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Faehling M, Witte H, Sebastian M, Ulmer M, Sätzler R, Steinestel K, Brückl WM, Evers G, Büschenfelde CMZ, Bleckmann A. Real-world multicentre analysis of neoadjuvant immunotherapy and chemotherapy in localized or oligometastatic non-small cell lung cancer (KOMPASSneoOP). Ther Adv Med Oncol 2022; 14:17588359221085333. [PMID: 35356258 PMCID: PMC8958675 DOI: 10.1177/17588359221085333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/17/2022] [Indexed: 12/25/2022] Open
Abstract
Background: Recent clinical trials demonstrate the feasibility of neoadjuvant immuno(chemo)therapy and report high rates of pathological remission, a surrogate marker for overall survival. Patients and methods: This is a retrospective multicentre real-world analysis of patients with locally resectable NSCLC, including oligometastatic disease, who received neoadjuvant immuno(chemo)therapy and resection. Consolidating immunotherapy was applied following multidisciplinary board recommendation. Primary endpoint was the rate of complete pathological response (pCR, no residual vital tumour cells) or major pathological response (MPR, ⩽ 10% residual vital tumour cells). Secondary endpoints included the radiological response and survival. Results: Seven centres contributed 59 patients (56% stage IIB–IIIC, 44% in stage IVA–IVB with up to four oligometastatic sites). MPR was found in 68% including 53% with pCR. There were no radiological progressions. Median follow-up was 24.3 months. At 12 and 24 months, progression-free survival was 82.6% and 68.1%, and overall survival was 89.5% and 87.2%, respectively. Conclusion: To our knowledge, this study encompassed the largest NSCLC real-world cohort treated with neoadjuvant immuno(chemo)therapy to date. In routine clinical practice, resection after neoadjuvant immuno(chemo)therapy is feasible in patients with locally resectable NSCLC, including oligometastatic disease. In line with clinical trials, we found MPR in more than two-thirds of patients. Early data show encouraging survival.
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Affiliation(s)
- Martin Faehling
- Department of Cardiology and Pneumology, Hospital Esslingen, Esslingen 73730, Germany
| | - Hanno Witte
- Abteilung für Hämatologie und Onkologie, Bundeswehrkrankenhaus, Ulm, Germany
| | | | - Matthias Ulmer
- Hämatologie/Onkologie, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Rainer Sätzler
- Thoracic Surgery, Hospital Esslingen, Esslingen, Germany
| | - Konrad Steinestel
- Institut für Pathologie und Molekularpathologie, Bundeswehrkrankenhaus, Ulm, Germany
| | - Wolfgang M. Brückl
- Paracelsus Medical University Nuremberg and Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany
| | - Georg Evers
- Department of Medicine A – Hematology, Oncology, Hemostaseology and Pulmonology, University Hospital Münster, Münster, Germany
| | | | - Annalen Bleckmann
- Department of Medicine A – Hematology, Oncology, Hemostaseology and Pulmonology, University Hospital Münster, Münster, Germany
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Brückl WM, Reck M, Griesinger F, Schäfer H, Kortsik C, Gaska T, Rawluk J, Krüger S, Kokowski K, Budweiser S, Ficker JH, Hoffmann C, Schüler A, Laack E. Afatinib as first-line treatment in patients with EGFR-mutated non-small cell lung cancer in routine clinical practice. Ther Adv Med Oncol 2021; 13:17588359211012361. [PMID: 33995597 PMCID: PMC8111535 DOI: 10.1177/17588359211012361] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Lung cancer is a leading cause of cancer-related death in Germany and worldwide. Non-small cell lung cancer (NSCLC) comprises ~80% of lung cancer diagnoses; in White patients, around 10% of NSCLC cases are epidermal growth factor receptor mutation-positive (EGFRm+). Head-to-head clinical trials have demonstrated superior efficacy with second-/third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) versus first-generation EGFR TKIs in EGFRm+ NSCLC. Data from routine clinical practice are necessary to confirm that clinical trial findings are transferable to real-world populations. Methods: In NCT02047903, a prospective non-interventional study in Germany, patients with EGFRm+ NSCLC received first-line afatinib until disease progression or intolerable adverse events. Key objectives were progression-free survival (PFS) rate at 12 months, objective response rate (ORR) and overall survival (OS). Safety/tolerability was also assessed. Results: Of 152 patients, 106 (69.7%) were female, 20 (13.1%) patients had an uncommon EGFR mutation and 51 patients (33.6%) had brain metastases. A starting dose of <40 mg was received by 39 (25.7%) patients. Overall, the 12-month PFS rate was 50.2% while the median PFS was 12.2 months. The ORR was 74.6% and the median OS was 30.4 months. In patients with brain metastases and uncommon mutations, the median PFS was 10.5 and 10.7 months, and the ORR was 77.3% and 83.3%, respectively. Treatment effectiveness was similar in patients with a starting dose of <40 mg (median PFS: 16.4 months; ORR, 81.3%) and a starting dose of 40 mg (median PFS: 10.8 months; ORR, 72.1%). Adverse drug reactions were manageable and consistent with the known afatinib safety profile. Conclusion: The results support clinical trial data for afatinib in routine clinical practice, including in patients generally excluded from clinical trials. Outcomes were positive in patients with uncommon EGFR mutations and in those with brain metastases. Treatment benefit was also seen in patients receiving a <40 mg afatinib starting dose, supporting patient-tailored dosing.
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Affiliation(s)
- Wolfgang M Brückl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Ernst-Nathan-Str.1, Nuremberg, 90419, Germany
| | - Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius Hospital, University Department Internal Medicine-Oncology, University Medicine, Oldenburg, Germany
| | - Harald Schäfer
- Department of Pneumonology, SHG-Clinic Voelklingen, Germany
| | | | - Tobias Gaska
- Department of Hematology and Oncology, St. Josef Clinic, Paderborn, Germany
| | - Justyna Rawluk
- Faculty of Medicine, University of Freiburg, Germany; Department of Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Stefan Krüger
- Department for Pneumology, Cardiology and Intensive Care Medicine, Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Konrad Kokowski
- Department of Pneumonology, Bogenhausen Hospital, Munich, Germany
| | - Stephan Budweiser
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Christopher Hoffmann
- Human Pharma Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Andrea Schüler
- Human Pharma Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
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Faehling M, Schumann C, Christopoulos P, Hoffknecht P, Alt J, Horn M, Eisenmann S, Schlenska-Lange A, Schütt P, Steger F, Brückl WM, Christoph DC. Durvalumab after definitive chemoradiotherapy in locally advanced NSCLC: Data of the German EAP. Data Brief 2020; 34:106556. [PMID: 33364266 PMCID: PMC7750486 DOI: 10.1016/j.dib.2020.106556] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022] Open
Abstract
Following the PACIFIC trial, durvalumab has been approved by the European Medicines Agency (EMA) for consolidation of locally advanced PD-L1-positive NSCLC after chemoradiotherapy (CRT). Patients were treated with durvalumab in the EAP from 22.11.2017 to 15.10.2018 allowing analysis of its efficacy and safety. 211 patients were registered by 90 German centres. Data were collected retrospectively by questionnaire and queries. 56 centres reported data on 126 patients who actually received at least one cycle of durvalumab. In contrast to the PACIFIC-trial population, some patients with oligometastatic disease and a history of autoimmune disease are included in the EAP population. Information on PD-L1 status was obtained for 111 patients. Baseline data include age, gender, ECOG, stage (IASLC 8th ed.), and smoking history. Treatment data include mode of chemoradiotherapy, used chemotherapy agent, and duration of durvalumab therapy. Adverse evants were documented according to CTAEC 5.0. Data were analysed for progression-free survival (PFS), overall survival (OS), and adverse events (AE). The results were published in Lung Cancer [1].
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Affiliation(s)
- Martin Faehling
- Klinik für Kardiologie und Pneumologie, Klinikum Esslingen, 73730 Esslingen, Germany
| | - Christian Schumann
- Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Klinikum Kempten, 87439 Kempten, Germany
| | | | - Petra Hoffknecht
- Klinik für Thoraxonkologie und Palliativstation, Franziskus-Hospital Harderberg, 49124 Georgsmarienhütte, Germany
| | - Jürgen Alt
- III. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, 55131 Mainz, Germany
| | - Marlitt Horn
- LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Stephan Eisenmann
- Universitätsklinik und Poliklinik für Innere Medizin I (Gastroenterologie & Pneumologie), Universitätsklinikum Halle (Saale), 06120 Halle, Germany
| | - Anke Schlenska-Lange
- Klinik für Onkologie und Hämatologie, Krankenhaus Barmherzige Brüder Regensburg, 93049 Regensburg, Germany
| | | | - Felix Steger
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, 93053 Regensburg, Germany
| | - Wolfgang M Brückl
- Klinik für Innere Medizin 3, Klinikum Nürnberg Nord, 90419 Nürnberg, Germany
| | - Daniel C Christoph
- Klinik für Internistische Onkologie und Hämatologie mit integrierter Palliativmedizin, Evang. Kliniken Essen-Mitte, 45136 Essen, Germany
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Faehling M, Schumann C, Christopoulos P, Hoffknecht P, Alt J, Horn M, Eisenmann S, Schlenska-Lange A, Schütt P, Steger F, Brückl WM, Christoph DC. Durvalumab after definitive chemoradiotherapy in locally advanced unresectable non-small cell lung cancer (NSCLC): Real-world data on survival and safety from the German expanded-access program (EAP). Lung Cancer 2020; 150:114-122. [DOI: 10.1016/j.lungcan.2020.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
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Abstract
Dyspnea is a leading symptom in COPD. Bronchodilators (long acting anticholinergics and long acting beta agonists) are the mainstay of medical treatment. Non pharmacological therapies like pulmonary rehabilitation, long-term oxygen therapy or lung volume reduction can help to further improve dyspnea. Nevertheless, patients with advanced disease may develop refractory dyspnea. Randomized controlled trials demonstrated that the palliative treatment with low-dose systemic opioids is an effective treatment option in these patients. A low starting dose (e. g. 1.0 mg morphine, immediate release) is recommended. Subsequent doses are titrated to achieve the lowest effective dose based on whether dyspnea relief has been achieved and whether any side effects have developed. This low-dose opioid treatment has been demonstrated to be safe for symptom reduction in severe COPD and is not associated with increased hospital admissions or deaths. Physicians should offer a trial of low-dose oral opioids to patients with refractory dyspnea that affects their daily activities and quality of life.
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Brückl WM, Ficker JH, Tiemann M, Schumann C, Reinmuth N, Heigener D, Schütte W, Eberhardt R, Darwiche K, Wagner M. [Rebiopsy for Patients with Lung Cancer - Joint Opinion from both the Endoscopic and Thoracic Oncology Sections of the German Society of Pneumology (DGP)]. Pneumologie 2018; 72:617-623. [PMID: 30071539 DOI: 10.1055/a-0632-9174] [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: 10/28/2022]
Abstract
Performing rebiopsies for primary lung cancer and/or their metastases is becoming more and more prominent in daily practice, as the therapeutical spectrum increases and some newer strategies are dependent on immunohistochemical and/or molecular factors. In general, nearly all recurrent lesions or metastases can be reached. However, frequently invasive procedures are necessary with the need to carefully weigh risks and benefits of rebiopsies for the patient in each case. In this review indications for recurrent and progressive disease as well as risks are discussed and alternatives to rebiopsies are shown. This work is the joint opinion from both the endoscopic and thoracic oncology sections of the German Society of Pneumology (DGP).
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Affiliation(s)
- W M Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - J H Ficker
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - M Tiemann
- GMS Gemeinnütziges Molekularpathologisches Forschungslabor, Hamburg
| | - C Schumann
- Klinikverbund Kempten-Oberallgäu, Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Immenstadt
| | - N Reinmuth
- Asklepios Fachkliniken München-Gauting, Thorakale Onkologie, Gauting
| | - D Heigener
- LungenClinic Großhansdorf, Deutsches Zentrum für Lungenforschung und Christian-Albrechts-Universität zu Kiel, Hamburg
| | - W Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha-Maria Halle-Dölau, Halle (Saale)
| | - R Eberhardt
- Abteilung für Innere Medizin - Pneumologie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - K Darwiche
- Sektion für Interventionelle Bronchologie, Ruhrlandklinik - Universitätsmedizin Essen, Universitätsklinik Essen
| | - M Wagner
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
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Abstract
There is a wide spectrum of severities in patients with pulmonary bleeding with a range from mild haemoptysis to severe bleeding with an acute risk of asphyxiation. For the management of acute pulmonary haemorrhage, it is essential to identify the underlying cause in order to initiate a target-oriented or causal therapy. The most common causes of localized pulmonary bleeding are lung cancer as well as infections, anticoagulant therapy or bronchiectasis. Diffuse alveolar haemorrhage is mostly due to pulmonary vasculitis or connective tissue disease, but may also occur in pulmonary metastasis, congestive heart failure, coagulation disorders and from many other causes. In a case of severe pulmonary bleeding it is essential to secure the airways and ensure sufficient ventilation, i. e. by intubation with a double-lumen endotracheal tube and by appropriate positioning of the patient. Stabilizing haemodynamics is crucial. Simultaneously basic diagnostic measures, i. e. appropriate laboratory tests, chest X‑ray, computed tomography scan of the chest and bronchoscopy, are performed. Localized pulmonary bleeding usually requires local treatment, like bronchoscopic therapy, bronchial artery embolization or surgery. Diffuse alveolar haemorrhage must be treated systemically, i. e. by immunosuppressive therapy in cases of vasculitis or by medical treatment of coagulation disorders. Even with optimal interdisciplinary management the in-hospital mortality of severe pulmonary bleeding remains high. There is a significant risk of recurrent bleeding depending on the cause of haemorrhage. In patients with "cryptogenic" haemoptysis there is an increased rate of lung cancer within the following years and follow-up of these patients is recommended.
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Affiliation(s)
- J H Ficker
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Intensivmedizin, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - W M Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Intensivmedizin, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - J Suc
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - A Geise
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Intensivmedizin, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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Brückl WM, Wirtz RM, Bertsch T, Ficker JH, Jung A. [Liquid Biopsy: Detection of Molecular Markers for Treatment Decisions in Lung Cancer]. Pneumologie 2017; 71:151-163. [PMID: 28196386 DOI: 10.1055/s-0042-123803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Personalized, individualized, targeted therapy has successfully found entrance in the palliative treatment of lung cancer as they enable a personalized and individualized strategy going ahead with biomarker testing. Due to the crescending amount of predictive molecular and immunhistochemical analyses at different time points during therapy the need for more and actual tumor tissue increases; however these samples cannot always be obtained without major discomfort for the patients. Therefore, analyses from blood, the so called "liquid biopsy", is an alternative or additional method. Activating mutations in the EGFR gene and the inhibitory mutation T790 M can already be detected from blood during clinical routine. This review presents the status of liquid biopsy for diagnosis, prognosis and as predictive parameter during the course of therapy in lung cancer and gives an outlook on future developments.
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Affiliation(s)
- W M Brückl
- Universitätsklinik für Pneumologie, Allergologie und Schlafmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - R M Wirtz
- Institut für Pathologie, St. Elisabeth Krankenhaus, Köln
| | - T Bertsch
- Universitätsinstitut für Klinische Chemie, Laboratoriumsmedizin und Transfusionsmedizin - Zentrallaboratorium, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - J H Ficker
- Universitätsklinik für Pneumologie, Allergologie und Schlafmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - A Jung
- Pathologisches Institut der Ludwig-Maximilians Universität München
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Brückl WM, Wiest GH, Ficker JH. [Current status of erlotinib and gefitinib in palliative therapy for NSCLC--does the EGF-R mutation state have any significance?]. Pneumologie 2010; 64:727-35. [PMID: 20577948 DOI: 10.1055/s-0030-1255532] [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: 10/19/2022]
Abstract
In spite of intensive research and a huge amount of chemotherapy trials, the prognosis of metastastic non-small cell lung cancer (NSCLC) is still poor. Erlotinib and Gefitinb are tyrosine kinase inhibitors (TKIs) which act against the EGF receptor (EGF-R). Activation of mutations in the tyrosine kinase domain leads to an increase in effectiveness. What is the clinical impact of EGF-R mutation screening? What value do TKIs in 1st, 2nd and 3rd line have in therapy for metastatic NSCLC? Which treatment options exist after failure of TKI in the 1st line? These and other clinically relevant questions in the context of TKIs are discussed in the present comprehensive review.
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Affiliation(s)
- W M Brückl
- Leiter der pneumologischen Onkologie, Medizinische Klinik 3/Lungentumorzentrum, Prof.-Ernst-Nathan-Strasse 1, Nürnberg.
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Brückl WM, Lampert S, Zirlik S, Hahn EG, Wiest GH. [Drug therapy for small-cell lung cancer (SCLC)--new molecular strategies for therapy]. Pneumologie 2007; 62:23-30. [PMID: 17948174 DOI: 10.1055/s-2007-980131] [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: 10/22/2022]
Abstract
Small-cell lung cancer accounts for up to 20 % of lung cancer and is the most aggressive type. Although responding to chemotherapy, it often relapses early. In spite of more than thirty years of intensive research, its prognosis has not been improved. Through increasing knowledge about molecular mechanisms and the involved genes, translational research into antibodies, small molecules and even vaccines, might result in interesting new strategies for the near future. After a short introduction about the function of the relevant genes, the diagnostic and prognostic value will be described. In the second part of this review the focus will lie on current studies (mostly phases I and II) for the treatment of SCLC.
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Affiliation(s)
- W M Brückl
- Medizinische Klinik 1, Universitätsklinikum Erlangen.
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Wiest GH, Brückl WM. [Pronounced face swelling. What cause do you suspect?]. MMW Fortschr Med 2007; 149:5. [PMID: 17953254 DOI: 10.1007/bf03365001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Gunther H Wiest
- Medizinische Klinik I mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
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Link K, Happich K, Schirner I, Jüngert B, Brückl V, Männlein G, Brückl WM, Merkel S, Göhl J, Hohenberger W, Hahn EG, Wein A. Palliative second-line treatment with weekly high-dose 5-fluorouracil as 24-hour infusion and folinic acid (AIO) plus oxaliplatin after pre-treatment with the AIO-regimen in colorectal cancer (CRC). Anticancer Res 2004; 24:385-91. [PMID: 15015625] [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: 04/29/2023]
Abstract
BACKGROUND AND AIMS The aim of this work was to evaluate the efficacy and safety of second-line treatment with weekly high-dose 5-Fluorouracil (5-FU) as a 24-hour infusion (24-h inf.) and folinic acid (FA) (AIO-regimen) plus Oxaliplatin (L-OHP) after pre-treatment with the AIO regimen, focusing in particular on the efficacy of palliative first- and second-line treatment in colorectal carcinoma (CRC). PATIENTS AND METHODS Patients with non-resectable distant CRC metastases were enrolled in a prospective phase II study for palliative second-line treatment after previous palliative first-line treatment in accordance with the AIO regimen. On an outpatient basis, the patients received a treatment regimen comprising biweekly 85 mg/m2 L-OHP in the form of a 2-hour intravenous (i.v.) infusion and 500 mg/m2 FA as a 1 to 2-hour i.v. infusion, followed by 2,600 mg/m2 5-FU administered as a 24-h inf. i.v. once weekly. A single treatment cycle comprised 6 weekly infusions followed by 2 weeks of rest. RESULTS During second-line treatment, a total of 26 patients received 340 chemotherapy applications. As the main symptom of toxicity, diarrhoea (NCI-CTC toxicity grade 3+4) presented in 5 patients (19%; 95% CI: 4-34), followed by nausea (CTC grade 3) in one patient (4%; 95% CI: 0-11). Twenty-three patients were evaluable for treatment response. The remission data can be summarised as follows: Complete remission (CR): n=1 (4%; 95% CI: 0-13); partial remission (PR): n=3 (13%; 95% CI: 0-27); stable disease (SD): n=11 (48%; 95% CI: 27-68) and progressive disease (PD): n=8 (35%; 95% CI: 15-54). The median progression-free survival (PFS) rate (n=26) was 3.3 months (range 0-11.5), the median survival time counted from the start of second-line treatment (n=26) 11.6 months (range 2.1-33.0) and the median survival time counted from the start of first-line treatment (n=26) 19.9 months (range 7.7-49.8). CONCLUSION Palliative second-line treatment according to the AIO regimen plus L-OHP is feasible in an outpatient setting and well tolerated by the patients. Tumour control (CR + PR + SD) was achieved in 65% of the patients, the median survival time being 11.6 months. The AIO regimen followed by the 'AIO regimen plus L-OHP' therapy sequence led to a promising median survival time of 19.9 months (range 7.7-49.8).
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Affiliation(s)
- K Link
- Department of Internal Medicine I, University of Erlangen, Germany
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Brückl WM, Wein A, Riedel C, Wiest GH, Hohenberger W, Hahn EG. [Retroperitoneal desmoid tumor with kidney failure in familial adenomatous polyposis]. Dtsch Med Wochenschr 2000; 125:81-4. [PMID: 10686957 DOI: 10.1055/s-2007-1023927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND FINDINGS A 39-year-old man was hospitalized because of continually rising urinary creatinine and blood urea nitrogen concentration. He was known to have familial adenomatous polyposis (FAP), first diagnosed 18 years previously and re-Physical examination was unremarkable except for pain on percussion over both kidney regions. There was a well-healed laparotomy scar. INVESTIGATIONS Ultrasound revealed chronic bilateral obstructive renal disease, grade II-III, and computed tomography showed a conglomerate retroperitoneal tumour with obstruction of both ureters at the level of the lower pelvis. This tumour had first been noted first 3 years after the colectomy when the patient complained of abdominal pain. It had been identified histologically as a nonresectable retroperitoneal desmoid tumour. TREATMENT AND COURSE An external fistula was made, relieving the renal retention. To suppress growth of the desmoid tumour Sulindac, a nonsteroid anti-inflammatory drug, was administered. Genetic molecular analysis revealed a germ line defect in codon 1690 of the APC gene. It is intended to examine other members of the family for the presence of this defect. CONCLUSION Desmoid tumours are more common in persons with FAP and are among the most frequent extracolic causes of their death. Treatment options are critically analysed.
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Affiliation(s)
- W M Brückl
- Medizinische Klinik I mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg.
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