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Gatz SA, Harttrampf AC, Brard C, Bautista F, André N, Abbou S, Rubino J, Rondof W, Deloger M, Rübsam M, Marshall LV, Hübschmann D, Nebchi S, Aerts I, Thebaud E, De Carli E, Defachelles AS, Paoletti X, Godin R, Miah K, Mortimer PGS, Vassal G, Geoerger B. Phase I/II Study of the WEE1 Inhibitor Adavosertib (AZD1775) in Combination with Carboplatin in Children with Advanced Malignancies: Arm C of the AcSé-ESMART Trial. Clin Cancer Res 2024; 30:741-753. [PMID: 38051741 DOI: 10.1158/1078-0432.ccr-23-2959] [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: 09/27/2023] [Revised: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE AcSé-ESMART Arm C aimed to define the recommended dose and activity of the WEE1 inhibitor adavosertib in combination with carboplatin in children and young adults with molecularly enriched recurrent/refractory malignancies. PATIENTS AND METHODS Adavosertib was administered orally, twice every day on Days 1 to 3 and carboplatin intravenously on Day 1 of a 21-day cycle, starting at 100 mg/m2/dose and AUC 5, respectively. Patients were enriched for molecular alterations in cell cycle and/or homologous recombination (HR). RESULTS Twenty patients (median age: 14.0 years; range: 3.4-23.5) were included; 18 received 69 treatment cycles. Dose-limiting toxicities were prolonged grade 4 neutropenia and grade 3/4 thrombocytopenia requiring transfusions, leading to two de-escalations to adavosertib 75 mg/m2/dose and carboplatin AUC 4; no recommended phase II dose was defined. Main treatment-related toxicities were hematologic and gastrointestinal. Adavosertib exposure in children was equivalent to that in adults; both doses achieved the cell kill target. Overall response rate was 11% (95% confidence interval, 0.0-25.6) with partial responses in 2 patients with neuroblastoma. One patient with medulloblastoma experienced unconfirmed partial response and 5 patients had stable disease beyond four cycles. Seven of these eight patients with clinical benefit had alterations in HR, replication stress, and/or RAS pathway genes with or without TP53 alterations, whereas TP53 pathway alterations alone (8/10) or no relevant alterations (2/10) were present in the 10 patients without benefit. CONCLUSIONS Adavosertib-carboplatin combination exhibited significant hematologic toxicity. Activity signals and identified potential biomarkers suggest further studies with less hematotoxic DNA-damaging therapy in molecularly enriched pediatric cancers.
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Affiliation(s)
- Susanne A Gatz
- Institute of Cancer and Genomic Sciences, University of Birmingham; Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Anne C Harttrampf
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Villejuif, France
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Caroline Brard
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Francisco Bautista
- Hospital Niño Jesús, Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Madrid, Spain
| | - Nicolas André
- Hôpital de la Timone, AP-HM, Department of Pediatric Oncology, Marseille, France
- UMR INSERM 1068, CNRS UMR 7258, Aix Marseille Université U105, Marseille, Cancer Research Center (CRCM), Marseille, France
| | - Samuel Abbou
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Villejuif, France
| | - Jonathan Rubino
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Windy Rondof
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
- Gustave Roussy Cancer Campus, Bioinformatics platform, Université Paris-Saclay, Villejuif, France
| | - Marc Deloger
- Gustave Roussy Cancer Campus, Bioinformatics platform, Université Paris-Saclay, Villejuif, France
| | - Marc Rübsam
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center
| | - Lynley V Marshall
- Royal Marsden Hospital & The Institute of Cancer Research, Paediatric and Adolescent Oncology Drug Development Unit, London, United Kingdom
| | - Daniel Hübschmann
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center
- Pattern Recognition and Digital Medicine Group, Heidelberg Institute for Stem cell Technology and Experimental Medicine (HI-STEM); German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Souad Nebchi
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Isabelle Aerts
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), PSL Research University, Paris, France
| | - Estelle Thebaud
- Centre Hospitalier Universitaire, Department of Pediatric Oncology, Nantes, France
| | - Emilie De Carli
- Centre Hospitalier Universitaire, Department of Pediatric Oncology, Angers, France
| | | | - Xavier Paoletti
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Robert Godin
- AstraZeneca Oncology External R&D, Waltham, Massachusetts
| | - Kowser Miah
- Clinical Pharmacology and Quantitative Pharmacology, AstraZeneca, Waltham, Massachusetts
| | | | - Gilles Vassal
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Villejuif, France
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
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Parpinel G, Laas-Faron E, Balaya V, Guani B, Zola P, Mathevet P, Paoletti X, Lecuru FR. Survival after sentinel lymph node biopsy for early cervical cancers: a systematic review and meta-analysis. Int J Gynecol Cancer 2023; 33:1853-1860. [PMID: 37696646 DOI: 10.1136/ijgc-2023-004726] [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] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy represents an alternative to pelvic lymphadenectomy for lymph node staging of early-stage cervical carcinoma, but prospective evidence on long-term oncological safety of sentinel lymph node biopsy alone versus pelvic lymphadenectomy is missing. OBJECTIVE To investigate, with this meta-analysis, the impact of sentinel lymph node biopsy alone versus pelvic lymphadenectomy on survival for patients with early-stage cervical cancer. METHODS A systematic literature review was performed. We excluded studies in which pelvic lymphadenectomy was systematically performed after every sentinel lymph node biopsy, including only articles where pelvic lymphadenectomy was performed because sentinel lymph node biopsy was not conclusive. A meta-analysis was carried out combining 5-year disease-free survival and overall survival rates with a random and fixed effect model. Heterogeneity was tested using the Cochran Χ2 test and quantified with Higgins information I2. RESULTS The search of databases and registers found 927 items and six articles (two retrospective and four prospective). The median time of follow-up was 34.8 months (range 13-53). Overall common effect disease-free survival was 98% while random effect disease-free survival was 94%. Overall heterogeneity was 77%. A subgroup analysis was applied, dividing studies into one group including sentinel lymph node biopsy negative data only (common effect disease-free survival 91%; random effect disease-free survival 90%), and one group with a negative and positive sentinel lymph node biopsy (common effect disease-free survival 98%; random effect disease-free survival 96%). In the analysis of overall survival, positive and negative sentinel lymph node biopsy cases were examined together (common and random effect overall survival 99%). Ultrastaging did not affect disease-free survival (common and random effect disease-free survival 92% in the ultrastaging group vs common effect disease-free survival 99% and random effect disease-free survival 96% in the non-ultrastaging group). CONCLUSIONS Both 5-year disease-free survival and overall survival rate after sentinel lymph node biopsy alone are higher than 90% and do not differ from pelvic lymphadenectomy survival data. Ultrastaging did not impact survival.
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Affiliation(s)
| | - Enora Laas-Faron
- Department of Gynaecologic Oncology, Institute Curie, Paris, France
| | - Vincent Balaya
- Department of Obstetrics and Gynecology, Felix Guyon Hospital - CHU Nord Réunion, La Réunion Island, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, University Hospital of Fribourg, Fribourg, Switzerland
| | - Paolo Zola
- Gynecologic Oncology, Department of Gynecology and Obstetrics; University of Turin; Turin; Italy, Turin, Gynecology, Italy
| | - Patrice Mathevet
- Centre Hospitalier Universitaire Vaudois Departement de gynecologie-obstetrique et genetique medicale, Lausanne, Switzerland
| | - Xavier Paoletti
- Inserm U900, équipe de statistique pour la médecine de précision (STAMPM), Institut Curie, Paris, Île-de-France, France
| | - Fabrice R Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institute Curie, Paris, France
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3
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Geoerger B, Paoletti X, Bautista F, Gatz SA, Marshall LV, André N, Berlanga P, Ducassou S, Pasqualini C, Casanova M, Zwaan CM, Nysom K, Rubino J, Goff DVL, Archambaud B, Abbou S, Schleiermacher G, Dufour C, Blanc P, Hoog-Labouret N, Buzyn A, Vassal G. AcSé-ESMART, a European precision cancer medicine proof-of-concept platform trial. Nat Med 2023; 29:2985-2987. [PMID: 37857712 DOI: 10.1038/s41591-023-02580-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France.
- Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France.
| | - Xavier Paoletti
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, UVSQ, Villejuif, France
- Institut Curie, INSERM U900 STAMPM, UVSQ, St. Cloud, France
| | - Francisco Bautista
- Hospital Niño Jesús, Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Madrid, Spain
- Princess Máxima Center for Pediatric Oncology, Utrecht, and Erasmus MC, Rotterdam, the Netherlands
| | - Susanne A Gatz
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lynley V Marshall
- Royal Marsden Hospital & The Institute of Cancer Research, Paediatric and Adolescent Oncology Drug Development Unit, London, UK
| | - Nicolas André
- Hôpital de la Timone, Department of Pediatric Oncology, AP-HM; UMR INSERM 1068, CNRS UMR 7258, Aix Marseille Université U105, Marseille Cancer Research Center (CRCM); Metronomics Global Health Initiative, Marseille, France
| | - Pablo Berlanga
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | - Stephane Ducassou
- Centre Hospitalier Universitaire Pellegrin-Hôpital des Enfants, Bordeaux, France
| | - Claudia Pasqualini
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | - Michela Casanova
- Fondazione IRCCS Istituto Nazionale dei Tumori, Pediatric Oncology Unit, Milan, Italy
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, and Erasmus MC, Rotterdam, the Netherlands
| | - Karsten Nysom
- Rigshospitalet, Department of Paediatrics and Adolescent Medicine, Copenhagen, Denmark
| | - Jonathan Rubino
- Gustave Roussy Cancer Campus, Clinical Research Direction, Université Paris-Saclay, Villejuif, France
| | - Delphine Vuillier-Le Goff
- Gustave Roussy Cancer Campus, Clinical Research Direction, Université Paris-Saclay, Villejuif, France
| | - Baptiste Archambaud
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Samuel Abbou
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | - Gudrun Schleiermacher
- INSERM U830 RTOP (Recherche Translationelle en Oncologie Pédiatrique) and SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Christelle Dufour
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | | | | | - Agnes Buzyn
- Institut National du Cancer, Boulogne, France
| | - Gilles Vassal
- Gustave Roussy Cancer Campus, Clinical Research Direction, Université Paris-Saclay, Villejuif, France
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4
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Faron M, Cheugoua-Zanetsie M, Tierney J, Thirion P, Nankivell M, Winter K, Yang H, Shapiro J, Vernerey D, Smithers BM, Walsh T, Piessen G, Nilsson M, Boonstra J, Ychou M, Law S, Cunningham D, de Vathaire F, Stahl M, Urba S, Valmasoni M, Williaume D, Thomas J, Lordick F, Tepper J, Roth J, Gebski V, Burmeister B, Paoletti X, van Sandick J, Fu J, Pignon JP, Ducreux M, Michiels S. Individual Participant Data Network Meta-Analysis of Neoadjuvant Chemotherapy or Chemoradiotherapy in Esophageal or Gastroesophageal Junction Carcinoma. J Clin Oncol 2023; 41:4535-4547. [PMID: 37467395 PMCID: PMC10553121 DOI: 10.1200/jco.22.02279] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/13/2022] [Revised: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE The optimal neoadjuvant treatment for resectable carcinoma of the thoracic esophagus (TE) or gastroesophageal junction (GEJ) remains a matter of debate. We performed an individual participant data (IPD) network meta-analysis (NMA) of randomized controlled trials (RCTs) to study the effect of chemotherapy or chemoradiotherapy, with a focus on tumor location and histology subgroups. PATIENTS AND METHODS All, published or unpublished, RCTs closed to accrual before December 31, 2015 and having compared at least two of the following strategies were eligible: upfront surgery (S), chemotherapy followed by surgery (CS), and chemoradiotherapy followed by surgery (CRS). All analyses were conducted on IPD obtained from investigators. The primary end point was overall survival (OS). The IPD-NMA was analyzed by a one-step mixed-effect Cox model adjusted for age, sex, tumor location, and histology. The NMA was registered in PROSPERO (CRD42018107158). RESULTS IPD were obtained for 26 of 35 RCTs (4,985 of 5,807 patients) corresponding to 12 comparisons for CS-S, 12 for CRS-S, and four for CRS-CS. CS and CRS led to increased OS when compared with S with hazard ratio (HR) = 0.86 (0.75 to 0.99), P = .03 and HR = 0.77 (0.68 to 0.87), P < .001 respectively. The NMA comparison of CRS versus CS for OS gave a HR of 0.90 (0.74 to 1.09), P = .27 (consistency P = .26, heterogeneity P = .0038). For CS versus S, a larger effect on OS was observed for GEJ versus TE tumors (P = .036). For the CRS versus S and CRS versus CS, a larger effect on OS was observed for women (P = .003, .012, respectively). CONCLUSION Neoadjuvant chemotherapy and chemoradiotherapy were consistently better than S alone across histology, but with some variation in the magnitude of treatment effect by sex for CRS and tumor location for CS. A strong OS difference between CS and CRS was not identified.
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Affiliation(s)
- Matthieu Faron
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Maurice Cheugoua-Zanetsie
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Jayne Tierney
- MRC Clinical Trial Unit at UCL, London, United Kingdom
| | | | | | - Kathryn Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Hong Yang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Joel Shapiro
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - B. Mark Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - Thomas Walsh
- Connolly Hospital Blanchardstown, Dublin, Ireland
| | | | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technoglogy, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Simon Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David Cunningham
- National Institute for Health Research, Biomedical Research Centres, Royal Marsden, London, United Kingdom
| | - Florent de Vathaire
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | | | | | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Center for Esophageal Diseases, Padova, Italy
| | | | - Janine Thomas
- Princess Alexandra Hospital, Woolloongabba, Australia
| | | | - Joel Tepper
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | | | - Johanna van Sandick
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jianhua Fu
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jean-Pierre Pignon
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Michel Ducreux
- Departement d’Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- Oncostat, CESP, Inserm U1018, University Paris-Saclay, labeled Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
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5
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Lebret T, Paoletti X, Pignot G, Roumiguié M, Colombel M, Savareux L, Verhoest G, Guy L, Rigaud J, De Vergie S, Poinas G, Droupy S, Kleinclauss F, Courtade-Saïdi M, Piaton E, Radulescu C, Rioux-Leclercq N, Kandel-Aznar C, Renaudin K, Cochand-Priollet B, Allory Y, Nivet S, Rouprêt M. Artificial intelligence to improve cytology performance in urothelial carcinoma diagnosis: results from validation phase of the French, multicenter, prospective VISIOCYT1 trial. World J Urol 2023; 41:2381-2388. [PMID: 37480491 PMCID: PMC10465399 DOI: 10.1007/s00345-023-04519-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/22/2023] [Accepted: 07/01/2023] [Indexed: 07/24/2023] Open
Abstract
PURPOSE Cytology and cystoscopy, the current gold standard for diagnosing urothelial carcinomas, have limits: cytology has high interobserver variability with moderate or not optimal sensitivity (particularly for low-grade tumors); while cystoscopy is expensive, invasive, and operator dependent. The VISIOCYT1 study assessed the benefit of VisioCyt® for diagnosing urothelial carcinoma. METHODS VISIOCYT1 was a French prospective clinical trial conducted in 14 centers. The trial enrolled adults undergoing endoscopy for suspected bladder cancer or to explore the lower urinary tract. Participants were allocated either Group 1: with bladder cancer, i.e., with positive cystoscopy or with negative cystoscopy but positive cytology, or Group 2: without bladder cancer. Before cystoscopy and histopathology, slides were prepared for cytology and the VisioCyt® test from urine samples. The diagnostic performance of VisioCyt® was assessed using sensitivity (primary objective, 70% lower-bound threshold) and specificity (75% lower-bound threshold). Sensitivity was also assessed by tumor grade and T-staging. VisioCyt® and cytology performance were evaluated relative to the histopathological assessments. RESULTS Between October 2017 and December 2019, 391 participants (170 in Group 1 and 149 in Group 2) were enrolled. VisioCyt®'s sensitivity was 80.9% (95% CI 73.9-86.4%) and specificity was 61.8% (95% CI 53.4-69.5%). In high-grade tumors, the sensitivity was 93.7% (95% CI 86.0-97.3%) and in low-grade tumors 66.7% (95% CI 55.2-76.5%). Sensitivity by T-staging, compared to the overall sensitivity, was higher in high-grade tumors and lower in low-grade tumors. CONCLUSION VisioCyt® is a promising diagnostic tool for urothelial cancers with improved sensitivities for high-grade tumors and notably for low-grade tumors.
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Affiliation(s)
| | - Xavier Paoletti
- Institut Curie, Saint Cloud, France
- Université Versailles Saint-Quentin, Université Paris-Saclay, Saint Cloud, France
| | | | - Mathieu Roumiguié
- Urology Department, Centre Hospitalier Universitaire (CHU) Rangueil, IUCT Oncopole, Toulouse, France
| | - Marc Colombel
- Urology Department, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Savareux
- Urology Auvergne Centre, Clinique de la Chataigneraie, Beaumont, France
| | | | - Laurent Guy
- Urology Department of Urology, CHU Gabriel Montpied, Clermont-Ferrand, France
| | | | | | - Grégoire Poinas
- Urology Department, Clinique Beausoleil, Montpellier, France
| | | | | | | | - Eric Piaton
- Centre de Pathologie Est, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Camelia Radulescu
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Foch, Suresnes, France
| | | | | | - Karine Renaudin
- Department of Pathology, CHU Hôtel Dieu, Nantes, France
- Centre de Recherche en Transplantation et en Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | | | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, France
- Institut Curie, PSL Research University, CNRS, UMR144, Equipe Labellisée Ligue Contre le Cancer, Paris, France
| | | | - Morgan Rouprêt
- Urology Department, GRC n°5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
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6
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Corbaux P, You B, Glasspool RM, Yanaihara N, Tinker AV, Lindemann K, Ray-Coquard IL, Mirza MR, Subtil F, Colomban O, Péron J, Karamouza E, McNeish I, Kelly C, Kagimura T, Welch S, Lewsley LA, Paoletti X, Cook A. Survival and modelled cancer antigen-125 ELIMination rate constant K score in ovarian cancer patients in first-line before poly(ADP-ribose) polymerase inhibitor era: A Gynaecologic Cancer Intergroup meta-analysis. Eur J Cancer 2023; 191:112966. [PMID: 37542936 DOI: 10.1016/j.ejca.2023.112966] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND In patients with advanced ovarian cancer, the modelled CA-125 ELIMination rate constant K (KELIM) is an early indicator of the tumour intrinsic chemosensitivity. We assessed the prognostic and surrogate values of KELIM with respect to those of surgery outcome (based on post-operative residual lesions) in the Gynaecologic Cancer Intergroup (GCIG) individual patient data meta-analysis MAOV (Meta-Analysis in OVarian cancer) built before the emergence of poly(ADP-ribose) polymerase (PARP) inhibitors. METHODS The dataset was split into learning and validation cohorts (ratio 1:2). The individual modelled KELIM values were estimated, standardised by the median value, then scored as unfavourable (<1.0) or favourable (≥1.0). Overall survival (OS) and progression-free survival (PFS) analyses were performed with a two-step meta-analytic approach and surrogacy through a two-level meta-analytic model. RESULTS KELIM was assessed in 5884 patients from eight first-line trials (learning, 1962; validation, 3922). A favourable KELIM score was significantly associated with longer OS (validation set, median, 78.8 versus 28.4 months, hazard-ratios [HR] 0.46, 95% confidence interval [CI], 0.41-0.50, C-index 0.68), and longer PFS (validation set, median 30.5 versus 9.8 months, HR 0.49, 95% CI, 0.45-0.54, C-index 0.68), as were International Federation of Gynaecology and Obstetrics (FIGO) stage and debulking surgery outcome. Three prognostic groups were identified based on the surgery outcome and KELIM score, with large differences in OS (105.1, ∼45.0, and 22.1 months) and PFS (58.1, ∼15.0, and 8.0 months). Surrogacy for OS and for PFS was not established. CONCLUSION KELIM is an independent prognostic biomarker for survival, complementary to surgery outcome, representing a new determinant of first-line treatment success.
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Affiliation(s)
- Pauline Corbaux
- EA UCBL/HCL 3738, Centre pour l'lnnovation en Cancérologie de Lyon (CICLY), Faculty of Medicine Lyon-Sud, Claude Bernard University Lyon 1, Lyon, France; Medical Oncology, Institut de Cancérologie et d'Hématologie Universitaire de Saint-Étienne (ICHUSE), Centre Hospitalier Universitaire de Saint-Etienne, France
| | - Benoit You
- EA UCBL/HCL 3738, Centre pour l'lnnovation en Cancérologie de Lyon (CICLY), Faculty of Medicine Lyon-Sud, Claude Bernard University Lyon 1, Lyon, France; Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France.
| | - Rosalind M Glasspool
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Nozomu Yanaihara
- Department of Obstetrics and Gynecologye, The Jikei University School of Medicine, Tokyo, Japan
| | - Anna V Tinker
- Medical Oncology, BC Cancer - Vancouver, Vancouver, Canada
| | - Kristina Lindemann
- Department of Gynaecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Mansoor R Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Clinical Trial Unit, Nordic Society of Gynaecological Oncology, Copenhagen, Denmark
| | - Fabien Subtil
- Department of Biostatistics, Hospices Civils de Lyon, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, CNRS UMR 5558, Claude Bernard University Lyon 1, Lyon, France
| | - Olivier Colomban
- EA UCBL/HCL 3738, Centre pour l'lnnovation en Cancérologie de Lyon (CICLY), Faculty of Medicine Lyon-Sud, Claude Bernard University Lyon 1, Lyon, France
| | - Julien Péron
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France; Department of Biostatistics, Hospices Civils de Lyon, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, CNRS UMR 5558, Claude Bernard University Lyon 1, Lyon, France
| | - Eleni Karamouza
- Institut Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif, France; Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labelled Ligue Contre le Cancer, Villejuif, France
| | - Iain McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline Kelly
- Cancer Research UK Clinical Trial Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innovation at Kobe, Translational Research Center for Medical Innovation, Kobe, Japan
| | - Stephen Welch
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Liz-Anne Lewsley
- Cancer Research UK Clinical Trial Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Adrian Cook
- Medical Research Council Clinical Trials Unit, University College London, London, UK
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du Rusquec P, Guimbaud R, Le Malicot K, Gornet JM, Nguyen S, Lecomte T, Khemissa-Akouz F, Perrier H, Bouché O, Paoletti X, Le Tourneau C. Evaluation of the relevance of the growth modulation index (GMI) from the FFCD 0307 randomized phase III trial comparing the sequence of two chemotherapeutic regimens. ESMO Open 2023; 8:101616. [PMID: 37542912 PMCID: PMC10485393 DOI: 10.1016/j.esmoop.2023.101616] [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: 03/24/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Precision medicine trials disrupted the paradigm of randomized controlled trials in large populations. Patient selection may be based on molecular alterations rather than on primary tumor location. In small patient populations, the growth modulation index (GMI) has been developed to evaluate treatment efficacy by using each patient as its own control. The FFCD 0307 randomized phase III trial compared two sequences of chemotherapy in advanced gastric cancer, which represents a unique opportunity to evaluate the relevance of the GMI. PATIENTS AND METHODS In the FFCD 0307 trial, patients with advanced gastric cancer were randomized between two chemotherapy sequences [ECX followed by FOLFIRI at disease progression (arm A) versus FOLFIRI followed by ECX (arm B)]. GMI was defined as the ratio of the progression-free survival on second treatment (PFS2) to the time to progression on first treatment (TTP1). Sequence benefit was defined as a GMI exceeding 1.3 (GMI-high). GMI was correlated with overall survival (OS). OS1 and OS2 were measured from first randomization and second-line failure to death. RESULTS Four hundred and sixteen patients were randomized (209 in arm A, 207 in arm B). One hundred and seventy-five patients (42%) received the two sequences and were assessable for GMI (97 in arm A, 79 in arm B). The median GMI was higher in arm A than in arm B (0.62 versus 0.47, P = 0.04). Patients with a high GMI had a longer OS1 (median 14.9 versus 11.5 months, NS). Median OS2 was doubled in the GMI-high group (3.4 versus 1.6 months, NS). CONCLUSION GMI analyses suggest that ECX followed by FOLFIRI might represent a better therapeutic strategy than FOLFIRI followed by ECX. High GMI was associated with prolonged survival.
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Affiliation(s)
- P du Rusquec
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France; INSERM U900 Research Unit, PSL Research University, Institut Curie, Saint Cloud, France.
| | - R Guimbaud
- Medical Oncology, CHU de Toulouse, Toulouse, France
| | - K Le Malicot
- Department of Biostatistics, Fédération Francophone de la Cancérologie Digestive, Dijon FFCD, Dijon, France; EPICAD INSERM LNC-UMR 1231, Bourgogne Franche-Comté University, Dijon, France
| | - J-M Gornet
- Gastroenterology, Hôpital Saint-Louis, Paris, France
| | - S Nguyen
- Medical Oncology, CH de Pau, Pau, France
| | - T Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, University Hospital of Tours, Tours, France
| | | | - H Perrier
- Medical Oncology, Hôpital Saint-Joseph, Marseille, France
| | - O Bouché
- Gastroenterology and Digestive Oncology, CHU de Reims, Hôpital Robert Debré, Reims, France
| | - X Paoletti
- INSERM U900 Research Unit, PSL Research University, Institut Curie, Saint Cloud, France
| | - C Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France; INSERM U900 Research Unit, PSL Research University, Institut Curie, Saint Cloud, France
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8
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Moreno L, DuBois SG, Glade Bender J, Mauguen A, Bird N, Buenger V, Casanova M, Doz F, Fox E, Gore L, Hawkins DS, Izraeli S, Jones DT, Kearns PR, Molenaar JJ, Nysom K, Pfister S, Reaman G, Smith M, Weigel B, Vassal G, Zwaan CM, Paoletti X, Iasonos A, Pearson AD. Combination Early-Phase Trials of Anticancer Agents in Children and Adolescents. J Clin Oncol 2023; 41:3408-3422. [PMID: 37015036 PMCID: PMC10414747 DOI: 10.1200/jco.22.02430] [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: 11/01/2022] [Accepted: 02/07/2023] [Indexed: 04/06/2023] Open
Abstract
PURPOSE There is an increasing need to evaluate innovative drugs for childhood cancer using combination strategies. Strong biological rationale and clinical experience suggest that multiple agents will be more efficacious than monotherapy for most diseases and may overcome resistance mechanisms and increase synergy. The process to evaluate these combination trials needs to maximize efficiency and should be agreed by all stakeholders. METHODS After a review of existing combination trial methodologies, regulatory requirements, and current results, a consensus among stakeholders was achieved. RESULTS Combinations of anticancer therapies should be developed on the basis of mechanism of action and robust preclinical evaluation, and may include data from adult clinical trials. The general principle for combination early-phase studies is that, when possible, clinical trials should be dose- and schedule-confirmatory rather than dose-exploratory, and every effort should be made to optimize doses early. Efficient early-phase combination trials should be seamless, including dose confirmation and randomized expansion. Dose evaluation designs for combinations depend on the extent of previous knowledge. If not previously evaluated, limited evaluation of monotherapy should be included in the same clinical trial as the combination. Randomized evaluation of a new agent plus standard therapy versus standard therapy is the most effective approach to isolate the effect and toxicity of the novel agent. Platform trials may be valuable in the evaluation of combination studies. Patient advocates and regulators should be engaged with investigators early in a proposed clinical development pathway and trial design must consider regulatory requirements. CONCLUSION An optimized, agreed approach to the design and evaluation of early-phase pediatric combination trials will accelerate drug development and benefit all stakeholders, most importantly children and adolescents with cancer.
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Affiliation(s)
- Lucas Moreno
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Steven G. DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | | | - Nick Bird
- Solving Kids' Cancer UK, London, United Kingdom
| | - Vickie Buenger
- Coalition Against Childhood Cancer (CAC2), Philadelphia, PA
| | | | - François Doz
- Université Paris Cité, Paris, France
- SIREDO Centre (Care, Innovation Research in Pediatric, Adolescent and Young Adults Oncology), Institut Curie, Paris, France
| | | | - Lia Gore
- Children's Hospital Colorado, Aurora, CO
- University of Colorado, Aurora, CO
| | | | - Shai Izraeli
- Rina Zaizov Pediatric Hematology Oncology Division, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Hematological Malignancies Centre of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David T.W. Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Pamela R. Kearns
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pharmaceutical Sciences Utrecht University, Utrecht, the Netherlands
| | - Jan J. Molenaar
- Division of Pediatric Neurooncology, DKFZ, KiTZ
- Righospitalet, Copenhagen, Denmark
| | - Karsten Nysom
- Clinical Trial Unit and Childhood Brain Tumors, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Gilles Vassal
- Innovative Therapies for Children with Cancer, Paris, France
- ACCELERATE, Brussels, Belgium
- Gustave Roussy Cancer Centre, Paris, France
| | - Christian Michel Zwaan
- Righospitalet, Copenhagen, Denmark
- Department of Pediatric Oncology, Hematology, Erasmus MC, Sophia Children’s Hospital, the Netherlands
| | | | | | - Andrew D.J. Pearson
- Innovative Therapies for Children with Cancer, Paris, France
- ACCELERATE, Brussels, Belgium
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9
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Karamouza E, Glasspool RM, Kelly C, Lewsley LA, Carty K, Kristensen GB, Ethier JL, Kagimura T, Yanaihara N, Cecere SC, You B, Boere IA, Pujade-Lauraine E, Ray-Coquard I, Proust-Lima C, Paoletti X. CA-125 Early Dynamics to Predict Overall Survival in Women with Newly Diagnosed Advanced Ovarian Cancer Based on Meta-Analysis Data. Cancers (Basel) 2023; 15:1823. [PMID: 36980708 PMCID: PMC10047009 DOI: 10.3390/cancers15061823] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
(1) Background: Cancer antigen 125 (CA-125) is a protein produced by ovarian cancer cells that is used for patients' monitoring. However, the best ways to analyze its decline and prognostic role are poorly quantified. (2) Methods: We leveraged individual patient data from the Gynecologic Cancer Intergroup (GCIG) meta-analysis (N = 5573) to compare different approaches summarizing the early trajectory of CA-125 before the prediction time (called the landmark time) at 3 or 6 months after treatment initiation in order to predict overall survival. These summaries included observed and estimated measures obtained by a linear mixed model (LMM). Their performances were evaluated by 10-fold cross-validation with the Brier score and the area under the ROC (AUC). (3) Results: The estimated value and the last observed value at 3 months were the best measures used to predict overall survival, with an AUC of 0.75 CI 95% [0.70; 0.80] at 24 and 36 months and 0.74 [0.69; 0.80] and 0.75 [0.69; 0.80] at 48 months, respectively, considering that CA-125 over 6 months did not improve the AUC, with 0.74 [0.68; 0.78] at 24 months and 0.71 [0.65; 0.76] at 36 and 48 months. (4) Conclusions: A 3-month surveillance provided reliable individual information on overall survival until 48 months for patients receiving first-line chemotherapy.
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Affiliation(s)
- Eleni Karamouza
- Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, 94805 Villejuif, France
- Oncostat, Labeled Ligue Contre le Cancer, CESP U1018, Inserm, Université Paris-Saclay, 94805 Villejuif, France
| | - Rosalind M. Glasspool
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK
| | - Caroline Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Liz-Anne Lewsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Karen Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow G12 0YN, UK
| | - Gunnar B. Kristensen
- Department of Gynecologic Oncology, Institute for Cancer Genetics and Informatics, Oslo University Hospital, 0424 Oslo, Norway
| | - Josee-Lyne Ethier
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Tatsuo Kagimura
- Foundation for Biomedical Research and Innocation, Translational Research Center for Medical Innovation, Kobe 650-0047, Japan
| | | | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy
| | - Benoit You
- EMR UCBL/HCL 3738, Faculté de Médecine Lyon-Sud, Université Lyon, Université Claude Bernard Lyon 1, 69100 Lyon, France
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, 69495 Lyon, France
| | - Ingrid A. Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | | | | | - Cécile Proust-Lima
- UMR1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, 33000 Bordeaux, France
| | - Xavier Paoletti
- Faculty of Medicine, University of Versailles Saint-Quentin, Université Paris Saclay, 78000 Versailles, France
- INSERM U900, Statistics for Personalized Medicine, Institut Curie, 92210 Saint-Cloud, France
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10
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Roustit M, Demarcq O, Laporte S, Barthélémy P, Chassany O, Cucherat M, Demotes J, Diebolt V, Espérou H, Fouret C, Galaup A, Gambotti L, Gourio C, Guérin A, Labruyère C, Paoletti X, Porcher R, Simon T, Varoqueaux N. Les essais plateformes ☆. Therapie 2023; 78:19-28. [PMID: 36581520 PMCID: PMC9721267 DOI: 10.1016/j.therap.2022.11.011] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Les essais plateformes connaissent depuis quelques années un essor important, amplifié récemment par la pandémie de coronavirus disease 2019 (COVID-19). La mise en œuvre d’un essai plateforme s’avère particulièrement utile dans certaines pathologies, notamment lorsqu’il y a un nombre important de candidats médicaments à évaluer, une évolution rapide du traitement de référence ou dans les situations de besoin urgent d’évaluation, au cours desquelles la mutualisation des protocoles et des infrastructures permet d’optimiser le nombre de patients à inclure, les coûts et les délais de réalisation de l’investigation. Toutefois, la spécificité des essais plateformes soulève des problématiques méthodologiques, éthiques et règlementaires, qui ont fait l’objet de la table ronde et qui sont exposées dans cet article. La table ronde a également été l’occasion d’aborder la complexité de la promotion et de la gestion des données liée à la multiplicité des partenaires, le financement et la gouvernance de ces essais, et le niveau d’acceptabilité de leurs résultats par les autorités compétentes.
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Affiliation(s)
- Matthieu Roustit
- Inserm CIC1406, university Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France.
| | - Olivier Demarcq
- Pfizer, direction des affaires médicales, 75668 Paris, France
| | - Silvy Laporte
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Michel Cucherat
- metaEvidence.org, service hospitalo-universitaire de pharmacologie et toxicologie, hospices civils de Lyon, 69000 Lyon, France
| | | | - Vincent Diebolt
- F-CRIN, UMS 015, Pavillon Leriche, hôpital Purpan/CHU de Toulouse, 31059 Toulouse, France
| | - Hélène Espérou
- Inserm, pôle de recherche clinique, Institut de santé publique, 75013 Paris, France
| | - Cécile Fouret
- Medtronic, direction des affaires scientifiques, 75014 Paris, France
| | | | - Laetitia Gambotti
- Département recherche clinique, Institut national du cancer, 92100 Boulogne-Billancourt, France
| | | | | | - Carine Labruyère
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - Xavier Paoletti
- Inserm U900, équipe de statistique pour la médecine de précision (STAMPM), Institut Curie, université de Versailles St Quentin/Paris-Saclay, 92210 St-Cloud, France
| | - Raphael Porcher
- Inserm, Inra, centre d'épidémiologie clinique, université Paris Cité, METHODS Team, CRESS, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 75004 Paris, France
| | - Tabassome Simon
- Service de pharmacologie, plateforme de recherche clinique de l'Est parisien, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75012 Paris, France
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11
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Roustit M, Demarcq O, Laporte S, Barthélémy P, Chassany O, Cucherat M, Demotes J, Diebolt V, Espérou H, Fouret C, Galaup A, Gambotti L, Gourio C, Guérin A, Labruyère C, Paoletti X, Porcher R, Simon T, Varoqueaux N. Platform trials. Therapie 2023; 78:29-38. [PMID: 36529559 PMCID: PMC9756081 DOI: 10.1016/j.therap.2022.12.003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
For the past few years, platform trials have experienced a significant increase, recently amplified by the COVID-19 pandemic. The implementation of a platform trial is particularly useful in certain pathologies, particularly when there is a significant number of drug candidates to be assessed, a rapid evolution of the standard of care or in situations of urgent need for evaluation, during which the pooling of protocols and infrastructure optimizes the number of patients to be enrolled, the costs, and the deadlines for carrying out the investigation. However, the specificity of platform trials raises methodological, ethical, and regulatory issues, which have been the subject of the round table and which are presented in this article. The round table was also an opportunity to discuss the complexity of sponsorship and data management related to the multiplicity of partners, funding, and governance of these trials, and the level of acceptability of their findings by the competent authorities.
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Affiliation(s)
- Matthieu Roustit
- Inserm CIC1406, university Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France,Corresponding author. Centre d’investigation clinique – Inserm CIC1406, CHU Grenoble Alpes, 38043 Grenoble cedex 09, France
| | - Olivier Demarcq
- Pfizer, direction des affaires médicales, 75668 Paris, France
| | - Silvy Laporte
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP–HP, 75004 Paris, France
| | - Michel Cucherat
- metaEvidence.org, service hospitalo-universitaire de pharmacologie et toxicologie, hospices civils de Lyon, 69000 Lyon, France
| | | | - Vincent Diebolt
- F-CRIN, UMS 015, Pavillon Leriche, hôpital Purpan/CHU de Toulouse, 31059 Toulouse, France
| | - Hélène Espérou
- Inserm, pôle de recherche clinique, Institut de santé publique, 75013 Paris, France
| | - Cécile Fouret
- Medtronic, direction des affaires scientifiques, 75014 Paris, France
| | | | - Laetitia Gambotti
- Département recherche clinique, Institut national du cancer, 92100 Boulogne-Billancourt, France
| | | | | | - Carine Labruyère
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - Xavier Paoletti
- Inserm U900, équipe de statistique pour la médecine de précision (STAMPM), Institut Curie, université de Versailles St Quentin/Paris-Saclay, 92210 St-Cloud, France
| | - Raphael Porcher
- Inserm, Inra, centre d’épidémiologie clinique, université Paris Cité, METHODS Team, CRESS, Hôtel-Dieu, Assistance publique–Hôpitaux de Paris, 75004 Paris, France
| | - Tabassome Simon
- Service de pharmacologie, plateforme de recherche clinique de l’Est parisien, Sorbonne université, Assistance publique–Hôpitaux de Paris, 75012 Paris, France
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12
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Guani B, Gaillard T, Teo-Fortin LA, Balaya V, Feki A, Paoletti X, Mathevet P, Plante M, Lecuru F. Estimation risk of lymph nodal invasion in patients with early-stage cervical cancer: Cervical cancer application. Front Oncol 2022; 12:935628. [PMID: 36033437 PMCID: PMC9413841 DOI: 10.3389/fonc.2022.935628] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Lymph node status is a major prognostic factor in early-stage cervical cancer. Predicting the risk of lymph node metastasis is essential for optimal therapeutic management. The aim of the study was to develop a web-based application to predict the risk of lymph node metastasis in patients with early-stage (IA1 with positive lymph vascular space invasion, IA2 and IB1) cervical cancer. Materials and methods We performed a secondary analysis of data from two prospective multicenter trials, Senticol 1 and 2 pooled together in the training dataset. The histological risk factors were included in a multivariate logistic regression model in order to determine the most suitable prediction model. An internal validation of the chosen prediction model was then carried out by a cross validation of the ‘leave one out cross validation’ type. The prediction model was implemented in an interactive online application of the ‘Shinyapp’ type. Finally, an external validation was performed with a retrospective cohort from L’Hôtel-Dieu de Québec in Canada. Results Three hundred twenty-one patients participating in Senticol 1 and 2 were included in our training analysis. Among these patients, 280 did not present lymph node invasion (87.2%), 13 presented isolated tumor cells (4%), 11 presented micrometastases (3.4%) and 17 macrometastases (5.3%). Tumor size, presence of lymph-vascular space invasion and stromal invasion were included in the prediction model. The Receiver Operating Characteristic (ROC) Curve from this model had an area under the curve (AUC) of 0.79 (95% CI [0.69– 0.90]). The AUC from the cross validation was 0.65. The external validation on the Canadian cohort confirmed a good discrimination of the model with an AUC of 0.83. Discussion This is the first study of a prediction score for lymph node involvement in early-stage cervical cancer that includes internal and external validation. The web application is a simple, practical, and modern method of using this prediction score to assist in clinical management.
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Affiliation(s)
- Benedetta Guani
- Department of Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Department of Gynecology, Hopital Fribourgeois (HFR), Fribourg, Switzerland
- Faculty of Biology and Medicine, University of Fribourg, Fribourg, Switzerland
- *Correspondence: Benedetta Guani,
| | | | | | - Vincent Balaya
- Department of Gynecology and Obstetrics, FOCH Hospital, Suresnes, France
| | - Anis Feki
- Department of Gynecology, Hopital Fribourgeois (HFR), Fribourg, Switzerland
- Faculty of Biology and Medicine, University of Fribourg, Fribourg, Switzerland
| | | | - Patrice Mathevet
- Department of Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marie Plante
- Faculty of Medicine, Laval University of Quebec, Quebec, QC, Canada
- Division of Gynecologic Oncology, Centre Hospitalier Universitaire (CHU) de Quebec, L’Hôtel-Dieu de Quebec, Quebec, QC, Canada
| | - Fabrice Lecuru
- Department of Gynecology, Institut Curie, Paris, France
- Department of Medicine, University of Paris, Paris, France
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Vergote I, Gonzalez-Martin A, Lorusso D, Gourley C, Mirza MR, Kurtz JE, Okamoto A, Moore K, Kridelka F, McNeish I, Reuss A, Votan B, du Bois A, Mahner S, Ray-Coquard I, Kohn EC, Berek JS, Tan DSP, Colombo N, Zang R, Concin N, O'Donnell D, Rauh-Hain A, Herrington CS, Marth C, Poveda A, Fujiwara K, Stuart GCE, Oza AM, Bookman MA, Mahner S, Reuss A, du Bois A, Grimm C, Marth C, Berger R, Concin N, Chang TC, Ochiai K, Gebski V, Davis A, Beale P, Vergote I, Kridelka F, Denys H, Vandecaveye V, Cancido dos Reis FJ, Del Pilar Estevez Diz M, Stuart G, MacKay H, Carey M, Cibula D, Dundr (path) P, Dorigo O, Berek J, O'Donnell D, Saadeh A, Boere I, Lok C, Coronado P, Ottevanger N, Tan DSP, Ng J, Gonzalez Martin A, Oaknin A, Poveda A, Perez Fidalgo A, Rauh-Hain A, Lu K, López-Zavala C, Gómez-García EM, Ray-Coquard I, Paoletti X, Kurtz JE, Joly F, Votan B, Bookman M, Moore K, Arend R, Fujiwara K, Fujiwara H, Hasegawa K, Bruchim I, Tsoref D, Oda K, Okamoto A, Enomoto T, Michel D, Kim HS, Lee JY, Mukhopadhyay A, Katsaros D, Colombo N, Pignata S, Lorusso D, Scambia G, Kohn E, Lee JM, McNeish I, Nicum S, Farrelly L, Sehouli J, Keller M, Braicu E, Bjørge L, Mirza MR, Auranen A, Welch S, Oza AM, Heinzelmann V, Gourley C, Roxburgh P, Herrington CS, Glasspool R, Zang R, Zhu J. Clinical research in ovarian cancer: consensus recommendations from the Gynecologic Cancer InterGroup. Lancet Oncol 2022; 23:e374-e384. [PMID: 35901833 PMCID: PMC9465953 DOI: 10.1016/s1470-2045(22)00139-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/13/2022]
Abstract
The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research was held virtually in October, 2021, following published consensus guidelines. The goal of the consensus meeting was to achieve harmonisation on the design elements of upcoming trials in ovarian cancer, to select important questions for future study, and to identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within four topic groups on clinical research in ovarian cancer including first line treatment, recurrent disease, disease subgroups, and future trials. Unanimous consensus was obtained for 14 of 20 statements, with greater than 90% concordance in the remaining six statements. The high acceptance rate following active deliberation among the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote the harmonisation of international clinical research in ovarian cancer.
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Beaino ZE, Dupain C, Marret G, Paoletti X, Fuhrmann L, Martinat C, Bièche I, Tourneau CL, Kamal M, Vincent-Salomon A. Abstract 1724: Pancancer evaluation of tumor infiltrating lymphocytes (TILs) and PD-L1 in SHIVA-01 trial patients with different biopsy sites and histological types. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1724] [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: Immunologic characterization of tumors and their microenvironments had been proposed based on the combination of PD-L1 expression and the presence of tumor-infiltrating lymphocytes (TILs). This study aims to investigate in metastatic samples from patients with cancer, the distribution of TILs and expression of PD-L1 using Combined Positive Score (CPS), Tumor Proportion Score (TPS), as well as TILs. These variables were further evaluated in paired primary and metastatic samples and correlated with clinical outcome.
Patients and methods: 550 pan-cancer patients of SHIVA01 trial (NCT01771458) with available contributive FFPE sample from a metastatic biopsy and 111 paired primary and metastatic samples were evaluated for TILs. The 550 metastatic specimens were biopsies from different anatomical sites subdivided into 7 groups: liver biopsies (n=179; 33%), visceral organ biopsies (n=92; 17%), lung biopsies (n=89; 16%), lymph node biopsies (n= 88; 16%), cutaneous biopsies (n=53; 10%), soft tissue biopsies (n=48; 9%) and brain biopsy (n=1; 0.2%). PD-L1 expression was assessed by Immunohistochemistry using the 22C3 antibody clone (Merck & Co) and quantified using two scores: CPS and TPS, in 494 metastatic tumors and in 77 paired primary and metastatic tumors patients with contributive immunohistochemistry. The correlations of TILs and PD-L1 expression with clinical outcomes are ongoing.
Results: In metastatic samples, we found no difference in TILs distribution according to histological subtype, primary system or biopsy site with a median of 10% [range: 0%-70%]. A significant decrease in the median percentage of TILs was found in metastases in comparison to their paired primary lesions (20% [5%-60%] versus 10% [0%-40%], p<0.0001). PD-L1 expression was homogenous in all metastatic tumors independently of primary system or biopsy site (median TPS = 2% ; CPS = 0 n=218, CPS≥1 n=265 ; p=0.056). There was a strong association between TPS count and histological subtypes (p=0.015) that was not observed with CPS (p=0.23). In paired primary/metastatic samples, we did not observe any changes in the CPS and TPS scores (p>0.3 for both).
Conclusion: We show that metastatic sites are less infiltrated with lymphocytes as compared to their paired primary lesions independently of the initial primary tumor site, histological type or biopsy site. PD-L1 expression was similar in paired primary and metastatic samples.
Citation Format: Zakhia El Beaino, Célia Dupain, Grégoire Marret, Xavier Paoletti, Laëtitia Fuhrmann, Charlotte Martinat, Ivan Bièche, Christophe Le Tourneau, Maud Kamal, Anne Vincent-Salomon. Pancancer evaluation of tumor infiltrating lymphocytes (TILs) and PD-L1 in SHIVA-01 trial patients with different biopsy sites and histological types [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1724.
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Cabrit N, Faron M, Tierney J, Cheugoua-Zanetsie M, Thirion P, Cunningham D, Winter K, Fu J, Mauer M, Shapiro J, Burmeister B, Walsh T, Piessen G, Klevebro F, Ychou M, Van Der Gaast A, Law S, Stahl M, Paoletti X, Ducreux M, Michiels S. SO-5 Disease-free survival as surrogate for overall survival in neoadjuvant chemo(radio)therapy treatment of esophageal or gastro-esophageal junction carcinoma: An analysis of 4518 individual patients and 22 trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Leary A, Deluche E, Favier L, Paoletti X, Mansi L, Tredan O, Eberst L, De La Motte Rouge T, Joly F, Lortholary A, You B, Marmé F, Van Gorp T, Floquet A, Frenel JS. TEDOVA/GINECO-OV244b/ENGOT-ov58 trial: Neo-epitope based vaccine OSE2101 alone or in combination with pembrolizumab versus best supportive care (BSC) as maintenance in platinum-sensitive recurrent ovarian cancer with disease control after platinum. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps5614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS5614 Background: Besides PARP inhibitors and bevacizumab, there are no approved maintenance therapies after platinum based chemotherapy for patients with a platinum sensitive relapsed epithelial ovarian cancer (OC). Immune checkpoint inhibitors (ICI) as single agents have limited activity in OC. One attractive strategy is to turn OC from immunogenic “cold” to “hot” tumors via vaccination with tumor-associated antigens (TAAs). OSE2101 is a multiple-neoepitope vaccine restricted to HLA-A2-positive patients (45% of OC patients) targeting 5 TAAs: TP53, MAGE2, MAGE3, CEA and HER2. These neo-epitopes are modified to increase both major histocompatibility complex and the T cell receptor binding affinity. The proof of concept for this approach was recently demonstrated with OSE2101 improving overall survival in a phase III trial in lung cancer progressing after ICI (Besse et al. 2021). The combination of OSE2101 with an ICI may most effectively harness anti-tumor immunity. Methods: TEDOVA is an international randomized open-label, phase II trial evaluating the benefit of maintenance by OSE2101 alone or in combination with PD1 inhibition (pembrolizumab) after platinum based chemotherapy in relapsed OC, previously treated with bevacizumab (if eligible) and a PARP inhibitor (if eligible). Patients (N=180) with CR/PR/SD at the end of chemotherapy are randomized (1:1:2) to: Observation/BSC (Arm A), OSE2101 alone (Arm B), or OSE2101 in combination with pembrolizumab (Arm C). Experimental treatments are continued until progression, or intolerance, for up to 2 years. The primary endpoint is progression-free survival (PFS). Secondary endpoints include overall response rate, safety, time to subsequent first or second treatment (TTST-1, TTST-2) and overall survival. 180 HLA-A*02 positive patients will be randomized. HLA-A*02 negative patients will be followed in a separate observational cohort. The sample size is calculated to provide 90% power to detect an improvement in PFS for Arm C vs Arm A with a HR of 0.57. Three one-sided Log-rank tests will be considered in a pre-defined sequence: H1: C (OSE2101+pembrolizumab) vs A (BSC); H2: C (OSE2101+pembrolizumab) vs B (OSE2101) and H3: B vs A. The type I error will be α=5%. The type II error will be β=10%. Tests will be one-sided. Status: The TEDOVA/GINECO-OV244b/ENGOT-ov58 trial is currently recruiting. Clinical trial information: NCT04713514.
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Affiliation(s)
- Alexandra Leary
- Gustave-Roussy Cancer Campus, Villejuif, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Villejuif, France
| | | | | | | | | | | | - Lauriane Eberst
- Institut de Cancérologie de Strasbourg Europe, ICANS, Strasbourg, France
| | | | | | | | - Benoit You
- Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Pierre-Bénite, France
| | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University & AGO Study Group, Mannheim, Germany
| | - Toon Van Gorp
- Leuven Cancer Institute, University Hospital Leuven, and Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium
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Oufkir N, Bonneau C, Pouget N, Fourchotte V, Paoletti X, Rouzier R. Validation externe du KELIM standardisé et du score de récidive résistante au platine chez les patientes atteintes d'un cancer épithélial de l'ovaire avancé. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Guani B, Mahiou K, Crestani A, Cibula D, Buda A, Gaillard T, Mathevet P, Kocian R, Sniadecki M, Wydra DG, Feki A, Paoletti X, Lecuru F, Balaya V. Clinical impact of low-volume lymph node metastases in early-stage cervical cancer: A comprehensive meta-analysis. Gynecol Oncol 2021; 164:446-454. [PMID: 34949436 DOI: 10.1016/j.ygyno.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In order to define the clinical significance of low-volume metastasis, a comprehensive meta-analysis of published data and individual data obtained from articles mentioning micrometastases (MIC) and isolated tumor cells (ITC) in cervical cancer was performed, with a follow up of at least 3 years. METHODS We performed a systematic literature review and meta-analysis, following Cochrane's review methods guide and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was the disease-free survival (DFS), and the secondary outcome was the overall survival (OS). The hazard ratio (HR) was taken as the measure of the association between the low-volume metastases (MIC+ITC and MIC alone) and DFS or OS; it quantified the hazard of an event in the MIC (+/- ITC) group compared to the hazard in node-negative (N0) patients. A random-effect meta-analysis model using the inverse variance method was selected for pooling. Forest plots were used to display the HRs and risk differences within individual trials and overall. RESULTS Eleven articles were finally retained for the meta-analysis. In the analysis of DFS in patients with low-volume metastasis (MIC + ITC), the HR was increased to 2.60 (1.55-4.34) in the case of low-volume metastasis vs. N0. The presence of MICs had a negative prognostic impact, with an HR of 4.10 (2.71-6.20) compared to N0. Moreover, this impact was worse than that of MIC pooled with ITCs. Concerning OS, the meta-analysis shows an HR of 5.65 (2.81-11.39) in the case of low-volume metastases vs. N0. The presence of MICs alone had a negative effect, with an HR of 6.94 (2.56-18.81). CONCLUSIONS In conclusion, the presence of MIC seems to be associated with a negative impact on both the DFS and OS and should be treated as MAC.
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Affiliation(s)
- Benedetta Guani
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Faculty of Medicine and Biology, UNIL Lausanne, Lausanne, Switzerland; Department of Gynecology and Obstetrics, HFR Fribourg, Fribourg, Switzerland; Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland.
| | - Katia Mahiou
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - Adrien Crestani
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - David Cibula
- Department of Obstetrics and Gynecology of the 1(st) Faculty of Medicine, General University Hospital in Prague, Czech Republic
| | - Alessandro Buda
- Department of Gynecology Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | - Thomas Gaillard
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - Patrice Mathevet
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Faculty of Medicine and Biology, UNIL Lausanne, Lausanne, Switzerland
| | - Roman Kocian
- Department of Obstetrics and Gynecology of the 1(st) Faculty of Medicine, General University Hospital in Prague, Czech Republic
| | - Marcin Sniadecki
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Dariusz G Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Anis Feki
- Department of Gynecology and Obstetrics, HFR Fribourg, Fribourg, Switzerland; Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Xavier Paoletti
- Faculty of Medicine, University of Paris, 75006 Paris, France; Department of Biostatistics, Institut Curie, Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France; Faculty of Medicine, University of Paris, 75006 Paris, France
| | - Vincent Balaya
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Department of Gynecology and Obstetrics, FOCH Hospital, 92150 Suresnes, France
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Vaflard P, Paoletti X, Servois V, Tresca P, Pons-Tostivint E, Sablin MP, Ricci F, Loirat D, Hescot S, Torossian N, Bello Roufai D, Kamal M, Borcoman E, Le Tourneau C. Dissociated Responses in Patients with Metastatic Solid Tumors Treated with Immunotherapy. Drugs R D 2021; 21:399-406. [PMID: 34562258 PMCID: PMC8602606 DOI: 10.1007/s40268-021-00362-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Accepted: 09/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have been demonstrated to improve overall survival. Atypical patterns of response have been reported, including dissociated response (DR). We evaluated the prevalence of DR. PATIENTS AND METHODS Patients had to have a baseline computed tomography (CT) scan and at least one follow-up CT scan and two target lesions (TLs). Three types of DR were evaluated using RECIST1.1: DR1, defined as at least one progressive and one responding TL; DR2, defined as at least one progressive and one stable TL; and DR3, defined as at least one stable and one responding TL. RESULTS A total of 1244 measurements of 272 TLs were performed in 100 patients. Forty-nine out of the 272 TLs (18%) had received old or recent radiotherapy, and 42 (15%) had been biopsied. An objective response was observed in 22 patients (22%) and on 52 TLs (19%). DR1 were observed in 8% of patients. At the tumor measurement level, the response rate was lower in the case of prior radiotherapy (29% vs 34%, p = 0.01) and higher in the case of prior biopsy (40% vs 32%, p = 0.02). CONCLUSIONS A DR was observed in 8% of patients. Response rate was lower in the case of prior radiotherapy and higher in the case of prior biopsy.
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Affiliation(s)
- Pauline Vaflard
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Xavier Paoletti
- Versailles St Quentin University and Institut Curie, Saint-Cloud, France
- INSERM U900 Research unit, Saint-Cloud, France
| | | | - Patricia Tresca
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Elvire Pons-Tostivint
- Department of Medical Oncology, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - Marie-Paule Sablin
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Francesco Ricci
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Delphine Loirat
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Ségolène Hescot
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Nouritza Torossian
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Diana Bello Roufai
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Maud Kamal
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Edith Borcoman
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26 rue d'Ulm, 75005, Paris, France.
- INSERM U900 Research unit, Saint-Cloud, France.
- Paris-Saclay University, Paris, France.
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20
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Bautista F, Paoletti X, Rubino J, Brard C, Rezai K, Nebchi S, Andre N, Aerts I, De Carli E, van Eijkelenburg N, Thebaud E, Corradini N, Defachelles AS, Ducassou S, Morscher RJ, Vassal G, Geoerger B. Phase I or II Study of Ribociclib in Combination With Topotecan-Temozolomide or Everolimus in Children With Advanced Malignancies: Arms A and B of the AcSé-ESMART Trial. J Clin Oncol 2021; 39:3546-3560. [PMID: 34347542 DOI: 10.1200/jco.21.01152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 05/07/2021] [Revised: 06/14/2021] [Accepted: 07/08/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE AcSé-ESMART is a proof-of-concept, phase I or II, platform trial, designed to explore targeted agents in a molecularly enriched cancer population. Arms A and B aimed to define the recommended phase II dose and activity of the CDK4/6 inhibitor ribociclib with topotecan and temozolomide (TOTEM) or everolimus, respectively, in children with recurrent or refractory malignancies. PATIENTS AND METHODS Ribociclib was administered orally once daily for 16 days after TOTEM for 5 days (arm A) or for 21 days with everolimus orally once daily continuously in a 28-day cycle (arm B). Dose escalation followed the continuous reassessment method, and activity assessment the Ensign design. Arms were enriched on the basis of molecular alterations in the cell cycle or PI3K/AKT/mTOR pathways. RESULTS Thirty-two patients were included, 14 in arm A and 18 in arm B, and 31 were treated. Fourteen patients had sarcomas (43.8%), and 13 brain tumors (40.6%). Main toxicities were leukopenia, neutropenia, and lymphopenia. The recommended phase II dose was ribociclib 260 mg/m2 once a day, temozolomide 100 mg/m2 once a day, and topotecan 0.5 mg/m2 once a day (arm A) and ribociclib 175 mg/m2 once a day and everolimus 2.5 mg/m2 once a day (arm B). Pharmacokinetic analyses confirmed the drug-drug interaction of ribociclib on everolimus exposure. Two patients (14.3%) had stable disease as best response in arm A, and seven (41.2%) in arm B, including one patient with T-acute lymphoblastic leukemia with significant blast count reduction. Alterations considered for enrichment were present in 25 patients (81%) and in eight of nine patients with stable disease; the leukemia exhibited CDKN2A/B and PTEN deficiency. CONCLUSION Ribociclib in combination with TOTEM or everolimus was well-tolerated. The observed activity signals initiated a follow-up study of the ribociclib-everolimus combination in a population enriched with molecular alterations within both pathways.
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Affiliation(s)
- Francisco Bautista
- Hospital Niño Jesús, Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Madrid, Spain
| | - Xavier Paoletti
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, UVSQ, Villejuif, France
- Current address: Institut Curie, INSERM U900 STAMPM, UVSQ, St Cloud, France
| | - Jonathan Rubino
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Caroline Brard
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Keyvan Rezai
- Institut Curie, Radio-Pharmacology Department, Saint Cloud, France
| | - Souad Nebchi
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Nicolas Andre
- Department of Pediatric Oncology, Hôpital de la Timone, AP-HM, Marseille, France
- UMR Inserm 1068, CNRS UMR 7258, Aix Marseille Université U105, Marseille Cancer Research Center (CRCM), Marseille, France
| | - Isabelle Aerts
- SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), Institut Curie, PSL Research University, Paris, France
| | - Emilie De Carli
- Department of Pediatric Oncology, University Hospital, Angers, France
| | | | - Estelle Thebaud
- Department of Pediatric Oncology, Centre Hospitalier Universitaire, Nantes, France
| | - Nadege Corradini
- Pediatric Oncology Department, Institut of Pediatric Hematology and Oncology, Centre Leon Berard, Lyon, France
| | | | - Stephane Ducassou
- Centre Hospitalier Universitaire Pellegrin-Hôpital des Enfants, Bordeaux, France
| | - Raphael J Morscher
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
- INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Gilles Vassal
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
- INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
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Faron M, Cheugoua-Zanetsie AM, Thirion P, Nankivell M, Winter K, Cunningham D, Van der Gaast A, Law S, Langley R, de Vathaire F, Valmasoni M, Mauer M, Roth J, Gebski V, Burmeister BH, Paoletti X, van Sandick J, Fu J, Ducreux M, Blanchard P, Tierney J, Pignon JP, Michiels S. Individual patient data meta-analysis of neoadjuvant chemotherapy followed by surgery versus upfront surgery for carcinoma of the oesophagus or the gastro-oesophageal junction. Eur J Cancer 2021; 157:278-290. [PMID: 34555647 DOI: 10.1016/j.ejca.2021.08.014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Which neoadjuvant treatment for locally advanced thoracic oesophagus (TE) or gastro-oesophageal junction carcinoma is best remains an open question. Randomised controlled trials variously accrued patients with adenocarcinoma and squamous cell carcinoma, making strong conclusions hard to obtain. The primary objective of this individual participant data meta-analysis was to investigate the effect of neoadjuvant chemotherapy on overall survival (OS). PATIENTS AND METHODS Eligible trials should have closed to accrual before 2016 and compared neoadjuvant chemotherapy and surgery (CS) to surgery alone. All relevant published and unpublished trials were identified via searches of electronic databases, conference proceedings and clinical trial registers. The main end-point was OS. Investigators were contacted to obtain the individual patient data, which was recorded, harmonised and checked. A random-effects Cox model, stratified by trial, was used for meta-analysis and subgroup analyses were preplanned. RESULTS 16 trials were identified as eligible. Individual patient data were obtained from 12 trial and 2478 patients. CS was associated with an improved OS versus surgery, hazard ratio (HR) = 0.83 [0.72-0.96], p < 0.0001, translating to an absolute benefit of 5.7% at 5-years from 16.8% to 22.5%. Treatment effects did not vary substantially between adenocarcinoma (HR = 0.73 [0.62-0.87]) and squamous cell carcinoma (HR = 0.91 [0.76-1.08], interaction p = 0.26). A somewhat more pronounced effect was observed in gastro-oesophageal junction (HR = 0.68 [0.50-0.93]) versus TE (HR = 0.87 [0.75-1.00], interaction p = 0.07). CS was also associated with a greater disease-free survival (HR = 0.74 [0.64-0.85], p < 0.001). CONCLUSIONS Neoadjuvant chemotherapy conferred a better OS than surgery alone and should be considered in all anatomical location and histological subtypes.
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Affiliation(s)
- Matthieu Faron
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France; Service de Chirurgie Viscérale Oncologique, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Armel Maurice Cheugoua-Zanetsie
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France; Bureau de Biostatistiques et Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | - Kathryn Winter
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, United States
| | - David Cunningham
- National Institute for Health Research, Biomedical Research Centres, Royal Marsden, London, UK
| | - Ate Van der Gaast
- Department of Medical Oncology, Erasmus MC, Rotterdam, the Netherlands
| | - Simon Law
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Florent de Vathaire
- Epidémiologie des Radiations U1018, Inserm, Université Paris-Saclay, Villejuif, France
| | - Michele Valmasoni
- Padova University Hospital, Center for Esophageal Diseases, Department of Surgery, Oncology and Gastroenterology, Padova, Italy
| | | | - Jack Roth
- Department of Thoracic and Cardiovascular Surgery, Division of Surgery, MD Anderson, Houston, United States
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | - Xavier Paoletti
- Département de Biostatistiques, Institut Curie, Paris, France
| | - Johanna van Sandick
- Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Jianhua Fu
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Michel Ducreux
- Département de Médecine Oncologique, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif France, France
| | - Pierre Blanchard
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France; Département de Radiothérapie, Gustave Roussy Cancer Campus, France
| | | | - Jean-Pierre Pignon
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France; Bureau de Biostatistiques et Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France
| | - Stefan Michiels
- Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France; Bureau de Biostatistiques et Epidémiologie, Gustave Roussy Cancer Campus, Villejuif, France
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22
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Morscher RJ, Brard C, Berlanga P, Marshall LV, André N, Rubino J, Aerts I, De Carli E, Corradini N, Nebchi S, Paoletti X, Mortimer P, Lacroix L, Pierron G, Schleiermacher G, Vassal G, Geoerger B. First-in-child phase I/II study of the dual mTORC1/2 inhibitor vistusertib (AZD2014) as monotherapy and in combination with topotecan-temozolomide in children with advanced malignancies: arms E and F of the AcSé-ESMART trial. Eur J Cancer 2021; 157:268-277. [PMID: 34543871 DOI: 10.1016/j.ejca.2021.08.010] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
AIM Arms E and F of the AcSé-ESMART phase I/II platform trial aimed to define the recommended dose and preliminary activity of the dual mTORC1/2 inhibitor vistusertib as monotherapy and with topotecan-temozolomide in a molecularly enriched population of paediatric patients with relapsed/refractory malignancies. In addition, we evaluated genetic phosphatidylinositol 3-kinase (PI3K)/AKT/ mammalian (or mechanistic) target of rapamycin (mTOR) pathway alterations across the Molecular Profiling for Paediatric and Young Adult Cancer Treatment Stratification (MAPPYACTS) trial (NCT02613962). EXPERIMENTAL DESIGN AND RESULTS Four patients were treated in arm E and 10 in arm F with a median age of 14.3 years. Main diagnoses were glioma and sarcoma. Dose escalation was performed as per the continuous reassessment method, expansion in an Ensign design. The vistusertib single agent administered at 75 mg/m2 twice a day (BID) on 2 days/week and vistusertib 30 mg/m2 BID on 3 days/week combined with temozolomide 100 mg/m2/day and topotecan 0.50 mg/m2/day on the first 5 days of each 4-week cycle were safe. Treatment was well tolerated with the main toxicity being haematological. Pharmacokinetics indicates equivalent exposure in children compared with adults. Neither tumour response nor prolonged stabilisation was observed, including in the 12 patients whose tumours exhibited PI3K/AKT/mTOR pathway alterations. Advanced profiling across relapsed/refractory paediatric cancers of the MAPPYACTS cohort shows genetic alterations associated with this pathway in 28.0% of patients, with 10.5% carrying mutations in the core pathway genes. CONCLUSIONS Vistusertib was well tolerated in paediatric patients. Study arms were terminated because of the absence of tumour responses and insufficient target engagement of vistusertib observed in adult trials. Targeting the PI3K/AKT/mTOR pathway remains a therapeutic avenue to be explored in paediatric patients. CLINICAL TRIAL IDENTIFIER NCT2813135.
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Affiliation(s)
- Raphael J Morscher
- Gustave Roussy Cancer Campus, Department of Paediatric and Adolescent Oncology, Villejuif, France; INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Caroline Brard
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Pablo Berlanga
- Gustave Roussy Cancer Campus, Department of Paediatric and Adolescent Oncology, Villejuif, France
| | - Lynley V Marshall
- Paediatric and Adolescent Oncology Drug Development Unit, The Royal Marsden Hospital & The Institute of Cancer Research, London, United Kingdom
| | - Nicolas André
- Department of Paediatric Hematology & Oncology, Hôpital de la Timone, AP-HM, Marseille, France; UMR Inserm 1068, CNRS UMR 7258, Aix Marseille Université U105, Marseille Cancer Research Center (CRCM), Marseille, France
| | - Jonathan Rubino
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Isabelle Aerts
- SIREDO Oncology Center, Institut Curie, PSL Research University, Paris, France
| | - Emilie De Carli
- Centre Hospitalier Universitaire, Department of Paediatric Oncology, Angers, France
| | - Nadège Corradini
- Pediatric Oncology Department, Institute of Pediatric Hematology and Oncology, Centre Leon Berard, Lyon, France
| | - Souad Nebchi
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Xavier Paoletti
- Gustave Roussy Cancer Campus, Biostatistics and Epidemiology Unit, INSERM U1018, CESP, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | | | - Ludovic Lacroix
- Department of Medical Biology and Pathology of Translational Research and Biobank, AMMICA, Laboratory INSERM US23/CNRS UMS3655, Gustave Roussy Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Gaelle Pierron
- Unité de Génétique Somatique, Service d'oncogénétique, Institut Curie, Centre Hospitalier, Paris, France
| | - Gudrun Schleiermacher
- SIREDO Oncology Center, Institut Curie, PSL Research University, Paris, France; Laboratory of Translational Research in Paediatric Oncology - INSERM U830, Paris, France
| | - Gilles Vassal
- Gustave Roussy Cancer Campus, Clinical Research Direction, Villejuif, France
| | - Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Paediatric and Adolescent Oncology, Villejuif, France; INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France.
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23
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Mimoun C, Paoletti X, Gaillard T, Crestani A, Benifla JL, Mezzadri M, Bendifallah S, Touboul C, Bricou A, Dabi Y, Canlorbe G, Kerbage Y, Lavoué V, Ouldamer L, Lecointre L, Coutant C, Fauconnier A, Rouzier R, Huchon C. Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group. PLoS One 2021; 16:e0258783. [PMID: 34665839 PMCID: PMC8525770 DOI: 10.1371/journal.pone.0258783] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery. MATERIALS AND METHOD The FRANCOGYN group's multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM. RESULTS 277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p<0.05) associated with LNM in multivariate analysis: pelvic and/or para-aortic LNM on CT and/or PET/CT (p<0.00), initial PCI ≥ 10 and/or diaphragmatic carcinosis (p = 0.02), and initial CA125 ≥ 500 (p = 0.02). The ROC-AUC of this prediction model after leave-one-out cross-validation was 0.72. There was no difference between the predicted and the observed probabilities of LNM (p = 0.09). Specificity for the group at high risk of LNM was 83.5%, the LR+ was 2.73, and the observed probability of LNM was 79.3%; sensitivity for the group at low-risk of LNM was 92.0%, the LR- was 0.24, and the observed probability of LNM was 25.0%. CONCLUSION This new tool may prove useful for improving surgical planning and provide useful information for patients.
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Affiliation(s)
- Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
- Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", UVSQ, Montigny-Le-Bretonneux, France
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
- * E-mail:
| | | | - Thomas Gaillard
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
| | - Adrien Crestani
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Jean-Louis Benifla
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Matthieu Mezzadri
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, AP-HP, Paris, France
| | - Cyril Touboul
- Department of Gynecology and Obstetrics, Tenon University Hospital, AP-HP, Paris, France
| | - Alexandre Bricou
- Department of Obstetrics, Gynecology and Reproductive Medicine, CH Jean Verdier, AP-HP, Bondy, France
| | - Yohann Dabi
- Department of Gynecology and Obstetrics, CHIC, Créteil, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Yohan Kerbage
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHU of Lille, Loos, France
| | | | - Lobna Ouldamer
- Department of Obstetrics and Gynecology, Bretonneau Hospital, CHU of Tours, Tours, France
| | - Lise Lecointre
- Department of Obstetrics and Gynecology, University Hospital Center, Strasbourg, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-François Leclerc Cancer Center, Dijon, France
| | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Poissy-St Germain Hospital, Poissy, France
| | - Roman Rouzier
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
- INSERM U900 STAMPM Team, Saint Cloud, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
- Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", UVSQ, Montigny-Le-Bretonneux, France
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24
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Sirab N, Drubay D, Maillé P, Popova T, Ngo C, Gentien D, Moktefi A, Soyeux-Porte P, Pelletier R, Reyes C, Henry E, Pouessel D, Vordos D, Lebret T, de Reyniès A, Paoletti X, Radvanyi F, Allory Y. Multilayer spectrum of intratumoral heterogeneity in basal bladder cancer. J Pathol 2021; 256:108-118. [PMID: 34611919 DOI: 10.1002/path.5813] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/06/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022]
Abstract
Basal/squamous (Ba/Sq) subtype represents an intrinsic and robust group in the consensus molecular classification of muscle-invasive bladder cancer (MIBC), with poor outcome and controversial chemosensitivity. We aimed to investigate the spectrum of intratumor heterogeneity (ITH) in the Ba/Sq subtype. First, we validated a 29-gene NanoString CodeSet to predict the Ba/Sq subtype for FFPE samples. We identified heterogeneous Ba/Sq tumors in a series of 331 MIBC FFPE samples using dual GATA3/KRT5/6 immunohistochemistry (IHC). Heterogeneous regions with distinct immunostaining patterns were studied separately for gene expression using the 29-gene CodeSet, for mutations by targeted next-generation sequencing, and for copy number alteration (CNA) by microarray hybridization. Among 83 Ba/Sq tumors identified by GATA3/KRT5/6 dual staining, 19 tumors showed heterogeneity at the IHC level. In one third of the 19 cases, regions from the same tumor were classified in different distinct molecular subtypes. The mutational and CNA profiles confirmed the same clonal origin for IHC heterogeneous regions with possible subclonal evolution. Overall, two patterns of intratumoral heterogeneity (ITH) were observed in Ba/Sq tumors: low ITH (regions with distinct immunostaining, but common molecular subtype and shared CNA) or high ITH (regions with distinct immunostaining, molecular subtype, and CNA). These results showed multilayer heterogeneity in Ba/Sq MIBC. In view of personalized medicine, this heterogeneity adds complexity and should be taken into account for sampling procedures used for diagnosis and treatment choice. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Nanor Sirab
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Damien Drubay
- Gustave Roussy, Service de Biostatistique et d'Epidémiologie, INSERM U1018, CESP, Université Paris-Saclay, Villejuif, France
| | - Pascale Maillé
- Department of Pathology, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Tatiana Popova
- Institut Curie, INSERM, U830, DNA Repair and Uveal Melanoma (D.R.U.M.) Team, Paris, France
| | - Carine Ngo
- Université Paris-Est, U955 INSERM, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - David Gentien
- Institut Curie, Translational Research Department, Genomic Platform, PSL Research University, Paris, France
| | - Anissa Moktefi
- Department of Pathology, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Pascale Soyeux-Porte
- Université Paris-Est, U955 INSERM, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Romain Pelletier
- Department of Pathology, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Cécile Reyes
- Institut Curie, Translational Research Department, Genomic Platform, PSL Research University, Paris, France
| | - Emilie Henry
- Institut Curie, Translational Research Department, Genomic Platform, PSL Research University, Paris, France
| | - Damien Pouessel
- Department of Medical Oncology, Institut Universitaire du Cancer Oncopole de Toulouse, Toulouse, France
| | - Dimitri Vordos
- Department of Urology, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, Suresnes, France.,Université de Versailles-Saint-Quentin-en-Yvelines, UFR Santé Simone Veil, Guyancourt, France
| | - Aurélien de Reyniès
- Ligue Nationale Contre Le Cancer, Cartes D'Identité Des Tumeurs Program, Paris, France
| | - Xavier Paoletti
- Université de Versailles-Saint-Quentin-en-Yvelines, UFR Santé Simone Veil, Guyancourt, France.,Institut Curie, INSERM, U900, Statistical Methods for Precision Medicine (StaMPM), Saint-Cloud, France
| | - François Radvanyi
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Yves Allory
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France.,Université de Versailles-Saint-Quentin-en-Yvelines, UFR Santé Simone Veil, Guyancourt, France.,Department of Pathology, Institut Curie, Saint-Cloud, France
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25
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Moreau Bachelard C, Coquan E, du Rusquec P, Paoletti X, Le Tourneau C. Risks and benefits of anticancer drugs in advanced cancer patients: A systematic review and meta-analysis. EClinicalMedicine 2021; 40:101130. [PMID: 34746718 PMCID: PMC8548931 DOI: 10.1016/j.eclinm.2021.101130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Background: Randomized clinical trials (RCTs) of anticancer drugs without active comparators in patients who have exhausted standard of care treatment options are debated. We aimed to quantify the safety and the efficacy of anticancer drugs in advanced cancer patients who have exhausted standard of care treatments from RCTs without active comparators.Methods: This systematic review and meta-analysis was conducted according to preferred reporting Items for systematic review and Meta-Analyses (PRISMA) guidelines (CRD42021243968). A systematic literature search of English language publications from January 1, 2000, to January 7, 2021, was performed using MEDLINE (PubMed). Eligible trials included all RCTs evaluating anticancer drugs in adult patients with advanced solid tumors with a control arm without any anticancer drug consisting of best supportive care with or without a placebo. RCTs performed in the adjuvant, neoadjuvant or maintenance settings were excluded, as were clinical trials evaluating anticancer drugs in combination with radiotherapy. Two authors (C.M.B. and E.C.) independently reviewed the studies for inclusion. Data from published reports were extracted by investigators, and random-effects meta-analysis was performed to estimate the overall hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS). Correlations between severe toxicity and efficacy was assessed using R2 measures.Findings: Of 3551 studies screened, 128 eligible trials were found involving 47,432 patients. The HRs for PFS and OS were 0·58 [95%CI: 0·53-0·63] and 0·82 [95%CI: 0·78-0·85]. The absolute benefits however were limited with PFS and OS gains of 2·1 and 0·5 months. The absolute excesses in all grade, severe grade III, IV and V (death) adverse events between the two arms were +13·9%, 10·2%, and +0·5%. A weak correlation was measured between the excess of severe toxicity and efficacy (all R² < 0·2).Interpretation: Anticancer drugs evaluated in RCTs against no active treatment benefited trial participants. Severe toxicity did not significantly correlate with efficacy. FUNDING None.
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Affiliation(s)
- Camille Moreau Bachelard
- Department of Drug Development and innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26, rue d'Ulm, Paris 75005, France
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Nantes, France
| | - Elodie Coquan
- Department of Medical Oncology, Center François Baclesse, Caen, France
| | - Pauline du Rusquec
- Department of Drug Development and innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26, rue d'Ulm, Paris 75005, France
- INSERM U900 Research unit, Saint-Cloud, France
| | - Xavier Paoletti
- INSERM U900 Research unit, Saint-Cloud, France
- Paris-Saclay University, Paris, France
| | - Christophe Le Tourneau
- Department of Drug Development and innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26, rue d'Ulm, Paris 75005, France
- INSERM U900 Research unit, Saint-Cloud, France
- Paris-Saclay University, Paris, France
- Corresponding author at: Department of Drug Development and innovation (D3i), Institut Curie, Paris and Saint-Cloud, 26, rue d'Ulm, Paris 75005, France.
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26
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Corbaux P, You B, Glasspool R, Yanaihara N, Tinker A, Lindemann K, Ray-Coquard I, Mirza M, Subtil F, Colomban O, Peron J, Karamouza E, McNeish I, Hinsley S, Kagimura T, Welch S, Lewsley LA, Paoletti X, Cook A. 751P Survival prognostic and surrogate values of the early modeled CA-125 KELIM in newly diagnosed advanced ovarian cancer: Data from the GCIG meta-analysis group. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Dahan M, Hequet D, Bonneau C, Paoletti X, Rouzier R. Has tumor doubling time in breast cancer changed over the past 80 years? A systematic review. Cancer Med 2021; 10:5203-5217. [PMID: 34264009 PMCID: PMC8335823 DOI: 10.1002/cam4.3939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/23/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
Over the past century, epidemiologic changes and implementation of screening may have had an impact on tumor doubling time in breast cancer. Our study was designed to evaluate changes in tumor doubling time in breast cancer over the past 80 years. A systematic review of published literature and meta-regression analysis was performed. An online electronic database search was undertaken using the PubMed platform from inception until June 2020. All studies that measured tumor doubling time in breast cancer were included. A total of 151 publications were retrieved. Among them, 16 full-text articles were included in the qualitative analysis. An exponential growth model was used for quantitative characterization of tumor growth rate. Tumor doubling time has remained stable over the past 80 years. Recent studies have not only identified "fast growing tumor" (grade 3, human epidermal growth factor receptor 2-positive, triple-negative, or tumor with an elevated Ki-67) but also "inactive breast cancer" feeding the ongoing debate of overdiagnosis due to screening programs. The stability of tumor doubling time over the past 80 years, despite increasing and changing risk factors, supports the validity for our screening guidelines. Prospective studies based on more precise measurement of tumor size and adjustment for tumor characteristics are necessary to more clearly characterize the prognostic and predictive impact of tumor doubling time in breast cancer.
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Affiliation(s)
- Meryl Dahan
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
| | - Delphine Hequet
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
| | - Claire Bonneau
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
- University Versailles St‐QuentinUniversity Paris‐SaclayMontigny‐le‐BretonneuxFrance
| | - Xavier Paoletti
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
- University Versailles St‐QuentinUniversity Paris‐SaclayMontigny‐le‐BretonneuxFrance
| | - Roman Rouzier
- Department of SurgeryInstitut Curie Hospital GroupSaint‐CloudFrance
- Inserm U900Cancer et génome: bioinformatiquebiostatistiques et épidémiologieInstitut CurieSaint‐CloudFrance
- University Versailles St‐QuentinUniversity Paris‐SaclayMontigny‐le‐BretonneuxFrance
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Ranganathan P, Chinnaswamy G, Sengar M, Gadgil D, Thiagarajan S, Bhargava B, Booth CM, Buyse M, Chopra S, Frampton C, Gopal S, Grant N, Krailo M, Langley R, Mathur P, Paoletti X, Parmar M, Purushotham A, Pyle D, Rajaraman P, Stockler MR, Sullivan R, Swaminathan S, Tannock I, Trimble E, Badwe RA, Pramesh CS. The International Collaboration for Research methods Development in Oncology (CReDO) workshops: shaping the future of global oncology research. Lancet Oncol 2021; 22:e369-e376. [PMID: 34216541 PMCID: PMC8328959 DOI: 10.1016/s1470-2045(21)00077-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Low-income and middle-income countries (LMICs) have a disproportionately high burden of cancer and cancer mortality. The unique barriers to optimum cancer care in these regions necessitate context-specific research. The conduct of research in LMICs has several challenges, not least of which is a paucity of formal training in research methods. Building capacity by training early career researchers is essential to improve research output and cancer outcomes in LMICs. The International Collaboration for Research methods Development in Oncology (CReDO) workshop is an initiative by the Tata Memorial Centre and the National Cancer Grid of India to address gaps in research training and increase capacity in oncology research. Since 2015, there have been five CReDO workshops, which have trained more than 250 oncologists from India and other countries in clinical research methods and protocol development. Participants from all oncology and allied fields were represented at these workshops. Protocols developed included clinical trials, comparative effectiveness studies, health services research, and observational studies, and many of these protocols were particularly relevant to cancer management in LMICs. A follow-up of these participants in 2020 elicited an 88% response rate and showed that 42% of participants had made progress with their CReDO protocols, and 73% had initiated other research protocols and published papers. In this Policy Review, we describe the challenges to research in LMICs, as well as the evolution, structure, and impact of CReDO and other similar workshops on global oncology research.
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Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Durga Gadgil
- Research Administration Council, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Marc Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium; Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Chris Frampton
- Departments of Medicine and Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
| | | | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ruth Langley
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Bengaluru, India
| | - Xavier Paoletti
- University of Versailles Saint-Quentin-en-Yvelines, Versailles, France; Department of Biostatistics, Institut Curie, Saint-Cloud, France; Department of Statistics for Precision Medicine, INSERM U900, Paris, France
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Douglas Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Preetha Rajaraman
- US Department of Health and Human Services, Washington, DC, USA; US Embassy, New Delhi, India
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Ian Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Edward Trimble
- Office of the Director, National Cancer Institute, NIH, US Department of Health and Human Services, Washington, DC, USA
| | - Rajendra A Badwe
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Beddok A, Chevrier M, Calugaru V, Minsat M, Dendale R, Lantz O, Servois V, Paoletti X, Crehange G. Acute and late toxicities of patients infected with SARS-CoV-2 and treated for cancer with radiation therapy during the COVID-19 pandemic. Int J Radiat Biol 2021; 97:1436-1440. [PMID: 34269644 DOI: 10.1080/09553002.2021.1956008] [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] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aimed to assess the risk of acute and late radiation-induced toxicity in patients with COVID-19. MATERIAL AND METHODS All the patients irradiated in Institut Curie from March to July 2020 were included if the first symptoms related to COVID-19 occurred no more than two months before the start of radiation therapy (RT) or 15 days after the end of RT. RESULTS Twenty-nine patients were included in this analysis. Twenty-five patients had no co-morbidities (86.2%), including morbid obesity. The diagnosis of COVID-19 infection was based on a positive SARS-CoV-2 RNA test for 18 patients (62.1%), a positive serology test for three patients (10.3%), and/or radiologic findings for 12 patients (41.4%). Three patients with symptoms highly suggestive of COVID-19 were included, although they had negative biologic tests and did not have a chest CT scan. Median time from the diagnosis of COVID-19 to the onset of RT was 5.5 days. Modification of RT course due to COVID-19 status was observed in 15 patients, including four for whom RT was definitively stopped. Six patients needed hospitalization for hypoxemic lung disease requiring intensive care. The majority of patients did not experience severe (> grade 2) acute toxicity. After a median follow-up of 6 months (IQR, 1-9 months), none of the patients had unusual clinical or radiological late toxicities. CONCLUSION The observed acute and late toxicities were ultimately similar to those observed in a population not infected with COVID-19. These results do not prompt modification of standard RT protocols for irradiation of COVID-19 patients.
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Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Marion Chevrier
- Department of Statistics, Institut Curie, Saint-Cloud, France
| | | | - Mathieu Minsat
- Department of Radiation Oncology, Institut Curie, Saint-Cloud, France
| | - Rémi Dendale
- Department of Radiation Oncology. Proton Therapy Center, Institut Curie, Orsay, France
| | - Olivier Lantz
- Department of Immunotherapy, Institut Curie, Paris, France
| | | | - Xavier Paoletti
- Department of Statistics, Institut Curie, Saint-Cloud, France
| | - Gilles Crehange
- Department of Radiation Oncology, Institut Curie, Paris, France
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Pasqualini C, Rubino J, Brard C, Cassard L, André N, Rondof W, Scoazec JY, Marchais A, Nebchi S, Boselli L, Grivel J, Aerts I, Thebaud E, Paoletti X, Minard-Colin V, Vassal G, Geoerger B. Phase II and biomarker study of programmed cell death protein 1 inhibitor nivolumab and metronomic cyclophosphamide in paediatric relapsed/refractory solid tumours: Arm G of AcSé-ESMART, a trial of the European Innovative Therapies for Children With Cancer Consortium. Eur J Cancer 2021; 150:53-62. [PMID: 33892407 DOI: 10.1016/j.ejca.2021.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 12/24/2020] [Revised: 02/19/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE AcSé-ESMART is a European multicentre, proof-of-concept multiarm phase I/II platform trial in paediatric patients with relapsed/refractory cancer. Arm G assessed the activity and safety of nivolumab in combination with metronomic cyclophosphamide +/- irradiation. EXPERIMENTAL DESIGN Following a Phase II Simon two-stage design, nivolumab was administered intravenously at 3 mg/kg every 2 weeks of a 28-day cycle, oral cyclophosphamide at 25 mg/m2 twice a day, 1 week on/1 week off. The primary endpoint was objective response rate. Irradiation/radioablation of primary tumour or metastasis could be administered as per physician's choice. Biomarker evaluation was performed by tumour immunohistochemistry, whole exome and RNA sequencing, and immunophenotyping of peripheral blood by flow cytometry. RESULTS Thirteen patients were treated with a median age of 15 years (range: 5.5-19.4). The main histologies were high-grade glioma, neuroblastoma, and desmoplastic small round cell tumour (DSRCT). The safety profile was similar to those of single-agent nivolumab, albeit haematologic toxicity, mainly lymphocytopenia, was commonly reported with the addition of cyclophosphamide +/- irradiation. Two patients with DSRCT and ependymoma presented unconfirmed partial response and prolonged disease stabilisation. Low mutational load with modest intratumour CD3+ T-cell infiltration and immunosuppressive tumour microenvironment were observed in the tumour samples. Under combined treatment, no positive modulation of circulating T cells was displayed, while derived neutrophil-to-lymphocyte ratio increased. CONCLUSIONS Nivolumab in combination with cyclophosphamide was well tolerated but had limited activity in this paediatric setting. Metronomic cyclophosphamide did not modulate systemic immune response that could compensate limited T-cell infiltration and the immunosuppressive tumour microenvironment. CLINICALTRIALS. GOV IDENTIFIER NCT2813135.
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Affiliation(s)
- Claudia Pasqualini
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Jonathan Rubino
- Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Caroline Brard
- Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Saclay, Villejuif, France
| | - Lydie Cassard
- Laboratory of Immune-Monitoring in Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Nicolas André
- Department of Pediatric Oncology, Hôpital de La Timone, AP-HM, Marseille, France; UMR Inserm 1068, CNRS UMR 7258, Aix Marseille Université U105, Marseille Cancer Research Center (CRCM), Marseille, France; Metronomics Global Health Initiative, Marseille, France
| | - Windy Rondof
- INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Jean-Yves Scoazec
- Department of Medical Biology and Pathology of Translational Research and Biobank, AMMICA, Laboratory INSERM US23/CNRS UMS3655, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Antonin Marchais
- INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Souad Nebchi
- Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Saclay, Villejuif, France
| | - Lisa Boselli
- Laboratory of Immune-Monitoring in Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Jonathan Grivel
- Laboratory of Immune-Monitoring in Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Isabelle Aerts
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Estelle Thebaud
- Department of Pediatric Oncology, Centre Hospitalier Universitaire, Nantes, France
| | - Xavier Paoletti
- Biostatistics and Epidemiology Unit, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Saclay, Villejuif, France
| | - Véronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Gilles Vassal
- Clinical Research Direction, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France.
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31
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Faron M, Cheugoua-Zanetsie AM, Nankivell MG, Winter KA, Law S, van der Gaast AVD, Ychou M, Mauer M, Valmasoni M, Roth JA, Blanchard P, Thirion PG, Tierney JF, Gebski V, Burmeister BH, Paoletti X, Yang H, van Sandick JW, Ducreux M, Michiels S. Individual patient data meta-analysis of neoadjuvant chemotherapy followed by surgery versus upfront surgery in esophageal or gastro-esophageal carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4067] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4067 Background: Defining the optimal neoadjuvant treatment for resectable locally advanced esophageal carcinoma remains an open question. The debate is fuelled by the fact that most of the available randomized clinical trials (RCT) accrued two histological subtypes (adenocarcinoma (AC) and squamous cell carcinoma (SCC)) and two anatomical locations (TE and GEJ). The aim of this individual patient data (IPD) meta-analysis was to investigate the effect of preoperative chemotherapy on survival with a specific focus on histological subtypes and anatomical locations. Methods: Were eligible published or unpublished RCT closed to accrual before December 2015 and comparing neoadjuvant chemotherapy (CS) to primary surgery (S), identified by electronic database, conference proceedings and clinical trial register. All analyses were conducted on IPD obtained from trial Investigators. The Primary endpoint was overall survival (OS), Secondary endpoints were disease-free survival (DFS) with a 6-months landmark time, local/distant relapse/death without relapse as competing events. Two subgroup analyses were pre-planned one on the histological subtype and another on the anatomical location. A stratified logrank test was used for OS and DFS, and a stratified fine and gray model for competing events. HR, and risk ratios (RR) were combined using a random effect model. Results: IPD were obtained from 12 RCT (2601 patients) out of 16 identified (2863 patients) When compared to S, CS was associated with a significantly increased OS, (HR = 0.85[0.78-0.92], p < 0.0001), with a 5-year absolute OS benefit of 5.7%. However, the subgroup analysis by histological subtype showed an OS benefit from CS higher for AC (HR = 0.80[0.72-0.91], p < 0.01), when compared to SCC (HR = 0.90[0.80-1.01], p = 0.06), but with p for interaction = 0.2. In the subgroup analysis by anatomical location CS benefit was seen across both anatomical location with a trend in favor of GEJ (TE: HR = 0.89[0.81-0.98], p = 0.02 GEJ: HR = 0.71[0.57-0.88]), p < 0.01, p for interaction = 0.057). CS also improved DFS (HR = 0.81[0.74-0.88], p < 0.0001), with the same trend for the subgroup analyses, with apparent significant benefit for AC HR = 0.80[0.72-0.91] when compared to SCC HR = 0.90[0.80-1.01], (p for interaction 0.045) and a similar benefit for both location (TE: HR = 0.89[0.81-0.98] p < 0.01, GEJ: HR = 0.71[0.57-0.88], p = 0.095, P for interaction 0.11). Local (HR = 0.76[0.63-0.92], p = 0.0045) and distant (HR = 0.87[0.76-0.99], p = 0.04) relapses were also significantly lower in the CS arm, with no significant variation according to histological subtypes or tumor location. Conclusions: Neoadjuvant chemotherapy significantly improves OS when added to upfront surgery and was equally effective in AC and SCC. A slightly more pronounced effect was observed for overall survival in the GEJ location vs. the TE.
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Affiliation(s)
| | | | | | - Kathryn A. Winter
- Statistical Center, Radiation Therapy Oncology Group, Philadelphia, PA
| | - Simon Law
- Hong Kong University, Hong Kong, China
| | | | - Marc Ychou
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Murielle Mauer
- European Organisation for Research and Treatment of Cancer (EORTC) HeadQuarters, Brussels, Belgium
| | | | - Jack A. Roth
- Department of Thoracic and cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Bryan H. Burmeister
- Princess Alexandra Hospital/University of Queensland, Woolloongabba, Australia
| | | | - Hong Yang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | | | - Michel Ducreux
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
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Chamseddine AN, Oba K, Buyse M, Boku N, Bouché O, Satar T, Auperin A, Paoletti X. Impact of follow-up on generalized pairwise comparisons for estimating the irinotecan benefit in advanced/metastatic gastric cancer. Contemp Clin Trials 2021; 105:106400. [PMID: 33866004 DOI: 10.1016/j.cct.2021.106400] [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: 12/28/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The net treatment effect (∆) is a new method to assess the treatment benefit that combines multiple time-to-event, binary and continuous endpoints according to a pre-specified sequence. It represents the net probability for a random patient treated in the experimental arm to have a better overall outcome than a random patient from the control arm does. We aimed at characterizing the impact of follow-up on ∆ estimated from both time-to-event and binary toxicity endpoints, in randomized controlled trials (RCTs) of irinotecan-based regimen in advanced/metastatic gastric cancer (AGC). STUDY DESIGN Three RCTs are reanalysed. The net treatment effect using from one to three outcomes (i.e. overall survival, time to progression and toxicity in this order) and the hazard ratio (HR) were estimated after various cut-off dates and compared to the values obtained after complete follow-up were reported. RESULTS In all three RCTs (897 patients), the irinotecan-based regimen was superior to the non-irinotecan containing regimen in terms of HR and ∆. This superiority was lower when the net treatment effect also accounted for toxicity. The HR was slightly less influenced by an incomplete follow-up than ∆ was, but correction proposed by Péron to account for censored observations showed quite robust results. CONCLUSIONS The net treatment effect using Péron's correction can be used in case of interim analyses or high censoring rates. In addition to relative measures such as the hazard ratio, it provides a simple mean to evaluate the net treatment effect with and without toxicity outcomes.
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Affiliation(s)
- Ali N Chamseddine
- OncoStat CESP, INSERM, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France; Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Koji Oba
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium & Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University of Hasselt, Hasselt, Belgium
| | - Narikazu Boku
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Olivier Bouché
- Fédération Francophone de Cancérologie Digestive (FFCD), Department of Digestive Oncology, CHU Reims, Reims, France
| | - Tuvana Satar
- Service de Biostatistique et dEpidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Anne Auperin
- OncoStat CESP, INSERM, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France; Service de Biostatistique et dEpidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Xavier Paoletti
- Université de Versailles-St Quentin, France; Institut Curie & INSERM U900, Biostatistics for Precision Medicine (STAMPM), Saint-Cloud, France; Université Paris Saclay, France.
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Cottu P, Bozec L, Basse C, Paoletti X. Re: Clinical Characteristics and Outcomes of COVID-19-Infected Cancer Patients: A Systematic Review and Meta-Analysis. J Natl Cancer Inst 2021; 113:342-343. [PMID: 33404622 PMCID: PMC7928723 DOI: 10.1093/jnci/djaa213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Clémence Basse
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Xavier Paoletti
- Université de Versailles, St Quentin, France.,Biostatistics, INSERM U900, Institut Curie, Saint-Cloud, France
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Kurtz JE, Gebski V, Sukhin V, Carey M, Kong I, Glasspool RM, Berek JS, de Paiva Batista M, Hall M, Kim JW, Yeoshoua E, Fujiwara N, Nam BH, Polleis S, Lee JY, Strojna A, Farrelly L, Schwameis R, Fossati R, Darlington AS, Lai CH, Wright AA, Rosenblat O, Harter P, Roxburgh P, Chowdhury RR, Chang TC, Paoletti X, Friedlander M. Incorporating patient centered benefits as endpoints in randomized trials of maintenance therapies in advanced ovarian cancer: A position paper from the GCIG symptom benefit committee. Gynecol Oncol 2021; 161:502-507. [PMID: 33612336 DOI: 10.1016/j.ygyno.2021.02.018] [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: 11/27/2020] [Accepted: 02/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Quality of life and patient reported outcome measures (PROMs) are important secondary endpoints and incorporated in most contemporary clinical trials. There have been deficiencies in their assessment and reporting in ovarian cancer clinical trials, particularly in trials of maintenance treatment where they are of particular importance. The Gynecologic Cancer InterGroup (GCIG) symptom benefit committee (SBC) recently convened a brainstorming meeting with representation from all collaborative groups to address questions of how to best incorporate PROMs into trials of maintenance therapies to support the primary endpoint which is usually progression free survival (PFS). These recommendations should harmonize the collection, analysis and reporting of PROM's across future GCIG trials. METHODS Through literature review, trials analysis and input from international experts, the SBC identified four relevant topics to address with respect to promoting the role of PROMs to support the PFS endpoint in clinical trials of maintenance treatment for OC. RESULTS The GCIG SBC unanimously accepted the importance of integrating PROM's in future maintenance trials and developed four guiding principles to be considered early in trial design. These include 1) adherence to SPIRIT-PRO guidelines, 2) harmonization of selection, collection and reporting of PROM's; 3) combining Health Related Quality of Life (HRQL) measures with clinical endpoints and 4) common approaches to dealing with incomplete HRQL data. CONCLUSIONS Close attention to incorporating HRQL and PROM's is critical to interpret the results of ovarian cancer clinical trials of maintenance therapies. There should be a consistent approach to assessing and reporting patient centered benefits across all GCIG trials to enable cross trial comparisons which can be used to inform practice.
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Affiliation(s)
- Jean-Emmanuel Kurtz
- GINECO - Department of Medical and Surgical Oncology & Hematology, ICANS, 17 rue Albert Calmettes, 67200 Strasbourg, France.
| | - Val Gebski
- ANZGOG - NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia
| | - Vladyslav Sukhin
- CEEGOG - Grigoriev Institute for Medical Radiology, 82 Pushkinskaya St., Kharkiv, 61024, Ukraine Kharkiv, Ukraine
| | - Mark Carey
- CCTG - Division of Gynecologic Oncology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Iwa Kong
- CCTG - Department of Oncology, Division of Radiation Oncology, McMaster University and Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, Canada
| | - Rosalind M Glasspool
- SGCTG - Cancer Research UK Trials Unit, Level 0, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Jonathan S Berek
- COGI - Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University, 900 Blake Wilbur Dr, Stanford, CA 94305, USA
| | - Mariana de Paiva Batista
- BRASGYN - Hospital Sao Luiz Jabaquara, 1° floor - Cinical Oncology Department, Rua das Perobas, 344 - Jabaquara, São Paulo, SP, 04321-120, Brazil
| | - Marcia Hall
- NCRI - Department of Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, United Kingdom
| | - Jae-Weon Kim
- KGOG - Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Effi Yeoshoua
- ISGO - Department of Obstetrics and Gynecology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, 49100 Tel Aviv, Israel
| | - Noriko Fujiwara
- GOTIC - Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital of the Institute of Medical Science, The University of Tokyo, Japan
| | - Byung-Ho Nam
- KGOG - The Institute of Advanced Clinical & Biomedical Research, 560 Eonju-ro, 14F Gangnam-gu, Seoul, 06144, Republic of Korea
| | - Sandra Polleis
- AGO - Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom, Kaiser-Friedrich-Ring 71, 65185 Wiesbaden, Germany
| | - Jung-Yun Lee
- KGOG - Yonsei University, 50 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, Republic of Korea
| | - Aleksandra Strojna
- CEEGOG - Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Laura Farrelly
- NCRI - Cancer Research UK & University College London Cancer Trials Centre, University College London, 90 Tottenham Court Road, London, United Kingdom
| | - Richard Schwameis
- AGO-Austria Department of Gynecology and Obstetrics Section for Gynecology and Gynecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Roldano Fossati
- MANGO - IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milano, Italy
| | - Anne-Sophie Darlington
- EORTC - Faculty of Health Sciences, University of Southampton, Highfield, SO17 1BJ, Southampton, Hampshire, United Kingdom
| | - Chyong-Huey Lai
- AGOG, Chang Gung Memorial Hospital Linkou Medical Center, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Alexi A Wright
- GOG-F - GOG Foundation - Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Orgad Rosenblat
- ISGO - ISGO - Department of Gynecological oncology, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Phillip Harter
- AGO - Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Henricistrasse 40, 45136 Essen, Germany
| | - Patricia Roxburgh
- SGCTG - Scottish Gynaecological Cancer Trials Group, Wolfson Wohl Cancer Research Center G61 1BD, University of Glasgow, UK
| | - Rahul Roy Chowdhury
- KolGOTrg - Kolkata Gynecological Oncology Trials & Translational Research Group Room 404A, Chittaranjan National Cancer Institute 37, Shyamaprasad Mukherjee Rd, Bakul Bagan, CNCI, 404A, Kolkata, West Bengal 700026,India
| | - Ting-Chang Chang
- AGOG - Chang Gung Memorial Hospital Linkou Medical Center, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Xavier Paoletti
- GINECO - Biostatistics for Personalized Medicine Team, Institut Curie, 26 rue d'Ulm, Paris, France
| | - Michael Friedlander
- ANZGOG - The Prince of Wales Clinical School UNSW and Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
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35
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Altzerinakou MA, Paoletti X. Change-point joint model for identification of plateau of activity in early phase trials. Stat Med 2021; 40:2113-2138. [PMID: 33561898 DOI: 10.1002/sim.8889] [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: 01/25/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022]
Abstract
This article presents a phase I/II trial design for targeted therapies and immunotherapies, with the objective of identifying the optimal dose (OD). We employ a joint modeling technique for discrete time-to-event toxicity data and repeated and continuous biomarker measurements. For the biomarker measurements, we implement a change point linear mixed effects skeleton model. This model can accommodate both plateauing and nonplateauing dose-activity relationships. For each new cohort of patients, we estimate the maximum tolerated dose (MTD) taking toxicity as a cumulative endpoint, over six treatment cycles. Then, we select the OD using two different criteria. The OD is a dose that is equally active to the MTD or a dose located on the beginning of the plateau of the dose-activity relationship. Joint modeling allows us to take into account informative censoring due to toxicities or lack of activity and we also consider consent withdrawal and intermittent missing responses. Model estimation relies on likelihood inference.
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Affiliation(s)
| | - Xavier Paoletti
- Université Versailles St Quentin, Université Paris Saclay, INSERM U900 STAMPM, Saint-Cloud, France.,Institut Curie, Paris, France
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36
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Roumiguié M, Paoletti X, Neuzillet Y, Mathieu R, Vincendeau S, Kleinclauss F, Mejean A, Guy L, Timsit MO, Lebret T. Apalutamide, darolutamide and enzalutamide in nonmetastatic castration-resistant prostate cancer: a meta-analysis. Future Oncol 2021; 17:1811-1823. [PMID: 33543650 DOI: 10.2217/fon-2020-1104] [Citation(s) in RCA: 6] [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] [Indexed: 01/22/2023] Open
Abstract
Aim: Comparison of the efficacy/safety/health-related quality of life of apalutamide, enzalutamide and darolutamide in Phase III clinical trials involving patients with nonmetastatic castration-resistant prostate cancer was performed. Materials & methods: Relevant studies were identified by searching PubMed as well as conference abstracts reporting updated overall survival. Three pivotal trials were identified, SPARTAN (apalutamide), PROSPER (enzalutamide) and ARAMIS (darolutamide), and form the basis of this analysis. Results: All three drugs significantly prolonged metastasis-free survival, prostate-specific antigen response and overall survival versus placebo, and were generally well tolerated. Conclusion: Drug selection will likely be influenced by tolerability/safety and other factors, such as the propensity for drug-drug interactions and the presence of comorbidities, that affect the risk-benefit balance in individual patients.
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Affiliation(s)
- Mathieu Roumiguié
- Department of Urology, CHU-Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Xavier Paoletti
- Department of Public health, University of Versailles, Saint-Quentin, France.,Institut Curie, INSERM U900, Biostatistics for Personalized Medicine, Saint-Cloud, France
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, University of Paris-Saclay, Versailles Saint-Quentin-en-Yvelines, Suresnes, France
| | - Romain Mathieu
- Department of Urology, Univ rennes, CHU Rennes, Inserm, EHESP, Irset - UMR_S 1085, F 35000 Rennes, France
| | - Sebastien Vincendeau
- Department of Urology, Centre Hospitalier Privé Saint Grégoire, Saint-Grégoire, France
| | - François Kleinclauss
- Department of Urology, Andrology & Kidney Transplantation, University of Franche-Comté, Besançon, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Europeen Georges-Pompidou (HEGP), AP-HP, Paris, France
| | - Laurent Guy
- Department of Urology, CHU Clermont-Ferrand, UMR1240 INSERM, Université Clermont-Auvergne, Clermont Ferrand, France
| | - Marc Olivier Timsit
- Department of Urology, Hôpital Europeen Georges-Pompidou (HEGP), AP-HP, INSERM, PARCC, Paris, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, University of Paris-Saclay, Versailles Saint-Quentin-en-Yvelines, Suresnes, France
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Basse C, Diakite S, Servois V, Frelaut M, Noret A, Bellesoeur A, Moreau P, Massiani MA, Bouyer AS, Vuagnat P, Malak S, Bidard FC, Vanjak D, Kriegel I, Burnod A, Bilger G, Ramtohul T, Dhonneur G, Bouleuc C, Cassoux N, Paoletti X, Bozec L, Cottu P. Characteristics and Outcome of SARS-CoV-2 Infection in Cancer Patients. JNCI Cancer Spectr 2021; 5:pkaa090. [PMID: 33604509 PMCID: PMC7665636 DOI: 10.1093/jncics/pkaa090] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 12/30/2022] Open
Abstract
Background Concerns have emerged about the higher risk of fatal coronavirus disease 2019 (COVID-19) in cancer patients. In this article, we review the experience of a comprehensive cancer center. Methods A prospective registry was set up at Institut Curie at the beginning of the COVID-19 pandemic. All cancer patients with suspected or proven COVID-19 were entered and actively followed for 28 days. Results Among 9842 patients treated at Institut Curie between March 13 and May 1, 2020, 141 (1.4%) were diagnosed with COVID-19, based on reverse transcription polymerase chain reaction testing and/or computerized tomography scan. In line with our case mix, breast cancer (40.4%) was the most common tumor type, followed by hematological and lung malignancies. Patients with active cancer therapy or/and advanced cancer accounted for 87.9% and 68.9% of patients, respectively. At diagnosis, 78.7% of patients had COVID-19–related symptoms, with an extent of lung parenchyma involvement inferior to 50% in 95.8% of patients. Blood count variations and C-reactive protein elevation were the most common laboratory abnormalities. Antibiotics and antiviral agents were administered in 48.2% and 6.4% of patients, respectively. At the time of analysis, 26 patients (18.4%) have died from COVID-19, and 100 (70.9%) were cured. Independent prognostic factors at the time of COVID-19 diagnosis associated with death or intensive care unit admission were extent of COVID-19 pneumonia and decreased O2 saturation. Conclusions COVID-19 incidence and presentation in cancer patients appear to be very similar to those in the general population. The outcome of COVID-19 is primarily driven by the initial severity of infection rather than patient or cancer characteristics.
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Affiliation(s)
- Clémence Basse
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - Sarah Diakite
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | | | - Maxime Frelaut
- Department of Drug Development and Innovation, Institut Curie, Paris & Saint Cloud, France
| | - Aurélien Noret
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - Audrey Bellesoeur
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - Pauline Moreau
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | | | - Anne-Sophie Bouyer
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France.,Université Versailles Saint-Quentin, Université Paris-Saclay, Saint Cloud, France
| | - Sandra Malak
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - François-Clément Bidard
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France.,Université Versailles Saint-Quentin, Université Paris-Saclay, Saint Cloud, France
| | - Dominique Vanjak
- Infectious Diseases Unit, Institut Curie, Paris & Saint Cloud, France
| | - Irène Kriegel
- Department of Anesthesia, Intensive Care and Pain Medicine, Institut Curie, Paris & Saint Cloud, France
| | - Alexis Burnod
- Supportive and Palliative Care Department, Institut Curie, Paris & Saint-Cloud, France
| | - Geoffroy Bilger
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | | | - Gilles Dhonneur
- Department of Anesthesia, Intensive Care and Pain Medicine, Institut Curie, Paris & Saint Cloud, France
| | - Carole Bouleuc
- Supportive and Palliative Care Department, Institut Curie, Paris & Saint-Cloud, France
| | - Nathalie Cassoux
- Department of Surgical Oncology, Institut Curie, Paris & Saint-Cloud, France.,Université de Paris, Paris, France
| | | | - Xavier Paoletti
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France.,Université Versailles Saint-Quentin, Université Paris-Saclay, Saint Cloud, France
| | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
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Mozgunov P, Paoletti X, Jaki T. A benchmark for dose-finding studies with unknown ordering. Biostatistics 2021; 23:721-737. [PMID: 33409536 PMCID: PMC9291639 DOI: 10.1093/biostatistics/kxaa054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/16/2020] [Revised: 09/25/2020] [Accepted: 11/09/2020] [Indexed: 01/31/2023] Open
Abstract
An important tool to evaluate the performance of a dose-finding design is the nonparametric optimal benchmark that provides an upper bound on the performance of a design under a given scenario. A fundamental assumption of the benchmark is that the investigator can arrange doses in a monotonically increasing toxicity order. While the benchmark can be still applied to combination studies in which not all dose combinations can be ordered, it does not account for the uncertainty in the ordering. In this article, we propose a generalization of the benchmark that accounts for this uncertainty and, as a result, provides a sharper upper bound on the performance. The benchmark assesses how probable the occurrence of each ordering is, given the complete information about each patient. The proposed approach can be applied to trials with an arbitrary number of endpoints with discrete or continuous distributions. We illustrate the utility of the benchmark using recently proposed dose-finding designs for Phase I combination trials with a binary toxicity endpoint and Phase I/II combination trials with binary toxicity and continuous efficacy.
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Affiliation(s)
- Pavel Mozgunov
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Xavier Paoletti
- Université Versailles St Quentin & INSERM U900 STAMPM, Institut Curie, Paris, France
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK and MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Younes N, Claude LA, Paoletti X. Corrigendum: Reading, Conducting, and Developing Systematic Review and Individual Patient Data Meta-Analyses in Psychiatry for Treatment Issues. Front Psychiatry 2021; 12:789410. [PMID: 34858239 PMCID: PMC8631105 DOI: 10.3389/fpsyt.2021.789410] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2021.644980.].
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Affiliation(s)
- Nadia Younes
- Université Versailles Saint Quentin, Université Paris Saclay, CESP, Team DevPsy, Villejuif, France.,Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Le Chesnay, France.,UFR Sciences de la Santé S Veil, Université Versailles Saint Quentin, Paris Saclay, Gif-sur-Yvette, France
| | - Laurie-Anne Claude
- Université Versailles Saint Quentin, Université Paris Saclay, CESP, Team DevPsy, Villejuif, France.,Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Le Chesnay, France
| | - Xavier Paoletti
- UFR Sciences de la Santé S Veil, Université Versailles Saint Quentin, Paris Saclay, Gif-sur-Yvette, France.,Institut Curie, Biostatistics, Team Statistical Methods for Precision Medicine, St Cloud, France.,INSERM U900, Statistical Methods for Personalised Medicine Team (STAMPM), St Cloud, France
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40
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Younes N, Claude LA, Paoletti X. Reading, Conducting, and Developing Systematic Review and Individual Patient Data Meta-Analyses in Psychiatry for Treatment Issues. Front Psychiatry 2021; 12:644980. [PMID: 34393841 PMCID: PMC8360265 DOI: 10.3389/fpsyt.2021.644980] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Individual participant data meta-analyses (IPD-MAs) include the raw data from relevant randomised clinical trials (RCTs) and involve secondary analyses of the data. Performed since the late 1990s, ~50 such meta-analyses have been carried out in psychiatry, mostly in the field of treatment. IPD-MAs are particularly relevant for three objectives: (1) evaluation of the average effect of an intervention by combining effects from all included trials, (2) evaluation of the heterogeneity of an intervention effect and sub-group analyses to approach personalised psychiatry, (3) mediation analysis or surrogacy evaluation to replace a clinical (final) endpoint for the evaluation of new treatments with intermediate or surrogate endpoints. The objective is to describe the interest and the steps of an IPD-MA method applied to the field of psychiatric therapeutic research. Method: The method is described in three steps. First, the identification of the relevant trials with an explicit description of the inclusion/exclusion criteria for the RCT to be incorporated in the IPD-MA and a definition of the intervention, the population, the context and the relevant points (outcomes or moderators). Second, the data management with the standardisation of collected variables and the evaluation and the assessment of the risk-of-bias for each included trial and of the global risk. Third, the statistical analyses and their interpretations, depending on the objective of the meta-analysis. All steps are illustrated with examples in psychiatry for treatment issues, excluding study protocols. Conclusion: The meta-analysis of individual patient data is challenging. Only strong collaborations between all stakeholders can make such a process efficient. An "ecosystem" that includes all stakeholders (questions of interest prioritised by the community, funders, trialists, journal editors, institutions, …) is required. International medical societies can play a central role in favouring the emergence of such communities.
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Affiliation(s)
- Nadia Younes
- Université Versailles Saint Quentin, Université Paris Saclay, CESP, Team DevPsy, Villejuif, France.,Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Le Chesnay, France.,UFR Sciences de la Santé S Veil, Université Versailles Saint Quentin, Paris Saclay, Gif-sur-Yvette, France
| | - Laurie-Anne Claude
- Université Versailles Saint Quentin, Université Paris Saclay, CESP, Team DevPsy, Villejuif, France.,Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Le Chesnay, France
| | - Xavier Paoletti
- UFR Sciences de la Santé S Veil, Université Versailles Saint Quentin, Paris Saclay, Gif-sur-Yvette, France.,Institut Curie, Biostatistics, Team Statistical Methods for Precision Medicine, St Cloud, France.,INSERM U900, Statistical Methods for Personalised Medicine Team (STAMPM), St Cloud, France
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41
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Ramtohul T, Cabel L, Paoletti X, Chiche L, Moreau P, Noret A, Vuagnat P, Cherel P, Tardivon A, Cottu P, Bidard FC, Servois V. Quantitative CT Extent of Lung Damage in COVID-19 Pneumonia Is an Independent Risk Factor for Inpatient Mortality in a Population of Cancer Patients: A Prospective Study. Front Oncol 2020; 10:1560. [PMID: 33014804 PMCID: PMC7494966 DOI: 10.3389/fonc.2020.01560] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background: CT lung extent has emerged as a potential risk factor of COVID-19 pneumonia severity with mainly semiquantitative assessment, and outcome was not assessed in the specific oncology setting. The main goal was to evaluate the prognostic role of quantitative assessment of the extent of lung damage for early mortality of patients with COVID-19 pneumonia in cancer patients. Methods: We prospectively included consecutive cancer patients with recent onset of COVID-19 pneumonia assessed by chest CT between March 15, 2020, and April 20, 2020, and followed until May 1, 2020. Demographic, clinical, laboratory test data and imaging findings were recorded. Quantitative chest CT assessment of COVID-19 pneumonia was based on the density distribution of lung lesions using a freely available software recently released (Myrian XP-Lung). The association between extent of lung damage and overall survival was studied by univariate and multivariate Cox analysis. The Uno C-index was used to assess the discriminatory value of the quantitative CT extent of lung damage. Results: Seventy cancer patients with chest CT evidence of COVID-19 were included. After a median follow-up of 25 days, 17 patients (24%) had died. The median quantitative chest CT extent of COVID-19 was 20% (IQR = 14-35, range = 3-59) for non-survivors vs. 10% (IQR = 6-15, range = 2-55) for survivors (p = 0.002). The extent of COVID-19 pneumonia was correlated with inpatient management (p = 0.003) and oxygen therapy requirements (p < 0.001). Independent factors associated with death were performance status (PS) ≥2 (HR = 3.9, 95% CI = [1.1-13.8] p = 0.04) and extent of COVID-19 pneumonia ≥30% (HR = 12.0, 95% CI = [2.2-64.4] p = 0.004). No differences were found regarding the histology of cancer, cancer stage, metastases sites, or type of oncologic treatment between the survivor and non-survivor groups. The cross-validated Uno C-index of the model including PS and extent of COVID-19 pneumonia was 0.83, 95% CI = [0.73-0.93]. Conclusions: The quantitative chest CT extent of COVID-19 pneumonia was a strong independent prognostic factor of early inpatient mortality in a population of cancer patients.
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Affiliation(s)
- Toulsie Ramtohul
- Department of Radiology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Xavier Paoletti
- INSERM U900 STAMPM Team, Institut Curie Paris & Saint Cloud, Paris, France
- UVSQ, Université Paris-Saclay, Saint-Cloud, France
| | - Laurent Chiche
- Department of Radiology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Pauline Moreau
- Department of Medical Oncology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Aurélien Noret
- Department of Medical Oncology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Pascal Cherel
- Department of Radiology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Anne Tardivon
- Department of Radiology, Institut Curie Paris & Saint Cloud, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie Paris & Saint Cloud, Paris, France
| | - François-Clément Bidard
- Department of Medical Oncology, Institut Curie Paris & Saint Cloud, Paris, France
- UVSQ, Université Paris-Saclay, Saint-Cloud, France
| | - Vincent Servois
- Department of Radiology, Institut Curie Paris & Saint Cloud, Paris, France
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Abbas R, Rossoni C, Jaki T, Paoletti X, Mozgunov P. A comparison of phase I dose-finding designs in clinical trials with monotonicity assumption violation. Clin Trials 2020; 17:522-534. [PMID: 32631095 DOI: 10.1177/1740774520932130] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS In oncology, new combined treatments make it difficult to order dose levels according to monotonically increasing toxicity. New flexible dose-finding designs that take into account uncertainty in dose levels ordering were compared with classical designs through simulations in the setting of the monotonicity assumption violation. We give recommendations for the choice of dose-finding design. METHODS Motivated by a clinical trial for patients with high-risk neuroblastoma, we considered designs that require a monotonicity assumption, the Bayesian Continual Reassessment Method, the modified Toxicity Probability Interval, the Bayesian Optimal Interval design, and designs that relax monotonicity assumption, the Bayesian Partial Ordering Continual Reassessment Method and the No Monotonicity Assumption design. We considered 15 scenarios including monotonic and non-monotonic dose-toxicity relationships among six dose levels. RESULTS The No Monotonicity Assumption and Partial Ordering Continual Reassessment Method designs were robust to the violation of the monotonicity assumption. Under non-monotonic scenarios, the No Monotonicity Assumption design selected the correct dose level more often than alternative methods on average. Under the majority of monotonic scenarios, the Partial Ordering Continual Reassessment Method selected the correct dose level more often than the No Monotonicity Assumption design. Other designs were impacted by the violation of the monotonicity assumption with a proportion of correct selections below 20% in most scenarios. Under monotonic scenarios, the highest proportions of correct selections were achieved using the Continual Reassessment Method and the Bayesian Optimal Interval design (between 52.8% and 73.1%). The costs of relaxing the monotonicity assumption by the No Monotonicity Assumption design and Partial Ordering Continual Reassessment Method were decreases in the proportions of correct selections under monotonic scenarios ranging from 5.3% to 20.7% and from 1.4% to 16.1%, respectively, compared with the best performing design and were higher proportions of patients allocated to toxic dose levels during the trial. CONCLUSIONS Innovative oncology treatments may no longer follow monotonic dose levels ordering which makes standard phase I methods fail. In such a setting, appropriate designs, as the No Monotonicity Assumption or Partial Ordering Continual Reassessment Method designs, should be used to safely determine recommended for phase II dose.
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Affiliation(s)
- Rachid Abbas
- ONCOSTAT Team CESP INSERM U1018, Univ. Paris-Saclay and Biostatistics and Epidemiology department, Gustave Roussy Cancer Center, Villejuif, France
| | - Caroline Rossoni
- ONCOSTAT Team CESP INSERM U1018, Univ. Paris-Saclay and Biostatistics and Epidemiology department, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK.,MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Xavier Paoletti
- Université Versailles St Quentin & INSERM U900 STAMPM, Institut Curie, Paris, France
| | - Pavel Mozgunov
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
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Harter P, Pautier P, Van Nieuwenhuysen E, Reuss A, Redondo A, Lindemann K, Kurzeder C, Petru E, Heitz F, Sehouli J, Degregorio N, Wimberger P, Burges A, Cron N, Ledermann J, Lorusso D, Paoletti X, Marme F. Atezolizumab in combination with bevacizumab and chemotherapy versus bevacizumab and chemotherapy in recurrent ovarian cancer - a randomized phase III trial (AGO-OVAR 2.29/ENGOT-ov34). Int J Gynecol Cancer 2020; 30:1997-2001. [PMID: 32606097 DOI: 10.1136/ijgc-2020-001572] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Improvement in clinical outcomes of patients with platinum-resistant disease is an unmet medical need and trials in this population are urgently needed. Checkpoint-inhibitors have already shown activity in multiple other tumor entities and ovarian cancer, especially in the combination with anti-angiogenic treatment. PRIMARY OBJECTIVE To test if the activity of non-platinum-based chemotherapy and bevacizumab could be improved by the addition of atezolizumab. STUDY HYPOTHESIS The addition of atezolizumab to standard non-platinum combination of chemotherapy and bevacizumab improves median overall survival from 15 to 20 months. TRIAL DESIGN Patients are randomized to chemotherapy (paclitaxel weekly or pegylated liposomal doxorubicin) + bevacizumab + placebo vs chemotherapy + bevacizumab + atezolizumab. Stratification factors are: number of prior lines, planned type of chemotherapy, prior use of bevacizumab, and tumor programmed death-ligand 1 (PD-L1) status. MAJOR INCLUSION/EXCLUSION CRITERIA Recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer with up to three prior therapies and a treatment-free interval after platinum of less than 6 months. Patients with three prior lines of chemotherapy are eligible irrespective of the platinum free-interval. A de novo tumor tissue sample biopsy for determination of PD-L1 status prior to randomization for stratification is mandatory. Major exclusion criteria consider bevacizumab-specific and immunotherapy-specific criteria. PRIMARY ENDPOINT Overall survival and progression-free survival are co-primary endpoints. SAMPLE SIZE It is planned to randomize 664 patients. TRIAL REGISTRATION NCT03353831.
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Affiliation(s)
- Philipp Harter
- Gynecology and Gynecologic Oncology, AGO & Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Alexander Reuss
- Coordinating Centre for Clinical Trials, AGO & Philipps-University, Marburg, Germany
| | - Andres Redondo
- IdiPaz, GEICO & Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Edgar Petru
- AGO-Austria & Graz University, Graz, Austria
| | - Florian Heitz
- Gynecology and Gynecologic Oncology, AGO & Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, AGO & Charité Berlin, Berlin, Germany
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Altzerinakou MA, Collette L, Paoletti X. Cumulative Toxicity in Targeted Therapies: What to Expect at the Recommended Phase II Dose. J Natl Cancer Inst 2020; 111:1179-1185. [PMID: 30838405 DOI: 10.1093/jnci/djz024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/01/2019] [Accepted: 02/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the era of molecularly targeted agents (MTAs), it is recommended to account for toxicity over several cycles to identify the recommended phase II dose (RP2D). We investigated the relationship between the risk of toxicity at cycle 1 and the cumulative incidence of toxicity over subsequent cycles in trials of single MTAs. METHODS On individual patient data from 26 phase I clinical trials of single MTAs provided by the National Cancer Institute, we estimated the probability of first-severe toxicity per treatment cycle as well as the cumulative incidence at, below, and above the maximum tolerated dose (MTD). Toxicity was further subclassified into nonhematologic and hematologic. A prediction table was developed to estimate the cumulative incidence up to six cycles based on the toxicity rate observed in the first cycle. RESULTS Overall, 942 patients were included. For patients treated at the MTD, the probability of first-severe toxicity decreased from 24.8% (95% prediction interval [PI] = 20.3% to 32.9%) to 2.2% (95% PI = 0.1% to 7.7%) from cycle 1 to 6, whereas the cumulative incidence of toxicity reached 51.7% (95% PI = 40.5% to 66.3%) after six cycles. Toxicity rates ranging from 20.0% to 30.0% in the first cycle were associated with 46.8% (95% PI = 39.5% to 54.2%) and 65.8% (95% PI = 57.7% to 73.1%) cumulative incidence after six cycles. CONCLUSION This study examined the risk of severe toxicity over time of single MTAs. The cumulative incidence of toxicity at the MTD was higher than the usually accepted toxicity targets, challenging the definition of the RP2D of MTAs. The prediction table may help calibrate the target rate at the RP2D.
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Mozgunov P, Jaki T, Paoletti X. Using a dose-finding benchmark to quantify the loss incurred by dichotomization in Phase II dose-ranging studies. Biom J 2020; 62:1717-1729. [PMID: 32529689 DOI: 10.1002/bimj.201900332] [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: 10/30/2019] [Revised: 02/20/2020] [Accepted: 04/05/2020] [Indexed: 11/07/2022]
Abstract
While there is recognition that more informative clinical endpoints can support better decision-making in clinical trials, it remains a common practice to categorize endpoints originally measured on a continuous scale. The primary motivation for this categorization (and most commonly dichotomization) is the simplicity of the analysis. There is, however, a long argument that this simplicity can come at a high cost. Specifically, larger sample sizes are needed to achieve the same level of accuracy when using a dichotomized outcome instead of the original continuous endpoint. The degree of "loss of information" has been studied in the contexts of parallel-group designs and two-stage Phase II trials. Limited attention, however, has been given to the quantification of the associated losses in dose-ranging trials. In this work, we propose an approach to estimate the associated losses in Phase II dose-ranging trials that is free of the actual dose-ranging design used and depends on the clinical setting only. The approach uses the notion of a nonparametric optimal benchmark for dose-finding trials, an evaluation tool that facilitates the assessment of a dose-finding design by providing an upper bound on its performance under a given scenario in terms of the probability of the target dose selection. After demonstrating how the benchmark can be applied to Phase II dose-ranging trials, we use it to quantify the dichotomization losses. Using parameters from real clinical trials in various therapeutic areas, it is found that the ratio of sample sizes needed to obtain the same precision using continuous and binary (dichotomized) endpoints varies between 70% and 75% under the majority of scenarios but can drop to 50% in some cases.
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Affiliation(s)
- Pavel Mozgunov
- Medical and Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Thomas Jaki
- Medical and Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Xavier Paoletti
- Service de Biostatistique et d'Epidemiologie & CESP OncoStat, INSERM, Institut Gustave Roussy, UVSQ, Villejuif, France.,Institute Curie, Paris, France
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Vuagnat P, Frelaut M, Ramtohul T, Basse C, Diakite S, Noret A, Bellesoeur A, Servois V, Hequet D, Laas E, Kirova Y, Cabel L, Pierga JY, Bozec L, Paoletti X, Cottu P, Bidard FC. COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area. Breast Cancer Res 2020; 22:55. [PMID: 32460829 PMCID: PMC7254663 DOI: 10.1186/s13058-020-01293-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Cancer patients have been reported to be at higher risk of COVID-19 complications and deaths. We report the characteristics and outcome of patients diagnosed with COVID-19 during breast cancer treatment at Institut Curie hospitals (ICH, Paris area, France). Methods An IRB-approved prospective registry was set up at ICH on March 13, 2020, for all breast cancer patients with COVID-19 symptoms or radiologic signs. Registered data included patient history, tumor characteristics and treatments, COVID-19 symptoms, radiological features, and outcome. Data extraction was done on April 25, 2020. COVID-19 patients were defined as those with either a positive RNA test or typical, newly appeared lung CT scan abnormalities. Results Among 15,600 patients actively treated for early or metastatic breast cancer during the last 4 months at ICH, 76 patients with suspected COVID-19 infection were included in the registry and followed. Fifty-nine of these patients were diagnosed with COVID-19 based on viral RNA testing (N = 41) or typical radiologic signs: 37/59 (63%) COVID-19 patients were treated for metastatic breast cancer, and 13/59 (22%) of them were taking corticosteroids daily. Common clinical features mostly consisted of fever and/or cough, while ground-glass opacities were the most common radiologic sign at diagnosis. We found no association between prior radiation therapy fields or extent of radiation therapy sequelae and extent of COVID-19 lung lesions. Twenty-eight of these 59 patients (47%) were hospitalized, and 6 (10%) were transferred to an intensive care unit. At the time of analysis, 45/59 (76%) patients were recovering or had been cured, 10/59 (17%) were still followed, and 4/59 (7%) had died from COVID-19. All 4 patients who died had significant non-cancer comorbidities. In univariate analysis, hypertension and age (> 70) were the two factors associated with a higher risk of intensive care unit admission and/or death. Conclusions This prospective registry analysis suggests that the COVID-19 mortality rate in breast cancer patients depends more on comorbidities than prior radiation therapy or current anti-cancer treatment. Special attention must be paid to comorbidities when estimating the risk of severe COVID-19 in breast cancer patients.
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Affiliation(s)
- Perrine Vuagnat
- UVSQ, Université Paris-Saclay, Saint Cloud, France.,Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Maxime Frelaut
- Department of Drug Development and Innovation, Institut Curie, Paris, France
| | | | - Clémence Basse
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Sarah Diakite
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Aurélien Noret
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Audrey Bellesoeur
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | | | - Delphine Hequet
- Department of Surgical Oncology, Institut Curie, Paris, France
| | - Enora Laas
- Department of Surgical Oncology, Institut Curie, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France.,Université de Paris, Paris, France
| | | | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Xavier Paoletti
- UVSQ, Université Paris-Saclay, Saint Cloud, France.,INSERM U900 STAMPM Team, Saint Cloud, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - François-Clément Bidard
- UVSQ, Université Paris-Saclay, Saint Cloud, France. .,Department of Medical Oncology, Institut Curie, Paris, France. .,Department of Medical Oncology, Institut Curie, Saint Cloud, France.
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Oba K, Paoletti X, Bang YJ, Bouché O, Ducreux M, Michiels S, Moehler MH, Morita S, Ohashi Y, Sakamoto J, Sasako M, Shitara K, Van Cutsem E, Buyse ME, Burzykowski T. Progression-free survival (PFS) as a surrogate endpoint for overall survival (OS) in advanced/recurrent gastric cancer (AGC) treatment: Individual-patient-data (IPD) based meta-analysis of randomized trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16506 Background: In 2013, the GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research through International Collaboration) evaluated the surrogacy of PFS based on IPD of 4,069 patients from 20 randomized trials of AGC. Treatment effects on PFS and on OS were only moderately correlated, and we could not validate PFS as a surrogate endpoint for OS. More recent trials, with refined inclusion criteria and higher standards for evaluating progression, may allow for a more accurate estimate of the correlation. The 2nd round of the GASTRIC sought to re-evaluate the surrogacy of PFS for OS in AGC. Methods: The GASTRIC database was updated with trials published after 2010 which used RECIST (Response Evaluation Criteria in Solid Tumors). Since the proportional hazards assumption was questionable for PFS, we primarily used mean-time ratio as a treatment effect measure, estimated by using the log-logistic model. Using the meta-analytic approach, correlations between PFS and OS at the individual level (Rindiv), and between treatment effects on PFS and on OS at the trial level (Rtrial), were estimated using Spearman’s rank-correlation and estimation-error-adjusted regression, respectively. Surrogate threshold effect was estimated as well. Results: We analyzed 10,912 patient data (1st round 4,069 patients from 20 trials and 2nd round 6,843 patients from 17 trials). Overall, moderate correlations were found at the individual level (Rindiv = 0.75, 95%CI = 0.75 to 0.76 in Hougaard copula) and at the trial level (Rtrial = 0.77, 95%CI = 0.32 to 1.00), respectively. Surrogate threshold effect was equal to 1.29, i.e., observing 29% increase in mean PFS time would predict a significant increase of the OS time. In the subgroup of patients with measurable disease in the 2nd round dataset (4,866 patients), Rtrial was higher and equal to 0.93 (95%CI = 0.70 to 1.00), with STE equal to 1.21. These results were same for 1st and 2nd line trials. Conclusions: The meta-analysis indicates a strong correlation between treatment effects (expressed as log-mean-ratios) on PFS and OS in patients with measurable disease.
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Affiliation(s)
- Koji Oba
- Interfaculty Initiative in Information Studies,The University of Tokyo, Tokyo, Japan
| | | | - Yung-Jue Bang
- Seoul National University College of Medicine, Seoul, South Korea
| | | | - Michel Ducreux
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | | | | | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuo Ohashi
- Integrated Science and Engineering for Sustainable Society Chuo University, Tokyo, Japan
| | - Junichi Sakamoto
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | - Mitsuru Sasako
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven, KU Leuven, Leuven, Belgium
| | - Marc E. Buyse
- International Drug Development Institute, Louvain-La-Neuve, Belgium
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Chargari C, Levy A, Paoletti X, Soria JC, Massard C, Weichselbaum RR, Deutsch E. Methodological Development of Combination Drug and Radiotherapy in Basic and Clinical Research. Clin Cancer Res 2020; 26:4723-4736. [PMID: 32409306 DOI: 10.1158/1078-0432.ccr-19-4155] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 12/20/2019] [Revised: 02/14/2020] [Accepted: 05/12/2020] [Indexed: 01/03/2023]
Abstract
Newer technical improvements in radiation oncology have been rapidly implemented in recent decades, allowing an improved therapeutic ratio. The development of strategies using local and systemic treatments concurrently, mainly targeted therapies, has however plateaued. Targeted molecular compounds and immunotherapy are increasingly being incorporated as the new standard of care for a wide array of cancers. A better understanding of possible prior methodology issues is therefore required and should be integrated into upcoming early clinical trials including individualized radiotherapy-drug combinations. The outcome of clinical trials is influenced by the validity of the preclinical proofs of concept, the impact on normal tissue, the robustness of biomarkers and the quality of the delivery of radiation. Herein, key methodological aspects are discussed with the aim of optimizing the design and implementation of future precision drug-radiotherapy trials.
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Affiliation(s)
- Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Université Paris-Sud, Orsay, France
- INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Université Paris-Sud, Orsay, France
- INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Xavier Paoletti
- University of Versailles St. Quentin, France
- Institut Curie INSERM U900, Biostatistics for Personalized Medicine Team, St. Cloud, France
| | | | - Christophe Massard
- Université Paris-Sud, Orsay, France
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Université Paris-Sud, Orsay, France
- INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Cohen R, Vernerey D, Bellera C, Meurisse A, Henriques J, Paoletti X, Rousseau B, Alberts S, Aparicio T, Boukovinas I, Gill S, Goldberg RM, Grothey A, Hamaguchi T, Iveson T, Kerr R, Labianca R, Lonardi S, Meyerhardt J, Paul J, Punt CJA, Saltz L, Saunders MP, Schmoll HJ, Shah M, Sobrero A, Souglakos I, Taieb J, Takashima A, Wagner AD, Ychou M, Bonnetain F, Gourgou S, Yoshino T, Yothers G, de Gramont A, Shi Q, André T. Guidelines for time-to-event end-point definitions in adjuvant randomised trials for patients with localised colon cancer: Results of the DATECAN initiative. Eur J Cancer 2020; 130:63-71. [PMID: 32172199 DOI: 10.1016/j.ejca.2020.02.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The variability of definitions for time-to-event (TTE) end-points impacts the conclusions of randomised clinical trials (RCTs). The Definition for the Assessment of Time-to-event Endpoints in CANcer (DATECAN) initiative aims to provide consensus definitions for TTE end-points used in RCTs. Here, we formulate guidelines for adjuvant colon cancer RCTs. METHODS We performed a literature review to identify TTE end-points and events included in their definition in RCT publications. Then, a consensus was reached among a panel of international experts, using a formal modified Delphi method, with 2 rounds of questionnaires and an in-person meeting. RESULTS Twenty-four experts scored 72 events involved in 6 TTE end-points. Consensus was reached for 24%, 57% and 100% events after the first round, second round and in-person meeting. For RCTs not using overall survival as their primary end-point, the experts recommend using disease-free survival (DFS) rather than recurrence-free survival (RFS) or time to recurrence (TTR) as the primary end-point. The consensus definition of DFS includes all causes of death, second primary colorectal cancers (CRCs), anastomotic relapse and metastatic relapse as an event, but not second primary non-CRCs. Events included in the RFS definition are the same as for DFS with the exception of second primary CRCs. The consensus definition of TTR includes anastomotic or metastatic relapse, death with evidence of recurrence and death from CC cause. CONCLUSION Standardised definitions of TTE end-points ensure the reproducibility of the end-points between RCTs and facilitate cross-trial comparisons. These definitions should be integrated in standard practice for the design, reporting and interpretation of adjuvant CC RCTs.
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Affiliation(s)
- Romain Cohen
- Sorbonne Université, Department of Medical Oncology, AP-HP, Hôpital Saint-Antoine, F-7512, Paris, France; Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA.
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, F-33000, Bordeaux, France
| | - Aurélia Meurisse
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Xavier Paoletti
- Université de Versailles-St Quentin & Institut Curie, INSERM U900, équipe Biostatistique, France
| | | | | | - Thomas Aparicio
- Service de Gastroentérologie et Cancérologie Digestive, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | | | | | | | - Axel Grothey
- West Cancer Center and Research Institute, Germantown, TN, USA
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rachel Kerr
- Adjuvant Colorectal Cancer Group, University of Oxford, UK
| | | | | | - Jeffrey Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - James Paul
- Cancer Research UK Clinical Trials Unit (CTU), Institute of Cancer Sciences, University of Glasgow, UK
| | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marck P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Hans-Joachim Schmoll
- EORTC GI Study Group, AIO Colorectal Cancer Group, Martin Luther University, Halle, Germany
| | - Manish Shah
- Department of Medicine, Division of Hematology and Medical Oncology, Center for Advanced Digestive Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Alberto Sobrero
- Medical Oncology Unit at Ospedale San Martino, Genova, Italy
| | | | - Julien Taieb
- Sorbonne Paris Cité, Paris Descartes University, Department of Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | | | - Anna Dorothea Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Marc Ychou
- Department of Medical Oncology, Institut Régional Du Cancer de Montpellier (ICM), France
| | - Franck Bonnetain
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Sophie Gourgou
- Biometrics Unit, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | | | | | - Aimery de Gramont
- Department of Medical Oncology, Institut Hospitalier Franco Britannique, Levallois-Perret, France
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Thierry André
- Sorbonne Université, Department of Medical Oncology, AP-HP, Hôpital Saint-Antoine, F-7512, Paris, France
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50
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Drubay D, Collette L, Paoletti X. Proportional odds assumption for modeling longitudinal ordinal multiple toxicity outcomes in dose finding studies of targeted agents: A pooled analysis of 54 studies. Contemp Clin Trials Commun 2020; 17:100529. [PMID: 32055745 PMCID: PMC7005415 DOI: 10.1016/j.conctc.2020.100529] [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: 08/12/2019] [Revised: 01/03/2020] [Accepted: 01/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Data generated by phase I trials is richer than the classical binary DLT measured at the first cycle used as primary endpoints. Several works developed designs for more informative endpoints, e.g. ordinal toxicity grades and/or longitudinal data which relied however on strong assumptions, in particular the proportional odds (PO) assumption. METHODS We evaluated this PO assumption for the dose and cycle on a large database of individual patient data from 54 phase I clinical trials of molecularly targeted agents. The PO model is a specific case of the continuation ratio logit model (CRLM) with null parameters. We compared the PO and CRLM models using the widely applicable information criterion (WAIC). We considered a longitudinal multivariate ordinal toxicity outcome (cutaneous, digestive, hematological, general disorders, and other toxicities). RESULTS WAIC suggested that the CRLM model (WAIC = 30911.58) outperformed the PO model (WAIC = 31432.10). Deviance from PO assumption for dose was observed for digestive and general disorder toxicities. There was moderate cycle effect with slight deviance from PO assumption for the other type of toxicity. CONCLUSIONS Designs based on PO for dose should be a useful tool for drug with low expected digestive or general disorder toxicity dose-related incidence.
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Affiliation(s)
- Damien Drubay
- INSERM U1018, CESP, Université Paris-Saclay, UVSQ, Villejuif, F-94805, France
- Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, F-94805, France
| | - Laurence Collette
- European Organization of Research and Treatment of Cancer (EORTC), Headquarter, Biostatistics Department, 1200, Brussels, Belgium
| | - Xavier Paoletti
- INSERM U1018, CESP, Université Paris-Saclay, UVSQ, Villejuif, F-94805, France
- Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, F-94805, France
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