination of gemcitabine and erlotinib were reviewed. MAIN OUTCOME MEASURES Univariate survival analysis and multivariate analysis were carried out to indentify independent predictors factors of overall survival. RESULTS Our series included 55 patients. Overall disease control rate was 47%: 5% of patients presented complete response, 20% partial response and 22% stable disease. Median overall survival was 8.3 months). Cox regression analysis indicated that performance status and locally advanced versus metastatic disease were independent factors of overall survival. Patients who developed acne-like rash toxicity, related to erlotinib administration, presented a higher survival than those patients who did not develop this toxicity. CONCLUSIONS Gemcitabine plus erlotinib doublet is active in our series of patients with advanced pancreatic cancer. This study provides efficacy and safety results similar to those of the pivotal phase III clinical trial that tested the same combination.
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