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Ludwig H, Melchardt T, Sormann S, Schreder M, Andel J, Hartmann B, Tinchon C, Zojer N, Gunsilius E, Podar K, Egle A, Willenbacher W, Wöll E, Ruckser R, Bozic B, Krauth MT, Petzer A, Schmitt C, Machherndl-Spandl S, Agis H, Fillitz M, Wang SY, Zabernigg A, Knop S, Paiva B, Greil R. Randomized comparison between KTd and KRd induction therapy followed by maintenance therapy with K or observation in transplant-ineligible patients with newly diagnosed multiple myeloma. Am J Hematol 2024; 99:1008-1011. [PMID: 38425185 DOI: 10.1002/ajh.27280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
Randomized comparison between KTd and KRd induction followed by second randomization to carfilzomib in transplant-ineligable patients with newly diagnosed multiple myeloma.
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Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Clinic Ottakring, Wilhelminen Cancer Research Institute, Vienna, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
| | - Siegfried Sormann
- Department of Hematology, University Clinic for Internal Medicine, Graz, Austria
| | | | - Johannes Andel
- Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Bernd Hartmann
- Department of Internal Medicine II, LKH Rankweil, Rankweil, Austria
| | - Christoph Tinchon
- Department for Hematology, Oncology and Palliative Care, LKH Hochsteiermark, Standort Leoben, Standort Leoben, Austria
| | - Niklas Zojer
- Department of Medicine I, Clinic Ottakring, Vienna, Austria
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Podar
- Department of Internal Medicine II, University Hospital Krems, Krems an der Donau, Austria
- Molecular Oncology and Hematology Unit, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
- syndena GmbH, Connect to Cure, Innsbruck, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Krankenhaus Zams, Zams, Austria
| | | | - Boris Bozic
- Department of Medicine II, Clinic Donaustadt, Vienna, Austria
| | - Maria-Theresa Krauth
- University Clinic for Internal Medicine I, AKH, Medical University of Vienna, Vienna, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, BHS Linz, Linz, Austria
| | - Clemens Schmitt
- Clinic for Internal Medicine 3, Kepler University Clinic Linz, Linz, Austria
| | | | - Hermine Agis
- Department of Internal Medicine I, Division of Oncology, Medical University Vienna, Vienna, Austria
| | - Michael Fillitz
- Department of Internal Medicine, Hanusch Krankenhaus, Vienna, Austria
| | - Song-Yau Wang
- Medical Clinic and Policlinic I, University Clinic Leipzig, Leipzig, Germany
| | - August Zabernigg
- Department of Internal Medicine, Kufstein County Hospital, Kufstein, Austria
| | - Stefan Knop
- Klinik für Innere Medizin 5, Schwerpunkt Onkologie/Hämatologie, Klinikum Nürnberg Nord, Nürnberg, Germany
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, Pamplona, Spain
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
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Kiem D, Ocker M, Greil R, Neureiter D, Melchardt T. Enhancing anti-CD274 (PD-L1) targeting through combinatorial immunotherapy with bispecific antibodies and fusion proteins: from preclinical to phase II clinical trials. Expert Opin Investig Drugs 2024; 33:229-242. [PMID: 38354028 DOI: 10.1080/13543784.2024.2319317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Immune checkpoint inhibitors have achieved great success in the treatment of many different types of cancer. Programmed cell death protein ligand 1 (PD-L1, CD274) is a major immunosuppressive immune checkpoint and a target for several already approved monoclonal antibodies. Despite this, novel strategies are under development, as the overall response remains low. AREAS COVERED In this review, an overview of the current biomarkers for response to PD-L1 inhibitor treatment is given, followed by a discussion of potential novel biomarkers, including tumor mutational burden and circulating tumor DNA. Combinatorial immunotherapy is a potential novel strategy to increase the response to PD-L1 inhibitor treatment and currently, several interesting bispecific antibodies as well as bispecific fusion proteins are undergoing early clinical investigation. We focus on substances targeting PD-L1 and a secondary target, and a secondary immunomodulatory target like CTLA-4, TIGIT, or CD47. EXPERT OPINION Overall, the presented studies show anti-tumor activity of these combinatorial immunotherapeutic approaches. However, still relatively low response rates suggest a need for better biomarkers.
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Affiliation(s)
- Dominik Kiem
- III Medical Department, Paracelsus Medical University, Salzburg, Austria
| | - Matthias Ocker
- Medical Department, Division of Hematology, Oncology, and Cancer Immunology, Campus, Charité Mitte, Charité University Medicine Berlin, Berlin, Germany
- EO Translational Insights Consulting GmbH, Berlin, Germany
- Tacalyx GmbH, Berlin, Germany
| | - Richard Greil
- III Medical Department, Paracelsus Medical University, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Cancer Cluster Salzburg, Salzburg, Austria
- Institute of Pathology, Paracelsus Medical University, University Hospital Salzburg (SALK), Salzburg, Austria
| | - Thomas Melchardt
- III Medical Department, Paracelsus Medical University, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
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3
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Pleyer L, Vaisband M, Drost M, Pfeilstöcker M, Stauder R, Heibl S, Sill H, Girschikofsky M, Stampfl-Mattersberger M, Pichler A, Hartmann B, Petzer A, Schreder M, Schmitt CA, Vallet S, Melchardt T, Zebisch A, Pichler P, Zaborsky N, Machherndl-Spandl S, Wolf D, Keil F, Hasenauer J, Larcher-Senn J, Greil R. Cox proportional hazards deep neural network identifies peripheral blood complete remission to be at least equivalent to morphologic complete remission in predicting outcomes of patients treated with azacitidine-A prospective cohort study by the AGMT. Am J Hematol 2023; 98:1685-1698. [PMID: 37548390 DOI: 10.1002/ajh.27046] [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] [Received: 06/01/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
The current gold standard of response assessment in patients with myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) is morphologic complete remission (CR) and CR with incomplete count recovery (CRi), both of which require an invasive BM evaluation. Outside of clinical trials, BM evaluations are only performed in ~50% of patients during follow-up, pinpointing a clinical need for response endpoints that do not necessitate BM assessments. We define and validate a new response type termed "peripheral blood complete remission" (PB-CR) that can be determined from the differential blood count and clinical parameters without necessitating a BM assessment. We compared the predictive value of PB-CR with morphologic CR/CRi in 1441 non-selected, consecutive patients diagnosed with MDS (n = 522; 36.2%), CMML (n = 132; 9.2%), or AML (n = 787; 54.6%), included within the Austrian Myeloid Registry (aMYELOIDr; NCT04438889). Time-to-event analyses were adjusted for 17 covariates remaining in the final Cox proportional hazards (CPH) model. DeepSurv, a CPH neural network model, and permutation-based feature importance were used to validate results. 1441 patients were included. Adjusted median overall survival for patients achieving PB-CR was 22.8 months (95%CI 18.9-26.2) versus 10.4 months (95%CI 9.7-11.2) for those who did not; HR = 0.366 (95%CI 0.303-0.441; p < .0001). Among patients achieving CR, those additionally achieving PB-CR had a median adjusted OS of 32.6 months (95%CI 26.2-49.2) versus 21.7 months (95%CI 16.9-27.7; HR = 0.400 [95%CI 0.190-0.844; p = .0161]) for those who did not. Our deep neural network analysis-based findings from a large, prospective cohort study indicate that BM evaluations solely for the purpose of identifying CR/CRi can be omitted.
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Affiliation(s)
- Lisa Pleyer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Marc Vaisband
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Michael Pfeilstöcker
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 3rd Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University Vienna, Vienna, Austria
| | - Reinhard Stauder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Sonja Heibl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Heinz Sill
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Michael Girschikofsky
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
| | - Margarete Stampfl-Mattersberger
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Internal Medicine 2, Wiener Gesundheitsverbund, Klinik Donaustadt, Vienna, Austria
| | - Angelika Pichler
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Internal Medicine, Hematology and Internal Oncology, LKH Hochsteiermark, Leoben, Austria
| | - Bernd Hartmann
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Internal Medicine 2, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Andreas Petzer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Internal Medicine I: Medical Oncology and Hematology, Ordensklinikum Linz GmbH, Barmherzige Schwestern, Linz, Austria
| | - Martin Schreder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Wiener Gesundheitsverbund, Klinik Ottakring, Vienna, Austria
| | - Clemens A Schmitt
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Hematology and Internal Oncology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
- Charité-University Medical Center, Molecular Cancer Research Center, Berlin, Germany
| | - Sonia Vallet
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- University Hospital Krems, Department of Internal Medicine 2, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Thomas Melchardt
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Armin Zebisch
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Division of Hematology, Medical University of Graz, Graz, Austria
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - Petra Pichler
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Clinical Department for Internal Medicine, University Hospital St Poelten, Karl Landsteiner University of Health Sciences, St Poelten, Austria
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria
| | - Sigrid Machherndl-Spandl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
| | - Dominik Wolf
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Felix Keil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- 3rd Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University Vienna, Vienna, Austria
| | - Jan Hasenauer
- Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | | | - Richard Greil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, Vienna, Austria
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
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4
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Jansko-Gadermeir B, Leisch M, Gassner FJ, Zaborsky N, Dillinger T, Hutter S, Risch A, Melchardt T, Egle A, Drost M, Larcher-Senn J, Greil R, Pleyer L. Myeloid NGS Analyses of Paired Samples from Bone Marrow and Peripheral Blood Yield Concordant Results: A Prospective Cohort Analysis of the AGMT Study Group. Cancers (Basel) 2023; 15:cancers15082305. [PMID: 37190237 DOI: 10.3390/cancers15082305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Background: Next generation sequencing (NGS) has become indispensable for diagnosis, risk stratification, prognostication, and monitoring of response in patients with myeloid neoplasias. Guidelines require bone marrow evaluations for the above, which are often not performed outside of clinical trials, indicating a need for surrogate samples. Methods: Myeloid NGS analyses (40 genes and 29 fusion drivers) of 240 consecutive, non-selected, prospectively collected, paired bone marrow/peripheral blood samples were compared. Findings: Very strong correlation (r = 0.91, p < 0.0001), high concordance (99.6%), sensitivity (98.8%), specificity (99.9%), positive predictive value (99.8%), and negative predictive value (99.6%) between NGS analyses of paired samples was observed. A total of 9/1321 (0.68%) detected mutations were discordant, 8 of which had a variant allele frequency (VAF) ≤ 3.7%. VAFs between peripheral blood and bone marrow samples were very strongly correlated in the total cohort (r = 0.93, p = 0.0001) and in subgroups without circulating blasts (r = 0.92, p < 0.0001) or with neutropenia (r = 0.88, p < 0.0001). There was a weak correlation between the VAF of a detected mutation and the blast count in either the peripheral blood (r = 0.19) or the bone marrow (r = 0.11). Interpretation: Peripheral blood samples can be used to molecularly classify and monitor myeloid neoplasms via NGS without loss of sensitivity/specificity, even in the absence of circulating blasts or in neutropenic patients.
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Affiliation(s)
- Bettina Jansko-Gadermeir
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
- Laboratory for Molecular Cytology (MZL), 5020 Salzburg, Austria
- Department of Biosciences and Medical Biology, Allergy-Cancer-BioNano Research Centre, University of Salzburg, 5020 Salzburg, Austria
| | - Michael Leisch
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
| | - Franz J Gassner
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
| | - Thomas Dillinger
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Laboratory for Molecular Cytology (MZL), 5020 Salzburg, Austria
| | - Sonja Hutter
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Laboratory for Molecular Cytology (MZL), 5020 Salzburg, Austria
| | - Angela Risch
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Department of Biosciences and Medical Biology, Allergy-Cancer-BioNano Research Centre, University of Salzburg, 5020 Salzburg, Austria
| | - Thomas Melchardt
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
| | - Alexander Egle
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, 6020 Innsbruck, Austria
| | | | - Richard Greil
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
- Laboratory for Molecular Cytology (MZL), 5020 Salzburg, Austria
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
| | - Lisa Pleyer
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
- Laboratory for Molecular Cytology (MZL), 5020 Salzburg, Austria
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
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5
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Wagner SM, Magnes T, Melchardt T, Kiem D, Weiss L, Neureiter D, Wagner C, Aretin MB, Nemec S, Gamerith G, Pall G, Greil R, Fuereder T. Real-world Data of Palliative First-line Checkpoint Inhibitor Therapy for Head and Neck Cancer. Anticancer Res 2023; 43:1273-1282. [PMID: 36854497 DOI: 10.21873/anticanres.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND/AIM Pembrolizumab alone or combined with chemotherapy is now approved in PD-L1-positive patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). Since real-world data are pending, our goal was to evaluate the efficacy and safety of immune checkpoint inhibitor (CPI) therapy in an unselected cohort of patients with SCCHN. PATIENTS AND METHODS We analyzed 78 patients with recurrent or metastatic SCCHN from three Austrian cancer centers that received CPI therapy alone or with chemotherapy as palliative first-line systemic treatment for this retrospective study. Patient characteristics, details on treatment, and survival were analyzed by a chart-based review. RESULTS Of the 78 patients analyzed, 55 patients were treated with CPI alone (45 with Pembrolizumab, 10 with Nivolumab) and 23 patients received chemotherapy with a platinum and 5-FU in addition to CPI. With a median follow-up of twelve months, the median PFS of all patients was 4 months [95% confidence interval (CI)=2.2-5.8] and the median OS was 11 months (95% CI=7.1-14.9). The overall response and disease control rates were 20.5% and 46.1%, respectively. There was no statistically significant difference in clinical outcome between patient groups with a different combined positive score (CPS). The rate of reported immune related adverse events was comparable to existing data. CONCLUSION Our findings confirm the results of the KEYNOTE-048 trial that CPI therapy alone or together with chemotherapy is an effective treatment for patients with recurrent or metastatic CPS-positive SCCHN.
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Affiliation(s)
- Sandro M Wagner
- III Medical Department at the Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Salzburg, Austria
| | - Teresa Magnes
- III Medical Department at the Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Salzburg, Austria
| | - Thomas Melchardt
- III Medical Department at the Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Salzburg, Austria
| | - Dominik Kiem
- III Medical Department at the Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Salzburg, Austria
| | - Lukas Weiss
- III Medical Department at the Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Christina Wagner
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Nemec
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gabriele Gamerith
- Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Pall
- Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- III Medical Department at the Paracelsus Medical University, Salzburg, Austria; .,Salzburg Cancer Research Institute, Salzburg, Austria
| | - Thorsten Fuereder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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6
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Pleyer L, Heibl S, Tinchon C, Vallet S, Schreder M, Melchardt T, Stute N, Föhrenbach Quiroz KT, Leisch M, Egle A, Scagnetti L, Wolf D, Beswick R, Drost M, Larcher-Senn J, Grochtdreis T, Vaisband M, Hasenauer J, Zaborsky N, Greil R, Stauder R. Health-Related Quality of Life as Assessed by the EQ-5D-5L Predicts Outcomes of Patients Treated with Azacitidine-A Prospective Cohort Study by the AGMT. Cancers (Basel) 2023; 15:cancers15051388. [PMID: 36900181 PMCID: PMC10000211 DOI: 10.3390/cancers15051388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
In this prospective study (NCT01595295), 272 patients treated with azacitidine completed 1456 EuroQol 5-Dimension (EQ-5D) questionnaires. Linear mixed-effect modelling was used to incorporate longitudinal data. When compared with a matched reference population, myeloid patients reported more pronounced restrictions in usual activities (+28%, p < 0.0001), anxiety/depression (+21%, p < 0.0001), selfcare (+18%, p < 0.0001) and mobility (+15%, p < 0.0001), as well as lower mean EQ-5D-5L indices (0.81 vs. 0.88, p < 0.0001), and lower self-rated health on the EuroQol Visual Analogue Scale (EQ-VAS) (64 vs. 72%, p < 0.0001). After multivariate-adjustment, (i) the EQ-5D-5L index assessed at azacitidine start the predicted time with clinical benefit (TCB) (9.6 vs. 6.6 months; p = 0.0258; HR = 1.43), time to next treatment (TTNT) (12.8 vs. 9.8 months; p = 0.0332; HR = 1.42) and overall survival (OS) (17.9 vs. 12.9 months; p = 0.0143; HR = 1.52); (ii) Level Sum Score (LSS) predicted azacitidine response (p = 0.0160; OR = 0.451) and the EQ-5D-5L index showed a trend (p = 0.0627; OR = 0.522); (iii) up to 1432 longitudinally assessed EQ-5D-5L response/clinical parameter pairs revealed significant associations of EQ-5D-5L response parameters with haemoglobin level, transfusion dependence and hematologic improvement. Significant increases of the likelihood ratios were observed after addition of LSS, EQ-VAS or EQ-5D-5L-index to the International Prognostic Scoring System (IPSS) or the revised IPSS (R-IPSS), indicating that they provide added value to these scores.
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Affiliation(s)
- Lisa Pleyer
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: or ; Tel.: +43-(0)676-8997-58271
| | - Sonja Heibl
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Christoph Tinchon
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department for Hemato-Oncology, LKH Hochsteiermark, 8700 Leoben, Austria
| | - Sonia Vallet
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, 3500 Krems, Austria
| | - Martin Schreder
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Klinik Ottakring, Wiener Gesundheitsverbund, 1030 Vienna, Austria
| | - Thomas Melchardt
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Norbert Stute
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kim Tamara Föhrenbach Quiroz
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
| | - Michael Leisch
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Alexander Egle
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Scagnetti
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Dominik Wolf
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Richard Beswick
- International Marketing, Swiss Business School, 8302 Zurich, Switzerland
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, 6020 Innsbruck, Austria
| | | | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Marc Vaisband
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Jan Hasenauer
- Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
| | - Richard Greil
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Reinhard Stauder
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
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7
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Melchardt T, Egle A, Greil R. How I treat diffuse large B-cell lymphoma. ESMO Open 2023; 8:100750. [PMID: 36634531 PMCID: PMC9843196 DOI: 10.1016/j.esmoop.2022.100750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 01/11/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is usually treated with chemoimmunotherapy in curative intention at initial diagnosis. Novel agents have improved the prognosis of high-risk patients in the front-line and relapsed setting and more accurate prognostic tools enable less intensive treatment for low-risk patients, while maintaining their good prognosis. Here, we summarize our approach to DLBCL patients in the first-line setting according to their risk profile and other common challenges in clinical practice. We recommend an abbreviated course of chemoimmunotherapy in low-risk patients and a negative interim positron emission tomography. For patients with higher-risk disease, a new combination treatment with polatuzumab vedotin has been approved and is a new option in these patients. We also discuss our approach to patients with high risk for subsequent central nervous system involvement, with leg-type lymphoma or with severe comorbidities.
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Affiliation(s)
- T Melchardt
- IIIrd Medical Department at the Paracelsus Medical University Salzburg, Cancer Center, Salzburg; Salzburg Cancer Research Institute, Salzburg; Austrian Group for Medical Tumor Therapy (AGMT), Salzburg; Cancer Cluster, Salzburg, Austria
| | - A Egle
- IIIrd Medical Department at the Paracelsus Medical University Salzburg, Cancer Center, Salzburg; Salzburg Cancer Research Institute, Salzburg; Austrian Group for Medical Tumor Therapy (AGMT), Salzburg; Cancer Cluster, Salzburg, Austria
| | - R Greil
- IIIrd Medical Department at the Paracelsus Medical University Salzburg, Cancer Center, Salzburg; Salzburg Cancer Research Institute, Salzburg; Austrian Group for Medical Tumor Therapy (AGMT), Salzburg; Cancer Cluster, Salzburg, Austria.
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8
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Huemer F, Hecht S, Scharinger B, Schlintl V, Rinnerthaler G, Schlick K, Heregger R, Melchardt T, Wimmer A, Mühlbacher I, Koch OO, Neureiter D, Klieser E, Seyedinia S, Beheshti M, Greil R, Weiss L. Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04096-w. [PMID: 35864270 DOI: 10.1007/s00432-022-04096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/27/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Perioperative chemotherapy with FLOT constitutes a standard of care approach for locally advanced, resectable gastric or gastro-esophageal junction (GEJ) cancer. We aimed at investigating anthropometric, CT-based and FDG-PET-based body composition parameters and dynamics during this multidisciplinary approach and the impact on clinical outcomes. METHODS This retrospective, single-center study was based on medical records and (FDG-PET)-CT images among gastric/GEJ cancer patients undergoing perioperative FLOT chemotherapy. RESULTS Between 2016 and 2021, 46 gastric/GEJ cancer patients started perioperative FLOT at our tertiary cancer center (Salzburg, Austria). At a median follow-up of 32 months median PFS was 47.4 months and median OS was not reached. The skeletal muscle index (SMI, cm2/m2) turned out to be the only body composition parameter with a statistically significant decrease during pre-operative FLOT (51.3 versus 48.8 cm2/m2, p = 0.02). Neither pre-FLOT body mass index (BMI), nor SMI had an impact on the duration of pre-operative FLOT, the time interval from pre-operative FLOT initiation to surgery, the necessity of pre-operative or post-operative FLOT de-escalation or the likelihood of the start of postoperative chemotherapy. Pre-FLOT BMI (overweight versus normal, HR: 0.11, 95% CI: 0.02-0.65, p = 0.02) and pre-FLOT SMI (sarcopenia versus no sarcopenia, HR: 5.08, 95% CI: 1.27-20.31, p = 0.02) were statistically significantly associated with PFS in the multivariable analysis. CONCLUSION The statistically significant SMI loss during pre-operative FLOT and the meaningful impact of baseline SMI and BMI on PFS argue for the implementation of a nutritional screening and support program prior to the initiation of pre-operative FLOT in clinical routine.
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Affiliation(s)
- Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernhard Scharinger
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Verena Schlintl
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Konstantin Schlick
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ronald Heregger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Angela Wimmer
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Iris Mühlbacher
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Oliver Owen Koch
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Cancer Cluster Salzburg, Salzburg, Austria
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sara Seyedinia
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Paracelsus Medical University Salzburg, Salzburg, Austria.
- Cancer Cluster Salzburg, Salzburg, Austria.
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9
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Leisch M, Pfeilstöcker M, Stauder R, Heibl S, Sill H, Girschikofsky M, Stampfl-Mattersberger M, Tinchon C, Hartmann B, Petzer A, Schreder M, Kiesl D, Vallet S, Egle A, Melchardt T, Piringer G, Zebisch A, Machherndl-Spandl S, Wolf D, Keil F, Drost M, Greil R, Pleyer L. Adverse Events in 1406 Patients Receiving 13,780 Cycles of Azacitidine within the Austrian Registry of Hypomethylating Agents-A Prospective Cohort Study of the AGMT Study-Group. Cancers (Basel) 2022; 14:cancers14102459. [PMID: 35626063 PMCID: PMC9140081 DOI: 10.3390/cancers14102459] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Azacitidine is thus far the only drug shown to prolong overall survival and is, therefore, the recommended (backbone) treatment in patients diagnosed with myelodysplastic syndromes, chronic myelomonocytic leukemia and acute myeloid leukemia who are not eligible for intensive chemotherapy. Detailed reports on adverse events are often lacking. We performed a thorough analysis of the adverse events that occur during treatment with azacitidine in the largest cohort of patients treated with this drug published so far. We also compared the frequency of adverse events documented in our cohort to published data from randomized clinical trials with an azacitidine monotherapy arm. Adverse event documentation in the Austrian Registry was high. Hematologic adverse events occurred at a similar rate compared to published trials, whereas gastrointestinal toxicities were significantly less commonly reported. Our data complement results from clinical trials with real-world evidence and form a reference for future combination strategies with azacitidine. Abstract Background: Azacitidine is the treatment backbone for patients with acute myeloid leukemia, myelodysplastic syndromes and chronic myelomonocytic leukemia who are considered unfit for intensive chemotherapy. Detailed reports on adverse events in a real-world setting are lacking. Aims: To analyze the frequency of adverse events in the Austrian Registry of Hypomethylating agents. To compare real-world data with that of published randomized clinical trials. Results: A total of 1406 patients uniformly treated with a total of 13,780 cycles of azacitidine were analyzed. Hematologic adverse events were the most common adverse events (grade 3–4 anemia 43.4%, grade 3–4 thrombopenia 36.8%, grade 3–4 neutropenia 36.1%). Grade 3–4 anemia was significantly more common in the Registry compared to published trials. Febrile neutropenia occurred in 33.4% of patients and was also more common in the Registry than in published reports. Other commonly reported adverse events included fatigue (33.4%), pain (29.2%), pyrexia (23.5%), and injection site reactions (23.2%). Treatment termination due to an adverse event was rare (5.1%). Conclusion: The safety profile of azacitidine in clinical trials is reproducible in a real-world setting. With the use of prophylactic and concomitant medications, adverse events can be mitigated and azacitidine can be safely administered to almost all patients with few treatment discontinuations.
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Affiliation(s)
- Michael Leisch
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Michael Pfeilstöcker
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Reinhard Stauder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Sonja Heibl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Heinz Sill
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
| | - Michael Girschikofsky
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Margarete Stampfl-Mattersberger
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, Klinik Donaustadt, 1220 Vienna, Austria
| | - Christoph Tinchon
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department for Hemato-Oncology, LKH Hochsteiermark, 8700 Leoben, Austria
| | - Bernd Hartmann
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine, Landeskrankenhaus Feldkirch, 6800 Feldkirch, Austria
| | - Andreas Petzer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Medical Oncology and Hematology, Internal Medicine I, Ordensklinikum Linz GmbH Barmherzige Schwestern, 4020 Linz, Austria
| | - Martin Schreder
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Klinik Ottakring, 1160 Vienna, Austria
| | - David Kiesl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Hematology and Medical Oncology, Kepleruniversitätsklinikum, 4020 Linz, Austria
| | - Sonia Vallet
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, 3500 Krems, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Thomas Melchardt
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Gudrun Piringer
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Armin Zebisch
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Division of Hematology, Medical University of Graz, 8036 Graz, Austria
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, 8036 Graz, Austria
| | - Sigrid Machherndl-Spandl
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 1st Medical Department, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Dominik Wolf
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Felix Keil
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, 1140 Vienna, Austria
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, 6020 Innsbruck, Austria;
| | - Richard Greil
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
| | - Lisa Pleyer
- 3rd Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, 5020 Salzburg, Austria; (M.L.); (A.E.); (T.M.); (R.G.)
- Salzburg Cancer Research Institute (SCRI) Center for Clinical Cancer and Immunology Trials (CCCIT), Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Austrian Group of Medical Tumor Therapy (AGMT) Study Group, 1140 Vienna, Austria; (M.P.); (R.S.); (S.H.); (H.S.); (M.G.); (M.S.-M.); (C.T.); (B.H.); (A.P.); (M.S.); (D.K.); (S.V.); (G.P.); (A.Z.); (S.M.-S.); (D.W.); (F.K.)
- Correspondence:
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10
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Starzer AM, Heller G, Tomasich E, Melchardt T, Feldmann K, Hatziioannou T, Traint S, Minichsdorfer C, Schwarz-Nemec U, Nackenhorst M, Müllauer L, Preusser M, Berghoff AS, Fuereder T. DNA methylation profiles differ in responders versus non-responders to anti-PD-1 immune checkpoint inhibitors in patients with advanced and metastatic head and neck squamous cell carcinoma. J Immunother Cancer 2022; 10:jitc-2021-003420. [PMID: 35338086 PMCID: PMC8961155 DOI: 10.1136/jitc-2021-003420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Biomarkers for response prediction to anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors (ICI) in patients with head and neck squamous cell carcinoma (HNSCC) are urgently needed for a personalized therapy approach. We investigated the predictive potential of inflammatory parameters and DNA methylation profiling in patients with HNSCC treated with anti-PD-1 ICI. METHODS We identified patients with HNSCC that were treated with anti-PD-1 ICI therapy in the recurrent or metastatic setting after progression to platinum-based chemotherapy in two independent centers. We analyzed DNA methylation profiles of >850.000 CpG sites in tumor specimens of these patients by Infinium MethylationEPIC microarrays, immune cell density in the tumor microenvironment (CD8, CD3, CD45RO, forkhead box P3 (FOXP3), CD68), PD-1 and programmed cell death ligand 1 (PD-L1) expression by immunohistochemistry, and blood inflammation markers (platelet-to-lymphocyte ratio, leucocyte-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio). DNA methylation profiles and immunological markers were bioinformatically and statistically correlated with radiological response to anti-PD-1 ICI. RESULTS 37 patients with HNSCC (median age of 62 years; range 49-83; 8 (21.6%) women, 29 (78.4%) men) were included (Center 1 N=26, 70.3%; Center 2 N=11, 29.7%). Median number of prior systemic therapies was 1 (range 1-4). Five out of 37 (13.5%) patients achieved an objective response to ICI. Median progression-free survival and median overall survival times were 3.7 months (range 0-22.9) and 9.0 months (range 0-38.8), respectively. Microarray analyses revealed a methylation signature including both hypomethylation and hypermethylation which was predictive for response to ICI and included several genes involved in cancer-related molecular pathways. Over-represented differentially methylated genes between responders and non-responders were associated with 'Axon guidance', 'Hippo signaling', 'Pathways in cancer' and 'MAPK signaling'. A statistically significant correlation of PD-L1 expression and response was present (p=0.0498). CONCLUSIONS Our findings suggest that tumor DNA methylation profiling may be useful to predict response to ICI in patients with HNSCC.
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Affiliation(s)
- Angelika Martina Starzer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerwin Heller
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Erwin Tomasich
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Melchardt
- Laboratory for Immunological and Molecular Cancer Research, Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Katharina Feldmann
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Teresa Hatziioannou
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Traint
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Minichsdorfer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ursula Schwarz-Nemec
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maja Nackenhorst
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria .,Department of Medicine I, Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Thorsten Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
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11
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Schlintl V, Huemer F, Rinnerthaler G, Melchardt T, Winder T, Reimann P, Riedl J, Amann A, Eisterer W, Romeder F, Piringer G, Ilhan-Mutlu A, Wöll E, Greil R, Weiss L. Checkpoint inhibitors in metastatic gastric and GEJ cancer: a multi-institutional retrospective analysis of real-world data in a Western cohort. BMC Cancer 2022; 22:51. [PMID: 35012477 PMCID: PMC8744304 DOI: 10.1186/s12885-021-09115-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Safety and efficacy of immune checkpoint inhibitors in advanced gastric or gastroesophageal junction (GEJ) cancer could be demonstrated in predominantly Asian cohorts, whereas data in Western patients outside of clinical trials are vastly missing. Methods In this multi-institutional retrospective analysis conducted at nine oncologic centers in Austria, we tried to assess feasibility of checkpoint inhibitors in advanced gastric/GEJ cancer in a real-world Western cohort. Results In total, data from 50 patients with metastatic gastric/GEJ cancer who received nivolumab or pembrolizumab in a palliative setting between November 2015 and April 2020 have been evaluated. The median number of previous palliative therapy lines was two. The median progression-free survival (PFS) and overall survival (OS) were 2.1 (95% CI: 1.4–2.8) and 6.3 (95% CI: 3.3–9.3) months, respectively. There was no statistically significant difference in median OS according to microsatellite or PD-L1 status. However, a trend towards prolonged PFS and OS for the microsatellite instability high subgroup could be observed. Patients with an ECOG Performance Status (PS) ≥ 2 displayed a significantly worse outcome than those with an ECOG PS ≤ 1 (p = .03). Only one patient discontinued immunotherapy due to treatment-related toxicity. Conclusions Our results support feasibility of nivolumab and pembrolizumab in pre-treated patients with metastatic gastric and GEJ cancer in a Western real-world cohort. Further phase II/III studies are needed to confirm clinical efficacy.
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Affiliation(s)
- Verena Schlintl
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Paracelsus Medical University, Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Paracelsus Medical University, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Paracelsus Medical University, Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Paracelsus Medical University, Salzburg, Austria
| | - Thomas Winder
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Patrick Reimann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Jakob Riedl
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Arno Amann
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Eisterer
- Department of Internal Medicine and Oncology, Klagenfurt Hospital, Klagenfurt, Austria
| | - Franz Romeder
- Internal Medicine I: Department of Medical Oncology and Haematology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Gudrun Piringer
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Wels, Austria and Johannes Kepler University Linz, Linz, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine I, Comprehensive Cancer Center Vienna, Gastroesophageal Tumor Unit, Medical University of Vienna, Vienna, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Paracelsus Medical University, Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Center for Clinical Cancer and Immunology Trials (CCCIT), Paracelsus Medical University, Salzburg, Austria.
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12
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Schlick K, Markus S, Huemer F, Ratzinger L, Zaborsky N, Clemens H, Neureiter D, Neumayer B, Beate AS, Florian S, Martin V, Grundbichler M, Weiss L, Melchardt T, Greil R, Egle A. Evaluation of circulating cell-free KRAS mutational status as a molecular monitoring tool in patients with pancreatic cancer. Pancreatology 2021; 21:1466-1471. [PMID: 34511398 DOI: 10.1016/j.pan.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/06/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic carcinoma carries a devastating prognosis and is the 4th leading cause for cancer related death in the US and most European countries. Apart from imaging and CA 19-9, pancreatic carcinoma is still lacking reliable markers to assess tumor dynamics and to monitor treatment response over time. The aim of this study was to evaluate the feasibility of cell free tumor-DNA (cft-DNA), respectively KRAS mutation in peripheral blood, detection as a prognostic and predictive value for chemotherapy monitoring. METHODS Serial plasma samples from 42 patients with KRAS mutated pancreatic cancer were prospectively collected and the ctKRAS Mutation Assay (Idylla™, Biocartis, Mechelen, Belgium) of cft-DNA was performed on 29 patients that did not receive curative surgery and went on to palliative chemotherapy. To monitor cft-DNA KRAS mutation levels during treatment quantitative assessment of cft-DNA was performed at baseline and during follow up at predetermined times. RESULTS All 29 patients included in our analyses had a detected KRAS mutation in the tumor biopsy. In almost half (48.2%) of patients a KRAS mutation could also be detected in peripheral plasma. Patients with detectable KRAS mutations before treatment start in plasma had a significantly worse survival (16.8 months vs not reached, p < 0.031 and HR 3.303). Looking for a dynamic assessment of tumor response, we found a statistically significant association between the KRAS mutant ratio from first staging CT scan to basal levels with tumor response or progress (p = 0.014). CONCLUSION Performing KRAS testing from peripheral blood for patients, who have no elevated tumor markers, might be a novel option for treatment monitoring complementing routine imaging techniques.
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Affiliation(s)
- Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Steiner Markus
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Florian Huemer
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Lukas Ratzinger
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Nadja Zaborsky
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Hufnagl Clemens
- Department for Neuroinvention, Christian-Doppler-Klinik Universitätsklinik für Neurologie Paracelsus Medical University, Salzburg, Austria
| | - Daniel Neureiter
- Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bettina Neumayer
- Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Steiner Florian
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Varga Martin
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Grundbichler
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Lukas Weiss
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Richard Greil
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Laboratory for Immunological and Molecular Cancer Research (LIMCR), Salzburg, Austria; Center for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria.
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13
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Rinnerthaler G, Gampenrieder SP, Petzer A, Hubalek M, Petru E, Sandholzer M, Andel J, Balic M, Melchardt T, Hauser-Kronberger C, Schmitt CA, Ulmer H, Greil R. Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: results of a phase II trial (AGMT MBC-6). Ther Adv Med Oncol 2021; 13:17588359211042301. [PMID: 34691243 PMCID: PMC8529308 DOI: 10.1177/17588359211042301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Bendamustine, a medication approved for the treatment of indolent non-Hodgkin
lymphoma, has already shown anticancer activity in metastatic breast cancer
(MBC). Here, we present the results of a phase II trial of bendamustine in
combination with capecitabine in pre-treated patients with MBC. Patients and methods: AGMT MBC-6 is a multicentre, open-label, single-arm phase II study in
HER2-negative MBC. All patients were pre-treated with anthracyclines and/or
taxans and had measurable disease. Patients received per os
1000 mg/m2 capecitabine twice daily on days 1 to 14 in
combination with 80 mg/m2 bendamustine intravenously on days 1
and 8 of a 3-week cycle for a maximum of eight cycles, followed by a
capecitabine maintenance therapy. The primary endpoint was overall response
rate (ORR). Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian
centres. The median age was 60 years (range 29–77). Twenty-five per cent of
patients had triple-negative breast cancer (TNBC) and 93% showed visceral
involvement. With 17 partial and one complete remission, ORR was 46%. Median
progression-free survival (PFS) was 7.5 months [95% confidence interval (CI)
6.1–10.7]. The most common non-haematological adverse events (AEs) of grade
3 were hand-foot syndrome (13%), fatigue (10%), nausea (8%), and dyspnoea
(8%). One grade 4 non-haematological AE (hepatic failure) and three grade 4
haematological AEs (neutropenia) were observed. One patient died of
restrictive cardiomyopathy, in which a relationship to capecitabine cannot
be excluded, but seems unlikely. Conclusion: The combination of capecitabine and bendamustine shows promising efficacy and
moderate toxicity. Further evaluation of this drug combination is
warranted. The clinical trial AGMT MBC-6 was registered at ClinicalTrials.gov,
(https://clinicaltrials.gov/; identifier: NCT01891227).
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Affiliation(s)
- Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon Peter Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Internal Department I for Medical Oncology and Hematology, Barmherzige Schwestern Hospital/Linz, Linz, Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynaecology, Innsbruck Medical University, Innsbruck, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - Margit Sandholzer
- Department of Oncology, Hematology and Gastroenterology, Infectiology, Academic Teaching Hospital Feldkirch, Austria
| | - Johannes Andel
- Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, AustriaSalzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | | | - Clemens A Schmitt
- Department of Internal Medicine 3 - Hematology and Oncology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Hanno Ulmer
- Department of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
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14
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Kiem D, Wagner S, Magnes T, Egle A, Greil R, Melchardt T. The Role of Neutrophilic Granulocytes in Philadelphia Chromosome Negative Myeloproliferative Neoplasms. Int J Mol Sci 2021; 22:ijms22179555. [PMID: 34502471 PMCID: PMC8431305 DOI: 10.3390/ijms22179555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
Philadelphia chromosome negative myeloproliferative neoplasms (MPN) are composed of polycythemia vera (PV), essential thrombocytosis (ET), and primary myelofibrosis (PMF). The clinical picture is determined by constitutional symptoms and complications, including arterial and venous thromboembolic or hemorrhagic events. MPNs are characterized by mutations in JAK2, MPL, or CALR, with additional mutations leading to an expansion of myeloid cell lineages and, in PMF, to marrow fibrosis and cytopenias. Chronic inflammation impacting the initiation and expansion of disease in a major way has been described. Neutrophilic granulocytes play a major role in the pathogenesis of thromboembolic events via the secretion of inflammatory markers, as well as via interaction with thrombocytes and the endothelium. In this review, we discuss the molecular biology underlying myeloproliferative neoplasms and point out the central role of leukocytosis and, specifically, neutrophilic granulocytes in this group of disorders.
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Affiliation(s)
- Dominik Kiem
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (D.K.); (S.W.); (T.M.); (A.E.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Sandro Wagner
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (D.K.); (S.W.); (T.M.); (A.E.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Teresa Magnes
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (D.K.); (S.W.); (T.M.); (A.E.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Alexander Egle
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (D.K.); (S.W.); (T.M.); (A.E.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Richard Greil
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (D.K.); (S.W.); (T.M.); (A.E.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Thomas Melchardt
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (D.K.); (S.W.); (T.M.); (A.E.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-57255-25801
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15
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Heregger R, Huemer F, Hutarew G, Hecht S, Cheveresan L, Kotzot D, Schamschula E, Rinnerthaler G, Melchardt T, Weiss L, Greil R. Sustained response to brigatinib in a patient with refractory metastatic pheochromocytoma harboring R1192P anaplastic lymphoma kinase mutation: a case report from the Austrian Group Medical Tumor Therapy next-generation sequencing registry and discussion of the literature. ESMO Open 2021; 6:100233. [PMID: 34371380 PMCID: PMC8358412 DOI: 10.1016/j.esmoop.2021.100233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/21/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022] Open
Abstract
Metastatic pheochromocytoma and paraganglioma (PPGL) are rare diseases with dismal prognosis and standard therapies are lacking. We herein report the first case of a germline anaplastic lymphoma kinase (ALK) mutation in a patient with chemorefractory metastatic pheochromocytoma in the absence of mutations of known PPGL-associated predisposing genes. Therapy with the ALK inhibitor (ALKi) brigatinib led to dramatic and durable disease remission, despite previous disease progression on the ALKi alectinib. This case underscores the potential clinical use of molecular profiling in rare diseases with limited treatment options and suggests that the ALK-R1192P point mutation might predict sensitivity to brigatinib. First case of a germline ALK mutation in a patient with metastatic pheochromocytoma. Durable response to the ALKi brigatinib after disease progression on combination chemotherapy and alectinib. A germline ALK mutation in a patient with pheochromocytoma in the absence of mutations of known PPGL-associated genes.
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Affiliation(s)
- R Heregger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - G Hutarew
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - S Hecht
- Institute of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - L Cheveresan
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - D Kotzot
- Clinical Genetics Unit, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - E Schamschula
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - G Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; Austrian Group Medical Tumor Therapy, Vienna, Austria
| | - T Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria; Austrian Group Medical Tumor Therapy, Vienna, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Salzburg, Austria
| | - L Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; Austrian Group Medical Tumor Therapy, Vienna, Austria
| | - R Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; Austrian Group Medical Tumor Therapy, Vienna, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Salzburg, Austria.
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16
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Keil F, Hartl M, Altorjai G, Berghold A, Riedl R, Pecherstorfer M, Mayrbäurl B, De Vries A, Schuster J, Hackl J, Füreder T, Melchardt T, Burian M, Greil R. Docetaxel, cisplatin and 5-FU compared with docetaxel, cisplatin and cetuximab as induction chemotherapy in advanced squamous cell carcinoma of the head and neck: Results of a randomised phase II AGMT trial. Eur J Cancer 2021; 151:201-210. [PMID: 34022697 DOI: 10.1016/j.ejca.2021.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/11/2021] [Accepted: 03/27/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE Induction chemotherapy (ICT) with cisplatin (P), 5-FU (F) and taxanes (T) is a therapeutical option in patients suffering from locally advanced or unresectable stage III or IV squamous cell carcinoma of the head and neck (SCCHN). The role of ICT is controversial, and toxicity and/or delay of radiotherapy (RT) may reduce the potential benefit of this treatment regimen. Here, we report the results of a randomised phase II trial comparing TPF with TP + cetuximab (C). PATIENTS AND METHODS In this trial, 100 patients with locally advanced stage III or IV SCCHN were included in the analysis. Patients were randomly assigned to either TPF-ICT (N = 49) or TPC-ICT (N = 51), both followed by RT + C. The primary end-point of the study was overall response rate (ORR) three months after RT + C was finished. RESULTS On an intention-to-treat basis, the ORR (complete remission + partial remission) was 74.5% in the TPC arm compared with 63.3% in the TPF arm (p = 0.109). OS was similar in both arms 400 days after treatment was initiated (86.1% [95% confidence interval {CI}, 73.0-93.1%] in the TPC arm and 78.5% [95% CI, 63.7-87.8%] in the TPF arm). TPC resulted in slightly less serious adverse events and in less haematological, but more skin toxicities. Two patients randomised in the TPC arm died during ICT and RT. Four patients in the TPF arm died after completion of RT. No delay from the end of ICT to RT + C was observed. A total of 83.1% of patients (80% in the TPC arm; 86% in the TPF arm) received RT without dose reduction and/or modification. CONCLUSION TPC-containing ICT for patients with locally advanced SCCHN was found to be an effective and tolerable one-day regimen. Further prospective evidence from larger trials is warranted.
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Affiliation(s)
- Felix Keil
- Medical Dept. Int. Med. 3, Hematology and Oncology, Hanusch-Krankenhaus, Heinrich-Collin-Straße 30, Wien, A-1140, Austria.
| | - Maximilian Hartl
- Department of Otolaryngology, Head and Neck Surgery, Hospital of Bamherzigen Schwestern, Linz, Seilerstätte 4, Linz, A-4010, Austria
| | - Gabriela Altorjai
- Medical University Vienna, University Clinic of Radiation Therapy and Radiation Biology, General Hospital of Vienna, Währinger Gürtel 18-20, Wien, A-1090, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Auenbruggerplatz 2, Graz, A-8036, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Auenbruggerplatz 2, Graz, A-8036, Austria
| | - Martin Pecherstorfer
- University Clinic of Internal Medicine II, Department of Hematology and Oncology, Mitterweg 10, Krems, A-3500, Austria
| | - Beate Mayrbäurl
- Department of Internal Medicine IV, Hematology, Internal Oncology and Palliative Medicine, Nephrology and Dialysis, Hospital of Wels-Grieskirchen, Grieskirchner Straße 42, Wels, A-4600, Austria
| | - Alexander De Vries
- Radiation Therapy LKH Feldkirch, Carinagasse 47, Feldkirch, A-6807, Austria
| | - Judith Schuster
- Arbeitsgemeinschaft Medikamento¨se Tumortherapie gemeinnu¨tzige GmbH, Wolfsgartenweg 31, A-5020 Salzburg, Austria
| | - Jutta Hackl
- Kepler University Clinic of Internal Medicine II, Department of Hematology and Oncology, Krankenhausstraße 7a, Linz, A-4020, Austria
| | - Thorsten Füreder
- Medical University of Vienna, Department of Internal Medicine I & Comprehensive Cancer Center Division of Oncology, General Hospital of Vienna, Währinger Gürtel 18-20, Wien, A-1090, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
| | - Martin Burian
- Department of Otolaryngology, Head and Neck Surgery, Hospital of Bamherzigen Schwestern, Linz, Seilerstätte 4, Linz, A-4010, Austria
| | - Richard Greil
- Paracelsus Medical University, Internal Medicine III, Hematology & Medical Oncology, Mu¨llner Hauptstraße 48, A-5020 Salzburg, Austria; Salzburg Cancer Research Institute-CCCIT and Cancer Cluster Salzburg, Austria
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17
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Magnes T, Wagner S, Kiem D, Weiss L, Rinnerthaler G, Greil R, Melchardt T. Prognostic and Predictive Factors in Advanced Head and Neck Squamous Cell Carcinoma. Int J Mol Sci 2021; 22:4981. [PMID: 34067112 PMCID: PMC8125786 DOI: 10.3390/ijms22094981] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous disease arising from the mucosa of the upper aerodigestive tract. Despite multimodality treatments approximately half of all patients with locally advanced disease relapse and the prognosis of patients with recurrent or metastatic HNSCC is dismal. The introduction of checkpoint inhibitors improved the treatment options for these patients and pembrolizumab alone or in combination with a platinum and fluorouracil is now the standard of care for first-line therapy. However, approximately only one third of unselected patients respond to this combination and the response rate to checkpoint inhibitors alone is even lower. This shows that there is an urgent need to improve prognostication and prediction of treatment benefits in patients with HNSCC. In this review, we summarize the most relevant risk factors in the field and discuss their roles and limitations. The human papilloma virus (HPV) status for patients with oropharyngeal cancer and the combined positive score are the only biomarkers consistently used in clinical routine. Other factors, such as the tumor mutational burden and the immune microenvironment have been highly studied and are promising but need validation in prospective trials.
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Affiliation(s)
- Teresa Magnes
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
| | - Sandro Wagner
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
| | - Dominik Kiem
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
| | - Lukas Weiss
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Gabriel Rinnerthaler
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Richard Greil
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Thomas Melchardt
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
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18
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Magnes T, Wagner S, Thorner AR, Neureiter D, Klieser E, Rinnerthaler G, Weiss L, Huemer F, Schlick K, Zaborsky N, Steiner M, Greil R, Egle A, Melchardt T. Spatial Heterogeneity in Large Resected Diffuse Large B-Cell Lymphoma Bulks Analysed by Massively Parallel Sequencing of Multiple Synchronous Biopsies. Cancers (Basel) 2021; 13:650. [PMID: 33561953 PMCID: PMC7914762 DOI: 10.3390/cancers13040650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 11/21/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) usually needs to be treated immediately after diagnosis from a single lymph node biopsy. However, several reports in other malignancies have shown substantial spatial heterogeneity within large tumours. Therefore, we collected multiple synchronous biopsies of twelve patients that had diagnostic or therapeutic resections of large lymphoma masses and performed next-generation sequencing of 213 genes known to be important for lymphoma biology. Due to the high tumour cell content in the biopsies, we were able to detect several mutations which were present with a stable allelic frequency across all the biopsies of each patient. However, ten out of twelve patients had spatially discordant mutations and similar results were found by the analysis of copy number variants. The median Jaccard similarity coefficient, a measure of the similarity of a sample set was 0.77 (range 0.47-1), and some of the involved genes such as CARD11, CD79B, TP53, and PTEN have a known prognostic or therapeutic relevance in DLBCL. This shows that single biopsies underestimate the complexity of the disease and might overlook possible mechanisms of resistance and therapeutic targets. In the future, the broader application of liquid biopsies will have to overcome these obstacles.
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Affiliation(s)
- Teresa Magnes
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
| | - Sandro Wagner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
| | - Aaron R. Thorner
- Center for Cancer Genomics, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA;
| | - Daniel Neureiter
- Department of Pathology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (D.N.); (E.K.)
| | - Eckhard Klieser
- Department of Pathology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (D.N.); (E.K.)
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Cancer Cluster Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Cancer Cluster Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Cancer Cluster Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Konstantin Schlick
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
| | - Nadja Zaborsky
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Markus Steiner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Cancer Cluster Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Cancer Cluster Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria; (T.M.); (S.W.); (G.R.); (L.W.); (F.H.); (K.S.); (R.G.); (A.E.); (N.Z.); (M.S.)
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Müllner Hauptstraße 48, 5020 Salzburg, Austria
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19
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Pleyer L, Leisch M, Kourakli A, Padron E, Maciejewski JP, Xicoy Cirici B, Kaivers J, Ungerstedt J, Heibl S, Patiou P, Hunter AM, Mora E, Geissler K, Dimou M, Jimenez Lorenzo MJ, Melchardt T, Egle A, Viniou AN, Patel BJ, Arnan M, Valent P, Roubakis C, Bernal Del Castillo T, Galanopoulos A, Calabuig Muñoz M, Bonadies N, Medina de Almeida A, Cermak J, Jerez A, Montoro MJ, Cortés A, Avendaño Pita A, Lopez Andrade B, Hellstroem-Lindberg E, Germing U, Sekeres MA, List AF, Symeonidis A, Sanz GF, Larcher-Senn J, Greil R. Outcomes of patients with chronic myelomonocytic leukaemia treated with non-curative therapies: a retrospective cohort study. Lancet Haematol 2021; 8:e135-e148. [PMID: 33513373 DOI: 10.1016/s2352-3026(20)30374-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Approval of hypomethylating agents in patients with chronic myelomonocytic leukaemia is based on trials done in patients with myelodysplastic syndromes. We aimed to investigate whether hypomethylating agents provide a benefit in subgroups of patients with chronic myelomonocytic leukaemia compared with other treatments. METHODS For this retrospective cohort study, data were retrieved between Nov 30, 2017, and Jan 5, 2019, from 38 centres in the USA and Europe. We included non-selected, consecutive patients diagnosed with chronic myelomonocytic leukaemia, who received chronic myelomonocytic leukaemia-directed therapy. Patients with acute myeloid leukaemia according to 2016 WHO criteria at initial diagnosis (ie, ≥20% blasts in the bone marrow or peripheral blood) or with unavailability of treatment data were excluded. Outcomes assessed included overall survival, time to next treatment, and time to transformation to acute myeloid leukaemia. Analyses were adjusted by age, sex, platelet count, and Chronic myelomonocytic leukaemia-Specific Prognostic Scoring System (CPSS). Patients were grouped by first received treatment with either hydroxyurea, hypomethylating agents, or intensive chemotherapy, and stratified by risk according to blast count, French-American-British subtype, CPSS, WHO 2016 subtype, and the eligibility criteria of the DACOTA trial (NCT02214407). FINDINGS 949 patients diagnosed with chronic myelomonocytic leukaemia between April 13, 1981, and Oct 26, 2018, were included. Median follow-up was 23·4 months (IQR 11·5-42·3) from diagnosis and 16·2 months (6·6-31·6) from start of first-line treatment. 412 (43%) of 949 patients received hypomethylating agents as first treatment, 391 (41%) hydroxyurea, and 83 (9%) intensive chemotherapy. Adjusted median overall survival for patients treated with hydroxyurea versus hypomethylating agents was 15·6 months (95% CI 13·1-17·3) versus 20·7 months (17·9-23·4); hazard ratio (HR) 1·39 (1·17-1·65; p=0·0002) and 14·0 months (9·8-17·2) versus 20·7 months (17·9-23·4; HR 1·55 [1·16-2·05]; p=0·0027) for those treated with intensive chemotherapy versus hypomethylating agents. In patients with myeloproliferative chronic myelomonocytic leukaemia (myeloproliferative CMML), median overall survival was 12·6 months (10·7-15·0) versus 17·6 months (14·8-21·5; HR 1·38 [1·12-1·70]; p=0·0027) for patients treated with hydroxyurea versus hypomethylating agents, and 12·3 months (8·4-16·6) versus 17·6 months (14·8-21·5; HR 1·44 [1·02-2·03]; p=0·040) for intensive chemotherapy versus hypomethylating agents. Hypomethylating agents did not confer an overall survival advantage for patients classified as having lower-risk disease (ie, myelodysplastic chronic myelomonocytic leukaemia with <10% blasts, CMML-0, or lower-risk CPSS). INTERPRETATION These data suggest hypomethylating agents as the preferred therapy for patients with higher-risk chronic myelomonocytic leukaemia and those with myeloproliferative CMML. Our findings also suggest that CPSS is a valuable tool to identify patients who are most likely to benefit from hypomethylating agents. Further evidence from prospective cohorts would be desirable. FUNDING The Austrian Group for Medical Tumor Therapy.
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Affiliation(s)
- Lisa Pleyer
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.
| | - Michael Leisch
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Alexandra Kourakli
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Eric Padron
- Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaroslaw Pawel Maciejewski
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Blanca Xicoy Cirici
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jennifer Kaivers
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Johanna Ungerstedt
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institute, and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Peristera Patiou
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Anthony Michael Hunter
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Elvira Mora
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Klaus Geissler
- Fifth Medical Department, Hospital Hietzing, Vienna, Austria
| | - Maria Dimou
- 141st Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria-José Jimenez Lorenzo
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Thomas Melchardt
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Alexander Egle
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Athina-Nora Viniou
- 141st Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Bhumika Jayantibhai Patel
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Montserrat Arnan
- Institut Català d'Oncologia-Hospital Duran y Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Peter Valent
- Department of Internal Medicine, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Teresa Bernal Del Castillo
- Hospital Universitario Central Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University Institute of Oncology of Asturias-Cajastur Social Programme, Oviedo, Spain
| | | | | | - Nicolas Bonadies
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antonio Medina de Almeida
- Hospital da Luz, Lisbon, Portugal; Centro de Investigação Interdisciplinar em Saúde, Universidade Católica Portuguesa de Lisboa, Lisbon, Portugal
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Andrés Jerez
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB, Murcia, Spain
| | - Maria Julia Montoro
- Hematology Department, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Cortés
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Eva Hellstroem-Lindberg
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institute, and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mikkael Aaron Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan Francis List
- Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Guillermo Francisco Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigacion Biomedica en Red Cance, Instituto Carlos III, Madrid, Spain
| | | | - Richard Greil
- Third Medical Department with Hematology, Medical Oncology, Rheumatology and Infectiology, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
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20
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Magnes T, Wagner S, Thorner AR, Neureiter D, Klieser E, Rinnerthaler G, Weiss L, Huemer F, Zaborsky N, Steiner M, Weis S, Greil R, Egle A, Melchardt T. Clonal evolution in diffuse large B-cell lymphoma with central nervous system recurrence. ESMO Open 2021; 6:100012. [PMID: 33399078 PMCID: PMC7807834 DOI: 10.1016/j.esmoop.2020.100012] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The prognosis of patients with secondary central nervous system lymphoma (SCNSL) is poor and despite massive advances in understanding the mutational landscape of primary diffuse large B-cell lymphoma (DLBCL), the genetic comparison to SCNSL is still lacking. We therefore collected paired samples from six patients with DLBCL with available biopsies from a lymph node (LN) at primary diagnosis and the central nervous system (CNS) at recurrence. PATIENTS AND METHODS A targeted, massively parallel sequencing approach was used to analyze 216 genes recurrently mutated in DLBCL. Healthy tissue from each patient was also sequenced in order to exclude germline mutations. The results of the primary biopsies were compared with those of the CNS recurrences to depict the genetic background of SCNSL and evaluate clonal evolution. RESULTS Sequencing was successful in five patients, all of whom had at least one discordant mutation that was not detected in one of their samples. Four patients had mutations that were found in the CNS but not in the primary LN. Discordant mutations were found in genes known to be important in lymphoma biology such as MYC, CARD11, EP300 and CCND3. Two patients had a Jaccard similarity coefficient below 0.5 indicating substantial genetic differences between the primary LN and the CNS recurrence. CONCLUSIONS This analysis gives an insight into the genetic landscape of SCNSL and confirms the results of our previous study on patients with systemic recurrence of DLBCL with evidence of substantial clonal diversification at relapse in some patients, which might be one of the mechanisms of treatment resistance.
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Affiliation(s)
- T Magnes
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - S Wagner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - A R Thorner
- Center for Cancer Genomics, Dana-Farber Cancer Institute, Boston, USA
| | - D Neureiter
- Department of Pathology, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - E Klieser
- Department of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - G Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - L Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - F Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - N Zaborsky
- Cancer Cluster Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Salzburg, Austria
| | - M Steiner
- Cancer Cluster Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Salzburg, Austria
| | - S Weis
- Division of Neuropathology, Department of Pathology and Neuropathology, Kepler University Hospital and School of Medicine, Johannes Kepler University, Linz, Austria
| | - R Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Salzburg, Austria
| | - A Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Salzburg, Austria
| | - T Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Salzburg, Austria.
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21
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Schlick K, Hohla F, Hamacher F, Hackl H, Hufnagl C, Markus S, Magnes T, Gampenrieder SP, Melchardt T, Stättner S, Hauser-Kronberger C, Greil R, Rinnerthaler G. Overcoming negative predictions of microRNA expressions to gemcitabine response with FOLFIRINOX in advanced pancreatic cancer patients. Future Sci OA 2020; 7:FSO644. [PMID: 33437513 PMCID: PMC7787156 DOI: 10.2144/fsoa-2020-0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/18/2020] [Indexed: 01/05/2023] Open
Abstract
FOLFIRINOX is superior to gemcitabine in patients with pancreatic cancer, but this regimen is associated with toxicity and biomarkers for response are warranted. MicroRNAs can mediate drug resistance and could provide predictive information. Altered expressions of several microRNAs including miR-21-5p, miR-10b-5p and miR-34a-5p have been previously linked to a worse response to gemcitabine. We investigated the influence of expression levels in tumor tissue of those three microRNAs on outcome to FOLFIRINOX. Twenty-nine patients with sufficient formalin-fixed paraffin-embedded tumor tissue were identified. There was no significant association between high and low expression groups for these three microRNA. We conclude that polychemotherapy combination can overcome intrinsic negative prognostic factors.
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Affiliation(s)
- Konstantin Schlick
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
| | - Florian Hohla
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
| | - Frank Hamacher
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
| | - Hubert Hackl
- Division of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Hufnagl
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
| | - Steiner Markus
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Teresa Magnes
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
| | - Simon Peter Gampenrieder
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Stefan Stättner
- Department of Surgery, Salzkammergutklinikum, Standort Vöcklabruck, Oberösterreich, Austria
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Richard Greil
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology & Medical Oncology, Hemostaseology, Rheumatology & Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, Salzburg 5020, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological & Molecular Cancer Research & Center for Clinical Cancer & Immunology Trials, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
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22
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Buxhofer-Ausch V, Heibl S, Sliwa T, Beham-Schmid C, Wolf D, Geissler K, Krauth MT, Krippl P, Petzer A, Wölfler A, Melchardt T, Gisslinger H. Austrian recommendations for the management of essential thrombocythemia. Wien Klin Wochenschr 2020; 133:52-61. [PMID: 33215234 DOI: 10.1007/s00508-020-01761-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
According to the World Health Organization (WHO) classification, essential (primary) thrombocythemia (ET) is one of several Bcr-Abl negative chronic myeloproliferative neoplasms (MPN). The classical term MPN covers the subcategories of MPN: ET, polycythemia vera (PV), primary myelofibrosis (PMF), and prefibrotic PMF (pPMF). ET is marked by clonal proliferation of hematopoietic stem cells, leading to a chronic overproduction of platelets. At the molecular level a JAK2 (Janus Kinase 2), calreticulin, or MPL mutation is found in the majority of patients. Typical ongoing complications of the disease include thrombosis and hemorrhage. Primary and secondary prevention of these complications can be achieved with platelet function inhibitors and various cytoreductive drugs including anagrelide, hydroxyurea and interferon. After a long follow up, in a minority of ET patients the disease transforms into post-ET myelofibrosis or secondary leukemia. Overall, life expectancy with ET is only slightly decreased.
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Affiliation(s)
- Veronika Buxhofer-Ausch
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020, Linz, Austria. .,Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Austria.
| | - Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Thamer Sliwa
- 3rd Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Dominik Wolf
- Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Geissler
- 5th Medical Department with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Vienna, Austria
| | - Maria Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria
| | - Peter Krippl
- Department of Internal Medicine with Hematology and Oncology, Steiermärkische Krankenanstaltengesellschaft m. b. H. Krankenhausverbund Feldbach-Fürstenfeld, Fürstenfeld, Austria
| | - Andreas Petzer
- Medizinische Fakultät, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Austria.,Departments of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz, Linz, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria
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23
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Heibl S, Buxhofer-Ausch V, Schmidt S, Webersinke G, Lion T, Piringer G, Kuehr T, Wolf D, Melchardt T, Greil R, Thaler J. A phase 1 study to evaluate the feasibility and efficacy of the addition of ropeginterferon alpha-2b to imatinib treatment in patients with chronic phase chronic myeloid leukemia (CML) not achieving a deep molecular response (molecular remission 4.5)-AGMT_CML 1. Hematol Oncol 2020; 38:792-798. [PMID: 32757230 DOI: 10.1002/hon.2786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/25/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022]
Abstract
The goal of current management of patients with chronic phase chronic myeloid leukemia (CML) is to reach treatment-free remission with sustained deep molecular remission (DMR) being the prerequisite therefor. Second-generation tyrosine kinase inhibitors can induce deeper and faster remission than imatinib, but are often associated with severe adverse events (AEs). The combination of pegylated interferon (IFN) with imatinib was shown to induce higher molecular remissions than imatinib alone in two studies. Treatment discontinuation rates due to IFN induced AEs were high in both studies. To investigate safety, tolerability (primary objective), and efficacy (secondary objective) of the combination of imatinib with ropeginterferon alpha-2b this phase I study was initiated. Twelve patients were planned to be enrolled. Nine patients completed the study according to protocol. Three patients terminated the study early, one due to occurrence of a dose-limiting toxicity (neutropenia grade 3), one due to an AE (panic attacks grade 2) and one due to the patient's decision. Tolerability was good, non-hematologic AEs were mainly grade 1/2, hematologic AEs were mainly neutropenias. No new AEs were reported for the combination of imatinib and ropeginterferon alpha-2b. In a nondose-dependent manner the addition of ropeginterferon alpha-2b led to the achievement of a DMR in four out of nine patients after a treatment duration of 18 months. The combination of imatinib and ropeginterferon alpha-2b is safe and showed in this phase I study the ability to deepen the molecular response in patients with chronic phase CML not achieving a DMR with imatinib alone.
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Affiliation(s)
- Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I with Hematology, Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria.,Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Stefan Schmidt
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Gerald Webersinke
- Labor für Molekulargenetische Diagnostik, Ordensklinikum Linz GmbH Barmherzige Schwestern, Linz, Austria
| | - Thomas Lion
- Labdia Labordiagnostik GmbH, Children's Cancer Research Institute, Vienna, Austria
| | - Gudrun Piringer
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Thomas Kuehr
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Dominik Wolf
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Cancer Cluster Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria.,Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Cancer Cluster Salzburg, Salzburg, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
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24
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Abstract
Ropeginterferon alfa-2b is a novel mono-PEGylated alfa interferon. It is the first interferon approved for the treatment of patients with polycythemia vera (PV) and the first and only approved treatment for PV independent of previous hydroxyurea exposure. In contrast to other interferons, the drug has to be subcutaneously injected every 2 weeks only, with intervals of 4 weeks being possible after prolonged use. It is generally well tolerated and can lead to deep molecular responses. In this article, we provide a review of available preclinical and clinical data of ropeginterferon alfa-2b leading to its E.U. approval and give an outlook on future clinical trials involving this drug.
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Affiliation(s)
- S M Wagner
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
| | - T Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
| | - R Greil
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute-CCCIT; and Cancer Cluster Salzburg, Salzburg, Austria.
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25
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Huemer F, Leisch M, Geisberger R, Melchardt T, Rinnerthaler G, Zaborsky N, Greil R. Combination Strategies for Immune-Checkpoint Blockade and Response Prediction by Artificial Intelligence. Int J Mol Sci 2020; 21:E2856. [PMID: 32325898 PMCID: PMC7215892 DOI: 10.3390/ijms21082856] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022] Open
Abstract
The therapeutic concept of unleashing a pre-existing immune response against the tumor by the application of immune-checkpoint inhibitors (ICI) has resulted in long-term survival in advanced cancer patient subgroups. However, the majority of patients do not benefit from single-agent ICI and therefore new combination strategies are eagerly necessitated. In addition to conventional chemotherapy, kinase inhibitors as well as tumor-specific vaccinations are extensively investigated in combination with ICI to augment therapy responses. An unprecedented clinical outcome with chimeric antigen receptor (CAR-)T cell therapy has led to the approval for relapsed/refractory diffuse large B cell lymphoma and B cell acute lymphoblastic leukemia whereas response rates in solid tumors are unsatisfactory. Immune-checkpoints negatively impact CAR-T cell therapy in hematologic and solid malignancies and as a consequence provide a therapeutic target to overcome resistance. Established biomarkers such as programmed death ligand 1 (PD-L1) and tumor mutational burden (TMB) help to select patients who will benefit most from ICI, however, biomarker negativity does not exclude responses. Investigating alterations in the antigen presenting pathway as well as radiomics have the potential to determine tumor immunogenicity and response to ICI. Within this review we summarize the literature about specific combination partners for ICI and the applicability of artificial intelligence to predict ICI therapy responses.
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Affiliation(s)
- Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria; (F.H.); (M.L.); (T.M.); (G.R.)
| | - Michael Leisch
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria; (F.H.); (M.L.); (T.M.); (G.R.)
| | - Roland Geisberger
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria; (R.G.); (N.Z.)
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria; (F.H.); (M.L.); (T.M.); (G.R.)
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria; (F.H.); (M.L.); (T.M.); (G.R.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria; (R.G.); (N.Z.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria; (F.H.); (M.L.); (T.M.); (G.R.)
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria; (R.G.); (N.Z.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
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26
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Wagner SM, Melchardt T, Egle A, Magnes T, Skrabs C, Staber P, Simonitsch-Klupp I, Panny M, Lehner B, Greil R, Keil F, Jäger U, Sillaber C. Treatment with brentuximab vedotin plus bendamustine in unselected patients with CD30-positive aggressive lymphomas. Eur J Haematol 2020; 104:251-258. [PMID: 31838747 PMCID: PMC7065019 DOI: 10.1111/ejh.13368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A treatment regimen consisting of bendamustine and brentuximab vedotin (BV) has been described as a highly potent salvage therapy and as an effective induction therapy leading to high response rates before autologous stem cell transplantation (ASCT) in patients with classical Hodgkin lymphoma (cHL). In this retrospective analysis, we aimed to assess this therapy's efficacy in unselected patients with cHL and CD30+ peripheral T-cell lymphoma (PTCL). PATIENTS AND METHODS Data of 28 patients with cHL and five patients with PTCL treated with a combination of bendamustine and BV at three Austrian tertiary cancer centers were analyzed. RESULTS In patients with cHL, the ORR was 100% (78.6% CR, 21.4% PR). After 17 months median follow-up, median survival times were not reached; 1-year PFS was 81.9%, and 1-year OS was 95.7%. Thirteen eligible patients (46.4%) successfully underwent planned ASCT after salvage therapy with bendamustine and BV and subsequent high-dose chemotherapy. Three of the five PTCL patients achieved CR, while two did not respond and died during or shortly after therapy. CONCLUSION A combination of bendamustine and BV is an effective salvage and induction therapy before ASCT in patients with relapsed/refractory cHL. Further research is warranted to evaluate the use in patients with PTCL.
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Affiliation(s)
- Sandro M Wagner
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Teresa Magnes
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
| | - Cathrin Skrabs
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Philipp Staber
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Michael Panny
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus Wien, Vienna, Austria
| | - Barbara Lehner
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus Wien, Vienna, Austria
| | - Richard Greil
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Felix Keil
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus Wien, Vienna, Austria
| | - Ulrich Jäger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christian Sillaber
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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27
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Hufnagl C, Leisch M, Weiss L, Melchardt T, Moik M, Asslaber D, Roland G, Steininger P, Meissnitzer T, Neureiter D, Greil R, Egle A. Evaluation of circulating cell-free DNA as a molecular monitoring tool in patients with metastatic cancer. Oncol Lett 2019; 19:1551-1558. [PMID: 31966080 DOI: 10.3892/ol.2019.11192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/06/2019] [Indexed: 01/16/2023] Open
Abstract
The clinical decisions made when treating patients with metastatic cancer require knowledge of the current tumor extent and response to therapy. For the majority of solid tumors, a response assessment, which is based on imaging, is used to guide these decisions. However, measuring serum protein biomarkers (i.e. tumor markers) may be of additional use. Furthermore, tumor markers exhibit variable specificity and sensitivity and cannot therefore be solely relied upon when making decisions regarding cancer treatment. Therefore, there is a clinical requirement for the identification of specific, sensitive and quantitative biomarkers. In recent years, circulating cell-free DNA (cfDNA) and mutation-specific circulating cell-free tumor DNA (cftDNA) have been identified as novel potential biomarkers. In the current study, cfDNA and cftDNA were compared using imaging-based staging and current tumor markers in 15 patients with metastatic colorectal, pancreatic or breast cancer. These patients were treated at the Third Medical Department of Paracelsus Medical University Salzburg (Austria). The results of the current study demonstrated a statistically significant correlation between the concentration changes of cfDNA and cftDNA and response to treatment, which was assessed by imaging. A correlation was not indicated with current clinically used tumor markers, including carcinoembryonic antigen, carcinoma antigen 15-3 and carcinoma antigen 19-9. The present study also indicated a correlation between cfDNA and cftDNA and the tumor volume of metastatic lesions, which was not observed with the current clinically used tumor markers. In conclusion, cfDNA and cftDNA exhibit the potential to become novel biomarkers for the response assessment following cancer treatment, and may serve as a tool for the estimation of tumor volume. The current study further supports the increasingly important role of cfDNA and cftDNA as new monitoring tools for use during cancer therapy.
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Affiliation(s)
- Clemens Hufnagl
- Institute of Pathology, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria
| | - Michael Leisch
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
| | - Lukas Weiss
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
| | - Martin Moik
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
| | - Daniela Asslaber
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
| | - Geisberger Roland
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
| | - Philipp Steininger
- Institute for Research and Development on Advanced Radiation Technologies, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria
| | - Thomas Meissnitzer
- Institute of Radiology, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
| | - Alexander Egle
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, A-5020 Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, A-5020 Salzburg, Austria.,Cancer Cluster Salzburg, A-5020 Salzburg, Austria
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28
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Ludwig H, Poenisch W, Knop S, Egle A, Schreder M, Lechner D, Hajek R, Gunsilius E, Krenosz KJ, Petzer A, Weisel K, Niederwieser D, Einsele H, Willenbacher W, Melchardt T, Greil R, Zojer N. Ixazomib-Thalidomide-Dexamethasone for induction therapy followed by Ixazomib maintenance treatment in patients with relapsed/refractory multiple myeloma. Br J Cancer 2019; 121:751-757. [PMID: 31558804 PMCID: PMC6889132 DOI: 10.1038/s41416-019-0581-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/03/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background Ixazomib-revlimid-dexamethason showed significant activity in relapsed/refractory multiple myeloma (RRMM). Here, we evaluate ixazomib in combination with thalidomide and dexamethasone for induction treatment followed by ixazomib maintenance therapy in RRMM patients. Methods Ninety patients have been included. Ixazomib–thalidomide–dexamethasone (4 mg, day 1, 8, 15; 100 mg daily; and 40 mg weekly) was scheduled for eight cycles followed by maintenance with ixazomib for one year. Results The overall response rate was 51.1%, 23.3% achieved CR or VGPR and 10% MR resulting in a clinical benefit rate of 61.1%. In patients completing ≥2 cycles, the rates were 60.5%, 27.6% and 68.4%, respectively. Median progression-free survival (PFS) was 8.5 months in all, and 9.4 months in those completing ≥2 cycles. Response rates, PFS and overall survival (OS) were similar in patients with and without t(4;14) and/or del(17p), but PFS and OS was significantly shorter in patients with gain of 1q21. Multivariate regression analysis revealed gain of 1q21 as the most important factor associated with OS. Ixazomib maintenance resulted in an upgrade in the depth of response in 12.4% of patients. Grade 3/4 toxicities were relatively rare. Conclusions Ixazomib–thalidomide–dexamethasone followed by ixazomib maintenance therapy is active and well tolerated in patients with RRMM. Trial registration number NCT02410694
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria.
| | - Wolfram Poenisch
- Department of Hematology, University of Leipzig, Leipzig, Germany
| | - Stefan Knop
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Cancer Cluster Salzburg, Austria
| | - Martin Schreder
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria
| | - Daniel Lechner
- Department of Medicine I-Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Roman Hajek
- Fakultní Nemocnice Ostrava, Ostrava, Czech Republic
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Karl Jochen Krenosz
- Department of Internal Medicine 3, Kepler Universitaetsklinikum GmbH, Med Campus III, Linz, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Ordensklinikum Linz-Barmherzige Schwestern, Linz, Austria
| | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany and University of Tuebingen, Tuebingen, Germany
| | | | - Hermann Einsele
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.,Oncotyrol, Center for personalized Cancer Medicine, Innsbruck, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Cancer Cluster Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Salzburg, Cancer Cluster Salzburg, Austria
| | - Niklas Zojer
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria
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29
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Ludwig H, Pönisch W, Knop S, Egle A, Hinke A, Schreder M, Lechner D, Hajek R, Gunsilius E, Petzer A, Weisel K, Niederwieser D, Einsele H, Willenbacher W, Rumpold H, Pour L, Jelinek T, Krenosz KJ, Meckl A, Nolte S, Melchardt T, Greil R, Zojer N. Quality of life in patients with relapsed/refractory multiple myeloma during ixazomib-thalidomide-dexamethasone induction and ixazomib maintenance therapy and comparison to the general population. Leuk Lymphoma 2019; 61:377-386. [PMID: 31556753 DOI: 10.1080/10428194.2019.1666381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/20/2023]
Abstract
This trial evaluated quality of life (QoL) using the EORTC QLQ-C30 and the EORTC QLQ-MY20 instruments in 90 patients with relapsed/refractory multiple myeloma during induction and maintenance therapy with eight cycles of ixazomib-thalidomide-dexamethasone, followed by 12 months of ixazomib maintenance therapy. When patient's baseline QoL was compared with data of the general population, a significant impairment in health-related QoL, physical, role, and social functioning and several other dimensions, as well as more pain and fatigue, was noted. Induction therapy resulted in significant improvement of pain and worsening of neuropathy, with no significant variation of other parameters. During maintenance treatment, scores for most dimensions including health-related QoL, physical functioning and pain, improved, while for neuropathy no improvement was observed. Time to deterioration (≥10 score points) of health-related QoL, physical functioning, pain, and neuropathy was distinctly shorter than time to progression. Health-related QoL and physical functioning at baseline correlated with overall survival.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Wolfram Pönisch
- Department of Hematology, University of Leipzig, Leipzig, Germany
| | - Stefan Knop
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Axel Hinke
- CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Martin Schreder
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Daniel Lechner
- Department of Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Roman Hajek
- Fakultní Nemocnice Ostrava, Ostrava, Czech Republic
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Ordensklinikum Linz - Barmherzige Schwestern, Linz, Austria
| | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hermann Einsele
- Division of Hematology and Medical Oncology, Department of Internal Medicine II, Wuerzburg University Medical Center, Wuerzburg, Germany
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.,Oncotyrol, Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Holger Rumpold
- Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Karl Jochen Krenosz
- Department of Internal Medicine 3, Kepler Universitaetsklinikum GmbH, Med. Campus III, Linz, Austria
| | - Angela Meckl
- Wilhelminen Cancer Research Institute, Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
| | - Sandra Nolte
- Medical Department, Division of Psychosomatic Medicine, Charité- Universitätsmedizin, Berlin, Germany
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute - Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Austria
| | - Niklas Zojer
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria
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30
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Egle A, Jäger U, Skrabs C, Dürig J, Nösslinger T, Wanner D, Steurer M, Ringshausen I, Melchardt T, Greil R, Ysebaert L. UNMAINTAINED REMISSION AFTER DISCONTINUATION OF KINASE INHIBITOR TREATEMENT IN CHRONIC LYMPHOCYTIC LEUKEMIA: AN OBSERVATIONAL COHORT. Hematol Oncol 2019. [DOI: 10.1002/hon.33_2630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Egle
- 3rd Medical Department; Paracelsus Medical University; Salzburg Austria
| | - U. Jäger
- Dept. Internal Medicine I; Medical University Vienna; Vienna Austria
| | - C. Skrabs
- Dept. Internal Medicine I; Medical University Vienna; Vienna Austria
| | - J. Dürig
- Dept. Hematology; University Hospital Essen; Essen Germany
| | - T. Nösslinger
- 3rd Medical Department for Hematology and Oncology; Hanusch Hospital Vienna; Vienna Austria
| | - D. Wanner
- Dept. Internal Medicine V; Medical University Innsbruck; Innsbruck Austria
| | - M. Steurer
- Dept. Internal Medicine V; Medical University Innsbruck; Innsbruck Austria
| | - I. Ringshausen
- Department of Haematology; University of Cambridge; Cambridge United Kingdom
| | - T. Melchardt
- 3rd Medical Department; Paracelsus Medical University; Salzburg Austria
| | - R. Greil
- 3rd Medical Department; Paracelsus Medical University; Salzburg Austria
| | - L. Ysebaert
- Service d'Hématologie; IUCT-Oncopole; Toulouse France
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31
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Huemer F, Schlintl V, Hecht S, Hackl H, Melchardt T, Rinnerthaler G, Greil R, Weiss L. Regorafenib Is Associated With Increased Skeletal Muscle Loss Compared to TAS-102 in Metastatic Colorectal Cancer. Clin Colorectal Cancer 2019; 18:159-166.e3. [PMID: 31060856 DOI: 10.1016/j.clcc.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/15/2019] [Accepted: 04/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current guidelines of the National Comprehensive Cancer Network and the European Society of Medical Oncology recommend regorafenib or trifluridine/tipiracil (TAS-102) for third-line therapy of metastatic colorectal cancer (mCRC). We evaluated the impact of regorafenib and TAS-102 treatment on skeletal muscle dynamics and sarcopenia. PATIENTS AND METHODS This retrospective analysis was based on unselected, consecutive mCRC patients treated with regorafenib and/or TAS-102 during third or later line of therapy at our tertiary-care cancer center in Salzburg, Austria. The skeletal muscle index (SMI, cm2/m2) and sarcopenia were evaluated from cross-sectional computed tomographic images at the level of the third lumbar vertebra. RESULTS Between January 2013 and April 2018, a total of 45 patients had received regorafenib and/or TAS-102. At initial mCRC diagnosis and at initiation of third-line therapy, 24% and 54% of patients presented with sarcopenia. A statistically significant skeletal muscle loss was observed during regorafenib treatment (median SMI change: -2.75 cm2/m2 [-6.3%]; P < .0001), which was not the case during TAS-102 therapy (-1.5 cm2/m2 [-3.5%]; P = .575). Furthermore, subclassification of patients into 3 groups-normal muscle mass, stable sarcopenia, and new-onset sarcopenia-at initiation of third-line therapy permitted discrimination of overall survival, with 1-year overall survival rates of 61%, 29%, and 16%, respectively (P = .04). CONCLUSION The frequency of sarcopenia increases during the course of mCRC and negatively affects survival. In contrast to TAS-102, regorafenib is associated with increased skeletal muscle loss during mCRC treatment and should therefore be used with caution in mCRC patients with preexisting sarcopenia or a history of recent weight loss.
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Affiliation(s)
- Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Verena Schlintl
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Hubert Hackl
- Division of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology, and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute, Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University Salzburg, Salzburg, Austria.
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32
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Egle A, Melchardt T, Obrtlíková P, Smolej L, Kozák T, Steurer M, Andel J, Burgstaller S, Mikušková E, Gercheva L, Nösslinger T, Papajík T, Ladická M, Girschikofsky M, Hrubiško M, Jäger U, Voskova D, Pecherstorfer M, Králiková E, Burcoveanu C, Spasov E, Petzer A, Mihaylov G, Raynov J, Oexle H, Zabernigg A, Flochová E, Palášthy S, Stehlíková O, Doubek M, Altenhofer P, Weiss L, Magnes T, Pleyer L, Klingler A, Mayer J, Greil R. Rituximab maintenance overcomes the negative prognostic factor of obesity in CLL: Subgroup analysis of the international randomized AGMT CLL-8a mabtenance trial. Cancer Med 2019; 8:1401-1405. [PMID: 30888118 PMCID: PMC6488104 DOI: 10.1002/cam4.1980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022] Open
Abstract
No data are available regarding obesity and outcome in Chronic Lymphocytic Leukemia (CLL). We analyzed 263 patients from the AGMT CLL‐8a Mabtenance trial for the impact of obesity. The trial included patients after rituximab‐containing induction treatment in first or second line that had achieved at least a PR. A randomization to rituximab maintenance treatment (375 mg/m2 q3 months for 2 years) vs observation was performed. In this cohort 22% of the patients (58/263) were classified as obese. The baseline response to induction treatment was inferior in obese patients with a lower CR rate (43.1% vs 60.5% in obese vs non‐obese, P = 0.018) and with a lower rate of patients achieving MRD negativity after chemoimmunotherapy induction treatment (19.6% vs 35.8%, P = 0.02). The PFS outcome of obese patients was significantly worse in the observation group of the trial (24 vs 39 months median PFS, P = 0.03). However, in the rituximab maintenance group the outcome for obese vs non‐obese was not different (P = 0.4). In summary, obesity was overall associated with a worse outcome of chemoimmunotherapy induction. However, rituximab maintenance treatment seems to be able to overcome this negative effect.
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Affiliation(s)
- Alexander Egle
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Thomas Melchardt
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Petra Obrtlíková
- First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Smolej
- Fourth Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Králové, Czech Republic
| | - Tomáš Kozák
- Department of Internal Medicine - Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Steurer
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | | | - Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Eva Mikušková
- Department of Hemato-oncology 2, National Cancer Institute Bratislava, Bratislava, Slovakia
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St Marina Varna, Varna, Bulgaria
| | - Thomas Nösslinger
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus der Wiener Gebietskrankenkasse, Vienna, Austria
| | - Tomáš Papajík
- Department of Hemato-oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Miriam Ladická
- Department of Clinical Oncology 1, National Cancer Institute Bratislava, Bratislava, Slovakia
| | | | - Mikuláš Hrubiško
- Clinic of Hematology and Transfusiology, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaeology, Medical University Vienna, Vienna, Austria
| | - Daniela Voskova
- Department of Internal Medicine 3, Kepler Universitätsklinikum GmbH, Med Campus III., Linz, Austria
| | - Martin Pecherstorfer
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Eva Králiková
- Department of Hematology, FNsP F D Roosevelta Banská Bystrica, Banska Bystrica, Slovakia
| | | | - Emil Spasov
- Clinic of Hematology, UMHAT St George and Medical University Plovdiv, Plovdiv, Bulgaria
| | - Andreas Petzer
- Innere Medizin I, Ordensklinikum Linz GmbH, Linz, Austria
| | - Georgi Mihaylov
- Hematological Clinic NSHATHD Sofia, Queen Joanna University Hospital, Sofia, Bulgaria
| | - Julian Raynov
- Clinic of Medical Hematology, Military Medical Academy Sofia, Sofia, Bulgaria
| | - Horst Oexle
- Innere Medizin, Landeskrankenhaus Hall, Hall in Tirol, Austria
| | - August Zabernigg
- Innere Medizin II, Bezirkskrankenhaus Kufstein, Kufstein, Austria
| | - Emília Flochová
- Department of Hematology and Transfusion, University Hospital Martin, Martin, Slovakia
| | - Stanislav Palášthy
- Department of Clinical Hematology, FNsP, J A Reimana Prešov, Prešov, Slovakia
| | - Olga Stehlíková
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Michael Doubek
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Petra Altenhofer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lukas Weiss
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Teresa Magnes
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Jiří Mayer
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Richard Greil
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
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Huemer F, Melchardt T, Jansko B, Wahida A, Jilg S, Jost PJ, Klieser E, Steiger K, Magnes T, Pleyer L, Greil-Ressler S, Rass C, Greil R, Egle A. Durable remissions with venetoclax monotherapy in secondary AML refractory to hypomethylating agents and high expression of BCL-2 and/or BIM. Eur J Haematol 2019; 102:437-441. [PMID: 30725494 PMCID: PMC6849823 DOI: 10.1111/ejh.13218] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 02/03/2023]
Abstract
Acute myeloid leukemia (AML) is a disease of the elderly population and survival remains poor after failure of hypomethylating agents (HMA). The BCL‐2 inhibitor venetoclax demonstrated activity as monotherapy and in combination with chemotherapy or HMA in AML. In this case series, patients with secondary AML (sAML) not eligible for intensive chemotherapy and refractory to HMA were treated with venetoclax within a named patient program at our tertiary cancer center in Salzburg, Austria. Between April 2017 and September 2018, seven patients with sAML received venetoclax therapy. Two out of seven patients achieved a complete remission upon venetoclax initiation with a PFS of 505 days and 352 days and another patient achieved complete peripheral blood blast clearing within nine days after start of venetoclax. Among the venetoclax responders, primary refractory disease to prior HMA therapy was documented, 2 patients harbored IDH1/IDH2 mutations and one patient had an antecedent myeloproliferative neoplasm. High BCL‐2 and/or BIM expression in myeloblasts was found in venetoclax responders and response was significantly associated with overall survival (responders: 364 days versus non‐responders: 24 days, P = 0.018). Venetoclax monotherapy is safe and is able to induce durable responses in elderly patients with secondary AML after treatment failure with HMA.
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Affiliation(s)
- Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Bettina Jansko
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Adam Wahida
- Medizinische Klinik für Hämatologie und Internistische Onkologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefanie Jilg
- Medizinische Klinik für Hämatologie und Internistische Onkologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Philipp J Jost
- Medizinische Klinik für Hämatologie und Internistische Onkologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Katja Steiger
- Comparative Experimental Pathology and Digital Pathology, Institute of Pathology and Pathological Anatomy, Technical University of Munich, Munich, Germany
| | - Teresa Magnes
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sigrun Greil-Ressler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christof Rass
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Cancer Cluster Salzburg, Paracelsus Medical University, Salzburg, Austria
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34
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Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract OT3-07-01: Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-07-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Recently, the PARP inhibitor olaparib was approved as first targeted treatment beyond antiVEGF therapy for the BRCA1/2 mutated subgroup of TNBC. However, cytotoxic agents still remain the mainstay of treatment for this breast cancer subtype. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated as treatment of multiple myeloma. In a preclinical cell line model for TNBC the first-generation proteasome inhibitor bortezomib showed synergistic efficacy with cisplatin. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity (47% and 38% response rate, respectively) and good tolerability. In solid tumors cytotoxic effect of proteasome inhibitors is thought to be mediated through different mechanisms: (1) Inhibition of the Fanconi Anemia and BRCA1 DNA repair mechanism (2) Inhibition of p53 degradation (3) Inhibition of NF-kappa B signaling cascade. Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the oral second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC. Trial Design: Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease are eligible for this study.Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study uses an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), accrual continues to evaluate the efficacy and safety of the combination (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include safety profile, progression-free survival and quality of life. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within two years. ClinicalTrials.gov Identifier: NCT02993094
Citation Format: Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-07-01.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - S Burgstaller
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Voskova
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Rossmann
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - D Egle
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - H Rumpold
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - CF Singer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - E Petru
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - T Melchardt
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
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Krauth MT, Burgstaller S, Buxhofer-Ausch V, Gastl G, Geissler K, Keil F, Krippl P, Melchardt T, Petzer A, Rumpold H, Sliwa T, Wöhrer S, Wölfler A, Gisslinger H. Correction to: Ruxolitinib therapy formyelofibrosis in Austria : Consensus on therapy management. Wien Klin Wochenschr 2018; 131:47. [PMID: 30542777 DOI: 10.1007/s00508-018-1428-7] [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: 11/30/2022]
Abstract
Correction to:Wien Klin Wochenschr 2018 https://doi.org/10.1007/s00508-018-1365-5 The original version of this article unfortunately contained a mistake. Table Nr. 1 was inconsistent. The corrected version of Table 1 is given below. We apologize for any inconveniences this may have ….
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Affiliation(s)
- Maria-Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria.
| | - Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Günther Gastl
- Department of Internal Medicine V, Division Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Geissler
- Fifth Medical Department, Hospital Hietzing, Vienna, Austria
| | - Felix Keil
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Peter Krippl
- Department of Internal Medicine, LKH Fürstenfeld, Krankenhausverbund Feldbach, Fürstenfeld, Austria
| | - Thomas Melchardt
- Third Medical Department, Division Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Holger Rumpold
- Internal Medicine II, Medical Oncology, Hematology, Gastroenterology and Rheumatology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Thamer Sliwa
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Stefan Wöhrer
- Permedio Center for Personalized Medicine and Sanatorium Hera Vienna, Vienna, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria
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36
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Westphal T, Rinnerthaler G, Gampenrieder SP, Niebauer J, Thaler J, Pfob M, Fuchs D, Riedmann M, Mayr B, Reich B, Melchardt T, Mlineritsch B, Pleyer L, Greil R. Supervised versus autonomous exercise training in breast cancer patients: A multicenter randomized clinical trial. Cancer Med 2018; 7:5962-5972. [PMID: 30415507 PMCID: PMC6308077 DOI: 10.1002/cam4.1851] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/24/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022] Open
Abstract
Background There is a well‐known correlation between obesity, sedentary lifestyle, and breast cancer incidence and outcome. The Arbeitsgemeinschaft Medikamentöse Tumortherapie (AGMT) exercise study was a multicenter, randomized clinical trial and assessed the feasibility and efficacy of physical training in 50 breast cancer patients undergoing aromatase inhibitor treatment. Methods Postmenopausal, estrogen receptor‐positive breast cancer patients under aromatase inhibitor treatment were randomized 1:1 to counseling and unsupervised training for 48 weeks (unsupervised arm) or counseling and a sequential training (supervised arm) with a supervised phase (24 weeks) followed by unsupervised physical training (further 24 weeks). Primary endpoint was the individual maximum power output on a cycle ergometer after 24 weeks of exercise. A key secondary endpoint was the feasibility of achieving 12 METh/week (metabolic equivalent of task hours per week). Results Twenty‐three patients (92%) in the unsupervised arm and 19 patients (76%) in the supervised arm with early‐stage breast cancer completed the study. After 24 weeks, the supervised arm achieved a significantly higher maximum output in watt (mean 132 ± standard deviation [SD] 34; 95% confidence interval [CI] 117‐147) compared to baseline (107 ± 25; 95%CI 97‐117; P = 0.012) with a numerically higher output than the unsupervised arm (week 24 115 ± 25; 95%CI 105‐125; P = 0.059). Significantly higher METh/week was reported in the supervised arm compared to the unsupervised arm during the whole study period (week 1‐24 unsupervised: 18.3 (7.6‐58.3); supervised: 28.5 (6.7‐40.1); P = 0.043; week 25‐48; P = 0.041)). Conclusion This trial indicates that patients in an exercise program achieve higher fitness levels during supervised than unsupervised training.
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Affiliation(s)
- Theresa Westphal
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Simon Peter Gampenrieder
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Josef Thaler
- IVth department of Internal Medicine with Hematology and Medical Oncolocy, Klinikum Wels-Grieskirchen, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Michael Pfob
- mediFIT Wels, Medical Fitness and Training Center, Wels, Austria
| | - David Fuchs
- Department of Internal Medicine 3, Hematology and Oncology, Kepler University Hospital Med Campus III, Linz, Austria
| | - Marina Riedmann
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Mayr
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernhard Reich
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Brigitte Mlineritsch
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
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Schlick K, Magnes T, Ratzinger L, Jaud B, Weiss L, Melchardt T, Greil R, Egle A. Novel models for prediction of benefit and toxicity with FOLFIRINOX treatment of pancreatic cancer using clinically available parameters. PLoS One 2018; 13:e0206688. [PMID: 30412592 PMCID: PMC6226156 DOI: 10.1371/journal.pone.0206688] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite modern chemotherapy regimens, survival of pancreatic cancer patients remains dismal. Toxicity is a major concern and it is a challenge to upfront identify patients with the highest benefit from aggressive polychemotherapy. We aimed to evaluate ORR and side effects of the FOLFIRINOX regimen, highlighting dose modification and to explore possible prognostic response factors as a clinical tool. METHODS This retrospective study includes 123 patients with metastatic PC that were treated with FOLFIRINOX between the years 2007 to 2016 in a single academic institution. Survival rates were analysed using the Kaplan-Meier method. Prognostic models including laboratory and clinical parameters were calculated using Cox proportional models in univariate and multivariate analyses. RESULTS Median age at diagnosis was 64 years (47-78 years), 71 (57, 7%) were male and the majority had an ECOG performance status of 0 or 1 (63 patients; 83.7%). After a median follow up of 17.8 months, median progression free survival (PFS) and overall survival (OS) were 5.7 (4.55-6.84; 95%CI) and 11.8 months (9.35-14.24; 95%CI) respectively. Overall response rate with FOLFIRINOX was 34.9% and stable disease rate was 21.9%. Regarding Grade 3/4 side effects, 62 events, were reported in 37 patients. Looking at risk factors e.g. patient characteristics, tumor marker, inflammatory markers and body composition multivariate analyses proved CEA >4 elevation and BMI > 25 at the time point before palliative chemotherapy to be independent negative prognostic factors for OS. Grouping patients with no risk factor, one or two of these risk factors we analyzed a median OS of 17.4 moths, 9.6 months and 6.7 months (p<0.001) respectively. In addition we identified thrombocytosis and low BMI as predictors of early toxicity. CONCLUSION This study identifies two easily available factors influencing overall survival with FOLFIRINOX therapy. By combining these two factors to create a score for OS, we propose a prognostic tool for physicians to identify patients, who are unlikely to benefit more from FOLFIRINOX or likely to experience toxicity.
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Affiliation(s)
- Konstantin Schlick
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Teresa Magnes
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Ratzinger
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Jaud
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Weiss
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
- * E-mail:
| | - Alexander Egle
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
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Rinnerthaler G, Gampenrieder SP, Petzer A, Burgstaller S, Fuchs D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Bartsch R, Petru E, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple-negative breast cancer, a phase I/II trial of the AGMT (AGMT MBC-10 trial). BMC Cancer 2018; 18:1074. [PMID: 30400780 PMCID: PMC6220453 DOI: 10.1186/s12885-018-4979-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Up to now, no targeted treatment beyond anti-VEGF therapy has been approved for TNBC and cytotoxic agents remain the mainstay of treatment. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated in the treatment of multiple myeloma. In a preclinical study TNBC cells were treated with the first-generation proteasome inhibitor bortezomib in combination with cisplatin and synergistic efficacy was demonstrated. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity and good tolerability (Mol Cancer 11:26 2012, J Thorac Oncol 4:87–92 2009, J Thorac Oncol 7:1032–1040, 2012). Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC. Methods Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease according to RECIST criteria 1.1 are eligible for this study. Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study utilizes an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), the efficacy and safety of the combination will be further evaluated (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include progression-free survival, safety, and quality of life. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within 2 years. Discussion Based on preclinical and clinical findings an ixazomib and carboplatin combination is thought to be effective in metastatic TNBC patients. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. Trial registration EudraCT Number: 2016–001421-13 received on March 31, 2016, ClinicalTrials.gov Identifier: NCT02993094 first posted on December 15, 2016. This trial was registered prospectively.
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Affiliation(s)
- Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Simon Peter Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Internal Department I for Medical Oncology and Hematology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Sonja Burgstaller
- IVth Department of Internal Medicine with Hematology and Medical Oncolocy, Klinikum Wels-Grieskirchen, Wels, Austria
| | - David Fuchs
- Department of Internal Medicine 3 - Hematology and Oncology, Kepler University Hospital, Linz, Austria
| | - Dieter Rossmann
- 2nd Medical Department, County Hospital Steyr, Steyr, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Innsbruck Medical University, Innsbruck, Austria
| | - Holger Rumpold
- Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Department of Internal Medicine 1, Division of Oncology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynaecology, Clinical Department of Gynecology, Medical University Graz, Graz, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Hanno Ulmer
- Department of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Brigitte Mlineritsch
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.,Cancer Cluster Salzburg, Salzburg, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. .,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria. .,Cancer Cluster Salzburg, Salzburg, Austria.
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Egle A, Steurer M, Melchardt T, Weiss L, Gassner FJ, Zaborsky N, Geisberger R, Catakovic K, Hartmann TN, Pleyer L, Voskova D, Thaler J, Lang A, Girschikofsky M, Petzer A, Greil R. Correction to: Fludarabine and rituximab with escalating doses of lenalidomide followed by lenalidomide/rituximab maintenance in previously untreated chronic lymphocytic leukaemia (CLL): the REVLIRIT CLL-5 AGMT phase I/II study. Ann Hematol 2018; 97:1745. [PMID: 29934835 PMCID: PMC6828337 DOI: 10.1007/s00277-018-3403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article contained a mistake. The name of Tanja Nicole Hartman should have been Tanja Nicole Hartmann. The original article has been corrected.
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Affiliation(s)
- Alexander Egle
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Michael Steurer
- Division of Hematology and Oncology, Laboratory for Molecular Genetics and Diagnostics, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Franz Josef Gassner
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Roland Geisberger
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Kemal Catakovic
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Tanja Nicole Hartmann
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Daniela Voskova
- Centre for Hematology and Medical Oncology, Kepler University Hospital, Linz, Austria
| | - Josef Thaler
- Department for Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Alois Lang
- Internal Medicine, Hospital, Feldkirch, Austria
| | - Michael Girschikofsky
- Internal Medicine I (Hemostasis, Hematology and Stem Cell Transplantation and Medical Oncology), Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Andreas Petzer
- Department for Internal Medicine IV, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria.
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria.
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Egle A, Pleyer L, Melchardt T, Hartmann TN, Greil R. Remission maintenance treatment options in chronic lymphocytic leukemia. Cancer Treat Rev 2018; 70:56-66. [PMID: 30121491 DOI: 10.1016/j.ctrv.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
Chronic lymphocytic leukemia (CLL) treatment has come a long way in the last two decades, producing increases in tumor control to the point of generating sizeable numbers of patients with undetectable minimal residual disease and creating overall survival benefits in randomized comparisons. Most of this has been achieved by limited-term treatment approaches including chemotherapeutic and immune-therapeutic drugs. More recently, novel therapies targeting signaling pathways essential for the survival of the neoplastic clones have opened avenues that provide disease control in long-term treatment designs, mostly without producing deep remissions. In this disease, where current treatments are largely unable to effect a cure, prolonged therapy designs using maintenance approaches are explored and 5 randomized studies of maintenance have recently been published. This review shall summarize available results from a systematic literature review in a clinical context and outline basic biology principles that should be heeded in this regard.
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Affiliation(s)
- Alexander Egle
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Tanja Nicole Hartmann
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Disease, Rheumatology, Oncologic Center, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Salzburg, Austria; Salzburg Cancer Research Institute and Cancer Cluster Salzburg, Austria.
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Krauth MT, Burgstaller S, Buxhofer-Ausch V, Gastl G, Geissler K, Keil F, Krippl P, Melchardt T, Petzer A, Rumpold H, Sliwa T, Wöhrer S, Wölfler A, Gisslinger H. Ruxolitinib therapy for myelofibrosis in Austria : Consensus on therapy management. Wien Klin Wochenschr 2018; 130:495-504. [PMID: 30043249 PMCID: PMC6132876 DOI: 10.1007/s00508-018-1365-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/04/2018] [Indexed: 12/19/2022]
Abstract
The oral Janus associated kinase (JAK1/2) inhibitor ruxolitinib has been available for treatment of patients with intermediate or high-risk myelofibrosis in Europe since 2012. Since its introduction, the expertise of prescribing doctors with respect to ruxolitinib function, efficacy and adverse effects has consistently been augmented, resulting in therapy modalities that are better tailored to individual patients as well as in increased safety of the treatment. The present consensus on ruxolitinib therapy management has been elaborated by Austrian experts in myeloproliferative neoplasms in line with international treatment guidelines. Our recommendations aim to contribute to an improved management of patients with myelofibrosis treated with ruxolitinib.
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Affiliation(s)
- Maria-Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria.
| | - Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Günther Gastl
- Department of Internal Medicine V, Division Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Geissler
- Fifth Medical Department, Hospital Hietzing, Vienna, Austria
| | - Felix Keil
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Peter Krippl
- Department of Internal Medicine, LKH Fürstenfeld, Krankenhausverbund Feldbach, Fürstenfeld, Austria
| | - Thomas Melchardt
- Third Medical Department, Division Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz-Elisabethinen, Linz, Austria
| | - Holger Rumpold
- Internal Medicine II, Medical Oncology, Hematology, Gastroenterology and Rheumatology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Thamer Sliwa
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Stefan Wöhrer
- Permedio Center for Personalized Medicine and Sanatorium Hera Vienna, Vienna, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University Vienna, Vienna, Austria
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Burgstaller S, Buxhofer-Ausch V, Sliwa T, Beham-Schmid C, Gastl G, Geissler K, Melchardt T, Krauth M, Krippl P, Petzer A, Rumpold H, Wölfler A, Gisslinger H. Austrian recommendations for the management of polycythemia vera. Wien Klin Wochenschr 2018; 130:535-542. [PMID: 30027395 DOI: 10.1007/s00508-018-1359-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/22/2018] [Indexed: 01/07/2023]
Abstract
Polycythemia vera (PV) is a clonal disease arising from hematopoietic stem cells. Erythrocytosis is the hallmark of the disease but leukocytosis, thrombocytosis and splenomegaly may also be present. Thromboembolic complications occur in about 20% of patients. Circulatory disturbances as well as pruritus represent frequent symptoms of the disease. Mutations in the JAK2 gene are present in 95% of patients in exon 14 (V617F) and in 3% in exon 12. The main goal of the treatment for patients with PV is the prevention of thromboembolic events, transformation to myelofibrosis and acute myeloid leukemia. Interferon alpha and hydroxyurea are used as first-line treatment for high risk patients. For patients unresponsive to first-line therapy ruxolitinib is available.
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Affiliation(s)
- Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria.
| | | | - Thamer Sliwa
- 3rd Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Günther Gastl
- Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Geissler
- 5th Medical Department with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Vienna, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Maria Krauth
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria
| | - Peter Krippl
- Department of Internal Medicine with Hematology and Oncology, Steiermärkische Krankenanstaltengesellschaft m. b. H. Krankenhausverbund Feldbach-Fürstenfeld, Fürstenfeld, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, Ordensklinikum Barmherzige Schwestern, Linz, Austria
| | - Holger Rumpold
- Department of Internal Medicine II, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria
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Rinnerthaler G, Gampenrieder SP, Petzer A, Pusch R, Voskova D, Rossmann D, Balic M, Egle D, Rumpold H, Singer CF, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract CT160: Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with poor prognosis. Recently, the PARP inhibitor olaparib was approved as first targeted treatment beyond antiVEGF therapy for the BRCA1/2 mutated subgroup of TNBC. However, cytotoxic agents still remain the mainstay of treatment for this breast cancer subtype. Ixazomib is a selective and reversible inhibitor of the proteasome, which has been mainly investigated as treatment of multiple myeloma. In a preclinical cell line model for TNBC the first-generation proteasome inhibitor bortezomib showed synergistic efficacy with cisplatin. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity (47% and 38% response rate, respectively) and good tolerability. In solid tumors cytotoxic effect of proteasome inhibitors is thought to be mediated through different mechanisms: (1) Inhibition of the Fanconi Anemia and BRCA1 DNA repair mechanism (2) Inhibition of p53 degradation (3) Inhibition of NF-kappa B signaling cascade. Based on this evidence, the phase I/II MBC-10 trial will evaluate the toxicity profile and efficacy of the oral second-generation proteasome inhibitor ixazomib in combination with carboplatin in patients with advanced TNBC.
Trial Design: Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease are eligible for this study. Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study uses an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), accrual continues to evaluate the efficacy and safety of the combination (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include safety profile, progression-free survival and quality of life. The MBC-10 trial is accompanied by a broad biomarker program investigating predictive biomarkers for treatment response and potential resistance mechanisms to the investigational drug combination. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within two years. ClinicalTrials.gov Identifier: NCT02993094
Citation Format: Gabriel Rinnerthaler, Simon P. Gampenrieder, Andreas Petzer, Renate Pusch, Daniela Voskova, Dieter Rossmann, Marija Balic, Daniel Egle, Holger Rumpold, Christian F. Singer, Thomas Melchardt, Hanno Ulmer, Brigitte Mlineritsch, Richard Greil. Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, an ongoing phase I/II trial (AGMT MBC-10 trial) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT160.
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Affiliation(s)
- Gabriel Rinnerthaler
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon P. Gampenrieder
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Petzer
- 2Internal Department I for Medical Oncology and Hematology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Renate Pusch
- 3IVth department of Internal Medicine with Hematology and Medical Oncology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Daniela Voskova
- 43rd Medical Department, Johannes Kepler University Linz, Linz, Austria
| | - Dieter Rossmann
- 52nd Medical Department, County Hospital Steyr, Steyr, Austria
| | - Marija Balic
- 6Division of Oncology, Medical University Graz, Graz, Austria
| | - Daniel Egle
- 7Department of Obstetrics and Gynaecology, Innsbruck Medical University, Innsbruck, Austria
| | - Holger Rumpold
- 8Department of Oncology, Hematology and Gastroenterology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christian F. Singer
- 9Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Thomas Melchardt
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Hanno Ulmer
- 10Department of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Brigitte Mlineritsch
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Richard Greil
- 1IIIrd Medical Department with Hematology and Medical Oncology, Hemostseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
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Rinnerthaler G, Gampenrieder SP, Petzer A, Pusch R, Fridrik M, Rossmann D, Balic M, Egle D, Rumpold H, Singer C, Bartsch R, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract OT2-07-11: Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, a phase I/II trial (AGMT MBC-10 trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-07-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple-negative breast cancer (TNBC) comprises a heterogeneous group of diseases which are generally associated with a poor prognosis. Up to now, no targeted treatment beyond anti-VEGF therapy is approved for TNBC so far and cytotoxic agents are the mainstay for the treatment of advanced tumor stages. Ixazomib is a selective, and reversible inhibitor of the proteasome, which has been mainly investigated in the treatment of multiple myeloma. In a preclinical study triple-negative breast cancer cells were treated with bortezomib, a first generation proteaseome inhibitor, alone and in combination with cisplatin, which had a synergistic effect. Clinical data are available for carboplatin plus bortezomib in metastatic ovarian and lung cancers showing remarkable antitumor activity and good tolerability. Based on this rational, the MBC-10 trial will evaluate the toxicity profile and efficacy of ixazomib in combination with carboplatin in patients with advanced TNBC.
Trial Design: Patients with metastatic TNBC pretreated with at least one prior line of chemotherapy for advanced disease with a confirmed disease progression and measurable disease are eligible for this study. Patients will receive ixazomib in combination with carboplatin on days 1, 8, and 15 in a 28-day cycle. The phase I part of this study uses an alternate dose escalation accelerated titration design. After establishing the maximum tolerated dose (MTD), accrual continues to evaluate the efficacy and safety of the combination (phase II, including 41 evaluable patients). All patients will continue on study drugs until disease progression, unacceptable toxicity or discontinuation for any other reason. Primary endpoint of the phase II is overall response rate, secondary endpoints include safety profile, progression-free survival and quality of life. This trial is open for patient enrollment since November 2016 in six Austrian cancer centers. Accrual is planned to be completed within two years. ClinicalTrials.gov Identifier: NCT02993094
Citation Format: Rinnerthaler G, Gampenrieder SP, Petzer A, Pusch R, Fridrik M, Rossmann D, Balic M, Egle D, Rumpold H, Singer C, Bartsch R, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Ixazomib in combination with carboplatin in pretreated women with advanced triple negative breast cancer, a phase I/II trial (AGMT MBC-10 trial) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-07-11.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Pusch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Fridrik
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - D Rossmann
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - D Egle
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - H Rumpold
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - C Singer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Bartsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - T Melchardt
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Paracelsus Medical University Salzburg, Salzburg, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Klinikum Wels-Grieskirchen, Wels, Austria; Johannes Kepler University Linz, Linz, Austria; County Hospital Steyr, Steyr, Austria; Medical University Graz, Graz, Austria; Innsbruck Medical University, Innsbruck, Austria; General Hospital Feldkirch, Feldkirch, Austria; Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria; Medical University Innsbruck, Innsbruck, Austria
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Bottini GB, Steiner C, Melchardt T, Gaggl A. Multiple myeloma of the mandibular condyle: a rare presentation. Br J Oral Maxillofac Surg 2017; 55:1046-1047. [PMID: 29122338 DOI: 10.1016/j.bjoms.2017.09.016] [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] [Received: 07/11/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- G B Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Private Medical University Hospital of Salzburg, Austria.
| | - C Steiner
- Department of Oral and Maxillofacial Surgery, Paracelsus Private Medical University Hospital of Salzburg, Austria.
| | - T Melchardt
- Department of Internal Medicine III-Oncology, Paracelsus Private Medical University Hospital of Salzburg, Austria.
| | - A Gaggl
- Department of Oral and Maxillofacial Surgery, Paracelsus Private Medical University Hospital of Salzburg, Austria.
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Magnes T, Egle A, Greil R, Melchardt T. Update on squamous cell carcinoma of the head and neck: ASCO annual meeting 2017. Memo 2017; 10:220-223. [PMID: 29250200 PMCID: PMC5725515 DOI: 10.1007/s12254-017-0358-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/26/2017] [Indexed: 11/25/2022]
Abstract
At the annual ASCO meeting clinically relevant data concerning the management of advanced head and neck cancer that will influence clinical practice in the future were presented. Chemoradiation with high-dose cisplatin remains the mainstay of treatment for patients with locally advanced squamous cell head and neck cancer. Adjuvant therapy with afatinib following chemoradiation failed to show clinical benefit. The combination of bevacizumab with platinum-based chemotherapy improved progression-free survival but did not lead to a significant difference in overall survival compared to chemotherapy alone. However, the addition of immunotherapy may improve multimodal treatment concepts in locally advanced disease and new treatment combinations might overcome resistance to checkpoint inhibition.
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Affiliation(s)
- Teresa Magnes
- Third Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Alexander Egle
- Third Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Richard Greil
- Third Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Thomas Melchardt
- Third Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
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Magnes T, Melchardt T, Weiss L, Mittermair C, Neureiter D, Klieser E, Gampenrieder S, Moser G, Gaggl A, Greil R, Egle A. Prognostic score in patients with recurrent or metastatic carcinoma of the head and neck treated with cetuximab and chemotherapy. PLoS One 2017; 12:e0180995. [PMID: 28686697 PMCID: PMC5501656 DOI: 10.1371/journal.pone.0180995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/23/2017] [Indexed: 01/05/2023] Open
Abstract
Despite modern treatment approaches, survival of patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) remains low and it is difficult to identify patients who derive optimal benefit from treatment. We therefore analyzed which commonly available laboratory and clinical parameters may help improve the prognostication in this patient group. This retrospective monocenter analysis includes 128 patients with recurrent or metastatic SCCHN treated with cetuximab alone or in combination with polychemotherapy as first line therapy. Factors with independent prognostic power in the multivariate analysis were used to build up a score separating patient groups with different survival. Patients had a median age of 61 years and 103 patients were treated with polychemotherapy plus cetuximab. An ECOG score above 1, high CRP and leukocyte levels, less intensive treatment and a time below 12 months from primary diagnosis to relapse remained as independent negative prognostic factors in multivariate analysis. Patients with 0 to 1 risk factors had a median OS of 13.6 months compared to a median OS of less than one month for patients 4 to 5 risk factors (p<0.001). This study identifies 5 clinical and serum values that influence survival of patients with recurrent or metastatic SCCHN treated with cetuximab. By combining these factors to create a score for OS, it is possible to distinguish a group of patients with significantly improved survival and define those most likely to have no benefit from cetuximab treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- C-Reactive Protein/metabolism
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Cetuximab/therapeutic use
- Female
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/pathology
- Humans
- Leukocyte Count
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Research Design
- Retrospective Studies
- Squamous Cell Carcinoma of Head and Neck
- Survival Analysis
- Time Factors
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Affiliation(s)
- Teresa Magnes
- IIIrd Medical Department at the Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Thomas Melchardt
- IIIrd Medical Department at the Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Lukas Weiss
- IIIrd Medical Department at the Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Christof Mittermair
- IIIrd Medical Department at the Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology at the Paracelsus Medical University, Salzburg, Austria
| | - Eckhard Klieser
- Institute of Pathology at the Paracelsus Medical University, Salzburg, Austria
| | - Simon Gampenrieder
- IIIrd Medical Department at the Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Gerhard Moser
- Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Richard Greil
- IIIrd Medical Department at the Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
| | - Alexander Egle
- IIIrd Medical Department at the Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
- * E-mail:
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Weiss L, Melchardt T, Egle A, Hopfinger G, Hackl H, Greil R, Barth J, Rummel M. Influence of body mass index on survival in indolent and mantle cell lymphomas: analysis of the StiL NHL1 trial. Ann Hematol 2017; 96:1155-1162. [PMID: 28456850 PMCID: PMC5486799 DOI: 10.1007/s00277-017-3003-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Abstract
Obesity is a well-known risk factor for the development of cancer, but its influence on the course of disease is still controversial. We investigated the influence of body mass index (BMI) on overall survival (OS) in 502 patients with indolent non-Hodgkin’s lymphoma or mantle cell lymphoma in a subgroup analysis of the StiL (Study Group Indolent Lymphomas) NHL1 trial. We defined a cut-off of 22.55 kg/m2 by ROC calculation and Youden Index analysis and stratified patients into “low BMI” and “high BMI”. Five-year OS was significantly longer in the high BMI group (82.2%) when compared to that of the low BMI group (66.2%) (HR 0.597; 95%CI 0.370–0.963; p = 0.034). BMI was also an independent prognostic factor for OS in multivariate analysis (HR 0.541; 95%CI 0.332–0.883; p = 0.014). Of note, patients had a significantly lower BMI in the presence than patients in the absence of B-symptoms (p = 0.025). BMI significantly impacts on OS in indolent non-Hodgkin’s lymphoma and mantle cell lymphoma, which may be influenced by the effect of B-symptoms on BMI.
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Affiliation(s)
- Lukas Weiss
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Thomas Melchardt
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Alexander Egle
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Georg Hopfinger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Hubert Hackl
- Division of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Greil
- Salzburg Cancer Research Institute, Department of Internal Medicine III, Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Juergen Barth
- Medizinische Klinik IV, Hospital of the Justus-Liebig-University, Giessen, Germany
| | - Mathias Rummel
- Medizinische Klinik IV, Hospital of the Justus-Liebig-University, Giessen, Germany
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Rinnerthaler G, Gampenrieder SP, Voskova D, Petzer A, Hubalek M, Petru E, Hartmann B, Andel J, Balic M, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Abstract P5-15-13: Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: Final PFS results of a phase II trial (AGMT MBC-6). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-15-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Capecitabine is a well-established treatment option in HER2-negative advanced breast cancer (ABC) patients. Bendamustine is a generally well tolerated cytotoxic drug. Since bendamustine has already shown anticancer activity in ABC we evaluated the efficacy and tolerability of bendamustine in combination with capecitabine in pretreated patients with ABC. Here we present the final PFS results of this phase II trial.
Patients and methods: MBC-6 is a non-randomized, multicenter, open-label, single-arm phase II study in patients with HER2-negative ABC (ClinicalTrials.gov: NCT01891227). All patients were pretreated with anthracyclines and/or taxans and had measurable disease according to RECIST 1.1. Patients received 1000 mg/m2 capecitabine twice daily on days 1 to 14 in combination with 80 mg/m2 bendamustine on day 1 and 8 of a 3-week cycle for a maximum of 6 cycles. Afterwards capecitabine was continued as monotherapy. The primary endpoint was overall response rate (ORR). Secondary endpoints were progression-free survival (PFS), clinical benefit rate (CBR), safety and quality of life.
Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian centers. Median age was 60 years (range 29-77). Twenty-five percent of patients had triple-negative disease (TNBC) and 93% showed visceral involvement. Sixty-five percent had received prior chemotherapy in the (neo)adjuvant setting and 63% for ABC (43% one line, 15% two lines, 5% three lines). All patients with ER-positive disease had received prior endocrine therapy.At data cut-off on 06/08/16 overall 39 of 40 patients had discontinued treatment with a median PFS of 7.0 months (95% CI 4.6-9.5), 7.4 months in ER-positive and 4.0 months in triple negative disease (TNBC), respectively. Twelve patients (30%) experienced at least one drug related non-hematological AE ≥ grade 3 during combination treatment and further 6 patients (15%) during capecitabine maintenance. Three grade 4 hematological AEs (neutropenia) were observed. One patient died as a result of restrictive cardiomyopathy, where a relationship to capecitabine cannot be excluded, but seems unlikely.
Conclusion: The combination of capecitabine and bendamustine shows promising efficacy and a moderate toxicity profile. Further evaluation of this drug combination is warranted.Background: Capecitabine is a well-established treatment option in HER2-negative advanced breast cancer (ABC) patients. Bendamustine is a generally well tolerated cytotoxic drug. Since bendamustine has already shown anticancer activity in ABC we evaluated the efficacy and tolerability of bendamustine in combination with capecitabine in pretreated patients with ABC. Here we present the final PFS results of this phase II trial.
Patients and methods: MBC-6 is a non-randomized, multicenter, open-label, single-arm phase II study in patients with HER2-negative ABC (ClinicalTrials.gov: NCT01891227). All patients were pretreated with anthracyclines and/or taxans and had measurable disease according to RECIST 1.1. Patients received 1000 mg/m2 capecitabine twice daily on days 1 to 14 in combination with 80 mg/m2 bendamustine on day 1 and 8 of a 3-week cycle for a maximum of 6 cycles. Afterwards capecitabine was continued as monotherapy. The primary endpoint was overall response rate (ORR). Secondary endpoints were progression-free survival (PFS), clinical benefit rate (CBR), safety and quality of life.
Results: From September 2013 to May 2015, 40 patients were recruited in eight Austrian centers. Median age was 60 years (range 29-77). Twenty-five percent of patients had triple-negative disease (TNBC) and 93% showed visceral involvement. Sixty-five percent had received prior chemotherapy in the (neo)adjuvant setting and 63% for ABC (43% one line, 15% two lines, 5% three lines). All patients with ER-positive disease had received prior endocrine therapy.At data cut-off on 06/08/16 overall 39 of 40 patients had discontinued treatment with a median PFS of 7.0 months (95% CI 4.6-9.5), 7.4 months in ER-positive and 4.0 months in triple negative disease (TNBC), respectively. Twelve patients (30%) experienced at least one drug related non-hematological AE ≥ grade 3 during combination treatment and further 6 patients (15%) during capecitabine maintenance. Three grade 4 hematological AEs (neutropenia) were observed. One patient died as a result of restrictive cardiomyopathy, where a relationship to capecitabine cannot be excluded, but seems unlikely.
Conclusion: The combination of capecitabine and bendamustine shows promising efficacy and a moderate toxicity profile. Further evaluation of this drug combination is warranted.
Citation Format: Rinnerthaler G, Gampenrieder SP, Voskova D, Petzer A, Hubalek M, Petru E, Hartmann B, Andel J, Balic M, Melchardt T, Ulmer H, Mlineritsch B, Greil R. Capecitabine in combination with bendamustine in pretreated women with HER2-negative metastatic breast cancer: Final PFS results of a phase II trial (AGMT MBC-6) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-15-13.
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Affiliation(s)
- G Rinnerthaler
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - SP Gampenrieder
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - D Voskova
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - A Petzer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Hubalek
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - E Petru
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - B Hartmann
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - J Andel
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - M Balic
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - T Melchardt
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - H Ulmer
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - B Mlineritsch
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
| | - R Greil
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Cancer Cluster Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Kepler University Linz, Linz, Austria; Barmherzige Schwestern Hospital Linz, Linz, Austria; Innsbruck Medical University, Innsbruck, Austria; Medical University Graz, Graz, Austria; General Hospital Feldkirch, Feldkirch, Austria; County Hospital Steyr, Steyr, Austria; Medical University Innsbruck, Innsbruck, Austria
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Kazianka L, Drucker C, Skrabs C, Thomas W, Melchardt T, Struve S, Bergmann M, Staber PB, Porpaczy E, Einberger C, Heinz M, Hauswirth A, Raderer M, Pabinger I, Thalhammer R, Egle A, Wendtner CM, Follows G, Hoermann G, Quehenberger P, Jilma B, Jaeger U. Ristocetin-induced platelet aggregation for monitoring of bleeding tendency in CLL treated with ibrutinib. Leukemia 2016; 31:1117-1122. [PMID: 27909342 PMCID: PMC5338745 DOI: 10.1038/leu.2016.316] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 05/10/2016] [Revised: 09/28/2016] [Accepted: 10/05/2016] [Indexed: 12/11/2022]
Abstract
Bleeding because of impaired platelet function is a major side effect of the Bruton's tyrosine kinase (BTK) inhibitor ibrutinib. We quantitatively assessed ristocetin-induced platelet aggregation (RIPA) in 64 patients with chronic lymphocytic leukemia (CLL) under ibrutinib at 287 time points. Eighty-seven bleeding episodes in 39 patients were registered (85 Common Toxicity Criteria (CTC) grade 1 or 2, 2 CTC grade 3) during a median observation period of 10.9 months. At times of bleeding, RIPA values were significantly lower (14 vs 28 U; P<0.0001). RIPA was impaired in patients receiving concomitant antiplatelet therapy or anticoagulation (14 vs 25 U, P=0.005). A gradual decline of median RIPA values was observed with increasing bleeding severity. Importantly, no CTC grade 2 or 3 bleeding were observed with RIPA values of >36 U. Sequential monitoring indicated a decrease of RIPA values from a median of 17 to 9 U within 2 weeks after initiation of treatment as well as an increase above the critical threshold of 36 U within 7 days when ibrutinib was paused. Low RIPA values were similar during treatment with another BTK inhibitor, CC292. Quantitative assessment of platelet function is a practical tool to monitor bleeding tendency under BTK-inhibitor therapy.
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Affiliation(s)
- L Kazianka
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C Drucker
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - C Skrabs
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - W Thomas
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - T Melchardt
- Department of Medicine III, Paracelsus Medical University, Salzburg, Austria
| | - S Struve
- Klinikum Schwabing, Academic Teaching Hospital of the University of Munich, Munich, Germany
| | - M Bergmann
- Klinikum Schwabing, Academic Teaching Hospital of the University of Munich, Munich, Germany
| | - P B Staber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - E Porpaczy
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C Einberger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Heinz
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - A Hauswirth
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Raderer
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - I Pabinger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - R Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - A Egle
- Department of Medicine III, Paracelsus Medical University, Salzburg, Austria
| | - C-M Wendtner
- Klinikum Schwabing, Academic Teaching Hospital of the University of Munich, Munich, Germany
| | - G Follows
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - G Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - P Quehenberger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - B Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - U Jaeger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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