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Pantano F, Tramontana F, Iuliani M, Leanza G, Simonetti S, Piccoli A, Paviglianiti A, Cortellini A, Spinelli GP, Longo UG, Strollo R, Vincenzi B, Tonini G, Napoli N, Santini D. Changes in bone turnover markers in patients without bone metastases receiving immune checkpoint inhibitors: An exploratory analysis. J Bone Oncol 2022; 37:100459. [PMID: 36338920 PMCID: PMC9633734 DOI: 10.1016/j.jbo.2022.100459] [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: 09/20/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are correlated with immune-related adverse events (irAEs) that may potentially affect all host tissues. The effects of ICIs on the skeleton are poorly investigated, thus we evaluated the changes of specific markers of bone resorption and formation. We found an increase of type I collagen C-terminal telopeptide (CTX-I) levels after 3 months of ICIs treatment with a concomitant reduction of N-terminal propeptide of type I procollagen (PINP) levels with a trend toward statistical significance. CTX-I increase was also associated with poor prognosis in terms of treatment response and survival.
Immune checkpoint inhibitors (ICIs) has revolutionized the treatment of different advanced solid tumors, but most patients develop severe immune-related adverse events (irAEs). Although a bi-directional crosstalk between bone and immune systems is widely described, the effect of ICIs on the skeleton is poorly investigated. Here, we analyze the changes in plasma levels of type I collagen C-terminal telopeptide (CTX-I) and N-terminal propeptide of type I procollagen (PINP), reference makers of bone turnover, in patients treated with ICIs and their association with clinical outcome. A series of 44 patients affected by advanced non-small cell lung cancer or renal cell carcinoma, without bone metastases, and treated with ICIs as monotherapy were enrolled. CTX-I and PINP plasma levels were assessed at baseline and after 3 months of ICIs treatment by ELISA kits. A significant increase of CTX-I with a concomitant decreasing trend towards the reduction of PINP was observed after 3 months of treatment. Intriguingly, CTX-I increase was associated with poor prognosis in terms of treatment response and survival. These data suggest a direct relationship between ICIs treatment, increased osteoclast activity and potential fracture risk. Overall, this study reveals that ICIs may act as triggers for skeletal events, and if confirmed in larger prospective studies, it would identify a new class of skeletal-related irAEs.
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Key Words
- APRIL, a proliferation-inducing ligand
- Bone health
- CT-scan, Computed Tomography Scan
- CTX-I, type I collagen C-Terminal telopeptide
- ECOG, Eastern Cooperative Oncology Group
- ELISA, Enzyme-Linked Immunosorbent Assay
- ICIs, Immune Checkpoint Inhibitors
- IFN-γ, Interferon-γ
- IL-6, Interleukin-6
- Immune checkpoint inhibitors (ICIs)
- N-terminal propeptide of type I procollagen (PINP)
- NSCLC, Non-Small Cell Lung Cancer
- OPG, Osteoprotegerin
- OS, Overall Survival
- PD-L1, Programmed cell Death Ligand 1
- PINP, N-terminal Propeptide of type I Procollagen
- RANKL, nuclear factor kappa-B ligand
- RCC, Renal Cell Carcinoma
- RECIST, Response Evaluation Criteria in Solid Tumors
- T0, Time 0
- T1, Time 1
- TNF-α, Tumor Necrosis Factor-α
- TTF, Time to Treatment Failure
- Th17, T helper 17
- Type I Collagen C-Terminal Telopeptide (CTX-I)
- irAEs, Immune-Related Adverse Events
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Affiliation(s)
- Francesco Pantano
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Flavia Tramontana
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Michele Iuliani
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy,Corresponding author.
| | - Giulia Leanza
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sonia Simonetti
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Alessandra Piccoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Annalisa Paviglianiti
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy,Hematology Department, Institut Català d’Oncologia Hospitalet, Barcelona, Spain,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Alessio Cortellini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gian Paolo Spinelli
- UOC Oncologia Universitaria, Sapienza University of Rome- Polo Pontino, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocky Strollo
- Dipartimento di Scienze e Tecnologie per l'Uomo e l'Ambiente, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Bruno Vincenzi
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giuseppe Tonini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Napoli
- Department of Medicine, Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico University of Rome, Rome, Italy,UOC Oncologia Universitaria, Sapienza University of Rome- Polo Pontino, Italy
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Yang Y, Jiang X, Liu Y, Huang H, Xiong Y, Xiao H, Gong K, Li X, Kuang X, Yang X. Elevated tumor markers for monitoring tumor response to immunotherapy. EClinicalMedicine 2022; 46:101381. [PMID: 35434583 PMCID: PMC9011015 DOI: 10.1016/j.eclinm.2022.101381] [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: 10/27/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As the immune-related response evaluation criteria in solid tumors (irRECIST) by imaging greatly underestimated the objective response to immunotherapy, we established the response evaluation criteria in solid tumors based on tumor markers (RecistTM) to explore whether RecistTM can compensate for the deficiencies of the irRECIST criteria. METHODS This was an observational study, which consisted of two parts. The first part (Group A) was a retrospective study including the patients with malignant solid tumors. The second part (Group B) was a prospective study, which were EGFR-negative and ALK-negative patients with stage IIIB-IV non-small cell lung cancer receiving first-line treatment. From January 2017 to September 2020, one hundred and ten patients with a three-time increase in tumor markers receiving immunotherapy were recruited. The treatment response to immunotherapy was evaluated by irRECIST and RecistTM. Efficacy, overall survival (OS), first evaluation time and earliest response time under the different evaluation criteria were compared by statistics. FINDINGS The treatment response evaluated by the RecistTM criteria was not consistent with that evaluated by the irRECIST criteria (Kappa = 0.386, p < 0.001). RecistTM had a higher completed response (CR) rate compared to irRECIST criteria (20.9% vs 1.8%, p < 0.001). The earliest response time under the RecistTM criteria was 3.42 weeks earlier than that under the irRECIST criteria (u = -5.233, p < 0.001). There were significant differences in median OS between tumor marker-related complete response (tmCR) and tumor marker-related partial response (tmPR), as well as between tmPR and tumor marker-related stable disease (tmSD) (χ2 = 15.572, p < 0.001; χ2 = 7.720, p = 0.005), but not between tmSD and tumor marker-related progressive disease (tmPD) (χ2 = 1.596, p = 0.206). When applying both criteria together, for patients with immune-related CR / immune-related PR (irCR/irPR) (n = 54) under irRECIST criteria, there was a significant difference in median OS between achieving tmCR (n = 22) and tmPR (n = 32) (χ2 = 14.011, p < 0.001). RecistTM criteria can predict 1-year and 2-year OS more accurately than irRECIST criteria (AUCs:0.862 vs 0.552, 0.649 vs 0.521, respectively;both p < 0.001). In RecistTM, 4 patients had been observed with pseudoprogression in tumor markers. INTERPRETATION The RecistTM criteria could effectively distinguish CR, PR, and SD, which may help resolve the shortcomings of the RECIST criteria in evaluating the treatment response to immunotherapy, especially in assessing whether patients can achieve deep or even complete response as soon as possible. FUNDING This work was supported by the Key projects of Chongqing Health and Family Planning Commission (to Xueqin Yang, 2019ZDXM011).
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Key Words
- CR, Complete response
- Efficacy evaluation
- ICIs, Immune checkpoint inhibitors
- Immunotherapy
- NE, Not estimated
- NSCLC, Non-small cell lung cancer
- ORR, Objective response rate
- OS, Overall survival
- PD, Progressive disease
- PR, Partial response
- RECIST
- RECIST, Response Evaluation Criteria in Solid Tumors
- RecistTM, Response evaluation criteria in solid tumors based on tumor markers
- SD, Stable disease
- Tumor markers
- irCR, Immune-related complete response
- irPD, Immune-related progression disease
- irPR, Immune-related partial response
- irRECIST, Immune-related Response Evaluation Criteria in Solid Tumors
- irSD, Immune-related stable disease
- tmCR, Tumor marker-related complete response
- tmPD, Tumor marker-related progression disease
- tmPR, Tumor marker-related partial response
- tmSD, Tumor marker-related stable disease
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Kanda M, Shimizu D, Miyata K, Maeda O, Tanaka C, Inokawa Y, Hattori N, Hayashi M, Ando M, Kuwatsuka Y, Murotani K, Nakayama G, Koike M, Ando Y, Ebata T, Kodera Y. Neoadjuvant docetaxel, oxaliplatin plus S-1 for treating clinical stage III squamous cell carcinoma of the esophagus: Study protocol of an open-label phase II trial. Contemp Clin Trials Commun 2021; 24:100853. [PMID: 34820548 PMCID: PMC8601964 DOI: 10.1016/j.conctc.2021.100853] [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: 07/10/2021] [Accepted: 11/07/2021] [Indexed: 12/09/2022] Open
Abstract
In Japan, esophagectomy after two courses of 5-fluorouracil plus cisplatin is regarded a standard strategy for treating resectable stage II or III esophageal squamous cell carcinoma (ESCC). However, 5-fluorouracil plus cisplatin does not benefit cohorts with clinical stage III ESCC, suggesting the requirement for a more effective regimen. We are conducting a single-arm phase II study to assess the safety and efficacy of neoadjuvant docetaxel, oxaliplatin plus S-1 (DOS) for treating patients with clinical stage III ESCC. The primary endpoint is the pathological response rate, and the target number is 45 patients. Safety, response rate, R0 resection rate, and survival are secondary endpoints. This trial is registered in the Japan Registry of Clinical Trials as jRCTs041210023. We are conducting a prospective phase II trial to evaluate the safety and efficacy of three courses of neoadjuvant DOS treatment followed by radical esophagectomy for clinical stage III ESCC.
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Affiliation(s)
- Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Dai Shimizu
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Osamu Maeda
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshikuni Inokawa
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Norofumi Hattori
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahi-cho, Kurume, 830-0011, Japan
| | - Goro Nakayama
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahiko Koike
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Zhu XD, Li KS, Sun HC. Adjuvant therapies after curative treatments for hepatocellular carcinoma: Current status and prospects. Genes Dis 2020; 7:359-369. [PMID: 32884990 PMCID: PMC7452398 DOI: 10.1016/j.gendis.2020.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
Tumor recurrence rate after surgery or ablation of hepatocellular carcinoma (HCC) is as high as 70%. However, there are no widely accepted adjuvant therapies; therefore, no treatment has been recommended by guidelines from the American Association for the Study of Liver Disease or the European Association for the Study of the Liver. All the registered trials failed to find any treatment to prolong recurrence-free survival, which is the primary outcome in most studies, including sorafenib. Some investigator-initiated studies revealed that anti-hepatitis B virus agents, interferon-α, transcatheter chemoembolization, chemokine-induced killer cells, and other treatments prolonged patient recurrence-free survival or overall survival after curative therapies. In this review, we summarize the current status of adjuvant treatments for HCC and explain the challenges associated with designing a clinical trial for adjuvant therapy. Promising new treatments being used as adjuvant therapy, especially anti-PD-1 antibodies, are also discussed.
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Key Words
- Adjuvant therapy
- Anti-PD-1 antibody
- CIK, chemokine-induced killer cells
- CR, complete response
- Clinical trial
- HCC, hepatocellular carcinoma
- Hepatocellular carcinoma
- ICI, immune checkpoint inhibitor
- Molecular targeted therapy
- ORR, objective response rate
- OS, overall survival
- PD-1, program death-1
- PD-L1, program death-1 ligand
- PR, partial response
- RCT, randomized clinical trial
- RECIST, Response Evaluation Criteria in Solid Tumors
- RFS, recurrence-free survival
- Recurrence-free survival
- TACE, transcatheter chemoembolization
- TKI, tyrosine kinase inhibitor
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Affiliation(s)
- Xiao-Dong Zhu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Kang-Shuai Li
- Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hui-Chuan Sun
- Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Abstract
Liver cancer, mostly hepatocellular carcinoma (HCC), is the second leading cause of cancer mortality globally. Most patients were diagnosed at an advanced stage, and systemic therapy is the standard of care. All the approved systemic therapies for HCC are molecular targeted therapies with anti-angiogenic effects targeting the vascular endothelial growth factor signaling pathway. Sorafenib and lenvatinib are the first-line treatment, and regorafenib, ramucirumab, and cabozantinib are second-line treatment options. Although anti-PD-1 antibodies, including nivolumab and pembrolizumab, demonstrated promising anti-tumor effects as monotherapy for advanced HCC in phase II clinical trials, both failed in phase III studies. Anti-angiogenic treatment remains the backbone of systemic therapy for HCC. In this review, we summarized the approved anti-angiogenic medicines and discussed the potential strategies to improve the efficacy of anti-angiogenic therapy, including combination therapy with other treatments, and discussed the approaches to overcome the drawbacks of anti-angiogenic therapies.
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Key Words
- Anti-angiogenic therapy
- CR, complete response
- Combinational therapy
- HCC, hepatocellular carcinoma
- Hepatocellular carcinoma
- ICI, immune checkpoint inhibitor
- Molecular targeted therapy
- ORR, objective response rate
- OS, overall survival
- PD-1, program death-1
- PD-L1, program death-1 ligand
- PFS, progression-free survival
- PR, partial response
- RECIST, Response Evaluation Criteria in Solid Tumors
- Systemic therapy
- TACE, transcatheter chemoembolization
- TKI, tyrosine kinase inhibitor
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Affiliation(s)
- Xiao-Dong Zhu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhao-You Tang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hui-Chuan Sun
- Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Ou J, Zhu X, Chen P, Du Y, Lu Y, Peng X, Bao S, Wang J, Zhang X, Zhang T, Pang CLK. A randomized phase II trial of best supportive care with or without hyperthermia and vitamin C for heavily pretreated, advanced, refractory non-small-cell lung cancer. J Adv Res 2020; 24:175-182. [PMID: 32368355 PMCID: PMC7190757 DOI: 10.1016/j.jare.2020.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/29/2020] [Accepted: 03/14/2020] [Indexed: 12/13/2022] Open
Abstract
Our previous study indicated that intravenous vitamin C (IVC) treatment concurrent with modulated electrohyperthermia (mEHT) was safe and improved the quality of life (QoL) of non-small-cell lung cancer (NSCLC) patients. The aim of this trial was to further verify the efficacy of the above combination therapy in previously treated patients with refractory advanced (stage IIIb or IV) NSCLC. A total of 97 patients were randomized to receive IVC and mEHT plus best supportive care (BSC) (n = 49 in the active arm, receiving 1 g/kg * d IVC concurrently with mEHT, three times a week for 25 treatments in total) or BSC alone (n = 48 in the control arm). After a median follow-up of 24 months, progression-free survival (PFS) and overall survival (OS) were significantly prolonged by combination therapy compared to BSC alone (PFS: 3 months vs 1.85 months, P < 0.05; OS: 9.4 months vs 5.6 months, P < 0.05). QoL was significantly increased in the active arm despite the advanced stage of disease. The 3-month disease control rate after treatment was 42.9% in the active arm and 16.7% in the control arm (P < 0.05). Overall, IVC and mEHT may have the ability to improve the prognosis of patients with advanced NSCLC.
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Key Words
- AUC, area under the curve
- BSC, best supportive care
- CA15-3, carbohydrate antigen 15-3
- CEA, carcinoembryonic antigen
- CI, confidence interval
- CR, complete response
- CRP, C-reactive protein
- CT, computed tomography
- CYFRA21-1, cytokeratin-19 fragments
- DCR, disease control rate
- ECOG, Eastern Cooperative Oncology Group
- EGFR, epidermal growth factor receptor
- G6PD, glucose 6-phosphate dehydrogenase
- HT, hyperthermia
- IL-6, interleukin- 6
- IVC, intravenous vitamin C
- Modulated electrohyperthermia
- NSCLC, non-small-cell lung cancer
- Non-small-cell lung cancer
- OS, overall survival
- Overall survival
- PD, progressive disease
- PFS, progression-free survival
- PR, partial response
- QLQ-C30, Quality of Life Questionnaire
- QoL, quality of life
- Quality of life
- RECIST, Response Evaluation Criteria in Solid Tumors
- Remission rate
- SCC, squamous cell carcinoma antigen
- SD, stable disease
- TKIs, tyrosine kinase inhibitors
- TNF-α, Tumor Necrosis Factor-α
- Vitamin C
- mEHT, modulated electrohyperthermia
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Affiliation(s)
- Junwen Ou
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Xinyu Zhu
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Pengfei Chen
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Yanping Du
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Yimin Lu
- Hyperthermia Center, Clifford Hospital, Jinan University, PR China
| | - Xiufan Peng
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Shuang Bao
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Junhua Wang
- Hyperthermia Center, Clifford Hospital, Jinan University, PR China
| | - Xinting Zhang
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Tao Zhang
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
| | - Clifford L K Pang
- Cancer Center, Clifford Hospital, Jinan University, Guangzhou, PR China
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Lee KW, Zang DY, Ryu MH, Kim KH, Kim MJ, Han HS, Koh SA, Park JH, Kim JW, Nam BH, Choi IS. Comparison of efficacy and tolerance between combination therapy and monotherapy as first-line chemotherapy in elderly patients with advanced gastric cancer: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2017; 8:55-61. [PMID: 29696197 PMCID: PMC5898575 DOI: 10.1016/j.conctc.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/24/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The combination of a fluoropyrimidine [5-fluorouracil (5-FU), capecitabine, or S-1] with a platinum analog (cisplatin or oxaliplatin) is the most widely accepted first-line chemotherapy regimen for metastatic or recurrent advanced gastric cancer (AGC), based on the results of clinical trials. However, there is little evidence to guide chemotherapy for elderly patients with AGC because of under-representation of this age group in clinical trials. Thus, the aim of this study is to determine the optimal chemotherapy regimen for elderly patients with AGC by comparing the efficacies and safeties of combination therapy versus monotherapy as first-line chemotherapy. METHODS This study is a randomized, controlled, multicenter, phase III trial. A total of 246 elderly patients (≥70 years old) with metastatic or recurrent AGC who have not received previous palliative chemotherapy will be randomly allocated to a combination therapy group or a monotherapy group. Patients randomized to the combination therapy group will receive fluoropyrimidine plus platinum combination chemotherapy (capecitabine/cisplatin, S-1/cisplatin, capecitabine/oxaliplatin, or 5-FU/oxaliplatin), and those randomized to the monotherapy group will receive fluoropyrimidine monotherapy (capecitabine, S-1, or 5-FU). The primary outcome is the overall survival of patients in each treatment group. The secondary outcomes include progression-free survival, response rate, quality of life, and safety. DISCUSSION We are conducting this pragmatic trial to determine whether elderly patients with AGC will obtain the same benefit from chemotherapy as younger patients. We expect that this study will help guide decision-making for the optimal treatment of elderly patients with AGC.
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Key Words
- 5-FU, 5-fluorouracil
- ADL, activities of daily living
- AGC, advanced gastric cancer
- AST/ALT, aspartate aminotransferase/alanine aminotransferase
- CCr, creatinine clearance
- CGA, comprehensive geriatric assessment
- CI, confidence interval
- CRF, case report form
- CT, computed tomography
- Chemotherapy
- DSMB, data safety monitoring board
- ECOG, Eastern Cooperative Oncology Group
- EORTC QLQ-C30, European Organization for Research and Treatment of Cancer core quality of life questionnaire
- EORTC QLQ-STO22, European Organization for Research and Treatment of Cancer quality of life questionnaire-gastric
- Elderly
- FAS, full analysis set
- Gastric cancer
- HER-2, human epidermal growth factor receptor-2
- HR, hazard ratio
- IADL, independent activities of daily living
- IIT, intent to treat
- KCSG, Korean Cancer Study Group
- KG-7, Korean Cancer Study Group geriatric tool
- KPS, Karnofsky performance status
- NCI CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events
- OS, overall survival
- PFS, progression-free survival
- PPS, per-protocol set
- PS, performance status
- QoL, quality of life
- RCT, randomized controlled trial
- RECIST, Response Evaluation Criteria in Solid Tumors
- RR, response rate
- Randomized controlled trial
- SAE, serious adverse event
- SEER, Surveillance, Epidemiology, and End Results
- UNL, upper normal limit
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Affiliation(s)
- Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki Hyang Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | - Mi-Jung Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Hye Sook Han
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Sung Ae Koh
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, South Korea
| | - Jin Hyun Park
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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Abstract
Despite a major improvement in the treatment of advanced kidney cancer by the recent introduction of targeted agents such as multi-kinase inhibitors, long-term benefits are still limited and a significant unmet medical need remains for this disease. Cancer immunotherapy has shown its potential by the induction of long-lasting responses in a small subset of patients, however, the unspecific immune interventions with (high dose) cytokines used so far are associated with significant side effects. Specific cancer immunotherapy may circumvent these problems by attacking tumor cells while sparing normal tissue with the use of multi-peptide vaccination being one of the most promising strategies. We here summarize the clinical and translational data from phase I and II trials investigating IMA901. Significant associations of clinical benefit with detectable T cell responses against the IMA901 peptides and encouraging survival data in treated patients has prompted the start of a randomized, controlled phase III trial in 1st line advanced RCC with survival results expected toward the end of 2015. Potential combination strategies with the recently discovered so-called checkpoint inhibitors are also discussed.
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Key Words
- 5-FU, 5 fluorouracil
- AE, Adverse event
- CTL, Cytotoxic T-lymphocyte
- CY, Cyclophosphamide
- Cancer vaccine
- DC, Dendritic cell
- DCR, Disease control rate
- ECG, Electrocardiogram
- ELISpot, Enzyme-linked immunospot assay
- FDA, Food and Drug Administration
- GM-CSF
- HBV, Hepatitis B virus
- HLA, Human leukocyte antigen
- IFN, Interferon
- IL, Interleukin
- IMA901
- MDSC, Myeloid-derived suppressor cells
- MHC, Major histocompatibility complex
- MSKCC, Memorial Sloan Kettering Cancer Center
- NCI-CTC, National Cancer Institute-Common Toxicity Criteria
- OS, Overall survival
- PD, Progressive disease
- PFS, Progression-free survival
- PK, Pharmacokinetic
- PR, Partial response
- RCC, Renal cell carcinoma
- RECIST, Response Evaluation Criteria in Solid Tumors
- SAE, Serious adverse event
- SD, Stable disease
- TKI, Tyrosine-kinase inhibitors
- TNF, Tumor necrosis factor
- TUMAP, Tumor-associated peptides
- Tregs, Regulatory T-cells
- VEGF, Vascular endothelial growth factor
- ccRCC, Clear cell renal cell carcinoma
- checkpoint inhibitor
- cyclophosphamide
- i.d., intradermal
- immunotherapy
- intradermally
- kidney cancer
- mRNA, Messenger ribonucleic acid
- mTOR, Mammalian target of rapamycin
- mg, Milligram
- n, Number
- renal cell carcinoma
- s.c., subcutaneous, subcutaneously
- tumor-associated peptides
- vaccination
- μg, Microgram
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9
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Abstract
Cancer vaccines are aimed at stimulating an immune response to tumor tissue. There is a high level of clinical activity in this rapidly advancing field with over 1,400 trials registered on Clincaltrials.gov. The recent approval of Sipuleucel-T which is the first cancer vaccine approved in the US and EU has encouraged developers in this field. In contrast to more established approaches for treating cancer such as chemotherapy, regulatory guidelines have been developed relatively recently for cancer vaccines. These guidelines advise on general clinical requirements. As there is an increase in innovative strategies with novel products, a 2-way dialog with regulators is recommended on a case-by-case basis to justify the clinical development plan, taking into account specific quality issues related to the product(s) in development. It is important that the rationale, background and justification for the planned development is convincing when interacting with the regulatory authorities, to enable drug developers and regulators to reach agreement.
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Key Words
- AIDS, Acquired Immunodeficiency Syndrome
- CAR, T-cell Chimeric Antigen Receptor T-cell
- CTL-4, Cytotoxic T-lymphocyte-associated protein 4
- DCs, Dendritic cells
- EBV, Ebstein Barr Virus
- EMA, European Medicines Agency
- EU, European Union
- FDA, Federal Drug Administration
- HHV-8, Human Herpes Virus 8
- HTA, Health Technology Assessment
- ICH, International Conference on Harmonisation
- ICI, Immune Checkpoint Inhibitors
- ITF, Innovation Task Force
- MDSC, Myeloid-derived suppressor cells
- MHRA, Medicines and Healthcare products Regulatory Agency
- MUC1, Membrane-bound glycoprotein MUC1 mucin
- NICE, National Institute for Heath and Care excellence
- OS, Overall survival
- PD, Pharmacodynamic
- PD-1, Programmed cell death 1
- PFS, Progression-free survival
- PMDA, Pharmaceutical and Medical Devices Agency
- PTLD, Post-transplant lymphoproliferative disease
- RECIST, Response Evaluation Criteria in Solid Tumors
- Serum Igs, Serum immunoglobulins
- T cells
- TAA, Tumor associated antigens
- TIMs, Tumor Infiltrating Myeloid Cell
- Tregs, Regulatory T cells
- US, United States of America
- antigens
- cancer vaccines
- immune system
- immunesurveillance
- siRNA, Small interfering RNA
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10
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Kumar A, Acharya SK, Singh SP, Saraswat VA, Arora A, Duseja A, Goenka MK, Jain D, Kar P, Kumar M, Kumaran V, Mohandas KM, Panda D, Paul SB, Ramachandran J, Ramesh H, Rao PN, Shah SR, Sharma H, Thandassery RB. The Indian National Association for Study of the Liver (INASL) Consensus on Prevention, Diagnosis and Management of Hepatocellular Carcinoma in India: The Puri Recommendations. J Clin Exp Hepatol 2014; 4:S3-S26. [PMID: 25755608 PMCID: PMC4284289 DOI: 10.1016/j.jceh.2014.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 04/08/2014] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease. There are no consensus guidelines on diagnosis and management of HCC in India. The Indian National Association for Study of the Liver (INASL) set up a Task-Force on HCC in 2011, with a mandate to develop consensus guidelines for diagnosis and management of HCC, relevant to disease patterns and clinical practices in India. The Task-Force first identified various contentious issues on various aspects of HCC and these issues were allotted to individual members of the Task-Force who reviewed them in detail. The Task-Force used the Oxford Center for Evidence Based Medicine-Levels of Evidence of 2009 for developing an evidence-based approach. A 2-day round table discussion was held on 9th and 10th February, 2013 at Puri, Odisha, to discuss, debate, and finalize the consensus statements. The members of the Task-Force reviewed and discussed the existing literature at this meeting and formulated the INASL consensus statements for each of the issues. We present here the INASL consensus guidelines (The Puri Recommendations) on prevention, diagnosis and management of HCC in India.
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Key Words
- AFP, alpha-fetoprotein
- AIIMS, All India Institute of Medical Sciences
- ASMR, age standardized mortality rate
- BCLC, Barcelona-Clinic Liver Cancer
- CEUS, contrast enhanced ultrasound
- CT, computed tomography
- DCP, des-gamma-carboxy prothrombin
- DDLT, deceased donor liver transplantation
- DE, drug eluting
- FNAC, fine needle aspiration cytology
- GPC-3, glypican-3
- GS, glutamine synthase
- Gd-EOB-DTPA, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid
- HBV, Hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, Hepatitis C virus
- HSP-70, heat shock protein-70
- HVPG, hepatic venous pressure gradient
- ICG, indocyanine green
- ICMR, Indian Council of Medical Research
- INASL, Indian National Association for Study of the Liver
- LDLT, living donor liver transplantation
- MRI, magnetic resonance imaging
- Mabs, monoclonal antibodies
- NAFLD, non-alcoholic fatty liver disease
- OLT, orthotopic liver transplantation
- PAI, percutaneous acetic acid injection
- PEI, percutaneous ethanol injection
- PET, positron emission tomography
- PVT, portal vein thrombosis
- RECIST, Response Evaluation Criteria in Solid Tumors
- RFA
- RFA, radio frequency ablation
- SVR, sustained viral response
- TACE
- TACE, transarterial chemoembolization
- TART, trans-arterial radioisotope therapy
- UCSF, University of California San Francisco
- liver cancer
- targeted therapy
- transplant
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Affiliation(s)
- Ashish Kumar
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Subrat K. Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Road, New Delhi 110 029, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Arora
- Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh K. Goenka
- Department of Gastroenterology, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, West Bengal 700 054, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Premashish Kar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Vinay Kumaran
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Kunisshery M. Mohandas
- Department of Digestive Diseases, Tata Medical Center, Kolkata, West Bengal 700156, India
| | - Dipanjan Panda
- Department of Oncology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Jeyamani Ramachandran
- Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu 632 004, India
| | - Hariharan Ramesh
- Department of Surgical Gastroenterology, Lakeshore Hospital and Research Center, Cochin, Kerala, India
| | - Padaki N. Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India
| | - Samir R. Shah
- Department of Gastroenterology, Jaslok Hospital and Research Centre, Peddar Road, Mumbai, Maharashtra 400 026, India
| | - Hanish Sharma
- Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Road, New Delhi 110 029, India
| | - Ragesh B. Thandassery
- Department of Gastroenterology, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, West Bengal 700 054, India
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