Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Abstract P6-11-04: Capecitabine Therapy for Locally Advanced or Metastatic Breast Cancer: A Difference between Reported Clinical Trials and Routine Clinical Practice? Results from the ELIXIR Study in Routine Oncology Practice

Background: Capecitabine (X) monotherapy is an effective and well-tolerated treatment for locally advanced or metastatic breast cancer (LABC/MBC), showing consistently high activity in both the 1st-line setting andpretreated disease. The registered dose is 1250 mg/m2 bid, d1-14 q21d, but there is considerable variation in the administration of X (dose, line, monotherapy vs combination) in everyday practice. Patients and methods: ELIXIR is a French, multicenter, prospective, observational cohort study assessing the use of X in routine oncology practice in patients (pts) with LABC/MBC. The observation period is 24 months.

Results: Between Dec 05 and Jan 08, 668 pts were enrolled, of whom 655 were evaluable. The majority of pts (540; 82%) received X as monotherapy (1st line: n=201; 2nd line: n=205; ≥3rd line: n=134). The remaining 115 pts received X combined with chemotherapy (1st line: n=60; 2nd line: n=36; ≥3rd line: n=19), typically vinorelbine (n=66) or a taxane (n=42). Overall, 57 pts (9%) received X in combination with trastuzumab. Among pts receiving X monotherapy, only 21 % began therapy at the full registered dose, 60% of pts started at 75% of the registered dose and in 19% of pts, therapy was initiated at ≥50% of the registered dose. At the 12-month analysis, median progression-free survival (PFS) in the overall population was 8.0 months (95% CI 7.1-8.8), 61% of pts were still alive, and median overall survival had not been reached. Analysis of safety data among pts receiving X monotherapy revealed no major differences in tolerability according to treatment line, except for less grade 3 hand-foot syndrome (HFS) and grade 3/4 diarrhea in pts treated in later lines (Table).

Conclusion: ELIXIR is one of the largest prospective cohort studies of X in LABC/MBC. Tolerability in the 1st-line setting compares favorably with that of X 1000 or 1250 mg/m2 bid observed in the exclusively 1st-line GBG39 (MoniCa) and PELICAN trials, presumably reflecting the selection of a lower dose in most pts treated in ELIXIR. Despite the tailored dose, median PFS of 8.0 months is consistent with the median time to progression of 7.1-7.3 months reported in GBG39 and PELICAN. These data suggest that the efficacy of X seen in clinical trials can be reproduced in the real-life setting, despite widespread use of lower doses to improve tolerability. The wide array of variables in routine clinical practice makes interpretation of the data complex. Slight qualitative differences in the safety profile between treatment lines may be attributable to differences in starting dose and/or disease symptoms and require further investigation. Analysis of efficacy and safety results according to treatment line and starting dose is ongoing and 24-month results will be presented.

A fractionated schedule of oral vinorelbine (NVBo) with cisplatin (CDDP) concomitantly with radiotherapy (RT) after induction chemotherapy (CT) in locally advanced (LA) non-small cell lung cancer (NSCLC): Safety and efficacy results of a phase II trial

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Background: NVB+CDDP as induction and concomitant regimen with RT is a recognized treatment in LA NSCLC (Vokes, J Clin Oncol. 2002). The oral formulation of NVB may simplify the administration and a new fractionated schedule may further improve the results during CT-RT. Methods: Non operable stage IIIA-IIIB NSCLC patients (pts) received an induction CT of 2 cycles of NVBiv 25 mg/m2 + CDDP 80 mg/m2 on D1 and NVBo 60mg/m2 on D8 every 3 weeks. Non progressive pts received 2 additional cycles of fixed dose NVBo of 20 mg on D1, D3 and D5, + CDDP 80 mg/m2 on D1 every 3 weeks, combined with a conformal RT at 66 Gy. Results: Between October 05 and May 08, 70 pts were enrolled (68 evaluable for the safety, 64 for response) : 28% stage IIIA, 72% IIIB; 44 % squamous, 30 % adenocarcinoma; 85% male; median age 61 years (range 41;73); median KPS 90%. After induction CT, OR was 42% (PR), Disease Control (DC) = 87%. 4 pts were down-staged and underwent surgery. After CT-RT completion, OR was 55% (CR = 7%), DC = 88%. Main Toxicities (G3–4, % of pts) were: neutropenia (19%), N/V (1%), radic pneumopathy (1%), anorexia (7%). Oesophagitis was recorded in 42% of pts with no G3–4 : G1 (26%), G2 (16%). Conclusions: This new schedule provides a disease control in 88% of pts with 55% OR. Given the optimal tolerance profile of this fractionated administration of NVBo+CDDP, 72% of pts could complete the planned treatment. Furthermore, NVBo taken at home at D3 and D5 reduces the organizational constraints linked to CT-RT. This new scheme offers a well tolerated and efficient therapeutic option in the treatment of non operable IIIA-IIIB NSCLC. Further follow-up is required in order to assess time to progression and survival.

[Table: see text]

French experience of patient management when receiving oral vinorelbine chemotherapy (NVBO) for metastatic breast cancer: Final results of a prospective observational survey on practices

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Background: An observatory on practices has been implemented in France with the aim of investigating the correlation between patient (pt) profile and the use of an oral chemotherapy (OCT), NVBO. Methods and Materials: Three questionnaires were used: a “Physician” questionnaire (medical practice conditions, role of OCT), a “Patient” questionnaire (pt disease history, prescription selection factors and compliance), and a Patient Preference self-questionnaire (partly based on the EORTC QLQ-BR23). Results: Between February 06 and February 08,355 pts were enrolled in 47 centers. Breast tumours were classified as having limited aggressiveness with or without visceral metastasis (41.2%) or slowly progressing visceral metastasis and DFI>24 months (42.3%) or aggressive disease with visceral metastasis and DFI<12 months (16.5%). Pts had previously received hormonotherapy in 72.4%, iv CT in 78.6% and OCT in 31%. NVBO was prescribed as monotherapy in 53,6% and association in 46,4%, with iv in 35% (66.7% with trastuzumab), with oral in 65% ( 97.2% with capecitabine ). 86.2% of pts preferred OCT for 3 main reasons : more time with their family, social life maintained and treatment at home. Physicians’ major parameters of OCT choice according to score (1 to 4) were : patient-related factors (QOL 3.61), reduced hospital stays (2.99) and problems related to venous administration (2.62). Conclusion: NVBO brings added value in terms of pt convenience allowing improved QOL and reduced hospital stays while keeping optimal compliance to treatment schedule.

[Table: see text]

Combination of raltitrexed and oxaliplatin is an active regimen in malignant mesothelioma: results of a phase II study

PURPOSE

The aim of this open-label phase II study was to evaluate the activity of raltitrexed (Tomudex; AstraZeneca, Cergy, France) and oxaliplatin combination therapy in patients with diffuse malignant pleural mesothelioma. PATIENT AND METHODSs: Fifteen pretreated and 55 chemotherapy-naive patients (median age, 60 years; World Health Organization performance status of < or = 2) were enrolled. Most patients (66%) had advanced disease. Patients received raltitrexed 3 mg/m2 followed by oxaliplatin 130 mg/m2 every 3 weeks.

RESULTS

Twenty-four patients (34%) were classified as having a poor prognosis. In the overall study population, 14 patients (20%) had a partial response, and 32 patients (46%) had stable disease. The symptomatic response rates were as follows: shortness of breath, 36%; pain, 30%; activity, 23%; appetite, 21%; and asthenia, 20%. Median time to disease progression was 18 weeks (95% confidence interval [CI], 13 to 22 weeks). In chemotherapy-naive patients, median survival was 31 weeks (95% CI, 23 to 40 weeks) from the start of treatment and 49 weeks (95% CI, 40 to 52 weeks) from diagnosis of mesothelioma. In pretreated patients, median survival was 44 weeks (95% CI, 24 to 40 weeks) from the start of treatment and 226 weeks (95% CI, 63 to 292 weeks) from the diagnosis of mesothelioma. Overall 1-year survival was 26% (95% CI, 15.5% to 36.4%), survival was 22% (95% CI, 10.9% to 33.2%) in chemotherapy-naive patients and 40% (95% CI, 15.2% to 64.8%) in pretreated patients. Hematologic toxicity was mild, and there was no alopecia. The most common adverse events were asthenia, nausea/vomiting, and paraesthesia, and no treatment-related deaths were reported.

CONCLUSION

The raltitrexed and oxaliplatin combination is an active outpatient regimen in malignant mesothelioma and has an acceptable tolerability profile.

[Iris metastasis in 2 patients. Importance for diagnosis and treatment of the primary tumor]

Two cases of cancer with secondary metastases to the iris were examined. In the first case, the work-ups performed after appearance of the iris lesion led to the discovery of wide spreading from the primary tumor already known and treated. An iris biopsy in the second case revealed the nature of the primary tumor which was an oat-cell lung carcinoma. We describe the frequency, the differential diagnosis and treatment for iris metastases and propose several investigations for the work-up of tumoral lesions of the iris.

[Iris metastases in two patients, important for the diagnosis and treatment of the primary tumor]

Two cases of cancer with secondary metastases to the iris were examined. In the first case, the work-up performed after appearance of the iris lesion led to the discovery of a general spread from the already known and treated primary tumor which was an oat cell carcinoma of the lung.

Phase III trial of modulation of cisplatin/fluorouracil chemotherapy by interferon alfa-2b in patients with recurrent or metastatic head and neck cancer. Head and Neck Interferon Cooperative Study Group

PURPOSE

In preclinical experiments, interferon alfa modulates the anticancer activity of fluorouracil (5-FU) and cisplatin (CDDP). To test this effect clinically in patients with recurrent or metastatic head and neck cancer (RMHNC), a multicenter randomized controlled trial with CDDP and 5-FU with or without interferon alfa-2b (IFNalpha) was performed.

PATIENTS AND METHODS

Eligible patients had histologically confirmed RMHNC; a good performance status; measurable disease; adequate bone marrow, hepatic, and renal function; no prior chemotherapy for recurrent or metastatic disease; only one chemotherapy regimen administered with previous local therapy; and a treatment-free interval of at least 3 months following previous local therapy. Patients were randomized and stratified according to treatment center, and prior radiotherapy and chemotherapy. The treatment regimen consisted of CDDP 100 mg/m2 on day 1 and 5-FU 1,000 mg/m2/d by continuous infusion for 96 hours (days 1 to 4), without (arm A) or with (arm B) IFNg alpha 3 x 10(6) U/d subcutaneously on days 1 to 5. Cycles were repeated every 21 days.

RESULTS

One hundred twenty-two patients were entered on each arm. The response rate (RR) was similar in both arms (arm A: complete response [CR] 10.7%, partial response [PR] 36.4%; arm B: CR 6.8%, PR 31.6%) (.70 < P < .50). There was no difference in median survival between the two arms (arm A 6.3 months v arm B 6.0 months; P = .49). Anorexia, fever, leukopenia, and thrombocytopenia grade III to IV were significantly more frequent in the IFNalpha arm.

CONCLUSION

Modulation of CDDP and 5-FU with IFNalpha as used in this study does not improve the RR or the median survival in patients with RMHNC. Patients on both study arms had a poor prognosis, which indicates the need for novel therapies.

Clinical randomized study of 5FU monitoring versus standard dose in patients with head and neck cancer: preliminary results

Prospective studies of dose adaptation of continuous 5FU infusion combined with cisplatin have shown that pharmacologically guided dosing was feasible in the treatment of head and neck carcinomas. Adaptative dosing results in reduced haematological toxicity, but few data are available for clinical response rate. Preliminary results (38 patients) of a randomized trial comparing standard dose of 5FU (20 patients) and monitoring of 5FU based on pharmacokinetic information (half-cycle area under the curve, 18 patients) indicate that haematological tolerance and complete response rate were improved. Severe (GIII-GIV) thrombocytopenia and neutropenia were significantly reduced during cycle 2 (0% versus 11.1% and 5.5% versus 27.7% respectively, p < 0.01) and cycle 3 (0% versus 27.7% and 6.6% versus 33.3% respectively, p < 0.001). The complete response rate was increased in the group with monitoring of 5FU doses (55.5% versus 40.0%, p < 0.001). These interesting results will be confirmed at the end of the trial, which is expected to include 126 patients.

A three-arm trial of vinorelbine (Navelbine) plus cisplatin, vindesine plus cisplatin, and single-agent vinorelbine in the treatment of non-small cell lung cancer: an expanded analysis

Phase II studies have demonstrated that vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) alone or in combination with cisplatin has promising activity against non-small cell lung cancer (NSCLC). On the basis of these preliminary trials, a phase III study was designed to compare intravenous vinorelbine (30 mg/m2 weekly) plus cisplatin (120 mg/m2 on day 1 and day 29 and then every 6 weeks) with vindesine (3 mg/m2 weekly for 6 weeks and then every 2 weeks) plus cisplatin, and to evaluate whether the best of these regimens afforded a survival benefit compared with intravenous vinorelbine alone, an outpatient regimen. This report presents an expanded analysis of data from this previously published study. Six hundred twelve patients were enrolled in this trial: 206 in the vinorelbine plus cisplatin arm, 200 in the vindesine plus cisplatin group, and 206 in the single-agent vinorelbine arm. The vinorelbine plus cisplatin regimen was superior to the other two arms of the study in objective response rate (30% v 19% for vindesine plus cisplatin [P = .02] and 14% for vinorelbine alone [P = .001]), median survival duration (40 weeks v 32 weeks for vindesine plus cisplatin and 31 weeks for vinorelbine alone), and 1-year survival rate (35% v 27% for vindesine plus cisplatin and 30% for vinorelbine alone). An adjusted log-rank test provided a significant advantage for vinorelbine plus cisplatin when compared with vindesine plus cisplatin (P = .04) and with vinorelbine alone (P = .02). The major difference in survival between the two cisplatin-containing regimens occurred in patients with metastatic (stage IV) NSCLC. The incidence of granulocytopenia was significantly higher in the vinorelbine plus cisplatin arm compared with the other two treatment groups, but neurotoxicity was significantly more frequent in the vindesine plus cisplatin group. The results of this study indicate that the combination of vinorelbine plus cisplatin is a viable treatment option for patients with NSCLC and may provide advantages compared with other commonly used regimens.

Dose finding study of granisetron in patients receiving high-dose cisplatin chemotherapy. The Granisetron Study Group

The efficacy and safety of three different doses of granisetron (2 micrograms kg-1, group A; 10 micrograms kg-1, group B; 40 micrograms kg-1, group C) were compared in a randomised, double-blind study of 157 patients due to receive high-dose cisplatin therapy (mean dose > 97 mg m-2). In each group, up to two 3 mg rescue doses of granisetron were allowed if more than mild nausea or vomiting occurred. In group A 30.8%, in group B 61.5% and in group C 67.9% of patients were complete responders (i.e. no vomiting or nothing worse than mild nausea) during the first 24 h. These differences are significant between groups A and B, and A and C. There were no statistically significant differences in any efficacy variable between the 10 micrograms kg-1 and 40 micrograms kg-1 groups, although in each case the trend favoured the higher dose. Additional rescue doses resulted in resolved or improved symptoms in 95.3% for the first rescue dose and 93.3% for the second. Over the 7 days of the study, 82.7%, 82.7% and 86.8% of patients in groups A, B and C respectively were treated with granisetron alone. Headache was the most common side-effect, reported by 9.6% of patients; the majority of headaches were mild. There was no difference between the treatment groups regarding the adverse event rate. We concluded that prophylactic doses of 10 or 40 micrograms kg-1 lead to a safe and satisfactory degree of control of nausea and vomiting induced by high-dose cisplatin.

Randomized study of vinorelbine and cisplatin versus vindesine and cisplatin versus vinorelbine alone in advanced non-small-cell lung cancer: results of a European multicenter trial including 612 patients

PURPOSE

We designed a prospective randomized trial to compare vinorelbine and cisplatin (NVB-P) with vindesine and cisplatin (VDS-P) and to evaluate whether the best of these regimens affords a survival benefit compared with vinorelbine alone (NVB), an outpatient regimen, in patients with non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Forty-five centers included 612 patients in this study: 206 on NVB-P, 200 on VDS-P, and 206 on NVB. Vinorelbine was administered at a dose of 30 mg/m2 weekly, cisplatin at 120 mg/m2 on days 1 and 29 and then every 6 weeks, and vindesine at 3 mg/m2 weekly for 6 weeks and then every other week. Treatment was continued until progression or toxicity. Four percent of the patients entered were ineligible and 59% had metastatic disease.

RESULTS

An objective response rate was observed in 30% of patients in the NVB-P arm versus 19% in the VDS-P arm (P = .02) and 14% in the NVB arm (P < .001). The median duration of survival was 40 weeks in the NVB-P arm, compared with 32 weeks in the VDS-P arm and 31 weeks in the NVB arm. Comparison of survival among the three groups demonstrated an advantage for NVB-P compared with VDS-P (P = .04) and NVB (P = .01). Neutropenia was significantly higher in the NVB-P group (P < .001), and neurotoxicity was more frequent with VDS-P (P < .004).

CONCLUSION

Since our results have demonstrated that NVB-P yields a longer survival duration and a higher response rate than VDS-P or NVB alone, with acceptable toxicity, this combination should be considered a relevant regimen in advanced NSCLC.

Prevalence survey of precancerous lesions of the oesophagus in a high-risk population for oesophageal cancer in France

The prevalence of precancerous lesions of the oesophagus and their association with alcohol drinking, tobacco smoking and some dietary factors were examined in an endoscopic survey carried out in Lower Normandy, France, a high-risk area for oesophageal cancer. The study included 134 male volunteers of 35-64 years of age. In 124 of the volunteers oesophageal biopsies were evaluable. At histology, the prevalence of chronic oesophagitis, epithelial atrophy and dysplasia was 63%, 1.6% and 4.8%, respectively. The prevalence of these precancerous lesions was significantly associated with cigarette smoking and frequent consumption of butter.

Physiological cost of vocational activities after myocardial infarction

Oxygen consumption was measured during 30 min of work in 16 patients, after a myocardial infarction (anterior or posterior), and compared with 16 normal subjects, of the same age, involved in the same activities, in a steel factory. The VO2 at work of the patients was a little lower than in normals. The mean heart rate for 8 h was also a little lower in patients than in normals. The patients used a higher percentage of their residual capacity (VO2 max) as evaluated on a bicycle ergometer in the laboratory; the difference may be important between patients with a residual coronary insufficiency and controls. There are no important differences in the psychological attitudes of the two groups; the patient seems to be more motivated. From this study, based on a limited number of patients who had returned to work and had no complaints in daily life, it appears that the patients were working more 'economically' that the normals, that they are able to use a higher percentage of their residual physiological capacity and that the psychological attitude is comparable in the two groups towards work. Return to previous work should never be excluded a priori in post-infarction patients with good clinical progress.

Penile/anal condylomas and squamous cell cancer. A HPV DNA hybridization study

Acuminate condylomas from the penis (n = 17) and anus (six cases), three anal/penile giant condylomas, anal Bowen's disease (four cases), and intraanal squamous cell carcinomas with associated condylomatous changes (10 cases) including two verrucous carcinoma were studied for human papillomavirus (HPV) infections with nick translated, biotinylated cDNA probes for HPV 6, 11, 16 and 18. In addition, six cases of flat white penile lesions designated as lichen sclerosus et atrophicus were examined. Reannealed complementary DNA strands were detected in situ with either immunoenzyme or immunogold protocols. The in situ hybridizations resulted in 1/6 positive penile lichenoid lesions, 12/17 positive penile acuminate condylomas, 6/6 positive anal acuminate condylomas (including two condylomas with cellular atypias), 2/3 positive giant condylomas, 1/4 positive anal bowenoid lesions, and 4/10 positive keratinized squamous cell carcinomas, two of them being verrucous carcinomas. All penile/anal condylomas and two giant condylomas harboured HPV 6 and/or 11 DNA. The five positive carcinomas (carcinoma in situ/invasive cancer) contained HPV 6 and/or 11 in two cases (including the verrucous carcinomas), and HPV 16 and/or 18 in three cases (one carcinoma in situ, two invasive carcinomas). Recurrent malignancies were seen in one case to harbour the same HPV type as the primary lesions (HPV 16). In one particular patient, a double infection with HPV 16 and HPV 18 was demonstrated in distantly located malignant tumours. Our study confirms the restrictions and the value of non-isotopic hybridization methods applied to archival tissues, and extends the knowledge on the presence and distribution of HPV infections at anogenital sites.