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Dorman K, Boeck S, Snijder RJ, Siveke JT, Schenk M, Mayerle J, Caca K, Freiberg-Richter J, Fischer von Weikersthal L, Kullmann F, Reinacher-Schick A, Fuchs M, Kanzler S, Kunzmann V, Ettrich TJ, Zhang D, Held S, Abdul-Ahad A, von Bergwelt-Baildon M, Heinemann V, Haas M. Integrated Analysis of the RASH Study with the Use of the "Burden of Therapy" (BOTh ®TM) Methodology-A Novel Tool for Assessing Adverse Events in Metastatic Pancreatic Cancer. Curr Oncol 2023; 30:5828-5834. [PMID: 37366919 DOI: 10.3390/curroncol30060436] [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: 04/15/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
This analysis of the RASH trial (NCT01729481) aimed at gaining a better understanding of the "Burden of Therapy" (BOTh®TM) in pancreatic ductal adenocarcinoma (PDAC). In the RASH study, 150 patients with newly diagnosed metastatic PDAC were treated with gemcitabine plus erlotinib (gem/erlotinib) for four weeks. Patients who developed a skin rash during this four-week run-in phase continued with the gem/erlotinib treatment, while rash-negative patients were switched to FOLFIRINOX. The study demonstrated a 1-year survival rate of rash-positive patients who received gem/erlotinib as first-line treatment that was comparable to previous reports of patients receiving FOLFIRINOX. To understand whether these comparable survival rates may be accompanied by better tolerability of the gem/erlotinib treatment compared to FOLFIRINOX, the BOTh®TM methodology was used to continuously quantify and depict the burden of therapy generated by treatment emergent events (TEAEs). Sensory neuropathy was significantly more common in the FOLFIRINOX arm, and prevalence as well as severity increased over time. In both arms, the BOTh®TM associated with diarrhea decreased over the course of treatment. The BOTh®TM caused by neutropenia was comparable in both arms but decreased in the FOLFIRINOX arm over time, possibly due to chemotherapy dose reductions. Overall, gem/erlotinib was associated with a slightly higher overall BOTh®TM, but the difference was not statistically significant (p = 0.6735). In summary, the BOTh®TM analysis facilitates the evaluation of TEAEs. In patients fit for intense chemotherapeutic regimens, FOLFIRINOX is associated with a lower BOTh®TM than gem/erlotinib.
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Affiliation(s)
- Klara Dorman
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
| | - Stefan Boeck
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
| | | | - Jens T Siveke
- Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, Partner site Essen) and German Cancer Research Center, DKFZ, 69120 Heidelberg, Germany
| | - Michael Schenk
- Department of Haematology and Oncology, Hospital Barmherzige Brüder, 93049 Regensburg, Germany
| | - Julia Mayerle
- Department of Internal Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Karel Caca
- Department of Internal Medicine I, Klinikum Ludwigsburg, 71640 Ludwigsburg, Germany
| | | | | | - Frank Kullmann
- Department of Medicine I, Klinikum Weiden, 92637 Weiden, Germany
| | - Anke Reinacher-Schick
- Department of Haematology and Oncology, St. Josef-Hospital, Ruhr University, 44791 Bochum, Germany
| | - Martin Fuchs
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, 81925 Munich, Germany
| | - Stephan Kanzler
- Department of Internal Medicine II, Leopoldina Krankenhaus Schweinfurt, 97422 Schweinfurt, Germany
| | - Volker Kunzmann
- Department of Medical Oncology, University Hospital of Wuerzburg, 97080 Wuerzburg, Germany
| | - Thomas J Ettrich
- Department of Internal Medicine I, University of Ulm, 89081 Ulm, Germany
| | - Danmei Zhang
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Swantje Held
- ClinAssess GmbH, Department of Biometry, 51379 Leverkusen, Germany
| | | | - Michael von Bergwelt-Baildon
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
| | - Volker Heinemann
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
| | - Michael Haas
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
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Schwamborn K, Ammann JU, Knüchel R, Hartmann A, Baretton G, Lasitschka F, Schirmacher P, Braunschweig T, Tauber R, Erlmeier F, Hieke-Schulz S, Weichert W. Multicentric analytical comparability study of programmed death-ligand 1 expression on tumor-infiltrating immune cells and tumor cells in urothelial bladder cancer using four clinically developed immunohistochemistry assays. Virchows Arch 2019; 475:599-608. [PMID: 31267201 PMCID: PMC6861354 DOI: 10.1007/s00428-019-02610-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023]
Abstract
Programmed death-ligand 1 (PD-L1) expression on tumor cells (TC) or tumor-infiltrating immune cells (IC) correlated in several studies with PD-L1/programmed death-1 (PD-1) checkpoint inhibitor efficacy. Since June 2018, a positive PD-L1 status is required for atezolizumab or pembrolizumab treatment of patients with advanced or metastasized urothelial bladder cancer, who are ineligible for cisplatin-containing therapy. We examined technical comparability and inter-reader agreement of four clinically developed PD-L1 assays in locally advanced disease. Archived, formalin-fixed, paraffin-embedded sections from 30 patients (73.3% cystectomies, 26.7% transurethral resections) were stained by PD-L1 immunohistochemistry using VENTANA SP142, VENTANA SP263, DAKO 22C3, and DAKO 28-8 at two sites per manufacturers’ protocols and scored blinded at five sites for PD-L1 expression on IC (% per tumor area) and TC (%). Small, non-significant inter-assay differences were observed for IC. For TC, SP142 showed significantly lower staining percentages. Pairwise comparisons revealed − 0.3 to 1.6% differences in adjusted means between assays for IC, and for TC, − 10.5 to − 7.8% (SP142 versus others) and − 1.9 to 2.7% (other comparisons). Inter-reader and inter-assay agreement was moderate to high for both IC and TC. Allocation to binary cutoffs (1%, 5%, 10%) showed substantial to high Kappa agreement scores (0.440–0.923) for IC and TC between assays for each reader. This first multicenter study, with five independent readers blinded with respect to the assay used, suggests that all four currently clinically relevant assays are analytically similar for evaluation of PD-L1-stained IC and three (SP263, 22C3, and 28-8) for PD-L1-stained TC. Inter-observer agreement for trained readers in scoring of both IC and TC positivity was generally high.
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Affiliation(s)
- Kristina Schwamborn
- Institute of Pathology, Technische Universität München, Trogerstr. 18, 81675, Munich, Germany.
| | | | - Ruth Knüchel
- Institute of Pathology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Gustavo Baretton
- Institute of Pathology, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Felix Lasitschka
- Institute of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Institut für Pathologie, Dres. med., Kaufmann und Wilke, Industriestr 11c, 67063, Ludwigshafen, Germany
| | - Peter Schirmacher
- Institute of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Robert Tauber
- Department of Urology, Technische Universität München, Munich, Germany
| | - Franziska Erlmeier
- Institute of Pathology, Technische Universität München, Trogerstr. 18, 81675, Munich, Germany
| | | | - Wilko Weichert
- Institute of Pathology, Technische Universität München and Member of the German Cancer Consortium (DKTK), Partner site München, Munich, Germany
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Gaiser MR, Skorokhod A, Gransheier D, Weide B, Koch W, Schif B, Enk A, Garbe C, Bauer J. Variables that influence BRAF mutation probability: A next-generation sequencing, non-interventional investigation of BRAFV600 mutation status in melanoma. PLoS One 2017; 12:e0188602. [PMID: 29176861 PMCID: PMC5703505 DOI: 10.1371/journal.pone.0188602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background The incidence of melanoma, particularly in older patients, has steadily increased over the past few decades. Activating mutations of BRAF, the majority occurring in BRAFV600, are frequently detected in melanoma; however, the prognostic significance remains unclear. This study aimed to define the probability and distribution of BRAFV600 mutations, and the clinico-pathological factors that may affect BRAF mutation status, in patients with advanced melanoma using next-generation sequencing. Materials and methods This was a non-interventional, retrospective study of BRAF mutation testing at two German centers, in Heidelberg and Tübingen. Archival tumor samples from patients with histologically confirmed melanoma (stage IIIB, IIIC, IV) were analyzed using PCR amplification and deep sequencing. Clinical, histological, and mutation data were collected. The statistical influence of patient- and tumor-related characteristics on BRAFV600 mutation status was assessed using multiple logistic regression (MLR) and a prediction profiler. Results BRAFV600 mutation status was assessed in 453 samples. Mutations were detected in 57.6% of patients (n = 261), with 48.1% (n = 102) at the Heidelberg site and 66.0% (n = 159) at the Tübingen site. The decreasing influence of increasing age on mutation probability was quantified. A main effects MLR model identified age (p = 0.0001), center (p = 0.0004), and melanoma subtype (p = 0.014) as significantly influencing BRAFV600 mutation probability; ultraviolet (UV) exposure showed a statistical trend (p = 0.1419). An interaction model of age versus other variables showed that center (p<0.0001) and melanoma subtype (p = 0.0038) significantly influenced BRAF mutation probability; age had a statistically significant effect only as part of an interaction with both UV exposure (p = 0.0110) and melanoma subtype (p = 0.0134). Conclusions This exploratory study highlights that testing center, melanoma subtype, and age in combination with UV exposure and melanoma subtype significantly influence BRAFV600 mutation probability in patients with melanoma. Further validation of this model, in terms of reproducibility and broader relevance, is required.
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Affiliation(s)
- Maria Rita Gaiser
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
- * E-mail:
| | - Alexander Skorokhod
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Diana Gransheier
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Benjamin Weide
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | | | | | - Alexander Enk
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Claus Garbe
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Jürgen Bauer
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
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