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Hoejgaard M, Drilon A, Lin J, Kummar S, Tan D, Patel J, Leyvraz S, Garcia VM, Rosen L, Solomon B, Yachnin J, Liu Y, Dai MS, Norenberg R, Burcoveanu DI, Yun L, Beckmann G, Mussi C, Shen L. 15MO Efficacy and ctDNA analysis in an updated cohort of patients with TRK fusion lung cancer treated with larotrectinib. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00269-1] [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: 04/03/2023]
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Leyvraz S, Schütte M, Kessler T, Lamping M, Burock S, Ochsenreither S, Amstislavskiy V, Risch T, Jelas I, Ulrich C, Dobos G, Klauschen F, Schäfer R, Lange B, Klinghammer K, Yaspo ML, Keilholz U. 847P Precision oncology for resistant acral, mucosal and cutaneous melanomas: A prospective broad high throughput genomics feasibility study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Moreno V, Lin J, Tan D, Lassen U, Leyvraz S, Liu Y, Patel J, Rosen L, Solomon B, Rudolph M, Norenberg R, Schulz A, Fellous M, Brega N, Shen L, Kummar S, Drilon A. 61P Updated efficacy and ctDNA analysis of patients with TRK fusion lung cancer treated with larotrectinib. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.070] [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: 11/28/2022] Open
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Drilon A, Lin J, Lassen U, Leyvraz S, Liu Y, Patel J, Rosen L, Solomon B, Norenberg R, Dima L, Brega N, Shen L, Moreno V, Kummar S, Tan D. P53.02 Efficacy and Safety of Larotrectinib in Patients With Tropomyosin Receptor Kinase (TRK) Fusion-Positive Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.551] [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: 10/20/2022]
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Piulats J, Sato T, Luke J, Collins L, Edukulla R, Abdullah S, Leyvraz S. 1013P Similar overall survival in tebentafusp-treated 2L+ metastatic uveal melanoma regardless of prior immunotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1397] [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: 10/20/2022] Open
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Garcia VM, Lin J, Patel J, Lassen U, Solomon B, Rosen L, Leyvraz S, Tan D, Reeves J, Beckmann G, Rudolph M, Wierzbinska J, Dima L, Brega N, Kummar S, Drilon A. 162P Long-term efficacy and genomic characteristics of patients with TRK fusion lung cancer treated with larotrectinib. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)02004-9] [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: 11/28/2022]
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Tan D, Farago A, Kummar S, Moreno V, Patel J, Lassen U, Solomon B, Rosen L, Leyvraz S, Reeves J, Brega N, Dima L, Childs B, Drilon A. MA11.09 Efficacy and Safety of Larotrectinib in Patients with Tropomyosin Receptor Kinase (TRK) Fusion Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.253] [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: 10/21/2022]
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Drilon A, Moreno V, Patel J, Lassen U, Solomon B, Rosen L, Leyvraz S, Tan D, Reeves J, Dima L, Brega N, Kummar S, Farago A. MO01.35 Efficacy and Safety of Larotrectinib in Patients with Tropomyosin Receptor Kinase (TRK) Fusion Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.140] [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: 10/22/2022]
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Sacco J, Carvajal R, Butler M, Shoushtari A, Hassel J, Ikeguchi A, Hernandez-Aya L, Nathan P, Hamid O, Rodriguez JP, Rioth M, Johnson D, Luke J, Espinosa E, Leyvraz S, Goodall H, Holland C, Abdullah S, Sato T. 64MO A phase (ph) II, multi-center study of the safety and efficacy of tebentafusp (tebe) (IMCgp100) in patients (pts) with metastatic uveal melanoma (mUM). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.552] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cabanillas M, Drilon A, Farago A, Brose M, McDermott R, Sohal D, Oh DY, Almubarak M, Bauman J, Chu E, Kummar S, Leyvraz S, Park K, Reeves J, Dima L, Maeda P, Rodrigues L, Brega N, Hong D, Waguespack S. 1916P Larotrectinib treatment of advanced TRK fusion thyroid cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1404] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Leyvraz S, Yang JH, Casali P, Castro G, Kim E, Lassen U, Lopez-Rios F, Penault-Llorca F, Pappo A, Rudzinski E, Tabatabai G, Vassal G, Reeves J, Nogai H, Fellous M, Drilon A, Brose M, Trent J. 604TiP ON-TRK: A non-interventional study of larotrectinib in patients with TRK fusion cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nathan P, Needham A, Corrie P, Danson S, Evans J, Ochsenreither S, Kumar S, Goodman A, Larkin J, Karydis I, Steven N, Lorigan P, Plummer R, Patel P, Shaw H, Leyvraz S, Rawcliffe C, Psarelli E, Handley L, Sacco J. SELPAC: A 3 arm randomised phase II study of the MEK inhibitor selumetinib alone or in combination with paclitaxel (PT) in metastatic uveal melanoma (UM). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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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Khoja L, Atenafu E, Suciu S, Leyvraz S, Sato T, Marshall E, Keilholz U, Zimmer L, Patel S, Piperno-Neumann S, Piulats J, Kivelä T, Pfoehler C, Bhatia S, Huppert P, Van Iersel L, De Vries I, Penel N, Vogl T, Cheng T, Fiorentini G, Mouriaux F, Tarhini A, Patel P, Carvajal R, Joshua A. Meta-analysis in metastatic uveal melanoma to determine progression free and overall survival benchmarks: an international rare cancers initiative (IRCI) ocular melanoma study. Ann Oncol 2019; 30:1370-1380. [DOI: 10.1093/annonc/mdz176] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Peuker C, Polzin L, Ochsenreither S, De Bucourt M, Leyvraz S, Keilholz U, Joussen A, Eucker J. Retrospective analysis of the treatment of metastatic uveal melanoma comparing systemic chemotherapy and transarterial chemoembolization. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.027] [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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Olive E, Grohé C, Sänger K, Lamping M, Leyvraz S, Ochsenreither S, Keilholz U, Tessmer A. Fallbericht zur Behandlung eines NSCLC Patienten und aktivierender p.G469A BRAF-Mutation mit Dabrafenib und Trametinib. Pneumologie 2018. [DOI: 10.1055/s-0037-1619263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E Olive
- Evangelische Lungenklinik Berlin
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin – Krankenhausbetriebs gGmbH
| | - K Sänger
- Pneumologie; Palliativmedizin, Evangelische Lungenklinik Berlin
| | - M Lamping
- Charité Comprehensive Cancer Center (Cccc); Charité Universitätsmedizin Berlin
| | - S Leyvraz
- Charité Comprehensive Cancer Center (Cccc); Charité Universitätsmedizin Berlin
| | - S Ochsenreither
- Charité Comprehensive Cancer Center (Cccc); Charité Universitätsmedizin Berlin
| | - U Keilholz
- Hematology-Oncology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
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Leyvraz S, Schuette M, Rieke D, Kessler T, Ochsenreither S, Amstislavskiy V, Risch T, Wierling C, Joehrens K, Peuker C, Lamping M, Burock S, Poch G, Kiecker F, Schaefer R, Lange B, Lehrach H, Joussen A, Keilholz U, Yaspo ML. Precision medicine for the treatment of metastatic uveal melanoma: A pilot study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.005] [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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Rieke D, Leyvraz S, Burock S, Keilholz U. A comparison of treatment recommendations by molecular tumor boards worldwide. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.059] [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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18
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Cassier PA, Kantor G, Bonvalot S, Lavergne E, Stoeckle E, Le Péchoux C, Meeus P, Sunyach MP, Vaz G, Coindre JM, Linassier C, Labib A, Delcambre C, Bay JO, Leyvraz S, Dubergé T, Lagrange JL, Duret A, Blay JY. Adjuvant radiotherapy for extremity and trunk wall atypical lipomatous tumor/well-differentiated LPS (ALT/WD-LPS): a French Sarcoma Group (GSF-GETO) study. Ann Oncol 2014; 25:1854-1860. [PMID: 24914041 DOI: 10.1093/annonc/mdu202] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The role of adjuvant radiotherapy (RT) in the management of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WD-LPS) remains controversial. METHODS Two hundred eighty-three patients with operable ALT/WD-LPS, no history of previous cancer, chemotherapy (CT) or RT, treated between 1984 and 2011 registered in the Conticabase database were included and described. Overall (OS), progression-free survival (PFS) and time to local relapse (TTLR) were evaluated from the time of first treatment. RESULTS Three of 20 centers enrolled 58% of the patients. Median age at diagnosis was 61 (range 25-94) years, 147 patients (52%) were males, 222 (78%) patients had their primary tumor located in an extremity while 36 (13%) and 25 (9%) had tumors involving the girdle and the trunk wall, respectively. The median size of primary tumors was 17 cm (range 2-48 cm). Adjuvant RT was given to 132 patients (47%). Patients who received adjuvant RT had larger tumors (P = 0.005), involving more often the distal limbs (P < 0.001). Use of adjuvant RT varied across centers and along the study period. Other characteristics were balanced between the two groups. Median follow-up was 61.7 months. None of the patients developed metastasis during follow-up. The 5-year local relapse-free survival rates were 98.3% versus 80.3% with and without adjuvant RT, respectively (P < 0.001). Once stratified on time period (before/after 2003), adjuvant RT, tumor site and margin status (R0 versus other) were independently associated with TTLR. No OS difference was observed (P = 0.105). CONCLUSION In this study, adjuvant RT following resection of ALT/WD-LPS was associated with a reduction of LR risk.
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Affiliation(s)
- P A Cassier
- Department of Medical Oncology, Centre Léon Bérard, Lyon; INSERM UMR5286, Centre de Recherche en Cancérologie de Lyon, Université de Lyon, Lyon.
| | - G Kantor
- Department of Radiotherapy, Institut Bergonié, Bordeaux
| | - S Bonvalot
- Department of Surgery, Institut Gustave Roussy, Villejuif
| | - E Lavergne
- Department of Biostatistics, Centre Léon Bérard, Lyon
| | - E Stoeckle
- Department of Surgery, Institut Bergonié, Bordeaux
| | - C Le Péchoux
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif
| | | | - M-P Sunyach
- Department of Radiotherapy, Centre Léon Bérard, Lyon
| | - G Vaz
- Department of Surgery, Hopital Edouard Herriot, Lyon
| | - J-M Coindre
- Department of Pathology, Institut Bergonié, Bordeaux
| | - C Linassier
- Department of Medical Oncology, Centre Hospitalier Universitaire, Tours
| | - A Labib
- Department of Radiotherapy, Institut Curie, Paris
| | - C Delcambre
- Department of Medical Oncology, Centre François Balcesse, Caen
| | - J-O Bay
- Department of Medical Oncology, Centre Hospitalier Universitaire, Clermont Ferrand, France
| | - S Leyvraz
- Department of Medical Oncology, Centre Hospitalier Universitaire, Lauzanne, Switzerland
| | - T Dubergé
- Department of Radiotherapy, Hôpital La Timone, Marseille
| | - J-L Lagrange
- Department of Radiotherapy, Hôpital Henri Mondor, Paris, France
| | - A Duret
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon; INSERM UMR5286, Centre de Recherche en Cancérologie de Lyon, Université de Lyon, Lyon
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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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20
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Leyvraz S, Piperno-Neumann S, Suciu S, Baurain JF, Zdzienicki M, Testori A, Marshall E, Scheulen M, Jouary T, Negrier S, Vermorken JB, Kaempgen E, Durando X, Schadendorf D, Gurunath RK, Keilholz U. Hepatic intra-arterial versus intravenous fotemustine in patients with liver metastases from uveal melanoma (EORTC 18021): a multicentric randomized trial. Ann Oncol 2014; 25:742-746. [PMID: 24510314 PMCID: PMC4433517 DOI: 10.1093/annonc/mdt585] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [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: 09/08/2013] [Revised: 11/13/2013] [Accepted: 12/02/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In uveal melanoma (UM) with metastatic disease limited to the liver, the effect of an intrahepatic treatment on survival is unknown. We investigated prospectively the efficacy and toxicity of hepatic intra-arterial (HIA) versus systemic (IV) fotemustine in patients with liver metastases from UM. PATIENTS AND METHODS Patients were randomly assigned to receive either IV or HIA fotemustine at 100 mg/m(2) on days 1, 8, 15 (and 22 in HIA arm only) as induction, and after a 5-week rest period every 3 weeks as maintenance. Primary end point was overall survival (OS). Response rate (RR), progression-free survival (PFS) and safety were secondary end points. RESULTS Accrual was stopped after randomization of 171 patients based on the results of a futility OS analysis. A total of 155 patients died and 16 were still alive [median follow-up 1.6 years (range 0.25-6 years)]. HIA did not improve OS (median 14.6 months) when compared with the IV arm (median 13.8 months), hazard ratio (HR) 1.09; 95% confidence interval (CI) 0.79-1.50, log-rank P = 0.59. However, there was a significant benefit on PFS for HIA compared with IV with a median of 4.5 versus 3.5 months, respectively (HR 0.62; 95% CI 0.45-0.84, log-rank P = 0.002). The 1-year PFS rate was 24% in the HIA arm versus 8% in the IV arm. An improved RR was seen in the HIA (10.5%) compared with IV treatment (2.4%). In the IV arm, the most frequent grade ≥3 toxicity was thrombocytopenia (42.1%) and neutropenia (62.6%), compared with 21.2% and 28.7% in the HIA arm. The main grade ≥3 toxicity related to HIA was catheter complications (12%) and liver toxicity (4.5%) apart from two toxic deaths. CONCLUSION HIA treatment with fotemustine did not translate into an improved OS compared with IV treatment, despite better RR and PFS. Intrahepatic treatment should still be considered as experimental. EUDRACT NUMBER AND CLINICALTRIALSGOV IDENTIFIER 2004-002245-12 and NCT00110123.
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Affiliation(s)
- S Leyvraz
- Oncology Department, University Hospital, Lausanne, Switzerland.
| | | | - S Suciu
- EORTC Headquarters, Brussels
| | - J F Baurain
- Centre du Cancer, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - M Zdzienicki
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - A Testori
- European Institute of Oncology, Milan, Italy
| | - E Marshall
- Clatterbridge Centre for Oncology, Wirral, UK
| | - M Scheulen
- West German Cancer Center, University of Essen Medical School, Essen, Germany
| | - T Jouary
- University Hospital Bordeaux Saint André, Bordeaux
| | - S Negrier
- Léon-Bérard Cancer Centre, Lyon, France
| | | | - E Kaempgen
- Universitätsklinik Erlangen, Erlangen, Germany
| | - X Durando
- Centre Jean Perrin, Clermont-Ferrand, France
| | | | | | - U Keilholz
- Department of Hematology and Medical Oncology, Charité, CBF, Berlin, Germany
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Ludwig G, Krenz S, Zdrojewski C, Bot M, Rousselle I, Stagno D, Luethi F, Leyvraz S, Stiefel F. Psychodynamic interventions in cancer care I: psychometric results of a randomized controlled trial. Psychooncology 2013; 23:65-74. [PMID: 23983096 DOI: 10.1002/pon.3374] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 10/23/2012] [Revised: 07/11/2013] [Accepted: 07/17/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to assess the effectiveness of psychodynamic interventions in cancer care. METHODS Between 2006 and 2009, each consecutive outpatient of the Oncology Center of the University Hospital of Lausanne was invited to participate in a trial evaluating the effects of psychological support. Accepting patients were randomly assigned to an immediate intervention or a delayed intervention [4-month waiting list]. Patients who declined support were asked to participate in an observational group [OG]. Socio-demographic and medical data, anxiety, and depression [HADS], psychological distress [SCL-90], alexithymia [TAS] and quality of life [EORTC] were recorded at baseline, and at 1, 4, 8, and 12-months follow-up. RESULTS Of the 1973 approached patients, 1057 were excluded, 530 refused, and 386 were included with 196 of them participating in the OG. Of the patients in the intervention group [IG] [N = 190], 94 were randomized to the immediate intervention and 96 to the delayed intervention group (dIG). IG patients were younger, predominantly female, and had more psychological symptoms compared with those in the OG. Although patients of the IG and OG showed significant improvement in quality of life from baseline to 12-months follow-up, other outcomes [anxiety, depression, psychological distress, and alexithymia] remained unchanged. CONCLUSIONS The intervention was not effective with regards to psychometric outcome. The results have to be interpreted in light of the study design [untargeted intervention], the low levels of psychiatric symptoms, dropout of symptomatic patients, and the high prevalence of alexithymia.
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Affiliation(s)
- G Ludwig
- Psychiatric Liaison Service, University Hospital of Lausanne, Lausanne, Switzerland
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Zaman K, Dahmane E, Perey L, Bodmer A, Anchisi S, Wolfer A, Galmiche M, Stravodimou A, Buclin T, Eap C, Decosterd L, Csajka C, Leyvraz S. Abstract P6-04-05: Tamoxifen dose escalation based on endoxifen level: a prospective trial with genotyping, phenotyping and pharmacokinetics over 4 months. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-04-05] [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: Retrospective studies assessing the impact of tamoxifen (Tam) metabolism and its active metabolite, endoxifen, on the efficacy of the treatment produced conflicting results. The prospective CYPTAM-BRUT 2 trial is ongoing1. In the present study we assessed if the level of Tam metabolites could be improved by doubling tamoxifen dose in breast cancer patients (pts) with any CYP2D6 genotype, poor (PM), intermediate (IM) and also extensive metabolizer (EM).
Patients and methods: This multicenter, prospective, open-label trial included pts treated with Tam for ≥ 4 months. CYP2D6 activity was determined centrally by genotyping and phenotyping (dextromethorphan test). Liquid chromatography-tandem-mass spectrometry was used to measure Tam, N-desmethyltamoxifen (N-DMT), 4-hydroxytamoxifen (4-HT) and endoxifen twice at baseline (Tam 20 mg qd), then at days 30, 90 and 120 after having increased the dose to 20 mg bid. Endoxifen increase and the differences between genotype/phenotype subgroups were analyzed by ANOVA.
Results: 76 pts were analyzed. Steady-state concentrations for Tam and its metabolites were reached in 30 days after doubling the dose. A range of 1.6 to 1.8 fold increase was observed. Geometric mean plasma concentrations in ng/ml (CV%) were: at baseline and day 30 respectively 134 (48) and 246 (46) for tamoxifen (p < 0.0001); 246 (53) and 413 (48) for N-DMT (p < 0.0001); 2.3 (44) and 3.7 (51) for 4HT (p < 0.0001); 18.7 (89) and 31.1 (92) for endoxifen (p = 0.005).
The level of endoxifen increased 1.4 to 1.7 folds in all genotype subgroups with geometric mean plasma concentrations in ng/ml (CV%): 6.9 (36) to 9.7 (24) in PMs (p = 0.7); 14.2 (69) to 20.7 (76) in IMs (p < 0.0001); and 22.6 (76) to 38.7 (85) in EMs (p < 0.0001). Similar results were obtained while considering phenotype subgroups. Genotypes and phenotypes explained less than 30% of the variability in endoxifen levels.
The occurrence of hot flashes and night sweating were followed prospectively. Endoxifen levels did not predict an increase in HF/NS events' overall occurrence (OR = 1.01, CI95% 0.78–1.31 for HF and 1.01, CI95% 0.79–1.29 for NS). Twelve pts received CYP2D6 inhibitors. Nine pts did not complete the planned 4 months with tamoxifen 20 mg bid. The main reasons were mood disorders, hot flashes, headache and nausea. Self-reported treatment compliance assessed by monthly anonymous questionnaire was ≥ 95%, except 80–95% in 4 pts.
Conclusions: This is the first trial reporting the impact of the increase of tamoxifen dose in all CYP2D6 genotypes, including EMs. Dose escalation of tamoxifen increased significantly the plasma level of endoxifen by similar ratio in all genotype subgroups.
Because of a huge inter-individual variability genotyping and phenotyping are not adequate surrogate markers of endoxifen level. Very low endoxifen levels are observed even in pts classified as EM.
Future trials aiming to improve the plasma level of endoxifen should consider direct measurement of the metabolite in plasma and adjust tamoxifen dose according to the initial level of the metabolite independently of the genotype.
Reference
1. A. Dieudonné, Journal of Clinical Oncology, 2011; vol 29, No 15, suppl (May 20, 2011): TPS 140
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-04-05.
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Affiliation(s)
- K Zaman
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - E Dahmane
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - L Perey
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - A Bodmer
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - S Anchisi
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - A Wolfer
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - M Galmiche
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - A Stravodimou
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - T Buclin
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - C Eap
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - L Decosterd
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - C Csajka
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
| | - S Leyvraz
- University Hospital CHUV, Lausanne, Switzerland; Ensemble Hospitalier de la Côte, Morges, Switzerland; University Hospital CHUV, University of Geneva, Lausanne, Switzerland; University Hospital, Geneva, Switzerland; Hôpital Cantonal, Sion, Switzerland
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23
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Berthod G, Homicsko K, Bouchaab H, Matter M, Cerottini JP, Guggisberg D, Speiser D, Leyvraz S, Michielin O. [Melanoma: a new therapeutic era]. Rev Med Suisse 2011; 7:1126-1130. [PMID: 21721201] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Melanoma is the cancer with the fastest incidence increase in Switzerland. 30% of the cases arise before the age of 50 years. Once metastatic, the median survival under current systemic therapies is about 8 months, with less than 5% of patients alive at 5 years. Many efforts in the understanding of cellular biology, intracellular signaling pathways, as well as the role of cellular immunity have been made in the recent years. This has resulted in the development of novel and very promising therapies. In this review, we will cover the results obtained with targeted therapies such as "tyrosin kinase inhibitors" (TKI), as well as those obtained with a monoclonal antibody directed against the CTLA-4 receptor of lymphocytes.
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Affiliation(s)
- G Berthod
- Centre pluridisciplinaire d'oncologie, CHUV, Lausanne.
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24
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Zaman K, Dahmane E, Csajka C, Perey L, Buclin T, Bodmer A, Leyvraz S, Galmiche Rindisbacher M, Berthod G, Chin E, Decosterd L. Abstract PD05-09: Prospective Assessment of CYP2D6 by Genotyping, Phenotyping and Measurement of Tamoxifen, 4-Hydroxy-Tamoxifen and Endoxifen in Breast Cancer Patients Treated with Tamoxifen. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd05-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: CYP2D6 is genetically highly polymorphic and several studies support that patients classified as poor-or intermediate-metabolizers achieve less or no benefit from tamoxifen treatment probably because they have lower levels of endoxifen. Genotyping is currently the major method used in studies and in clinical practice. However the ability of genotyping to predict plasma levels of endoxifen is uncertain for an individual patient. We assessed prospectively CYP2D6 activity by genotyping, phenotyping and the measurement of tamoxifen and its metabolites. Methods: Patients were genotyped for CYP2D6 (*1, *3, *4, *5, *6 and *XN) polymorphism. The CYP2D6 phenotype was determined by the dextromethorphan test. Plasma was collected at 2 time points after at least 4 months of treatment with tamoxifen 20 mg daily: tamoxifen, 4-hydroxytamoxifen, N-demethyltamoxifen and endoxifen were measured with high performance liquid chromatography coupled to triple stage tandem mass spectrometry. Linear regression analyses were performed on log transformed concentrations of tamoxifen, its metabolites, and the ratios 4- hydroxytamoxifen/tamoxifen, endoxifen/N-demethyltamoxifen versus the different genotype groups (UM, EM, IM, PM) and the dextromethorphan/dextrorphan ratio.
Results: The data of 26 patients are currently available. Geometric mean plasma concentrations (coefficient of variation %) of tamoxifen, N-desmethyltamoxifen, 4-OH-tamoxifen and endoxifen were 377 nmol/L (39%), 482 nmol/L (36%), 5.9 nmol/L (52%) and 60.7 nmol/L (94%), respectively. Genetic variation in CYP2D6 was significantly correlated with endoxifen, 4-hydroxytamoxifen and the ratios of 4-hydroxytamoxifen/tamoxifen and endoxifen/N-demethyltamoxifen: determination coefficients (R-squared) of 44% (P=0.0002), 30% (P=0.0038), 57% (P= <0.0001) and 47% (P=0.0001), respectively. Phenotypes defined by the dextromethorphan/dextrorphan ratio were significantly correlated with endoxifen and the ratios of 4-hydroxytamoxifen/tamoxifen and endoxifen/N-demethyltamoxifen: determination coefficients of 47% (P=0.0002), 39% (P=0.0012) and 59% (P= <0.0001), respectively. Conclusions: Our data confirm a significant correlation between CYP2D6 activity defined by genotyping or by phenotyping and plasma levels of endoxifen. However, the important interindividual variability in the concentrations of the metabolites of tamoxifen remains largely unexplained, suggesting that CYP2D6 genotyping and phenotyping are not sufficient to predict plasma levels of the active metabolites of tamoxifen. These preliminary results are consistent with a potential superiority of monitoring the active metabolites themselves rather than genetic or phenotypic surrogates. The study is ongoing and more data will be presented.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD05-09.
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Affiliation(s)
- K Zaman
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - E Dahmane
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - C Csajka
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - L Perey
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - T Buclin
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - A Bodmer
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - S Leyvraz
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - M Galmiche Rindisbacher
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - G Berthod
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - E Chin
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
| | - L. Decosterd
- CePO, University Hospital CHUV, Lausanne, Switzerland; Clinical Pharmacology, University Hospital CHUV, Lausanne, Switzerland; Center for Psychiatric Neurosciences, University Hospital, Lausanne, Switzerland; Medical Oncology, University Hospital HUG, Geneva, Switzerland; Medical Oncology, Hospital of Morges, Switzerland
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25
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Wagner AD, Zaman K, Peters S, Montemurro M, Leyvraz S. [Anti-angiogenic therapies for metastatic colorectal, breast and lung cancer: benefits and risks]. Rev Med Suisse 2010; 6:1070-1073. [PMID: 20564866] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Anti-angiogenic therapies have recently enriched the therapeutic armentarium against the most common cancers. Among these, bevacizumab, a monoclonal antibody against vascular endothelial growth factor, is currently used most frequently. While the addition of bevacizumab to chemotherapy improves overall survival in first and second line treatment of metastatic colorectal cancer, its effect in metastatic breast cancer is limited to improvements in tumor response and progression-free-survival. In non-small-cell lung cancer, the positive results of a first American phase III study have not been confirmed by a second European study and are subject to controversies. A summary of the data concerning anti-angiogenic therapies in these three cancers is presented including safety information.
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Affiliation(s)
- A D Wagner
- Centre pluridisciplinaire d'oncologie, CHUV, Lausanne.
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26
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Widmer N, Decosterd LA, Csajka C, Montemurro M, Haouala A, Leyvraz S, Buclin T. Imatinib plasma levels: correlation with clinical benefit in GIST patients. Br J Cancer 2010; 102:1198-9. [PMID: 20179709 PMCID: PMC2853086 DOI: 10.1038/sj.bjc.6605584] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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27
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Jichlinski P, Berthold DR, Zouhair A, Griesser AC, Meuwly JY, Prior JO, Lhermitte B, Doerfler A, Treuthardt C, Praz V, Tawadros T, Vaucher L, Aymon D, Marazzi A, Levi F, Beckmann J, Leyvraz S, Bauer J. [Active surveillance for early-stage prostate cancer]. Rev Med Suisse 2009; 5:2442-2447. [PMID: 20088118] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Diagnostic and treatment management of prostate cancer at its initial stage continues to raise important debates within the involved medical community. To establish a protocol for active surveillance, a validated option in specific conditions of localised prostate cancer management for eight years, is a unique opportunity to gather different specialists in this field. This paper presents this concept.
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Montemurro M, Prior J, Leyvraz S. 6630 Response evaluation in third- and fourth-line treatment of GIST: the role of PET. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71351-5] [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: 10/20/2022] Open
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29
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Haouala A, Zanolari B, Rochat B, Montemurro M, Zaman K, Duchosal M, Ris H, Leyvraz S, Widmer N, Decosterd L. Therapeutic Drug Monitoring of the new targeted anticancer agents imatinib, nilotinib, dasatinib, sunitinib, sorafenib and lapatinib by LC tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2009; 877:1982-96. [DOI: 10.1016/j.jchromb.2009.04.045] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 04/27/2009] [Accepted: 04/29/2009] [Indexed: 10/20/2022]
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30
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Reichardt P, Montemurro M, Gelderblom H, Blay J, Rutkowski P, Bui B, Hartmann JT, Pink D, Leyvraz S, Schütte J. Sorafenib fourth-line treatment in imatinib-, sunitinib-, and nilotinib-resistant metastatic GIST: A retrospective analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10564] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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
10564 Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors usually caused by mutations in the KIT or PDGFRA gene. Advanced disease generally cannot be cured by surgery nor by tyrosine kinase inhibitors (TKI), but TKIs have considerably improved outcome for patients (pts) with advanced GIST. Patients failing TKI treatment with imatinib (IM), sunitinib (SU) or nilotinib (NI) have a poor prognosis. Sorafenib is a multi kinase inhibitor that blocks not only receptor tyrosine kinases such as KIT, VEGFR and PDGFR but also serine/threonine kinases along the RAS/RAF/MEK/ERK pathway. Recently, clinical activity of sorafenib in third-line treatment in patients with GIST after IM and SU failure has been shown (Wiebe et al. ASCO 2008, #10502). Methods: We report herein preliminary data of 32 pts treated with sorafenib in nine European centers. Centers were selected based on their previous and known experience in GIST and reported all pts treated. Pts received sorafenib after failure of IM, SU and NI in fourth-line treatment. Baseline characteristics and treatment details have been retrieved via questionary. Results: Median age at sorafenib treatment start was 62 years (range 33–81 y), and the majority of pts were male (63 %). Primary tumor site was gastric or small intestine in 25% and 41% of pts, respectively. All pts had failed IM, SU, NI. 19 % of pts achieved partial remission and 44% disease stabilization. Approximately half of the pts had an improvement of symptoms and/or performance. Half of the pts were on treatment longer than 4 months (actuarial data) and 41% of pts continue to receive sorafenib. Median progression-free survival is 20 weeks and median overall survival 42 weeks (Kaplan-Meier), at a median follow-up of 22 weeks (range 3–54). Conclusions: This is the largest series assessing efficacy of sorafenib fourth-line treatment for IM, SU and NI refractory GIST reported yet. Sorafenib displays significant clinical activity in this heavily pretreated group of patients. [Table: see text]
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Affiliation(s)
- P. Reichardt
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - M. Montemurro
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - H. Gelderblom
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - J. Blay
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - P. Rutkowski
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - B. Bui
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - J. T. Hartmann
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - D. Pink
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - S. Leyvraz
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
| | - J. Schütte
- HELIOS Klinikum Bad Saarow, Sarcoma Center, Bad Saarow, Germany; Vaud University Hospital, Oncology, Lausanne, Switzerland; Leiden University Medical Center, Clinical Oncology, Leiden, Netherlands; University Claude Bernard, Oncology, Lyon, France; Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Institut Bergonie, Oncology, Bordeaux, France; South West German Comprehensive Cancer Center, Tübingen, Germany; Marien Hospital, Interdisciplinary Oncology Center, Düsseldorf, Germany
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Pampallona S, Leyvraz S. Response: Re: 'A Threefold Dose Intensity Treatment With Ifosfamide, Carboplatin, and Etoposide for Patients With Small-Cell Lung Cancer: A Randomized Trial'. J Natl Cancer Inst 2009. [DOI: 10.1093/jnci/djn407] [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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32
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Italiano A, Penel N, Robin YM, Bui B, Le Cesne A, Piperno-Neumann S, Tubiana-Hulin M, Bompas E, Chevreau C, Isambert N, Leyvraz S, du Chatelard PP, Thyss A, Coindre JM, Blay JY. Neo/adjuvant chemotherapy does not improve outcome in resected primary synovial sarcoma: a study of the French Sarcoma Group. Ann Oncol 2008; 20:425-30. [PMID: 19088169 DOI: 10.1093/annonc/mdn678] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There are only scarce data about the benefit of adjunctive chemotherapy in patients with localized synovial sarcoma (SS). PATIENTS AND METHODS Data from 237 SS patients recorded in the database of the French Sarcoma Group were retrospectively analyzed. The respective impact of radiotherapy, neo-adjuvant chemotherapy and adjuvant chemotherapy on overall survival (OS), local recurrence-free survival (LRFS) and distant recurrence-free survival (DRFS) were assessed after adjustment to prognostic factors. RESULTS The median follow-up was 58 months (range 1-321). Adjuvant, neo-adjuvant chemotherapy and postoperative radiotherapy were administered in 112, 45 and 181 cases, respectively. In all, 59% of patients treated with chemotherapy received an ifosfamide-containing regimen. The 5-year OS, LRFS and DRFS rates were 64.0%, 70% and 57%, respectively. On multivariate analysis, age >35 years old, grade 3 and not-R0 margins were highly significant independent predictors of worse OS. After adjustment to prognostic factors, radiotherapy significantly improved LRFS but not DRFS or OS. Neither neo-adjuvant nor adjuvant chemotherapy had significant impact on OS, LRFS or DRFS. CONCLUSION As for other high-grade soft-tissue sarcomas, well-planned wide surgical excision with adjuvant radiotherapy remains the cornerstone of treatment for SS. Neo-adjuvant or adjuvant chemotherapy should not be delivered outside a clinical trial setting.
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Affiliation(s)
- A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
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Montemurro M, Dirnhofer S, Borner M, Burkhard R, Demartines N, Furrer M, Guillou L, Kettelhack C, Knüsli C, Langer I, Metzger U, Redaelli C, Tornillo L, von Flüe M, von Moos R, Leyvraz S. Diagnose und Behandlung von Gastrointestinalen Stromatumoren (GIST) in der Schweiz. ACTA ACUST UNITED AC 2008. [DOI: 10.4414/smf.2008.06542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Voelter V, Rufer N, Reynard S, Greub G, Brookes R, Guillaume P, Grosjean F, Fagerberg T, Michelin O, Rowland-Jones S, Pinilla C, Leyvraz S, Romero P, Appay V. Characterization of Melan-A reactive memory CD8+ T cells in a healthy donor. Int Immunol 2008; 20:1087-96. [DOI: 10.1093/intimm/dxn066] [Citation(s) in RCA: 12] [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: 11/14/2022] Open
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35
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Michielin O, Rufer N, Romero P, Laurent J, Cerottini JP, Gugisberg D, Leyvraz S, Speiser D. [New developments in cancer immunotherapy]. Rev Med Suisse 2008; 4:1248-1251. [PMID: 18616206] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Recent progress unveiling the cellular and molecular basis of the immune response allows nowadays the design of novel therapies for tumor immunotherapy. These recent approaches translate into response rates that often surpass what can be obtained by conventional chemotherapies or targeted therapies. Here we present the main current developments with an accent on the Lausanne experience in the treatment of melanoma. First, the new developments of peptide-based vaccination are presented. Second, approaches related to adoptive transfer are illustrated with a particular attention for the patient conditioning using lymphodepletion. Finally, the Lausanne project of rational lymphocyte TCR optimization is described.
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Affiliation(s)
- O Michielin
- Centre pluridisciplinaire d'oncologie, CHUV, Lausanne.
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36
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Montemurro M, Achtari L, Röth A, Halkic N, Luthi F, Ozsahin M, Denys A, Bauer J, Demartines N, Leyvraz S. [Systemic treatment of metastatic colorectal cancer]. Rev Med Suisse 2008; 4:1254-1257. [PMID: 18616207] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Colorectal cancer is the 2nd cause of cancer related death in industrialised countries. 20% of all patients present with metastatic disease at diagnosis and need systemic treatment. Since the introduction of irinotecan and oxaliplatin as part of standard chemotherapy, and recently the new targeted agents bevacizumab, cetuximab and panitumumab, the overall survival for patients suffering from metastatic colorectal cancer (mCRC) has increased significantly and nearly reaches 2 years nowadays. Surgery or radiofrequency ablation has become central in the care of metastatic disease. This article resumes recent therapeutic advances in the field and emphasizes the multidisciplinary concertation between specialists to obtain the best outcome.
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Affiliation(s)
- M Montemurro
- Centre pluridisciplinaire d'oncologie, CHUV, Lausanne.
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Montemurro M, Schöffski P, Reichardt P, Gelderblom H, Joensuu H, Schütte J, Wendtner CM, Hartmann JT, Elsig V, Leyvraz S. Nilotinib in advanced GIST: A retrospective analysis of nilotinib in compassionate use. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moreau P, Attal M, Garban F, Hulin C, Facon T, Marit G, Michallet M, Doyen C, Leyvraz S, Mohty M, Wetterwald M, Mathiot C, Caillot D, Berthou C, Benboubker L, Garderet L, Chaleteix C, Traullé C, Fuzibet JG, Jaubert J, Lamy T, Casassus P, Dib M, Kolb B, Dorvaux V, Grosbois B, Yakoub-Agha I, Harousseau JL, Avet-Loiseau H. Heterogeneity of t(4;14) in multiple myeloma. Long-term follow-up of 100 cases treated with tandem transplantation in IFM99 trials. Leukemia 2007; 21:2020-4. [PMID: 17625611 DOI: 10.1038/sj.leu.2404832] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One hundred de novo multiple myeloma patients with t(4;14) treated with double intensive therapy according to IFM99 protocols were retrospectively analyzed. The median overall survival (OS) and event-free survival (EFS) were 41.4 and 21 months, respectively, as compared to 65 and 37 for patients included in the IFM99 trials without t(4;14) (P<10(-7)). We identified a subgroup of patients presenting at diagnosis with both low beta(2)-microglobulin <4 mg/l and high hemoglobin (Hb) >/=10 g/l (46% of the cases) with a median OS of 54.6 months and a median EFS of 26 months, respectively, which benefits from high-dose therapy (HDT); conversely patients with one or both adverse prognostic factor (high beta(2)-microglobulin and/or low Hb) had a poor outcome. The achievement of either complete response or very good partial response after HDT was also a powerful independent prognostic factor for both OS and EFS.
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Affiliation(s)
- P Moreau
- Hematology Department, University Hospital, Nantes, France
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Sappino AP, Leyvraz S. [Regional hospital, clinic, and physician collaboration in oncology care]. Rev Med Suisse 2007; 3:1283-4. [PMID: 17596063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Nay C, Luthi F, Ketterer N, Bauer J, Leyvraz S. [Overview on cancer in young adults]. Rev Med Suisse 2007; 3:1305-6, 1308-10. [PMID: 17596066] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
To make a diagnostic of cancer in a young adult (15-30 years of age) has important physical, psychological and social implications. The most frequent cancers seen at this age are cancer of the thyroid, testicular germ cell tumours, 'melanoma, Hodgkin's lymphoma, non-Hodgkin lymphoma, leukaemia, cerebral tumours and sarcomas. Even if the prognostic of most of these cancers is excellent, treatments are difficult and often associated with long-term side effects. A multidisciplinary approach of these patients is essential. A long-term follow-up by a general practicioner or an oncologist is indispensable.
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Affiliation(s)
- C Nay
- Centre pluridisciplinaire d'oncologie, CHUV, 1011 Lausanne.
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Widmer N, Decosterd LA, Csajka C, Leyvraz S, Duchosal MA, Rosselet A, Rochat B, Eap CB, Henry H, Biollaz J, Buclin T. Population pharmacokinetics of imatinib and the role of alpha-acid glycoprotein. Br J Clin Pharmacol 2007. [PMID: 16842382 DOI: 10.1111/j.1365-2125.2006.02719.x;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS The aims of this observational study were to assess the variability in imatinib pharmacokinetics and to explore the relationship between its disposition and various biological covariates, especially plasma alpha1-acid glycoprotein concentrations. METHODS A population pharmacokinetic analysis was performed using NONMEM based on 321 plasma samples from 59 patients with either chronic myeloid leukaemia or gastrointestinal stromal tumours. The influence of covariates on oral clearance and volume of distribution was examined. Furthermore, the in vivo intracellular pharmacokinetics of imatinib was explored in five patients. RESULTS A one-compartment model with first-order absorption appropriately described the data, giving a mean (+/-SEM) oral clearance of 14.3 l h-1 (+/-1.0) and a volume of distribution of 347 l (+/-62). Oral clearance was influenced by body weight, age, sex and disease diagnosis. A large proportion of the interindividual variability (36% of clearance and 63% of volume of distribution) remained unexplained by these demographic covariates. Plasma alpha1-acid glycoprotein concentrations had a marked influence on total imatinib concentrations. Moreover, we observed an intra/extracellular ratio of 8, suggesting substantial uptake of the drug into the target cells. CONCLUSION Because of the high pharmacokinetic variability of imatinib and the reported relationships between its plasma concentration and efficacy and toxicity, the usefulness of therapeutic drug monitoring as an aid to optimizing therapy should be further investigated. Ideally, such an approach should take account of either circulating alpha1-acid glycoprotein concentrations or free imatinib concentrations.
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Affiliation(s)
- N Widmer
- Division of ClinicAl Pharmacology, University Hospital, Lausanne, Switzerland
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Widmer N, Decosterd LA, Csajka C, Leyvraz S, Duchosal MA, Rosselet A, Rochat B, Eap CB, Henry H, Biollaz J, Buclin T. Population pharmacokinetics of imatinib and the role of alpha-acid glycoprotein. Br J Clin Pharmacol 2007; 62:97-112. [PMID: 16842382 PMCID: PMC1885072 DOI: 10.1111/j.1365-2125.2006.02719.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [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: 01/11/2023] Open
Abstract
AIMS The aims of this observational study were to assess the variability in imatinib pharmacokinetics and to explore the relationship between its disposition and various biological covariates, especially plasma alpha1-acid glycoprotein concentrations. METHODS A population pharmacokinetic analysis was performed using NONMEM based on 321 plasma samples from 59 patients with either chronic myeloid leukaemia or gastrointestinal stromal tumours. The influence of covariates on oral clearance and volume of distribution was examined. Furthermore, the in vivo intracellular pharmacokinetics of imatinib was explored in five patients. RESULTS A one-compartment model with first-order absorption appropriately described the data, giving a mean (+/-SEM) oral clearance of 14.3 l h-1 (+/-1.0) and a volume of distribution of 347 l (+/-62). Oral clearance was influenced by body weight, age, sex and disease diagnosis. A large proportion of the interindividual variability (36% of clearance and 63% of volume of distribution) remained unexplained by these demographic covariates. Plasma alpha1-acid glycoprotein concentrations had a marked influence on total imatinib concentrations. Moreover, we observed an intra/extracellular ratio of 8, suggesting substantial uptake of the drug into the target cells. CONCLUSION Because of the high pharmacokinetic variability of imatinib and the reported relationships between its plasma concentration and efficacy and toxicity, the usefulness of therapeutic drug monitoring as an aid to optimizing therapy should be further investigated. Ideally, such an approach should take account of either circulating alpha1-acid glycoprotein concentrations or free imatinib concentrations.
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Affiliation(s)
- N Widmer
- Division of ClinicAl Pharmacology, University Hospital, Lausanne, Switzerland
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Krenz SL, Stagno D, Krenz S, Zdrojewski C, Luthi F, Leyvraz S, Stiefel F. Development of a method investigating meaning in life in cancer patients. Psychother Psychosom Med Psychol 2007. [DOI: 10.1055/s-2007-970665] [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: 10/21/2022]
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Stagno D, Stiefel F, Krenz SL, Zdrojewski C, Lüthi F, Leyvraz S. Depression among cancer patients: A randomised controlled trial comparing standard care with short psychodynamic psychotherapy. Psychother Psychosom Med Psychol 2007. [DOI: 10.1055/s-2007-970720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bressoud A, Real del Sarte O, Stiefel S, Mordasini P, Perey L, Bauer J, Leyvraz PF, Leyvraz S. Impact of family structure on long-term survivors of osteosarcoma. Support Care Cancer 2007; 15:525-31. [PMID: 17205278 DOI: 10.1007/s00520-006-0196-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 11/08/2006] [Indexed: 10/23/2022]
Abstract
GOALS OF WORK Long-term outcomes of osteosarcoma have dramatically improved with the use of modern combination therapies. Such aggressive treatments, however, entail chronic complications. In the present study, we assessed the functional, psychological, and familial status of long-term survivors of osteosarcoma treated at our institution. MATERIALS AND METHODS Fifteen long-term survivors of osteosarcoma were evaluated for functional and psychological sequelae. Functional assessment was based on a method described by Enneking et al. Psychological assessment was based on General Health Questionnaire 28, Inventory Scale for Traumatic Neurosis, and Family System Test. MAIN RESULTS Ten patients showed mild functional impairments; only five patients were handicapped more seriously. Depressive symptoms were diagnosed in four patients. A total of six patients revealed unbalanced family structures, including three of the four patients with depressive symptoms, all four patients with symptoms of posttraumatic stress disorder, and five of seven patients who showed poor emotional acceptance. CONCLUSIONS Osteosarcoma survivors will generally recover good functional performance. Only a minority of them remain seriously impaired. One third of the patients present depressive symptoms and posttraumatic stress disorder. Poor coping is closely associated with unbalanced family structures. Therefore, the psychological and familial situation of patients with newly diagnosed osteosarcoma should be carefully assessed.
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Affiliation(s)
- A Bressoud
- Department of Clinical Oncology, Hôpital Pourtalès, Neuchâtel, Switzerland
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Peters S, Voelter V, Zografos L, Pampallona S, Popescu R, Gillet M, Bosshard W, Fiorentini G, Lotem M, Weitzen R, Keilholz U, Humblet Y, Piperno-Neumann S, Stupp R, Leyvraz S. Intra-arterial hepatic fotemustine for the treatment of liver metastases from uveal melanoma: Experience in 101 patients. Am J Ophthalmol 2007. [DOI: 10.1016/j.ajo.2006.11.007] [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: 11/28/2022]
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Leyvraz S, Herrmann R, Guillou L, Honegger HP, Christinat A, Fey MF, Sessa C, Wernli M, Cerny T, Dietrich D, Pestalozzi B. Treatment of advanced soft-tissue sarcomas using a combined strategy of high-dose ifosfamide, high-dose doxorubicin and salvage therapies. Br J Cancer 2006; 95:1342-7. [PMID: 17031396 PMCID: PMC2360595 DOI: 10.1038/sj.bjc.6603420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Having determined in a phase I study the maximum tolerated dose of high-dose ifosfamide combined with high-dose doxorubicin, we now report the long-term results of a phase II trial in advanced soft-tissue sarcomas. Forty-six patients with locally advanced or metastatic soft-tissue sarcomas were included, with age <60 years and all except one in good performance status (0 or 1). The chemotherapy treatment consisted of ifosfamide 10 g m−2 (continuous infusion for 5 days), doxorubicin 30 mg m−2 day−1 × 3 (total dose 90 mg m−2), mesna and granulocyte-colony stimulating factor. Cycles were repeated every 21 days. A median of 4 (1–6) cycles per patient was administered. Twenty-two patients responded to therapy, including three complete responders and 19 partial responders for an overall response rate of 48% (95% CI: 33–63%). The response rate was not different between localised and metastatic diseases or between histological types, but was higher in grade 3 tumours. Median overall survival was 19 months. Salvage therapies (surgery and/or radiotherapy) were performed in 43% of patients and found to be the most significant predictor for favourable survival (exploratory multivariate analysis). Haematological toxicity was severe, including grade ⩾3 neutropenia in 59%, thrombopenia in 39% and anaemia in 27% of cycles. Three patients experienced grade 3 neurotoxicity and one patient died of septic shock. This high-dose regimen is toxic but nonetheless feasible in multicentre settings in non elderly patients with good performance status. A high response rate was obtained. Prolonged survival was mainly a function of salvage therapies.
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Affiliation(s)
- S Leyvraz
- Centre Pluridisciplinaire d'Oncologie, University Hospital, CHUV BH06, Rue du Bugnon 46, Lausanne, Switzerland.
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Voelter V, Zouhair A, Vuilleumier H, Matter M, Bouzourene H, Leyvraz S, Bauer J, Coucke P, Stupp R. CPT-11 and concomitant hyperfractionated accelerated radiotherapy induce efficient local control in rectal cancer patients: results from a phase II. Br J Cancer 2006; 95:710-6. [PMID: 16940980 PMCID: PMC2360515 DOI: 10.1038/sj.bjc.6603322] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with rectal cancer are at high risk of disease recurrence despite neoadjuvant radiochemotherapy with 5-Fluorouracil (5FU), a regimen that is now widely applied. In order to develop a regimen with increased antitumour activity, we previously established the recommended dose of neoadjuvant CPT-11 (three times weekly 90 mg m−2) concomitant to hyperfractionated accelerated radiotherapy (HART) followed by surgery within 1 week. Thirty-three patients (20 men) with a locally advanced adenocarcinoma of the rectum were enrolled in this prospective phase II trial (1 cT2, 29 cT3, 3 cT4 and 21 cN+). Median age was 60 years (range 43–75 years). All patients received all three injections of CPT-11 and all but two patients completed radiotherapy as planned. Surgery with total mesorectal excision (TME) was performed within 1 week (range 2–15 days). The preoperative chemoradiotherapy was overall well tolerated, 24% of the patients experienced grade 3 diarrhoea that was easily manageable. At a median follow-up of 2 years no local recurrence occurred, however, nine patients developed distant metastases. The 2-year disease-free survival was 66% (95% confidence interval 0.48–0.83). Neoadjuvant CPT-11 and HART allow for excellent local control; however, distant relapse remains a concern in this patient population.
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Affiliation(s)
- V Voelter
- Multidisciplinary Oncology Centre, The University of Lausanne Hospitals, Rue du Bugnon 46, CH 1011, Lausanne, Switzerland.
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Leyvraz S, Pampallona S, Martinelli G, Ploner F, Aversa S, Rosti G, Brunsvig P, Montes A, Yilmaz U, Perey L. Randomized phase III study of high-dose sequential chemotherapy (CT) supported by peripheral blood progenitor cells (PBPC) for the treatment of small cell lung cancer (SCLC): Results of the EBMT Random-ICE trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7064 Background: EBMT has defined in a phase II trial (JCO 1999, 3531) feasibility and activity of high-dose sequential CT for SCLC increasing 3 fold the dose-intensity and significantly the peak-dose and the total dose of CT. Methods: Randomized prospective study aiming to improve the 3-year survival from 12% in the standard (S) to 24% in the high-dose (H) arm, for a total accrual of 340 patients. Limited or extensive ≤ 2 metastatic sites, age ≤ 65 y.o., PS 0–1. Arm S/Arm H: ifosfamide 5 g/m2 d1/2.5 g/m2/d × 4; carboplatin 300 mg/m2 d1/AUC = 5/d × 4; etoposide 180 mg/m2/d. × 2/300 mg/m2/d × 4, every 28 days, for 6 cycles in Arm S. Three cycles were given in Arm H supported by PBPC collected after 2 courses of epirubicin 150 mg/m2/paclitaxel 175 mg/m2. Due to low accrual, a formal stopping rule was introduced with boundaries for early stopping in favour of a difference (O’Brien-Fleming) or of lack thereof (Pocock). The present analysis has been done with 110 deaths. Results: Since June 1997, 145 patients have been accrued (evaluable =140, S = 71, H = 69), median age 53, prognostic factors balanced. Mobilization toxicity ≥ 3: neutropenia 61%, thrombopenia 11%, anemia 7%, infection 6%, mucositis 9% and 2 toxic deaths. Toxicity ≥ 3 among 353 cycles of S and 152 of H respectively: neutropenia 26%/100%, thrombopenia 12%/100%, anemia 8%/69%, infection 1%/15%, fever 11%/72%, toxic death 1/8. Response rate of S and H: 67% (CR 32%)/77% (CR 37%) (p = 0.188). Median follow-up 4.9 years. Progression free survival 8.8 and 12 months (p = 0.737, unadjusted) and median overall survival 15 and 19.1 months (p = 0.659, unadjusted) for S and H respectively. At 3 years, 19% of the patients were alive in both arms. Conclusions: Random-ICE was designed with strong statistical power and shows no evidence that the treatment of SCLC can be improved by increasing the dose-intensity, the peak-dose or the total dose of ICE and that such intensification strategy should probably be abandoned. No significant financial relationships to disclose.
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Affiliation(s)
- S. Leyvraz
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S. Pampallona
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - G. Martinelli
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - F. Ploner
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S. Aversa
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - G. Rosti
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - P. Brunsvig
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - A. Montes
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - U. Yilmaz
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - L. Perey
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
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