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Vogl UM, Testi I, De Santis M. Front-line Platinum Continues To Have a Role in Advanced Bladder Cancer. Eur Urol Focus 2024:S2405-4569(24)00049-X. [PMID: 38582643 DOI: 10.1016/j.euf.2024.03.005] [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: 02/20/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/08/2024]
Abstract
Cisplatin remains a valid option in muscle-invasive or metastatic urothelial carcinoma, and is even more efficient when nivolumab is added. The well-known side-effect profile and the limited number of treatment cycles represent great advantages over modern drug combinations such as enfortumab-vedotin plus pembrolizumab.
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Affiliation(s)
- Ursula M Vogl
- Oncology Institute of Southern Switzerland EOC, Bellinzona, Switzerland.
| | - Irene Testi
- Oncology Institute of Southern Switzerland EOC, Bellinzona, Switzerland; Medical Oncology Unit, University Hospital Parma, Parma, Italy
| | - Maria De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Medical University Vienna, Austria
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Çakar E, Oniangue-Ndza C, Schneider RP, Klijn SL, Vogl UM, Rothermundt C, May JR. Cost-Effectiveness of Nivolumab Plus Ipilimumab for the First-Line Treatment of Intermediate/Poor-Risk Advanced and/or Metastatic Renal Cell Carcinoma in Switzerland. Pharmacoecon Open 2023:10.1007/s41669-023-00395-1. [PMID: 36757568 DOI: 10.1007/s41669-023-00395-1] [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] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This study assessed the cost-effectiveness of nivolumab plus ipilimumab versus both sunitinib and pazopanib for the treatment of first-line unresectable advanced renal cell carcinoma (aRCC) from a healthcare system perspective in Switzerland. METHODS A three-state partitioned survival model, consisting of progression-free, progressed disease, and death, was constructed. Efficacy estimates were based on data from the CheckMate 214 trial (NCT02231749) with a minimum follow-up of 42 months. Two Swiss oncologists were consulted to determine disease management resource use. Costs were derived from the Swiss tariff lists for outpatient (TARMED Online Browser 1.09) and inpatient (2020 data from Swiss diagnosis-related groups) treatments. Drug acquisition costs (ex-factory prices) were obtained from the March 2020 price list published by the Swiss Federal Office of Public Health. Treatment-specific EQ-5D-3L-based utilities were derived from CheckMate 214 using a French value set as a proxy for Switzerland. The model utilized a 1-week cycle length and a 40-year time horizon, with costs and effects discounted by 3.0% per annum. One-way sensitivity analyses, probabilistic analysis, and scenario analyses assessed the robustness of the results. RESULTS Nivolumab plus ipilimumab yielded incremental 1.43 life-years and 1.36 lifetime discounted quality-adjusted life-years (QALYs) relative to sunitinib and pazopanib at an additional cost of 147,453 Swiss Francs (CHF) and CHF145,643, respectively. With an incremental cost-utility ratio of CHF108,326 per QALY gained versus sunitinib, and CHF106,996 per QALY gained versus pazopanib, the nivolumab plus ipilimumab combination can be considered a cost-effective option for the treatment of patients with aRCC in Switzerland, with a willingness-to-pay threshold of CHF200,000. Sensitivity and scenario analyses confirmed the robustness of the deterministic results. CONCLUSIONS This study showed that nivolumab plus ipilimumab, which represents one of the standard-of-care first-line treatments for intermediate- or poor-risk aRCC patients, is a life-extending and cost-effective treatment option for patients in Switzerland.
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Affiliation(s)
| | - César Oniangue-Ndza
- Bristol Myers Squibb SA, Hinterbergstrasse 16, 6330, Steinhausen, Switzerland.
| | - Ralph P Schneider
- Bristol Myers Squibb SA, Hinterbergstrasse 16, 6330, Steinhausen, Switzerland
| | | | - Ursula M Vogl
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Christian Rothermundt
- Klinik für Medizinische Onkologie und Hämatologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Vogl UM, Beer TM, Davis ID, Shore ND, Sweeney CJ, Ost P, Attard G, Bossi A, de Bono J, Drake CG, Efstathiou E, Fanti S, Fizazi K, Halabi S, James N, Mottet N, Padhani AR, Roach M, Rubin M, Sartor O, Small E, Smith MR, Soule H, Sydes MR, Tombal B, Omlin A, Gillessen S. Lack of consensus identifies important areas for future clinical research: Advanced Prostate Cancer Consensus Conference (APCCC) 2019 findings. Eur J Cancer 2022; 160:24-60. [PMID: 34844839 DOI: 10.1016/j.ejca.2021.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Innovations in treatments, imaging and molecular characterisation have improved outcomes for people with advanced prostate cancer; however, many aspects of clinical management are devoid of high-level evidence. At the Advanced Prostate Cancer Consensus Conference (APCCC) 2019, many of these topics were addressed, and consensus was not always reached. The results from clinical trials will most reliably plus the gaps. METHODS An invited panel of 57 experts voted on 123 multiple-choice questions on clinical management at APCCC 2019. No consensus was reached on 88 (71.5%) questions defined as <75% of panellists voting for the same answer option. We reviewed clinicaltrials.gov to identify relevant ongoing phase III trials in these areas of non-consensus. RESULTS A number of ongoing phase III trials were identified that are relevant to these non-consensus issues. However, many non-consensus issues appear not to be addressed by current clinical trials. Of note, no phase III but only phase II trials were identified, investigating side effects of hormonal treatments and their management. CONCLUSIONS Lack of consensus almost invariably indicates gaps in existing evidence. The high percentage of questions lacking consensus at APCCC 2019 highlights the complexity of advanced prostate cancer care and the need for robust, clinically relevant trials that can fill current gaps with high-level evidence. Our review of these areas of non-consensus and ongoing trials provides a useful summary, indicating areas in which future consensus may soon be reached. This review may facilitate academic investigators to identify and prioritise topics for future research.
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Affiliation(s)
- Ursula M Vogl
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Christopher J Sweeney
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Piet Ost
- Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Alberto Bossi
- Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Johann de Bono
- The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Charles G Drake
- Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | | | - Anwar R Padhani
- Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mark Rubin
- Bern Center for Precision Medicine, Bern, Switzerland; Department for Biomedical Research, University of Bern, Bern, Switzerland
| | | | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew R Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Aurelius Omlin
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; University of Bern, Bern, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland; Division of Cancer Science, University of Manchester, Manchester, UK.
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Vogl UM, Vormittag L, Winkler T, Kafka A, Weiser-Jasch O, Heinrich B, Roider-Schur S, Andalibi H, Autzinger E, Schima W, Klaus A, Zacherl J, Wimberger GM, Öhler L. Ramucirumab plus paclitaxel or FOLFIRI in platinum-refractory advanced or metastatic gastric or gastroesophageal junction adenocarcinoma-experience at two centres. J Gastrointest Oncol 2020; 11:366-375. [PMID: 32399277 DOI: 10.21037/jgo.2020.03.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Ramucirumab is a VEGFR-2 antibody that has proven to prolong overall survival (OS) in patients with pretreated metastatic gastric/gastrooesophageal junction (GEJ) adenocarcinoma. We present data from patients treated with ramucirumab and paclitaxel or FOLFIRI after failure of at least one platinum- and 5-FU-containing chemotherapy (CHT) regimen. Methods In this retrospective two-center study, 56 patients with metastatic gastric cancer (47%) or adenocarcinoma of the GEJ (53%) were treated with paclitaxel and ramucirumab (n=38) as second-line (75%) or beyond second-line (25%) therapy. FOLFIRI-ramucirumab (FOLFIRI-R) (n=16) was given to patients with a short interval between taxane-based perioperative CHT and occurrence of metastatic disease or to those ineligible for paclitaxel. Results The median progression-free survival (PFS) and OS for patients treated with paclitaxel-ramucirumab (pacl-R) were 2.9 (95% CI: 2.3-3.6) and 4.4 (4.1-4.7) months, respectively, and those for patients treated with FOLFIRI-R were 5.9 (95% CI: 0.35-11.4) and 8.3 (6.6-10) months, respectively (P=0.05). We observed a trend towards prolonged PFS after perioperative taxane-based FLOT CHT (n=12) with FOLFIRI-R compared with pacl-R. Adverse events were manageable, with neutropenia and polyneuropathy (PNP) being the most common events. More than two treatment lines were given to 48.2% of patients. Conclusions The use of ramucirumab in combination with FOLFIRI showed favourable PFS and OS in patients with prior treatments with platinum and/or taxane-based agents and allows further treatment lines after progression. In patients with taxane pretreatment or persistent high-grade PNP, the combination of FOLFIRI-R might be a promising combination.
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Affiliation(s)
- Ursula M Vogl
- Department of Medicine I, Oncology, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria
| | - Laurenz Vormittag
- Department of Medicine I, Oncology, St. Josef Krankenhaus, Vienna, Austria
| | - Thomas Winkler
- Department of Medicine I, Oncology, St. Josef Krankenhaus, Vienna, Austria
| | - Alice Kafka
- Department of Medicine I, Oncology, St. Josef Krankenhaus, Vienna, Austria
| | | | - Bettina Heinrich
- Department of Medicine I, Oncology, St. Josef Krankenhaus, Vienna, Austria
| | | | - Haleh Andalibi
- Department of Medicine I, Oncology, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria
| | - Eva Autzinger
- Department of Medicine I, Oncology, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Barmherzige Schwestern Krankenhaus Wien, St. Josef Krankenhaus and Krankenhaus Göttlicher Heiland, Vienna, Austria
| | - Alexander Klaus
- Department of Surgery, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria
| | | | | | - Leopold Öhler
- Department of Medicine I, Oncology, Barmherzige Schwestern Krankenhaus Wien, Vienna, Austria.,Department of Medicine I, Oncology, St. Josef Krankenhaus, Vienna, Austria
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Vogl UM, Andalibi H, Klaus A, Vormittag L, Schima W, Heinrich B, Kafka A, Winkler T, Öhler L. Nab-paclitaxel and gemcitabine or FOLFIRINOX as first-line treatment in patients with unresectable adenocarcinoma of the pancreas: does sequence matter? BMC Cancer 2019; 19:28. [PMID: 30621630 PMCID: PMC6325849 DOI: 10.1186/s12885-018-5240-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 09/22/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Locally advanced or metastatic adenocarcinoma of the pancreas remains - despite the implementation of new chemotherapy protocols - a disease with short overall survival (OS). METHODS Eighty-three patients were treated with locally advanced or metastatic adenocarcinoma of the pancreas with either FOLFIRINOX or nab-Paclitxel and Gemcitabine (nabPGem) as first- or second line therapy. We analysed the outcome for OS and progression-free survival (PFS) in terms of treatment regimen and sequence. RESULTS The majority of patients presented in good performance status (PS) with a median age of 68 years. Fourty-two patients received FOLFIRINOX as first-line therapy, 41 patients were treated with nabPGem as first line therapy. Forty-eight patients received both treatments. The OS of all 83 patients was 12.6 months (95% CI: 10.7-14.6), resulting in a 1-year OS of 54%. Forty-eight patients received FOLFIRINOX followed by nabPGem or vice versa. There was no significant difference in OS or PFS for either of the two sequences (p = 0.9). The OS for FOLFIRINOX followed by nabPGem or nabPGem followed by FOLFIRINOX was 13.7 months (95% CI: 12.6-14.7) and 13.8 months (95% CI: 8.6-19), respectively. CONCLUSIONS The sequence FOLFIRINOX followed by nab-Paclitaxel and Gemcitabine or vice versa lead to an equal OS outcome.
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Affiliation(s)
- Ursula M. Vogl
- Department of Internal Medicine II, Oncology, Barmherzige Schwestern Wien, Stumpergasse 13, 1060 Vienna, Austria
| | - Haleh Andalibi
- Department of Internal Medicine II, Oncology, Barmherzige Schwestern Wien, Stumpergasse 13, 1060 Vienna, Austria
| | - Alexander Klaus
- Department of Surgery, Barmherzige Schwestern Wien, Vienna, Austria
| | - Laurenz Vormittag
- Department of Internal Medicine I, Oncology, Sankt Josef Krankenhaus, Vienna, Austria
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Barmherzige Schwestern Krankenhaus Wien, Goettlicher Heiland Krankenhaus and Sankt Josef Krankenhaus, Vienna, Austria
| | - Bettina Heinrich
- Department of Internal Medicine I, Oncology, Sankt Josef Krankenhaus, Vienna, Austria
| | - Alice Kafka
- Department of Internal Medicine I, Oncology, Sankt Josef Krankenhaus, Vienna, Austria
| | - Thomas Winkler
- Department of Internal Medicine I, Oncology, Sankt Josef Krankenhaus, Vienna, Austria
| | - Leopold Öhler
- Department of Internal Medicine II, Oncology, Barmherzige Schwestern Wien, Stumpergasse 13, 1060 Vienna, Austria
- Department of Internal Medicine I, Oncology, Sankt Josef Krankenhaus, Vienna, Austria
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Vogl UM, Öhler L, Rasic M, Frischer JM, Modak M, Stöckl J. Evaluation of Prognostic Immune Signatures in Patients with Breast, Colorectal and Pancreatic Cancer Receiving Chemotherapy. Anticancer Res 2017; 37:1947-1955. [PMID: 28373465 DOI: 10.21873/anticanres.11535] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND CD97 is a member of the epidermal growth factor-seven transmembrane (EGF-TM7) receptor family and is dominantly expressed on immune cells and in a variety of malignant diseases. B7-H1 and B7-H3 are transmembrane proteins that are involved in suppression of the immune system. The aim of this study was to evaluate if these molecules are up-regulated in patients with cancer and change during chemotherapy. MATERIALS AND METHODS We analyzed cluster of differentiation (CD) protein expression levels on tumor cell lines and in blood samples of 37 patients with solid tumors at baseline and during chemotherapy; we correlated the serum levels of CD proteins with survival outcome. RESULTS Levels of soluble CD97 proteins were significantly elevated in all three cancer types compared to healthy controls. Patients with colorectal cancer and those with high CD97 levels had a significantly worse prognosis. CONCLUSION This study showed a marked elevation of soluble CD97 expression in patients with certain cancer types and demonstrated definite changes in CD protein expression during chemotherapy in one patient with metastatic breast cancer.
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Affiliation(s)
- Ursula M Vogl
- Internal Medicine I, Department of Oncology, St. Josef Hospital, Vienna, Austria
| | - Leopold Öhler
- Internal Medicine I, Department of Oncology, St. Josef Hospital, Vienna, Austria
| | - Masa Rasic
- Department of Immunology, Medical University Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Madhura Modak
- Department of Immunology, Medical University Vienna, Vienna, Austria
| | - Johannes Stöckl
- Department of Immunology, Medical University Vienna, Vienna, Austria
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Vogl UM, Nagayama K, Bojic M, Hoda MAR, Klepetko W, Jaksch P, Dekan S, Siersch V, Mitterbauer M, Schellongowski P, Greinix HT, Petkov V, Schulenburg A, Kalhs P, Rabitsch W. Lung Transplantation for Bronchiolitis Obliterans After Allogeneic Hematopoietic Stem Cell Transplantation. Transplantation 2013; 95:623-8. [DOI: 10.1097/tp.0b013e318277e29e] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Schmidinger M, Vogl UM, Bojic M, Lamm W, Heinzl H, Haitel A, Clodi M, Kramer G, Zielinski CC. Hypothyroidism in patients with renal cell carcinoma: blessing or curse? Cancer 2010; 117:534-44. [PMID: 20845482 DOI: 10.1002/cncr.25422] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/13/2010] [Accepted: 04/13/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sunitinib and sorafenib are tyrosine kinase inhibitors that have important antitumor activity in metastatic renal cell carcinoma (mRCC). Hypothyroidism constitutes a commonly reported side effect of both drugs, and particularly of sunitinib. The objective of this analysis was to investigate whether the occurrence of hypothyroidism during treatment with sunitinib and sorafenib affects the outcome of patients with mRCC. METHODS Eighty-seven consecutive patients with mRCC who were to receive treatment with sunitinib or sorafenib were included in a prospective analysis. Thyroid function was assessed in each patient every 4 weeks during the first 2 months of treatment and every 2 to 4 months thereafter. Assessment included serum levels of thyroid-stimulating hormone (TSH), tri-iodthyronine (T3), and thyroxine (T4). Subclinical hypothyroidism was defined as an increase in TSH above the upper limit of normal (>3.77 μM/mL) with normal T3 and T4 levels. RESULTS Subclinical hypothyroidism was evident in 5 patients at baseline and occurred in 30 patients (36.1%) within the first 2 months after treatment initiation. There was a statistically significant correlation between the occurrence of subclinical hypothyroidism during treatment and the rate of objective remission (hypothyroid patients vs euthyroid patients: 28.3% vs 3.3%, respectively; P < .001) and the median duration of survival (not reached vs 13.9 months, respectively; hazard ratio, 0.35; 95% confidence interval, 0.14-0.85; P = .016). In multivariate analysis, the development of subclinical hypothyroidism was identified as an independent predictor of survival (hazard ratio, 0.31; P = .014). CONCLUSIONS The current results indicated that hypothyroidism may serve as a predictive marker of treatment outcome in patients with mRCC. Thus, the interpretation of hypothyroidism during treatment with sunitinib and sorafenib as an unwanted side effect should be reconsidered.
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Affiliation(s)
- Manuela Schmidinger
- Clinical Division of Oncology, Department of Medicine I and Cancer Center, Medical University of Vienna, Vienna, Austria.
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Vogl UM, Bojic M, Lamm W, Frischer JM, Pichelmayer O, Kramer G, Haitel A, Kitz K, Harmankaya K, Zielinski CC, Schmidinger M. Extracerebral metastases determine the outcome of patients with brain metastases from renal cell carcinoma. BMC Cancer 2010; 10:480. [PMID: 20819239 PMCID: PMC2942853 DOI: 10.1186/1471-2407-10-480] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [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: 01/20/2010] [Accepted: 09/07/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In the era of cytokines, patients with brain metastases (BM) from renal cell carcinoma had a significantly shorter survival than patients without. Targeted agents (TA) have improved the outcome of patients with metastatic renal cell carcinoma (mRCC) however, their impact on patients with BM is less clear. The aim of this analysis was to compare the outcome of patients with and without BM in the era of targeted agents. METHODS Data from 114 consecutive patients who had access to targeted agent were analyzed for response rates (ORR), progression free survival (PFS) and overall survival (OS). All patients diagnosed with BM underwent local, BM-specific treatment before initiation of medical treatment. RESULTS Data of 114 consecutive patients who had access to at least one type of targeted agents were analyzed. Twelve out of 114 renal cell carcinoma (RCC) patients (10.5%) were diagnosed with BM. Systemic treatment consisted of sunitinib, sorafenib, temsirolimus or bevacizumab. The median PFS was 8.7 months (95% CI 5.1 - 12.3) and 11.4 months (95% CI 8.7 - 14.1) for BM-patients and non-BM-patients, respectively (p = 0.232). The median overall survival for patients with and without BM was 13.4 (95% CI 1- 43.9) and 33.3 months (95% CI 18.6 - 47.0) (p = 0.358), respectively. No patient died from cerebral disease progression. ECOG Performance status and the time from primary tumor to metastases (TDM) were independent risk factors for short survival (HR 2.74, p = 0.001; HR: 0.552, p = 0.034). CONCLUSIONS Although extracerebral metastases determine the outcome of patients with BM, the benefit from targeted agents still appears to be limited when compared to patients without BM.
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Affiliation(s)
- Ursula M Vogl
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Marija Bojic
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Wolfgang Lamm
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Josa M Frischer
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Oskar Pichelmayer
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Gero Kramer
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Andrea Haitel
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Klaus Kitz
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Kaan Harmankaya
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Christoph C Zielinski
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
| | - Manuela Schmidinger
- Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria
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Schmidinger M, Bojic A, Vogl UM, Lamm W, Zielinski CC. Management of cardiac adverse events occurring with sunitinib treatment. Anticancer Res 2009; 29:1627-1629. [PMID: 19443377] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sunitinib malate is the reference standard of care for the first-line treatment of metastatic renal cell carcinoma (mRCC). Cardiovascular adverse events (AEs) have been observed with sunitinib treatment. Here, we present the case report of a 49-year-old male patient with mRCC in whom cardiac AEs experienced during sunitinib treatment were successfully managed. The patient was at poor prognostic risk, with an Eastern Cooperative Oncology Group performance status of 3. RESULTS The patient was treated with sunitinib 50 mg/day (4 weeks on treatment followed by 2 weeks off treatment; Schedule 4/2) following lung and bone metastases. Cardiac AEs occurred following sunitinib initiation. These events were resolved with cardiovascular co-medication. Sunitinib improved the patient's quality of life and performance status, with a prolonged duration of treatment of 24 months. CONCLUSION This case indicates that cardiac AEs should not be a barrier to the effective use of sunitinib in mRCC.
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Affiliation(s)
- Manuela Schmidinger
- Medical University of Vienna, Department of Medicine I and Cancer Center, Clinical Division of Oncology, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Schmidinger M, Zielinski CC, Vogl UM, Bojic A, Bojic M, Schukro C, Ruhsam M, Hejna M, Schmidinger H. Cardiac Toxicity of Sunitinib and Sorafenib in Patients With Metastatic Renal Cell Carcinoma. J Clin Oncol 2008; 26:5204-12. [DOI: 10.1200/jco.2007.15.6331] [Citation(s) in RCA: 521] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Sunitinib and sorafenib are tyrosine kinase inhibitors (TKIs) that have considerable efficacy in metastatic renal cell carcinoma. TKI-associated cardiotoxicity was reported in approximately 10% of the patients. Detailed cardiovascular monitoring during TKI treatment may reveal early signs of myocardial damage. Patients and Methods In this observational, single-center study, all patients intended for TKI treatment were analyzed for coronary artery disease (CAD) risk factors, history or evidence of CAD, hypertension, rhythm disturbances, and heart failure. Monitoring included assessment of symptoms, ECGs, and biochemical markers (ie, creatine kinase-MB, troponin T). Echocardiography was performed at baseline in selected patients and in all patients who experienced a cardiac event. A cardiac event was defined as the occurrence of increased enzymes if normal at baseline, symptomatic arrhythmia that required treatment, new left ventricular dysfunction, or acute coronary syndrome. Results A total of 86 patients were treated with either sunitinib or sorafenib. Among 74 eligible patients, 33.8% experienced a cardiac event, 40.5% had ECG changes, and 18% were symptomatic. Seven patients (9.4%) were seriously compromised and required intermediate care and/or intensive care admission. All patients recovered after cardiovascular management (ie, medication, coronary angiography, pacemaker implantation, heart surgery) and were considered eligible for TKI continuation. Statistically, there was no significant survival difference between patients who experienced a cardiac event and those who did not experience a cardiac event. Conclusion Our observations indicate that cardiac damage from TKI treatment is a largely underestimated phenomenon but is manageable if patients have careful cardiovascular monitoring and cardiac treatment at the first signs of myocardial damage.
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Affiliation(s)
- Manuela Schmidinger
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Christoph C. Zielinski
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Ursula M. Vogl
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Andja Bojic
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Marija Bojic
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Christoph Schukro
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Marquerite Ruhsam
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Michael Hejna
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
| | - Herwig Schmidinger
- From the Clinical Division of Oncology, Department of Medicine I and Cancer Center and Department of Cardiology, Medical University Vienna, Vienna, Austria
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Vogl UM, Zehetgruber H, Dominkus M, Hejna M, Zielinski CC, Haitel A, Schmidinger M. Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable. Br J Cancer 2006; 95:691-8. [PMID: 16940978 PMCID: PMC2360513 DOI: 10.1038/sj.bjc.6603327] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prognostic and predictive factors in patients with metastatic renal cell carcinoma (MRCC) have been evaluated from untreated patients or patients on several different treatment approaches. The aim of this analysis was to define prognostic and predictive factors in patients treated uniformly with a low-dose outpatient cytokine combination. The relationship between patient-, tumour-, and treatment-related factors was analysed in 99 patients with MRCC. These features were first examined in univariate analyses, then a stepwise modelling approach based on Cox regression was used to form a multivariate model. Nuclear grade, metastasectomy – even incomplete – C-reactive protein and lactate dehydrogenase were identified as independent prognostic factors for survival. Patients assigned to three different risk groups had statistically significant survival differences (30, 22 and 6 months, respectively). A total of 43.4% had undergone metastasectomy, mostly incomplete. Risk group affiliation was correlated with response to treatment. Our findings strongly suggest the consideration of metastasectomy in the management of patients with metastatic renal cell cancer undergoing either immunotherapy or targeted treatment.
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Affiliation(s)
- U M Vogl
- Department of Medicine I, Clinical Division of Oncology, University Hospital, Waehringer Guertel 18-20, Vienna A-1090, Austria.
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