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Wiegand S, Wichmann G, Vogt J, Vogel K, Franke A, Kuhnt T, Lordick F, Scheuble AM, Hambsch P, Brossart P, Bauernfeind FG, Kaftan H, Maschmeyer G, Paland M, Münter M, Lewitzki V, Rotter N, Stromberger C, Beck M, Dommerich S, Gauler TC, Hapke G, Guntinas-Lichius O, Schröder U, Görner M, Hautmann MG, Steger F, Tamaskovics B, Schmiedeknecht A, Dietz A. Postoperative adjuvant radiochemotherapy with cisplatin versus adjuvant radiochemotherapy with cisplatin and pembrolizumab in locally advanced head and neck squamous cell carcinoma- the study protocol of the Adrisk trial. Front Oncol 2023; 13:1128176. [PMID: 37025596 PMCID: PMC10071022 DOI: 10.3389/fonc.2023.1128176] [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: 12/20/2022] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Most of the patients with head and neck squamous cell carcinoma (HNSCC) are diagnosed with locally advanced disease. Standards of care for curative-intent treatment of this patient group are either surgery and adjuvant radio(chemo)therapy (aRCT) or definitive chemoradiation. Despite these treatments, especially pathologically intermediate and high-risk HNSCC often recur. The ADRISK trial investigates in locally advanced HNSCC and intermediate and high risk after up-front surgery if the addition of pembrolizumab to aRCT with cisplatin improves event-free sur-vival compared to aRCT alone. ADRISK is a prospective, randomized controlled investiga-tor-initiated (IIT)-phase II multicenter trial within the German Interdisciplinary Study Group of German Cancer Society (IAG-KHT). Patients with primary resectable stage III and IV HNSCC of the oral cavity, oropharynx, hypopharynx and larynx with pathologic high (R1, extracapsular nodal extension) or intermediate risk (R0 <5 mm; N≥2) after surgery will be eligible. Two hun-dred forty patients will be randomly assigned (1:1) to either standard aRCT with cisplatin (standard arm) or aRCT with cisplatin + pembrolizumab (200 mg iv, in 3-week cycle, max. 12 months) (interventional arm). Endpoints are event-free and overall survival. Recruitment started in August 2018 and is ongoing.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
- *Correspondence: Susanne Wiegand,
| | - Gunnar Wichmann
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Jeannette Vogt
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Kathrin Vogel
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Annegret Franke
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - Anne-Marie Scheuble
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - Peter Hambsch
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Peter Brossart
- Department of Oncology, Hematology, Immuno-Oncology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Franz Georg Bauernfeind
- Department of Oncology, Hematology, Immuno-Oncology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Georg Maschmeyer
- Department of Haematology, Oncology, and Palliative Care, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Matthias Paland
- Department of Haematology, Oncology, and Palliative Care, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Marc Münter
- Institute of Radiotherapy, Klinikum Stuttgart, Stuttgart, Germany
| | - Victor Lewitzki
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité, Berlin, Germany
- Vivantes Klinikum Neukölln, Department of Radiooncology and Radiotherapy, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité, Berlin, Germany
| | | | - Thomas Christoph Gauler
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Gunnar Hapke
- Department of Hematology and Oncology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | | | - Ursula Schröder
- Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Martin Görner
- Department of Hematology, Oncology and Palliative Medicine, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Matthias G. Hautmann
- Department for Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Felix Steger
- Department for Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Bálint Tamaskovics
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | | | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, Leipzig University Medical Center, Leipzig, Germany
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Klinghammer KF, Gauler TC, Stromberger C, Kofla G, de Wit M, Gollrad J, Rauer I, Martus P, Tinhofer I, Budach V, Keilholz U, Burock S. DURTRERAD: A phase II open-label study evaluating feasibility and efficacy of durvalumab (D) and durvalumab and tremelimumab (DT) in combination with radiotherapy (RT) in non-resectable locally advanced HPV-negative HNSCC—Results of the preplanned feasibility interim analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6574 Background: DURTRERAD is a randomized phase II study evaluating feasibility and efficacy of durvalumab (anti-PD-L1) vs. durvalumab and tremelimumab (anti-CTLA-4) in combination with radiotherapy as primary treatment for locally advanced HPV negative HNSCC. (NCT03624231). Concurrent chemo-RT with a platinum-based regimen is considered the standard treatment, although efficacy and long-term toxicity are not satisfactory. Combining immunotherapy with RT might result in improved efficacy with limited long-term toxicity. Methods: The phase II study planned to enroll 120 pts, 60 pts (1:1) in each treatment arm. Treatment with DT (1500mg/75 mg, arm DT),or D (1500mg, arm D) both in combination with RT (70Gy) was considered to be feasible if less than 10% of the patients treated will discontinue treatment due to on-treatment toxicities. A first interim analysis for feasibility and efficacy was planned after randomisation of 20 patients. Results: So far 23 patients have been screened, 16 patients have been randomised and started their allocated treatment, 10 in arm D and 6 in arm DT. Of 10 patients in arm D 1 patient stopped infusional treatment due to immune related toxicity. Out of 6 patients in the DT arm, however, 5 patients stopped treatment due to treatment related AEs, 2 pts due to immune related toxicity with one Grade 5 AE. Three patients stopped due to non-immune related AE. The grade 5 AE prompted the interim analysis, which revealed non-feasibility as well as safety-issues of the DT+radiotherapy combination . As a result, the DT arm was prematurely terminated. Conclusions: Even though in the recurrent/metastatic setting DT was not associated with increased toxicity, DT in combination with RT was not feasible in our poor prognostic, vulnerable patient cohort of advanced HPV negative unresectable HNSCC, warranting early disclosure of these results. No increase in toxicity was observed in the D monotherapy arm, and the trial continued with D monotherapy in combination with RT. Clinical trial information: NCT03624231 .
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Affiliation(s)
| | - Thomas Christoph Gauler
- Department of Medicine, West German Cancer Center, University Hospital Essen of the University Duisburg-Essen, Essen, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Comprehensive Cancer Center, Charité University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometrics, University Hospital Tübingen, Tübingen, Germany
| | - Inge Tinhofer
- Department of Radiooncology and Radiotherapy, Charité University Hospital, Berlin, Germany
| | - Volker Budach
- German Cancer Consortium (DKTK) Core Center Heidelberg and DKTK Partner Site Berlin, Berlin, Germany
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Dietz A, Welslau M, Hahn D, Langer C, Bockmühl U, Müller-Huesmann H, Busch CJ, Riera-Knorrenschild J, Büntzel J, Kubuschok B, von der Grün J, Gauler TC, Waldenberger D, von der Heyde E. HANNA: Real-world outcomes from an observational study with nivolumab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck in Germany. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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
6532 Background: Nivolumab has demonstrated efficacy in clinical trials of recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). As only limited real-world data are available, we describe the use of nivolumab and its outcomes in routine clinical practice. Methods: HANNA is a prospective, observational study of patients with R/M SCCHN treated with nivolumab in 56 hospitals and practices in Germany. In total, 385 patients will be followed for ≤ 5 years from treatment initiation until death, withdrawal of consent, loss of follow-up/record, or end of study. The primary objective is overall survival (OS). Secondary objectives include baseline characteristics, safety profiles, and quality of life (QOL) assessment. Results: By November 2019, data from 311 patients were available. Median follow-up was 3.5 months. Baseline characteristics were male, 81.7%; median age, 63 years; history of smoking, 73.3%; Eastern Cooperative Oncology Group performance status (ECOG PS) 0/1, 60.8%; ECOG PS 2/3, 29.6%. Location of primary tumor was oropharynx, 38.3%; hypopharynx, 20.9%; oral cavity, 22.8%; larynx, 11.6%; others, 6.4%. 55.6% of R/M SCCHN patients progressed ≤ 6 months after platinum-based therapy, whereas 43.4% were platinum-sensitive (progressed > 6 months after platinum-based therapy). Nivolumab was received by 25.1% of patients as first therapy after platinum-based chemo- or radiochemotherapy, by 62.1% as second therapy, and by 12.9% as later line therapy. Median treatment duration was 4.6 months. OS at 1 year was 43.3%. 1-year OS for patients with ECOG PS 0 was 75.9%; ECOG PS 1, 41.2%; and ECOG PS 2, 27.3%. Platinum-sensitive patients had higher 1-year OS probability (51.6%). Drug-related adverse events (grade 1/2) and serious adverse events (grade 3/4) were observed in 28.9% and 10.0% of patients, respectively. Interim QOL data (per FACT-H&N and EQ-5D questionnaire) indicated a tendency toward stabilization or slight improvement. We will present an update of the data with longer follow-up (data cut March 2020). Conclusions: HANNA represents one of the largest real-world datasets for nivolumab in R/M SCCHN and comprises a more diverse set of patients than the phase 3 CheckMate 141 trial, including patients with higher ECOG PS, age, and platinum sensitivity. Outcomes from HANNA show that the improved OS, safety, and QOL seen with nivolumab in the real-world setting are consistent with the outcomes from CheckMate 141. Clinical trial information: NCT03114163 .
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Affiliation(s)
| | - Manfred Welslau
- Klinikum Aschaffenburg, Medizinische Klinik II, Aschaffenburg, Germany
| | - Dennis Hahn
- Department of Hematology, Oncology and Palliative Care, Katharinenhospital, Stuttgart, Germany
| | | | | | | | - Chia-Jung Busch
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Hamburg, Germany
| | | | - Jens Büntzel
- Südharz Klinikum Nordhausen gGmbH, Nordhausen, Germany
| | | | - Jens von der Grün
- Universitätsklinikum Frankfurt, Klinik für Strahlentherapie und Onkologie, Frankfurt Am Main, Germany
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Hasheminasab S, Knoll M, Schwager C, Nowrouzi A, Pfarr N, Weichert W, Rieken S, Pöttgen C, Gauler TC, Eberhardt W, Schuler MH, Theegarten D, Aigner C, Debus J, Stuschke M, Abdollahi A. Clonal tumor evolution under induction chemotherapy and concurrent radiochemotherapy (RCHT) in patients with resectable stage IIIA (N2) and selected IIIb non-small cell lung cancer (NSCLC): Molecular analysis of the ESPATUE randomized phase III trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8543] [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
8543 Background: A better understanding of molecular mechanisms governing clonal tumor evolution under RCHT is of utmost importance for development of novel biomarker and targeted therapies. We report here the first attempt to decipher RCHT induced cellular and molecular perturbation in NSCLC on an integrative multiscale level. Methods: Patients with stage III disease received induction chemotherapy with cisplatin and paclitaxel followed by concurrent RCHT with 45 Gy (1.5 Gy twice daily) and cisplatin/vinorelbine according to the ESPATUE protocol. Tumor tissue was sampled from tumor enriched areas marked by pathologists at diagnosis (biopsies, n= 23) and post RCHT during surgical resection (n=22, ESPATUE-Arm B) corresponding to 16 paired samples (PS). Transcriptome analysis (n=45, 16PS), methylome analysis (n=35, 12PS), deep whole exome sequencing (WES) including copy number variation (CNV) analysis by low-pass whole genome sequencing (WGS, n=34, 13PS) were performed. A confirmatory targeted ultra-deep NGS for 41 genes was conducted (n=20PS). Results: Similarity plots of delta transcriptome data identified three distinct clusters of tumor evolution under RCHT. Cluster 1 was highly enriched for STS (5 out of 7 Pat.) compared to cluster 3 enriched for LTS (4 out of 6), p<0.02. 146 transcripts were differentially expressed as the function of RCHT (FDR <0.05). Among them, 61 genes were upregulated and enriched for ECM and tissue remodeling (COL6A3/4, Col14A1, LAMA2, PAI1, MMP2), p53 signaling (p21, GADD45B) and stress response (FOSB, EGR1) pathways, p<0.01. 39 downregulated genes were enriched for genes attributed to cell cycle- and DDR signaling (FANCI, SLX1A) p<0.05. 4221 CpG were differentially methylated (FDR<0.05). Seven inversely regulated genes were found with SLIT3 and TBX5 being among upregulated and hypomethylated genes. WES analysis revealed patterns of tumor evolution with a range of clonal diversity. In 5/13 pairs the clonal composition remained unchanged after RCHT. Approximately 500 post RCHT exclusive mutations were found. Conclusions: Clonal, transcriptional and methylome dynamic of tumor evolution towards RCHT selection pressure is unrevealed in patients with locally advanced NSCLC. This multi-scale dynamic approach provides novel means for development of biomarker and therapeutic targets. Clinical trial information: ESPATUE.
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Affiliation(s)
- Sayedmohammad Hasheminasab
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center Heidelberg, German Cancer Research Center (DKFZ), Germany, Heidelberg, Germany
| | - Maximilian Knoll
- Departments of Radiation Oncology, Neurology, Neurosurgery, Heidelberg University Hospital, National Center for Tumor Disease (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Core-Center Heidelberg, Heidelberg, Germany
| | - Christian Schwager
- German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
| | - Ali Nowrouzi
- Clinical Cooperation Unit Translational Radiation Oncology, German Cancer Consortium (DKTK) Core Center Heidelberg, German Cancer Research Center (DKFZ), Germany, Heidelberg, Germany
| | - Nicole Pfarr
- DKTK Partner Site Munich and Pathology Department, TUM, Munich, Germany, Munich, Germany
| | - Wilko Weichert
- Technical University Munich, Institute of Pathology, Munich, Germany
| | - Stefan Rieken
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Core Center Heidelb, Heidelberg, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Tumor Centre, Essen, Germany
| | - Thomas Christoph Gauler
- Department of Medicine, West German Cancer Center, University Hospital Essen of the University Duisburg-Essen, Essen, Germany
| | - Wilfried Eberhardt
- Departments of Radiation Oncology, Pathology, Thoracic Surgery and Medical Oncology, West German Cancer Center (WTZ), University Medicine Essen; DKTK partner site University Hospital Essen, Essen, Germany., Essen, Germany
| | | | - Dirk Theegarten
- Department of Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy - Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Juergen Debus
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Core Center Heidelb, Heidelberg, Germany
| | - Martin Stuschke
- German Cancer Consortium (DKTK) Core Center Heidelberg and DKTK Partner Site Essen, Essen, Germany
| | - Amir Abdollahi
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), National Center for Tumor Diseases (NCT), UKHD and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Core Center Heidelb, Heidelberg, Germany
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5
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Joerger M, von Pawel J, Kraff S, Fischer JR, Eberhardt W, Gauler TC, Mueller L, Reinmuth N, Reck M, Kimmich M, Mayer F, Kopp HG, Behringer DM, Ko YD, Hilger RA, Roessler M, Kloft C, Henrich A, Moritz B, Miller MC, Salamone SJ, Jaehde U. Open-label, randomized study of individualized, pharmacokinetically (PK)-guided dosing of paclitaxel combined with carboplatin or cisplatin in patients with advanced non-small-cell lung cancer (NSCLC). Ann Oncol 2016; 27:1895-902. [PMID: 27502710 DOI: 10.1093/annonc/mdw290] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 05/24/2016] [Accepted: 07/14/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Variable chemotherapy exposure may cause toxicity or lack of efficacy. This study was initiated to validate pharmacokinetically (PK)-guided paclitaxel dosing in patients with advanced non-small-cell lung cancer (NSCLC) to avoid supra- or subtherapeutic exposure. PATIENTS AND METHODS Patients with newly diagnosed, advanced NSCLC were randomly assigned to receive up to 6 cycles of 3-weekly carboplatin AUC 6 or cisplatin 80 mg/m(2) either with standard paclitaxel at 200 mg/m(2) (arm A) or PK-guided dosing of paclitaxel (arm B). In arm B, initial paclitaxel dose was adjusted to body surface area, age, sex, and subsequent doses were guided by neutropenia and previous-cycle paclitaxel exposure [time above a plasma concentration of 0.05 µM (Tc>0.05)] determined from a single blood sample on day 2. The primary end point was grade 4 neutropenia; secondary end points included neuropathy, radiological response, progression-free survival (PFS) and overall survival (OS). RESULTS Among 365 patients randomly assigned, grade 4 neutropenia was similar in both arms (19% versus 16%; P = 0.10). Neuropathy grade ≥2 (38% versus 23%, P < 0.001) and grade ≥3 (9% versus 2%, P < 0.001) was significantly lower in arm B, independent of the platinum drug used. The median final paclitaxel dose was significantly lower in arm B (199 versus 150 mg/m(2), P < 0.001). Response rate was similar in arms A and B (31% versus 27%, P = 0.405), as was adjusted median PFS [5.5 versus 4.9 months, hazard ratio (HR) 1.16, 95% confidence interval (CI) 0.91-1.49, P = 0.228] and OS (10.1 versus 9.5 months, HR 1.05, 95% CI 0.81-1.37, P = 0.682). CONCLUSION PK-guided dosing of paclitaxel does not improve severe neutropenia, but reduces paclitaxel-associated neuropathy and thereby improves the benefit-risk profile in patients with advanced NSCLC. CLINICAL TRIAL INFORMATION NCT01326767 (https://clinicaltrials.gov/ct2/show/NCT01326767).
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Affiliation(s)
- M Joerger
- Department of Medical Oncology, Cantonal Hospital, St Gallen, Switzerland
| | - J von Pawel
- Pneumology Clinic, Asklepios Fachkliniken, Gauting
| | - S Kraff
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn
| | - J R Fischer
- Department of Medical Oncology, Klinik Löwenstein, Löwenstein
| | - W Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen
| | - T C Gauler
- Department of Medical Oncology (Cancer Research), West German Cancer Center, University Hospital Essen of University Duisburg-Essen, Essen
| | - L Mueller
- Oncological Practice, Praxis Leer, Leer
| | - N Reinmuth
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf
| | - M Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf
| | - M Kimmich
- Pulmonology and Oncology, Klinik Schillerhöhe, Gerlingen
| | - F Mayer
- Department of Oncology and Hematology, University Hospital, Medical Center II, Tübingen
| | - H-G Kopp
- Department of Oncology and Hematology, Eberhard Karls University Medical Center, Tübingen
| | | | - Y-D Ko
- Medical Oncology, Johanniter-Krankenhaus Bonn, Bonn
| | - R A Hilger
- Cancer Research, University Hospital Essen, Essen, Germany
| | - M Roessler
- CESAR Central Office (CCO), Vienna CESAR Central European Society for Anticancer Drug Research-EWIV, Vienna, Austria
| | - C Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Free University Berlin, Berlin, Germany
| | - A Henrich
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Free University Berlin, Berlin, Germany
| | - B Moritz
- CESAR Central Office (CCO), Vienna CESAR Central European Society for Anticancer Drug Research-EWIV, Vienna, Austria
| | - M C Miller
- Saladax Biomedical, Inc., Bethlehem, USA
| | | | - U Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn
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Motzer RJ, Sharma P, McDermott DF, George S, Hammers HJ, Srinivas S, Tykodi SS, Sosman JA, Procopio G, Plimack ER, Castellano DE, Gurney H, Donskov F, Bono P, Wagstaff J, Gauler TC, Ueda T, Zhao H, Waxman IM, Escudier B. CheckMate 025 phase III trial: Outcomes by key baseline factors and prior therapy for nivolumab (NIVO) versus everolimus (EVE) in advanced renal cell carcinoma (RCC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.498] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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
498 Background: Based on assessment by an independent Data Monitoring Committee, a phase III trial of NIVO (n=410) vs EVE (n=411) in previously treated patients with advanced or metastatic RCC (NCT01668784) was halted early as it met its endpoint; superior overall survival (OS) was seen with NIVO vs EVE. We present outcomes by key baseline factors, prior therapy, and subsequent anticancer therapy. Methods: Patients with 1 or 2 prior anti-angiogenic therapies and measurable disease (RECIST v1.1) were randomized 1:1 to NIVO 3 mg/kg IV every 2 weeks or EVE 10 mg orally once daily. Primary endpoint was OS. A key secondary endpoint was objective response rate (ORR). Results: The Table shows OS and ORR by key baseline factors. Median follow-up was 17-18 mo. 77% and 23% of patients received 1 or 2 prior anti-angiogenic therapies, respectively, for advanced RCC, mainly sunitinib (63%) or pazopanib (32%). In patients who had prior sunitinib, median OS was 23.6 mo for NIVO vs 19.8 mo for EVE; in those who had prior pazopanib, median OS was not estimable (NE) for NIVO vs 17.6 mo for EVE. For those who had prior IL-2 (10%), median OS was NE for NIVO vs 17.2 mo for EVE. Outcomes by subsequent anticancer therapy are planned. Conclusions: A consistent OS benefit with NIVO vs EVE was found across baseline factors (Karnofsky performance status [KPS], Heng risk group, number of prior therapies), and specific prior therapies (sunitinib, pazopanib, IL-2) in previously treated patients with advanced RCC. ORR benefit with NIVO was also seen across baseline factors. Clinical trial information: NCT01668784. [Table: see text]
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Affiliation(s)
| | - Padmanee Sharma
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Hans J. Hammers
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Scott S. Tykodi
- University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | | | | | | | | | | | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Petri Bono
- Helsinki University Central Hospital, Helsinki, Finland
| | - John Wagstaff
- South West Wales Cancer Institute, Swansea, United Kingdom
| | | | - Takeshi Ueda
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
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Köhler J, Schuler M, Gauler TC, Nöpel-Dünnebacke S, Ahrens M, Hoffmann AC, Kasper S, Nensa F, Gomez B, Hahnemann M, Breitenbuecher F, Cheufou D, Özkan F, Darwiche K, Hoiczyk M, Reis H, Welter S, Eberhardt WEE, Eisenacher M, Teschler H, Stamatis G, Schmiegel W, Hahn SA, Baraniskin A. Circulating U2 small nuclear RNA fragments as a diagnostic and prognostic biomarker in lung cancer patients. J Cancer Res Clin Oncol 2015; 142:795-805. [DOI: 10.1007/s00432-015-2095-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/08/2015] [Indexed: 01/06/2023]
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Eberhardt WEE, Pöttgen C, Gauler TC, Friedel G, Veit S, Heinrich V, Welter S, Budach W, Spengler W, Kimmich M, Fischer B, Schmidberger H, De Ruysscher D, Belka C, Cordes S, Hepp R, Lütke-Brintrup D, Lehmann N, Schuler M, Jöckel KH, Stamatis G, Stuschke M. Phase III Study of Surgery Versus Definitive Concurrent Chemoradiotherapy Boost in Patients With Resectable Stage IIIA(N2) and Selected IIIB Non-Small-Cell Lung Cancer After Induction Chemotherapy and Concurrent Chemoradiotherapy (ESPATUE). J Clin Oncol 2015; 33:4194-201. [PMID: 26527789 DOI: 10.1200/jco.2015.62.6812] [Citation(s) in RCA: 226] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Concurrent chemoradiotherapy with or without surgery are options for stage IIIA(N2) non-small-cell lung cancer. Our previous phase II study had shown the efficacy of induction chemotherapy followed by chemoradiotherapy and surgery in patients with IIIA(N2) disease and with selected IIIB disease. Here, we compared surgery with definitive chemoradiotherapy in resectable stage III disease after induction. PATIENTS AND METHODS Patients with pathologically proven IIIA(N2) and selected patients with IIIB disease that had medical/functional operability received induction chemotherapy, which consisted of three cycles of cisplatin 50 mg/m(2) on days 1 and 8 and paclitaxel 175 mg/m(2) on day 1 every 21 days, as well as concurrent chemoradiotherapy to 45 Gy given as 1.5 Gy twice daily, concurrent cisplatin 50 mg/m(2) on days 2 and 9, and concurrent vinorelbine 20 mg/m(2) on days 2 and 9. Those patients whose tumors were reevaluated and deemed resectable in the last week of radiotherapy were randomly assigned to receive a chemoradiotherapy boost that was risk adapted to between 65 and 71 Gy in arm A or to undergo surgery (arm B). The primary end point was overall survival (OS). RESULTS After 246 of 500 planned patients were enrolled, the trial was closed after the second scheduled interim analysis because of slow accrual and the end of funding, which left the study underpowered relative to its primary study end point. Seventy-five patients had stage IIIA disease and 171 had stage IIIB disease according to the Union for International Cancer Control TNM classification, sixth edition. The median age was 59 years (range, 33 to 74 years). After induction, 161 (65.4%) of 246 patients with resectable tumors were randomly assigned; strata were tumor-node group, prophylactic cranial irradiation policy, and region. Patient characteristics were balanced between arms, in which 81 were assigned to surgery and 80 were assigned to a chemoradiotherapy boost. In arm B, 81% underwent R0 resection. With a median follow-up after random assignment of 78 months, 5-year OS and progression-free survival (PFS) did not differ between arms. Results were OS rates of 44% for arm B and 40% for arm A (log-rank P = .34) and PFS rates of 32% for arm B and 35% for arm A (log-rank P = .75). OS at 5 years was 34.1% (95% CI, 27.6% to 40.8%) in all 246 patients, and 216 patients (87.8%) received definitive local treatment. CONCLUSION The 5-year OS and PFS rates in randomly assigned patients with resectable stage III non-small-cell lung cancer were excellent with both treatments. Both are acceptable strategies for this good-prognosis group.
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Affiliation(s)
- Wilfried Ernst Erich Eberhardt
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands.
| | - Christoph Pöttgen
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Thomas Christoph Gauler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Godehard Friedel
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Stefanie Veit
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Vanessa Heinrich
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Stefan Welter
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Wilfried Budach
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Werner Spengler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Kimmich
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Berthold Fischer
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Heinz Schmidberger
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Claus Belka
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Sebastian Cordes
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Rodrigo Hepp
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Diana Lütke-Brintrup
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Nils Lehmann
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Schuler
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Karl-Heinz Jöckel
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Georgios Stamatis
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
| | - Martin Stuschke
- Wilfried Ernst Erich Eberhardt, Christoph Pöttgen, Thomas Christoph Gauler, Sebastian Cordes, Rodrigo Hepp, Diana Lütke-Brintrup, Nils Lehmann, Martin Schuler, Karl-Heinz Jöckel, and Martin Stuschke, West German Cancer Center, University Hospital Essen, Essen; Stefan Welter and Georgios Stamatis, Ruhrlandklinik, Essen-Heidhausen; Godehard Friedel, Stefanie Veit, and Martin Kimmich, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen; Vanessa Heinrich, Wilfried Budach, and Werner Spengler, Universitätsklinikum Tübingen, Tübingen; Berthold Fischer and Heinz Schmidberger, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz; Claus Belka, Klinikum der Universität München, München, Germany; and Dirk De Ruysscher, Maastro Clinic, Maastricht, the Netherlands
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Joerger M, Von Pawel J, Kraff S, Fischer JR, Eberhardt W, Gauler TC, Mueller L, Reinmuth N, Reck M, Kimmich M, Mayer F, Kopp HG, Behringer DM, Ko YD, Frueh M, Hilger RA, Roessler M, Moritz B, Jaehde U. Open-label, randomized study of individualized, pharmacokinetically (PK)-guided dosing of paclitaxel combined with carboplatin in advanced non-small cell lung cancer (NSCLC) patient. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8051] [Citation(s) in RCA: 2] [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)
| | | | - Stefanie Kraff
- Institute of Pharmacy, University of Bonn, Bonn, Germany
| | | | - Wilfried Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | | | | | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Frank Mayer
- University Hospital, Medical Center II, Tuebingen, Germany
| | | | | | | | - Martin Frueh
- Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | | | - Berta Moritz
- CESAR Central European Society for Anticancer Drug Research - EWIV, Vienna, Austria
| | - Ulrich Jaehde
- Pharmaceutical Institute, University Bonn, Bonn, Germany
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10
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Cohen EEW, Licitra LF, Fayette J, Gauler TC, Clement PM, Grau JJ, Del Campo JM, Mailliez A, Haddad RI, Vermorken JB, Tahara M, Guigay J, Geoffrois L, Merlano MC, Dupuis NF, Burtness B, Gibson N, Solca F, Ehrnrooth E, Machiels JPH. Biomarker analysis in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients (pts) treated with second-line afatinib versus methotrexate (MTX): LUX-Head & Neck 1 (LUX-H&N1). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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)
| | | | - Jérôme Fayette
- Léon Bérard Center and Hospices Civils de Lyon, University of Lyon, Lyon, France
| | | | | | - Juan José Grau
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jose Maria Del Campo
- Medical Oncology Department, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | | | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School and Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Joel Guigay
- Gustave Roussy, Villejuif and Centre Antoine Lacassagne, Nice, France
| | | | | | | | | | - Neil Gibson
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Flavio Solca
- Boehringer Ingelheim RCV GmbH and Co KG, Vienna, Austria
| | - Eva Ehrnrooth
- Boehringer Ingelheim Denmark A/S, Copenhagen, Denmark
| | - Jean-Pascal H. Machiels
- Institut Roi Albert II, Service d’Oncologie Médicale, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
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11
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Grünwald V, Keilholz U, Boehm A, Guntinas-Lichius O, Hennemann B, Schmoll HJ, Ivanyi P, Abbas M, Lehmann U, Koch A, Karch A, Zörner A, Gauler TC. TEMHEAD: a single-arm multicentre phase II study of temsirolimus in platin- and cetuximab refractory recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN) of the German SCCHN Group (AIO). Ann Oncol 2014; 26:561-7. [PMID: 25527417 DOI: 10.1093/annonc/mdu571] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma of the head and neck (SCCHN) is a common disease, which has a poor prognosis after failure of therapy. Activation of the PI3K-AKT-mTOR axis is commonly detected in recurrent or metastatic SCCHN, and provided the rationale for the clinical phase II trial in pretreated SCCHN. PATIENTS AND METHODS The primary end point was the progression-free survival rate (PFR) at 12 weeks. Forty eligible patients have been recruited after failure of platinum chemotherapy and cetuximab. A preplanned futility analysis was successfully passed after ≥1 success was detected in 20 patients. Secondary objectives consisted of progression-free survival (PFS), disease control rate (DCR), overall survival (OS), safety and tolerability, and predictive biomarkers for KRAS, BRAF, PIK3CA mutations, and HPV status. Archived tumor tissue was analyzed for DNA sequence. RESULTS A total of 40 patients were eligible. The PFR at 12 weeks was 40% (95% CI 25.0-54.6). The median PFS and OS were 56 days (95% CI 36-113 days) and 152 days (76-256 days), respectively. In 33 assessable patients, disease stabilization occurred in 57.6%, with tumor shrinkage in 13 patients (39.4%). Overall, the treatment was well tolerated. Fatigue (47.5%), anemia (25.0%), nausea (20.0%), and pneumonia (20.0%) were the most common adverse events. Neither PIK3CA mutations, nor HPV status were predictive for success with temsirolimus treatment. No mutations were found for KRAS or BRAF. CONCLUSION Tumor shrinkage and efficacy parameter indicate that inhibition of the PI3K-AKT-mTOR axis was a putative novel treatment paradigm for SCCHN. We could not identify parameters predictive for treatment success of temsirolimus, which underscores the need for refinement of the molecular analysis in future studies. CLINICAL TRIALS NUMBER NCT01172769.
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Affiliation(s)
- V Grünwald
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover
| | - U Keilholz
- Charité Comprehensive Cancer Center, Berlin
| | - A Boehm
- Clinic and Policlinic for Ear, Nose and Throat, University Hospital, Leipzig
| | | | - B Hennemann
- Department for Hematology and Oncology, Ev. Bethesda- Johanniter Hospital, Duisburg
| | - H J Schmoll
- Clinic for Internal Medicine IV, University Hospital, Halle
| | - P Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover
| | | | | | | | | | - A Zörner
- Clinical Pharmacology, Hannover Medical School, Hannover
| | - T C Gauler
- West-German Cancer Center, University Hospital, Essen, Germany
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12
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Gauler TC, Espenhain L, Hoiczyk M, Nel I, Parr A, Roder J, Schuler MH, Eberhardt WEE, Roder H, Hoffmann AC. Correlation of proteomics and first-line platinum-based chemotherapy in stage III/IV NSCLC in a large single-center cohort. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19104] [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)
- Thomas Christoph Gauler
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lydia Espenhain
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Mathias Hoiczyk
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ivonne Nel
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Annette Parr
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Martin H. Schuler
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wilfried Ernst Erich Eberhardt
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Andreas Claudius Hoffmann
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Fenner MH, Dieing A, Oechsle K, Hentrich M, Gauler TC, Lorch A, Kopp HG, Beyer J, Bokemeyer C, Gruenwald V, Honecker F. A single arm, open-label multicenter phase II trial of everolimus in patients with relapsed/refractory germ cell cancer (RADIT). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15535] [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)
- Martin H Fenner
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Karin Oechsle
- Department of Oncology, Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Hentrich
- Harlaching Hospital, Department of Hematology, Oncology and Palliative Care, Munich, Germany
| | | | - Anja Lorch
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Duesseldorf, Germany
| | - Hans-Georg Kopp
- Department of Hematology, Oncology and Immunology, University of Tuebingen, Tuebingen, Germany
| | - Joerg Beyer
- Universitätsspital Zürich, Zürich, Switzerland
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Viktor Gruenwald
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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14
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Keilholz U, Gauler TC, Dietz A, Gruenwald V, Stoehlmacher-Williams J, Knipping S, Schroeder M, Guntinas-Lichius O, Frickhofen N, Lindemann HW, Fietkau R, Haxel B, Junghanss C, Maschmeyer G, Zipfel M, Martus P, Knoedler MK. Cetuximab (C), fluorouracil (F), and cisplatin (P) alone or with docetaxel (D) for recurrent/metastatic (RM) head and neck cancer (HNSCC): First analysis of AIO trial # 1108. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
| | | | | | - Viktor Gruenwald
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Jan Stoehlmacher-Williams
- University Hospital Carl Gustav Carus, University Cancer Center / Medical Department I, Dresden, Germany
| | - Stephan Knipping
- Department of Otolaryngology, Städtisches Klinikum Dessau, Dessau, Germany
| | - Michael Schroeder
- Onkologie und Hämatologie HELIOS St. Johannes Klinik, Duisburg, Germany
| | | | | | | | | | - Boris Haxel
- Universitätsmedizin Mainz Hals-Nasen-Ohrenklinik, Mainz, Germany
| | - Christian Junghanss
- Department of Hematology and Oncology, University Hospital, Rostock, Germany
| | | | - Matthias Zipfel
- Medizinische Klinik und Poliklinik III, Abteilung für Hämatologie und Onkologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Peter Martus
- Institute of Biostatistics and Clinical Epidemiology, Charite, Berlin, Germany
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15
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Eberhardt WEE, Gauler TC, Pöttgen C, Friedel G, Veit S, Heinrich V, Welter S, Spengler W, Kimmich M, Fischer B, Schmidberger H, Gkika E, Cordes S, Hepp R, Luetke-Brintrup D, Lehmann N, Schuler MH, Jöckel KH, Stamatis G, Stuschke M. Phase III study of surgery (S) versus definitive concurrent chemoradiotherapy boost (def ccCRTx-BOx) in patients (pts) with operable (OP+) stage IIIA(N2)/selected IIIb (sel IIIB) non-small cell lung cancer (NSCLC) following induction (IND) chemotherapy (CTx) and concurrent CRTx (ESPATUE). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7510] [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)
- Wilfried Ernst Erich Eberhardt
- Department of Medical Oncology, Ruhrlandklinik, West German Cancer Center, University Hospital Essen. University Duisburg-Essen, Essen, Germany
| | | | - Christoph Pöttgen
- Department of Radiation Oncology, West German Tumor Centre, Essen, Germany
| | - Godehard Friedel
- Robert-Bosch-Krankenhaus Klinik Schillerhöhe Abteilung für Thoraxchirurgie, Gerlingen, Germany
| | | | | | - Stefan Welter
- Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Werner Spengler
- Medizinische Klinik Abteilung II, Uniklinik Tübingen, Tübingen, Germany
| | | | | | - Heinz Schmidberger
- Universtätsmedizin Mainz Klinik für Strahlentherapie und Radioonkologie, Mainz, Germany
| | - Eleni Gkika
- Klinik für Radiologische Onkologie Westdeutsches Tumorzentrum Essen Universitätsklinikum Essen, Essen, Germany
| | - Sebastian Cordes
- Department of Medical Oncology, West German Cancer Centre, Universitätsklinikum Essen, Essen, Germany
| | - Rodrigo Hepp
- Department of Radiation Oncology, West German Tumor Centre, Essen, Germany
| | - Diana Luetke-Brintrup
- Department of Biomathematics and Statistics, West German Cancer Centre, Universitätsklinikum Essen, Essen, Germany
| | - Nils Lehmann
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
| | - Martin H. Schuler
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
| | | | - Martin Stuschke
- Department of Radiation Oncology, West German Tumor Centre, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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16
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Berger LA, Bokemeyer C, Lorch A, Hentrich M, Kopp HG, Gauler TC, Beyer J, de Wit M, Mayer F, Boehlke I, Oing C, Honecker F, Oechsle K. First salvage treatment in patients with advanced germ cell cancer after cisplatin-based chemotherapy: analysis of a registry of the German Testicular Cancer Study Group (GTCSG). J Cancer Res Clin Oncol 2014; 140:1211-20. [PMID: 24696231 DOI: 10.1007/s00432-014-1661-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE We analyzed prognostic categories at first relapse according to the International Prognostic Factors Study Group (IPFSG) criteria as well as the efficacy of salvage treatment. METHODS 143 patients with relapsed or refractory germ cell cancer undergoing first salvage treatment with conventional-dose (CD-CX, n = 48) or high-dose chemotherapy with autologous stem cell support (HD-CX, n = 95) contributed by nine centers were retrospectively analyzed. RESULTS Prognostic subgroups according to IPFSG criteria were: very low risk 13/143, low risk 36/143, intermediate risk 66/143, high risk 22/143, and very high risk 6/143 patients. The IPFSG categories significantly correlated with overall survival (OS) (p = 0.025) after 1st salvage treatment. After a median follow-up of 19 months, 55 % of all patients had relapsed and 33 % had died. For the entire cohort, progression-free survival (PFS) rate after 2 years was 43 %, and OS rate after 5 years was 52 %. Compared to the HD-CX group, vital carcinoma was found more often in secondarily resected lesions following CD-CX (22/29 vs. 22/45; p = 0.021). Second relapse rate was higher with 75 versus 44 %, resulting in a shorter median PFS with 8 versus 42 months (p < 0.001), but this did not translate into different OS (p = 0.931). At subsequent relapses, 26/36 patients received HD-CX as ≥2nd-salvage treatment. CONCLUSION This analysis confirms the prognostic value of the IPFSG prognostic score. HD-CX seemed superior to CD-CX as first salvage treatment with respect to PFS in this retrospective analysis.
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Affiliation(s)
- Lars Arne Berger
- Department of Oncology, Hematology, BMT with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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17
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Vermorken JB, Peyrade F, Krauss J, Mesía R, Remenar E, Gauler TC, Keilholz U, Delord JP, Schafhausen P, Erfán J, Brümmendorf TH, Iglesias L, Bethe U, Hicking C, Clement PM. Cisplatin, 5-fluorouracil, and cetuximab (PFE) with or without cilengitide in recurrent/metastatic squamous cell carcinoma of the head and neck: results of the randomized phase I/II ADVANTAGE trial (phase II part). Ann Oncol 2014; 25:682-688. [PMID: 24567516 PMCID: PMC3933250 DOI: 10.1093/annonc/mdu003] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 12/23/2013] [Accepted: 12/31/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M-SCCHN) overexpresses αvβ5 integrin. Cilengitide selectively inhibits αvβ3 and αvβ5 integrins and is investigated as a treatment strategy. PATIENTS AND METHODS The phase I/II study ADVANTAGE evaluated cilengitide combined with cisplatin, 5-fluorouracil, and cetuximab (PFE) in R/M-SCCHN. The phase II part reported here was an open-label, randomized, controlled trial investigating progression-free survival (PFS). Patients received up to six cycles of PFE alone or combined with cilengitide 2000 mg once (CIL1W) or twice (CIL2W) weekly. Thereafter, patients received maintenance therapy (cilengitide arms: cilengitide plus cetuximab; PFE-alone arm: cetuximab only) until disease progression or unacceptable toxicity. RESULTS One hundred and eighty-two patients were treated. Median PFS per investigator read was similar for CIL1W + PFE, CIL2W + PFE, and PFE alone (6.4, 5.6, and 5.7 months, respectively). Accordingly, median overall survival and objective response rates were not improved with cilengitide (12.4 months/47%, 10.6 months/27%, and 11.6 months/36%, respectively). No clinically meaningful safety differences were observed between groups. None of the tested biomarkers (expression of integrins, CD31, Ki-67, vascular endothelial growth factor receptor 2, vascular endothelial-cadherin, type IV collagen, epidermal growth factor receptor, or p16 for human papillomavirus) were predictive of outcome. CONCLUSION Neither of the cilengitide-containing regimens demonstrated a PFS benefit over PFE alone in R/M-SCCHN patients.
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Affiliation(s)
- J B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium.
| | - F Peyrade
- Medical Oncology Service, Center Antoine Lacassagne, Nice, France
| | - J Krauss
- Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - R Mesía
- Medical Oncology Service, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Remenar
- Head and Neck Surgery, National Oncology Institute, Budapest, Hungary
| | - T C Gauler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen
| | - U Keilholz
- Department of Hematology and Medical Oncology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - J P Delord
- Clinical Research Unit, Institute Claudius Regaud, Toulouse, France
| | - P Schafhausen
- II Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Erfán
- Onco-radiology, Jósa András Teaching Hospital, Nyíregyháza, Hungary
| | - T H Brümmendorf
- Department of Hematology and Oncology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - L Iglesias
- Lung and Head and Neck Cancer Unit, Hospital 12 de Octubre, Madrid, Spain
| | - U Bethe
- Merck KGaA, Darmstadt, Germany
| | | | - P M Clement
- Department of Oncology, KU Leuven, Leuven, Belgium
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18
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Pogorzelski M, Ting S, Gauler TC, Breitenbuecher F, Vossebein I, Hoffarth S, Markowetz J, Lang S, Bergmann C, Brandau S, Jawad JA, Schmid KW, Schuler M, Kasper S. Impact of human papilloma virus infection on the response of head and neck cancers to anti-epidermal growth factor receptor antibody therapy. Cell Death Dis 2014; 5:e1091. [PMID: 24577089 PMCID: PMC3944273 DOI: 10.1038/cddis.2014.62] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 12/20/2022]
Abstract
Infection with human papillomaviruses (HPVs) characterizes a distinct subset of head and neck squamous cell cancers (HNSCCs). HPV-positive HNSCC preferentially affect the oropharynx and tonsils. Localized HPV-positive HNSCCs have a favorable prognosis and treatment outcome. However, the impact of HPV in advanced or metastatic HNSCC remains to be defined. In particular, it is unclear whether HPV modulates the response to cetuximab, an antibody targeting the epidermal growth factor receptor (EGFR), which is a mainstay of treatment of advanced HNSCC. To this end, we have examined the sensitivity of HPV-positive and -negative HNSCC models to cetuximab and cytotoxic drugs in vitro and in vivo. In addition, we have stably expressed the HPV oncogenes E6 and E7 in cetuximab-sensitive cancer cell lines to specifically investigate their role in the antibody response. The endogenous HPV status or the expression of HPV oncogenes had no significant impact on cetuximab-mediated suppression of EGFR signaling and proliferation in vitro. Cetuximab effectively inhibited the growth of E6- and E7-expressing tumors grafted in NOD/SCID mice. In support, formalin-fixed, paraffin-embedded tumor samples from cetuximab-treated patients with recurrent or metastatic HNSCC were probed for p16INK4a expression, an established biomarker of HPV infection. Response rates (45.5% versus 45.5%) and median progression-free survival (97 versus 92 days) following cetuximab-based therapy were similar in patients with p16INK4A-positive and p16INK4A-negative tumors. In conclusion, HPV oncogenes do not modulate the anti-EGFR antibody response in HSNCC. Cetuximab treatment should be administered independently of HPV status.
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Affiliation(s)
- M Pogorzelski
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - S Ting
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - T C Gauler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - F Breitenbuecher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - I Vossebein
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - S Hoffarth
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - J Markowetz
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - C Bergmann
- Department of Otorhinolaryngology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - S Brandau
- Department of Otorhinolaryngology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - J A Jawad
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - K W Schmid
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Schuler
- 1] Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany [2] German Cancer Consortium (DKTK), Heidelberg, Germany
| | - S Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
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Eberhardt WEE, Gauler TC, LePechoux C, Stamatis G, Bildat S, Krbek T, Welter S, Grunenwald D, Fischer B, Rodrigo HDLR, Theegarten D, Le Chevalier T, Seeber S, Stuschke M, Poettgen C. 10-year long-term survival (LTS) of induction chemotherapy with three cycles cisplatin/paclitaxel followed by concurrent chemoradiation cisplatin/etoposide/45Gy (1.5Gy bid) plus surgery in locally advanced non-small-cell lung cancer (NSCLC)—A multicenter phase-II trial (CISTAXOL). Lung Cancer 2013; 82:83-9. [DOI: 10.1016/j.lungcan.2013.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/18/2013] [Accepted: 06/22/2013] [Indexed: 01/17/2023]
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Nel I, Gauler TC, Eberhardt WE, Nickel AC, Schuler M, Thomale J, Hoffmann AC. Formation and repair kinetics of Pt-(GpG) DNA adducts in extracted circulating tumour cells and response to platinum treatment. Br J Cancer 2013; 109:1223-9. [PMID: 23942068 PMCID: PMC3778280 DOI: 10.1038/bjc.2013.419] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 06/12/2013] [Accepted: 07/03/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pt-(GpG) intrastrand crosslinks are the major DNA adducts induced by platinum-based anticancer drugs. In the cell lines and mouse models, the persistence of these lesions correlates significantly with cell damage. Here we studied Pt-(GpG) DNA adducts in circulating tumour cells (CTC) treated with cisplatin in medium upfront to systemic therapy from patients with advanced non-small-cell lung cancer (NSCLC). METHODS Blood was drawn before systemic treatment and the CD45/CD15-depleted fraction of mononuclear cells was exposed to cisplatin, verified for the presence of CTC by pan-cytokeratin (pCK) staining and immunoanalysed for the level of Pt-(GpG) in DNA. RESULTS Immunostaining for pCK, CD45 and subsequently for Pt-(GpG) adducts in the cisplatin-exposed cells (ex vivo) at different time points depicted distinct differences for adduct persistence in CTC between responders vs non-responders. CONCLUSION Pt-(GpG) adducts can be detected in CTC from NSCLC patients and assessing their kinetics may constitute a clinically feasible biomarker for response prediction and dose individualisation of platinum-based chemotherapy. This functional pre-therapeutic test might represent a more biological approach than measuring protein factors or other molecular markers.
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Affiliation(s)
- I Nel
- Molecular Oncology Risk-Profile Evaluation, Department of Medical Oncology, West German Cancer Center, University Duisburg-Essen, Essen 45122, Germany
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Gauler TC, Christoph DC, Fischer J, Frickhofen N, Huber R, Gonschorek C, Roth K, Giurescu M, Eberhardt WEE. Phase-I study of sagopilone in combination with cisplatin in chemotherapy-naive patients with metastasised small-cell lung cancer. Eur J Cancer 2013; 49:2461-8. [DOI: 10.1016/j.ejca.2013.03.029] [Citation(s) in RCA: 5] [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] [Received: 02/13/2013] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 11/25/2022]
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Gauler TC, Besse B, Novello S, Smit EF, Plummer ER, Delord JP, Nicodemo M, Santoro A, Barone C, Marchetti P, Conte PF, De Jonge MJ, Awada A, Mariani M, Jannuzzo MG, Petroccione A, Ceruti R, Davite C, Eberhardt WEE. Phase II study of danusertib (D) in advanced/metastatic non-small cell lung cancers (NSCLC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e19138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19138 Background: D is an ATP competitive pan-aurora kinases inhibitor with activity also against FGFRs, VEGFR, Ret, TrkA, Scr, and Abl. Methods: Eligible pts had NSCLC progressing for advanced/metastatic disease after 1 prior chemotherapy line (CT). Primary endpoint was progression-free survival at 4 months (PFS-4) evaluated in a Simon two-stage design. Number of successes required for not rejecting the alternative hypothesis (40% PFS-4) was ≥4/19 evaluable pts while the number of successes required to reject at the end of stage 2 the null hypothesis (20% PFS-4) was ≥11/36 (α 1-sided = 0.1). D was administered at 500 mg/m² as 24 hr IV infusion q2w. The expression of Aurora A/B, TPX-2, MDR, Scr, Survivin by IHC and the amplification of FGFR1 by FISH on tumor biopsies of consenting pts were evaluated. Results: 3 out of 19 evaluable pts were PFS-4 at the end of the 1st stage, thus precluding passage to the 2nd stage. Interestingly, in pts with squamous (SCC) (n=7), median PFS and OS were 6.4 and 10.6 mos respectively (vs. 2.2 and 7.6 mos, in non-SCC pts), suggesting a possible specific effect in this subtype. Additional pts with SCC were therefore treated under a protocol amendment. At the end of this 2nd stage, 5/31 evaluable SCC pts (80% CI: 0.08-0.28) were PFS-4 indicating that the predefined threshold required to conclude for activity would not have been reached. Overall 56 pts, all histology NSCLC, were treated: median age 62 yrs (39-79), 64% male, 70% SCC, 36% with >1 prior CT. Best response was a PR in 1 pt and SD in 20 pts; median PFS and OS were 2.1 and 8.3 mos respectively. The most frequent drug-related AEs (any Grade, ≥20%) were: uncomplicated and short lasting neutropenia (94%), nausea (39%), fatigue (37%), asthenia (30%), anorexia and diarrhea (29%), alopecia (23%). Histological analyses by IHC and FISH is still ongoing: results will be presented. Conclusions: Limited evidence of activity was observed, insufficient to meet the predefined threshold to call efficacy in NSCLC when D was administered as monotherapy at this dose/schedule. D confirmed to have a manageable safety profile. Clinical trial information: 2006-003772-35.
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Affiliation(s)
| | | | - Silvia Novello
- Azienda Ospedaliera Universitaria San Luigi, University of Turin, Orbassano, Italy
| | | | | | | | | | - Armando Santoro
- Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | | | | | | | | | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | - Mariangela Mariani
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
| | | | - Anna Petroccione
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
| | | | - Cristina Davite
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
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Knoedler M, Dietz A, Gauler TC, Gruenwald V, Stoehlmacher J, Knipping S, Guntinas-Lichius O, Frickhofen N, Schroeder M, Maschmeyer G, Rethwisch V, Haxel B, Keilholz U. Cetuximab, fluorouracil (5-FU), cisplatin, and docetaxel as first-line treatment in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): Interim results of a randomized phase II clinical trial (CeFCiD). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17021] [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
e17021 Background: This study investigates efficacy and toxicity of docetaxel added to cetuximab, cisplatin and 5-FU for patients with R/M SCCHN. We here report a planned second interim analysis to compare response rates between arms in order to decide on continuing to full accrual. Methods: Inclusion criteria were: stage III/IV R/M SCCHN and ECOG 0-1. Patients were randomized to arm A: cetuximab (standard dose) plus a maximum of 6 cycles of docetaxel (40 mg/m², day 1+8), cisplatin (40 mg/m², day 1+8) and 5-FU (2000 mg/m², day 1+8) or to arm B: cetuximab (standard dose), cisplatin (100 mg/m², day 1) and 5-FU (1000 mg/m², day 1-4). Treatment was administered until progression or intolerability. The endpoint of this analysis was RR. Results: A first interim analysis for toxicity after treatment of 20 patients per arm revealed more hematologic and gastrointestinal grade III/IV toxicities in the experimental arm. Therefore dose reductions of cisplatin from 40 to 30 mg/m² and 5-FU from 2,000 to 1,000 mg/m² had been introduced. A secondary toxicity analysis with 40 patients per arm observed reduced treatment related toxicities. Currently 100 patients could be assessed for response: arm A: 82 % male, median age 58 years, arm B: 82 % male, median age 60 years. Best overall RR was 41 % (3 CR, 18 PR) in arm A compared to 45 % (4 CR, 19 PR) in arm B. The DCR was 75 % in arm A and 80 % in arm B. Conclusions: After introducing dose reductions toxicity is manageable. Comparable response rates were seen in both arms. CeFCiD continues per protocol for evaluation of the primary endpoint PFS. Enrollment is estimated to be completed in Aug 2013. Clinical trial information: CeFCiD-1108.
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Affiliation(s)
- Maren Knoedler
- Comprehensive Cancer Center, University Leipzig, Leipzig, Germany
| | | | | | - Viktor Gruenwald
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Stephan Knipping
- Department of Otolaryngology, Städtisches Klinikum Dessau, Dessau, Germany
| | | | | | | | | | | | - Boris Haxel
- Department of Otolaryngology, University Hospital Mainz, Mainz, Germany
| | - Ulrich Keilholz
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Oechsle K, Berger LA, Lorch A, Hentrich M, Kopp HG, Gauler TC, Beyer J, De Wit M, Honecker F, Bokemeyer C. First-salvage treatment in patients with recurrent or refractory advanced germ-cell cancer after cisplatin-based chemotherapy: A database of the German Testicular Cancer Study Group. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4559] [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
4559 Background: About 20-30% of patients (pts) with advanced germ-cell cancer (GCC) relapse after cisplatin-based chemotherapy. This database evaluates first salvage treatment and the prognostic categories at first relapse according to the International Prognostic Factors Study Group (= IPFSG; JCO 2010). Methods: A total of 144 pts (78% nonseminoma) with relapsed or refractory GCC undergoing 1st salvage treatment with either conventional (CD-CX) or high-dose chemotherapy with autologous stem cell support (HD-CX) from 16 German centers were retrospectively analysed. Results: Subgroups according to the IPFSG prognostic categories, were: very low risk in 9/144 (6%), low risk in 26/144 (18%), intermediate risk in 78/144 (54%), high risk in 27/144 (19%), and very high risk in 4/144 pts (3%). 1st salvage treatment consisted of HD-CX in 96 (67%) and CD-CX in 48 pts (33%). Treatment response was CR/PR- in 60%, PR+/SD in 33%, and PD in 7%. After a median follow-up (mFU) of 21 months (mos) (range, 0 – 193), 53% of all pts had relapsed and 30% had died resulting in a median progression-free survival (PFS) of 7 mos (95%CI 0-16) and overall survival (OS) of 47 mos (95%CI 21-73). At subsequent relapses, 25/48 pts (52%) received HD-CX as > 2nd-salvage treatment. For the total cohort, PFS rate after 2 years was 35%, and OS rate after 5 years was 53%. Stratification according to IPFSG prognostic categories significantly correlated with PFS (p=0.001) and OS (p=0.004) after 1st salvage treatment. Even among high-risk and very high risk (n=31, mFU 12 mos) a PFS of 37 % at 2 years and an OS of 60 % at 2 years was observed, after 1st or 2nd salvage treatment, which might be due to patient selection and short follow-up. Conclusions: IPFSG prognostic categories highly correlated with observed PFS and OS after first salvage treatment in this cohort of pts with refractory or relapsed GCC. First salvage treatment with CD- or HD-CX resulted in overall 5 year-OS rates of about 50% across all prognostic categories. Even pts with high and very high risk achieved 2 year-OS rates of about 60% with salvage HD-CX at first or subsequent relapses.
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Affiliation(s)
- Karin Oechsle
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Hematology and BMT with section of Pneumology, Hamburg, Germany
| | - Lars Arne Berger
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Hematology and BMT with section of Pneumology, Hamburg, Germany
| | - Anja Lorch
- University Hospital Düsseldorf, Department of Urology, Düsseldorf, Germany
| | - Marcus Hentrich
- Harlaching Hospital, Department of Hematology, Oncology and Palliative Care, Munich, Germany
| | - Hans-Georg Kopp
- Department of Hematology, Oncology and Immunology, University of Tuebingen, Tuebingen, Germany
| | | | - Joerg Beyer
- Vivantes Klinikum Am Urban, Department of Internal Medicine, Hematology and Oncology, Berlin, Germany
| | - Maike De Wit
- Vivantes Klinikum Neukölln, Department of Internal Medicine, Oncology and Hematology, Berlin, Germany
| | - Friedemann Honecker
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Hematology and BMT with section of Pneumology, Hamburg, Germany
| | - Carsten Bokemeyer
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Hematology and BMT with section of Pneumology, Hamburg, Germany
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Saloura V, Cohen EE, Licitra LF, Billan S, Dinis J, Lisby S, Gauler TC. An open-label single-arm, phase II trial of zalutumumab, a human monoclonal anti-EGFR antibody, in patients with platinum-refractory squamous cell carcinoma of the head and neck. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6065] [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
6065 Background: Treatment for patients with platinum-refractory metastatic squamous cell carcinoma of the head and neck (SCCHN) is limited. Cetuximab has been approved in the US in this patient population based on a phase II trial that demonstrated 13% response rate (RR) and 5.9 months median OS. A recently conducted phase III trial of zalutumumab, a human monoclonal IgG1k antibody against EGFR, versus best supportive care showed significant increase in PFS. Here, we present the results of a companion phase II trial in the same patient population. Methods: Patients with platinum-refractory recurrent or metastatic SCCHN received weekly infusions of zalutumumab starting at a loading dose of 8mg/kg. The dose was then reduced to 4mg/kg and individually titrated by increments of 4mg/kg every 2 weeks based on skin rash evaluation up to a maximum of 16mg/kg aiming at a grade 2 skin rash. Primary objective was OS. The analysis was based on the intent-to-treat principle and OS was estimated using the Kaplan-Meier method. Results: Between January 2008 till August 2011 90 patients were enrolled in 57 centers in the United States, Europe and South America. 23% of patients had WHO PS 2 and 74% had distant relapse metastases. Grade 3-4 adverse events (AEs) related to zalutumumab were observed in 19% of the patients and included skin rash (5%), hypomagnesemia (4%) and pneumonitis (1%). Infusion-related reactions occurred in 33% of patients. The frequency of all-cause grade 3-4 AEs was 62% and included infections (14%), gastrointestinal disorders (12%), hypokalemia (6%), dyspnea (9%) and anemia (6%). Two deaths secondary to cardiac arrest in a patient with history of myocardial infarction, and respiratory acidosis in a patient with a pleural effusion and hypomagnesemia were deemed related to zalutumumab. CR was observed in one (1%) patient and PR in four (5%) patients. The median PFS was 8.6 weeks (95% CI [8.0, 10.4]) and the estimated median OS was 5.3 months (95% CI [4.1, 7.1]). Conclusions: Zalutumumab showed reasonable efficacy in platinum-refractory recurrent or metastatic SCCHN patients and dosing titration based on skin rash evaluation was feasible. Clinical trial information: NCT00542308.
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Affiliation(s)
| | - Ezra E.W. Cohen
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Lisa F. Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salem Billan
- The Oncology Institute, Rambam Medical Center, Haifa, Israel
| | - Jose Dinis
- Grupo de Investigação Clínica, Porto, Portugal
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26
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Keilholz U, Knoedler M, Redlich I, Gauler TC. Pretreatment characteristics and early indicators of long-term efficacy of cetuximab in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (rmSCCHN). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17015] [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
e17015 Background: Cetuximab has established activity in rmSCCHN as a single agent as well as in conjunction with chemotherapy. Combination treatment protocols lead to significant toxicity. It would be of interest to identify pretreatment characteristics and early indicators of long-term cetuximab efficac. Methods: rmSCCHN patients were analysed, who participated in trials of chemotherapy plus cetuximab, followed by cetuximab maintenance. Patients were stratified into two groups of long term exposure (LTE) and short term exposure (STE) of cetuximab using 6 months as cut-off. Factors considered for analysis included age, sex, performance status, smoking behavior, primary tumor site, time from primary to treatment for rm-disease, number of chemotherapy cycles received, response, toxicity, and reason for treatment discontinuation. Results: In 2 institutions, 61 patients were enrolled in 5 clinical trials between 2008 and 2011. Cetuximab was administered in standard dose and schedule until disease progression or unacceptable toxicity. 27 patients received cetuximab <6 mo (STE, median 1.5 mo) and 34 >6 mo (LTE, median 9 mo). Patients with LTE as compared to STE only differed in 2 characteristics: oral/oropharyngeal primary (56% vs. 41%) and median chemotherapy cycles received (6 vs. 2). Comparing LTE to STE, treatment discontinuation during the chemotherapy phase was due to toxicity in 14 vs. 37% or death in 4 vs. 15%. Median OS in LTE vs. STE was 18 vs. 4 mo. Conclusions: LTE was associated with a huge improvement of OS. Toxicity of chemotherapy was a relevant factor for early discontinuation of combination treatments, limiting the overall efficacy of cetuximab. Results may be improved by further intensification of the already implemented proactive toxicity management, but also by development of less toxic chemotherapy schedules.
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Affiliation(s)
- Ulrich Keilholz
- Department of Medicine III and Charité Comprehensive Cancer Center, Berlin, Germany
| | - Maren Knoedler
- Comprehensive Cancer Center, University Leipzig, Leipzig, Germany
| | - Ines Redlich
- Department of Medicine III and Charité Comprehensive Cancer Center, Berlin, Germany
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27
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Machiels JPH, Specenier PM, Krauss J, Dietz A, Kaminsky MC, Lalami Y, Henke M, Keilholz U, Knecht R, Skartved NJO, Horak ID, Flensburg MF, Gauler TC. Sym004, a novel strategy to target EGFR with an antibody mixture, in patients with advanced SCCHN progressing after anti-EGFR monoclonal antibody: A proof of concept study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6002] [Citation(s) in RCA: 6] [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
6002 Background: Sym004 is a first-in-class drug mixture of two mAbs targeting non-overlapping epitopes on the EGFR. In preclinical models, Sym004 exhibited more pronounced EGFR internalization, degradation and tumor growth inhibition than cetuximab. Sym004 was investigated as monotherapy in palliative squamous cell carcinoma of the head and neck (SCCHN) patients (pts). Methods: SCCHN pts progressing after anti-EGFR mAbs for palliation were eligible. Documented clinical benefit (PR, CR or SD for at least 8 weeks according to RECIST) on an anti-EGFR mAb-containing regimen followed by disease progression during or within 12 weeks after treatment cessation was required. The primary endpoint of this multicentre single arm trial was centrally evaluated progression-free survival (PFS), estimated by median PFS and 24 week progression free rate. Secondary endpoints included objective tumor response, safety, biomarkers and pharmacokinetics. Pts received weekly iv infusions of 12 mg/kg Sym004 until disease progression. Tumor evaluation was performed week 6, 12 and every 8 weeks thereafter. Results: Based on the statistical hypothesis, 26 pts were included, of whom 23 had progressed while on anti-EGFR mAb treatment. One of 19 evaluable pts was HPV positive and no EGFRvIII mutation was detected in 21 evaluable pts. No anti-drug antibodies were detected. Independent central review of CT/MRI scans from 20 evaluable pts showed tumor shrinkage in 8 pts (% decrease in sum of the largest diameters: 6.5, 7.1, 9.6, 10.2, 11.3, 13.6, 16.7, 27.1) and 14 pts had SD as best overall response. Median PFS was 82 days (95% CI: 41, 140) and 24 week progression free rate was 12% (95% CI: 1, 39). During treatment 25/26 (96%) pts developed skin rash with ≥ grade 3 reported in 11/26 (42%) pts. Hypomagnesemia ≥ grade 3 was reported in 10/26 (38%) pts. Sym004 treatment resulted in a marked down regulation of EGFR in centrally reviewed biopsies from skin and tumors. Conclusions: Sym004 demonstrated clinical activity in heavily pretreated, predominately HPV negative pts with advanced SCCHN previously progressing on or after anti-EGFR mAbs. No unexpected toxicities were reported. Clinical trial information: NCT01417936.
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Affiliation(s)
| | | | | | | | | | | | | | - Ulrich Keilholz
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Rainald Knecht
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
In order to improve the prognosis for patients with head and neck squamous cell cancer (HNSCC) the introduction of new therapeutic strategies is necessary. The concept of immunotherapy has been applied and improved for several years and recent studies have used tumor-specific antigens which facilitates targeted oncologic therapy. However, immunotherapy is hampered by the fact that immunosuppressive mechanisms are pronounced and relevant effector cells are suppressed, especially in patients with HNSCC. Successful immunotherapy could induce an antitumor immune response by restitution of these cell populations. Current anti-tumor immunotherapy includes unspecific immune stimulation, genetic modification of tumor and immune cells, the use of monoclonal antibodies, e.g. cetuximab, adoptive cell transfer and tumor vaccination. In the future, these biologic therapies alone or in combination with conventional therapeutic regimens could present a valuable therapeutic option for HNSCC patients.
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Affiliation(s)
- P J Schuler
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, Universität Duisburg-Essen.
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29
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Boeck S, Jung A, Laubender RP, Neumann J, Egg R, Goritschan C, Vehling-Kaiser U, Winkelmann C, Fischer von Weikersthal L, Clemens MR, Gauler TC, Märten A, Klein S, Kojouharoff G, Barner M, Geissler M, Greten TF, Mansmann U, Kirchner T, Heinemann V. EGFR pathway biomarkers in erlotinib-treated patients with advanced pancreatic cancer: translational results from the randomised, crossover phase 3 trial AIO-PK0104. Br J Cancer 2012; 108:469-76. [PMID: 23169292 PMCID: PMC3566829 DOI: 10.1038/bjc.2012.495] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: We aimed to identify molecular epidermal growth factor receptor (EGFR) tissue biomarkers in pancreatic cancer (PC) patients treated with the anti-EGFR agent erlotinib within the phase 3 randomised AIO-PK0104 study. Methods: AIO-PK0104 was a multicenter trial comparing gemcitabine/erlotinib followed by capecitabine with capecitabine/erlotinib followed by gemcitabine in advanced PC; primary study end point was the time-to-treatment failure after first- and second-line therapy (TTF2). Translational analyses were performed for KRAS exon 2 mutations, EGFR expression, PTEN expression, the EGFR intron 1 and exon 13 R497K polymorphism (PM). Biomarker data were correlated with TTF, overall survival (OS) and skin rash. Results: Archival tumour tissue was available from 208 (74%) of the randomised patients. The KRAS mutations were found in 70% (121 out of 173) of patients and exclusively occurred in codon 12. The EGFR overexpression was detected in 89 out of 181 patients (49%) by immunohistochemistry (IHC), and 77 out of 166 patients (46%) had an EGFR gene amplification by fluorescence in-situ hybridisation (FISH); 30 out of 171 patients (18%) had a loss of PTEN expression, which was associated with an inferior TTF1 (first-line therapy; HR 0.61, P=0.02) and TTF2 (HR 0.66, P=0.04). The KRAS wild-type status was associated with improved OS (HR 1.68, P=0.005); no significant OS correlation was found for EGFR–IHC (HR 0.96), EGFR–FISH (HR 1.22), PTEN–IHC (HR 0.77), intron 1 (HR 0.91) or exon 13 R497K PM (HR 0.83). None of the six biomarkers correlated with the occurrence of skin rash. Conclusion: The KRAS wild-type was associated with an improved OS in erlotinib-treated PC patients in this phase 3 study; it remains to be defined whether this association is prognostic or predictive.
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Affiliation(s)
- S Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr 15, Munich D-81377, Germany.
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30
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Christoph DC, Kasper S, Gauler TC, Loesch C, Engelhard M, Theegarten D, Poettgen C, Hepp R, Peglow A, Loewendick H, Welter S, Stamatis G, Hirsch FR, Schuler M, Eberhardt WEE, Wohlschlaeger J. βV-tubulin expression is associated with outcome following taxane-based chemotherapy in non-small cell lung cancer. Br J Cancer 2012; 107:823-30. [PMID: 22836512 PMCID: PMC3425975 DOI: 10.1038/bjc.2012.324] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Tubulin-binding agents (TBAs) are effective in non-small cell lung cancer (NSCLC) treatment. Both βIII- and βV-tubulins are expressed by cancer cells and may lead to resistance against TBAs. Methods: Pre-treatment samples from 65 locally advanced or oligometastatic NSCLC patients, who underwent uniform induction chemotherapy with paclitaxel and platinum followed by radiochemotherapy with vinorelbine and platinum were retrospectively analysed by immunohistochemistry. Protein expression of βIII- and βV-tubulin was morphometrically quantified. Results: Median pre-treatment H-score for βIII-tubulin was 110 (range: 0–290), and 160 for βV-tubulin (range: 0–290). Low βIII-tubulin expression was associated with improved overall survival (OS) (P=0.0127, hazard ratio (HR): 0.328). An association between high βV-tubulin expression and prolonged progression-free survival (PFS, median 19.2 vs 9.4 months in high vs low expressors; P=0.0315, HR: 1.899) was found. Further, high βV-tubulin expression was associated with objective response (median H-score 172.5 for CR+PR vs 120 for SD+PD patients, P=0.0104) or disease control following induction chemotherapy (170 for CR+PR+SD vs 100 for PD patients, P=0.0081), but not radiochemotherapy. Conclusion: Expression of βV-tubulin was associated with treatment response and PFS following paclitaxel-based chemotherapy of locally advanced and oligometastatic NSCLC patients. Prolonged OS was associated with low levels of βIII-tubulin. Prospective evaluation of βIII/βV-tubulin expression in NSCLC is warranted.
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Affiliation(s)
- D C Christoph
- Department of Medical Oncology, West German Cancer Centre, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen 45147, Germany.
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31
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Gauler TC, Besse B, Mauguen A, Meric JB, Gounant V, Fischer B, Overbeck TR, Krissel H, Laurent D, Tiainen M, Commo F, Soria JC, Eberhardt WEE. Phase II trial of PTK787/ZK 222584 (vatalanib) administered orally once-daily or in two divided daily doses as second-line monotherapy in relapsed or progressing patients with stage IIIB/IV non-small-cell lung cancer (NSCLC). Ann Oncol 2012; 23:678-687. [PMID: 21617019 DOI: 10.1093/annonc/mdr255] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The objective of this multicenter, prospective uncontrolled phase II trial was to determine efficacy, safety and tolerability of vatalanib, an oral angiogenesis inhibitor targeting all known vascular endothelial growth factor receptors, in the second-line treatment of non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with stage IIIB/IV NSCLC-proven tumor progression during or after one platinum-based chemotherapy regimen received a fixed dose of 1250 mg vatalanib either once-daily dosing (QD) or two divided daily dosing (TDD: 500 mg a.m. + 750 mg p.m.) until disease progression or unacceptable toxicity. Primary end point was the disease control rate (DCR) at 12 weeks. RESULTS Fifty-four and 58 patients were enrolled to the QD and TDD arms. DCR at 12 weeks was 35% in the QD and 37% in the TDD arm. The best overall response included one (2%) patient with confirmed partial response with QD and three (5%) with TDD. Median progression-free survival and overall survival were 2.1/7.3 months in the QD arm and 2.8/9.0 months with TDD arm. This therapy showed a moderate toxicity profile for the majority of patients. CONCLUSIONS In the chosen patient population, vatalanib QD and TDD dosing demonstrated potential benefits in tumor size reduction, DCR, and survival.
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Affiliation(s)
- T C Gauler
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany.
| | - B Besse
- Institut Gustave Roussy, Villejuif, France
| | - A Mauguen
- Institut Gustave Roussy, Villejuif, France
| | | | | | - B Fischer
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | | | - H Krissel
- Bayer Healthcare Pharmaceuticals, Berlin, Germany
| | - D Laurent
- Bayer Healthcare Pharmaceuticals, Berlin, Germany
| | | | - F Commo
- Institut Gustave Roussy, Villejuif, France
| | - J C Soria
- Institut Gustave Roussy, Villejuif, France
| | - W E E Eberhardt
- Department of Medicine (Cancer Research), West German Tumor Center, University Hospital of University Duisburg-Essen, Essen, Germany
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32
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Abstract
UNLABELLED The therapeutic efficacy of placebo in a series of diseases has long been known. It is less well known, however, that treatment with placebo can also produce significant adverse drug reactions. Therefore, the placebo drug reactions from controlled trials were studied for the first time systematically. METHOD The efficacy and the safety of placebos were investigated using patient and drug data pooled from randomized, placebo-controlled, multicentre studies in five different groups of indications covering the therapeutic areas of cardiology (nisoldipine), neurology/psychiatry (nimodipine/ipsapirone), metabolism (acarbose) and gastroenterology (hydrotalcite). RESULTS The efficacy of placebo was clear, and varied not only between the five indication groups but also within them. Whereas placebo, unlike active treatment, produced hardly any improvement in symptoms in patients with severe stroke, it was as effective as active treatment in patients with mild neurological deficits, producing an improvement of about 50%. In patients with angina pectoris, placebo produced an increase in exercise tolerance (treadmill walking time to onset of ST-segment depression and angina attacks) of about 10% on average, compared with about 22% under active treatment (nisoldipine). In diabetes therapy, placebo produced no improvement in fasting and postprandial blood glucose levels compared with active treatment (acarbose), and also had no effect on HbA1C values. ADVERSE EFFECTS OF PLACEBO: Adverse drug reactions were observed under treatment with placebo. The frequency and type of placebo-induced adverse reactions also varied between indication groups. For example, typical cardiovascular effects such as tachycardia were observed in the control group. The placebo side effect profile was largely similar to the side effect profile of the active treatment. Some adverse drug reactions (such as "dry mouth" in patients with generalized anxiety syndromes) were observed more frequently under placebo than under active treatment. CONCLUSIONS Treatment with placebo is frequently effective and cannot therefore be considered as "non-treatment". Placebo effects can only be quantified by direct comparison with "non-treatment". Like active treatment, treatment with placebo is frequently accompanied by adverse drug reactions. Placebo adverse effects are often disease- and active treatment-specific. The effects and adverse effects of a placebo need to be known before the effects of active treatment in controlled clinical trials can be assessed. The mechanisms of placebo effects are many and varied (e.g. endorphin release, conditioning). Since the use of drugs without regard to evidence-based medicine (prescription of drugs without proven efficacy = pseudoplacebos) may clearly also result in serious adverse effects, such practice may not only be non-beneficial but may even be harmful.
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Affiliation(s)
- T R Weihrauch
- Pharmaceutical Research Center, Bayer AG, Wuppertal, Germany
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