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Karapetis CS, Liu H, Sorich MJ, Pederson LD, Van Cutsem E, Maughan T, Douillard JY, O'Callaghan CJ, Jonker D, Bokemeyer C, Sobrero A, Cremolini C, Chibaudel B, Zalcberg J, Adams R, Buyse M, Peeters M, Yoshino T, de Gramont A, Shi Q. Fluoropyrimidine type, patient age, tumour sidedness and mutation status as determinants of benefit in patients with metastatic colorectal cancer treated with EGFR monoclonal antibodies: individual patient data pooled analysis of randomised trials from the ARCAD database. Br J Cancer 2024; 130:1269-1278. [PMID: 38402342 PMCID: PMC11015038 DOI: 10.1038/s41416-024-02604-y] [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: 09/26/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND KRAS mutations in metastatic colorectal cancer (mCRC) are used as predictive biomarkers to select therapy with EGFR monoclonal antibodies (mAbs). Other factors may be significant determinants of benefit. METHODS Individual patient data from randomised trials with a head-to-head comparison between EGFR mAb versus no EGFR mAb (chemotherapy alone or best supportive care) in mCRC, across all lines of therapy, were pooled. Overall survival (OS) and progression-free survival (PFS) were compared between groups. Treatment effects within the predefined KRAS biomarker subsets were estimated by adjusted hazard ratio (HRadj) and 95% confidence interval (CI). EGFR mAb efficacy was measured within the KRAS wild-type subgroup according to BRAF and NRAS mutation status. In both KRAS wild-type and mutant subgroups, additional factors that could impact EGFR mAb efficacy were explored including the type of chemotherapy, line of therapy, age, sex, tumour sidedness and site of metastasis. RESULTS 5675 patients from 8 studies were included, all with known mCRC KRAS mutation status. OS (HRadj 0.90, 95% CI 0.84-0.98, p = 0.01) and PFS benefit (HRadj 0.73, 95% CI 0.68-0.79, p < 0.001) from EGFR mAbs was observed in the KRAS wild-type group. PFS benefit was seen in patients treated with fluorouracil (HRadj 0.75, 95% CI 0.68-0.82) but not with capecitabine-containing regimens (HRadj 1.04, 95% CI 0.86-1.26) (pinteraction = 0.002). Sidedness also interacted with EGFR mAb efficacy, with survival benefit restricted to left-sided disease (pinteraction = 0.038). PFS benefits differed according to age, with benefits greater in those under 70 (pinteraction = 0.001). The survival benefit was not demonstrated in those patients with mutations found in the KRAS, NRAS or BRAF genes. The presence of liver metastases interacted with EGFR mAb efficacy in patients with KRAS mutant mCRC (pinteraction = 0.004). CONCLUSION The benefit provided by EGFR mAbs in KRAS WT mCRC is associated with left-sided primary tumour location, younger patient age and absence of NRAS or BRAF mutations. Survival benefit is observed with fluorouracil but not capecitabine. Exploratory results support further research in KRAS mutant mCRC without liver metastases.
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Affiliation(s)
- C S Karapetis
- Flinders Medical Centre, Adelaide, SA, Australia.
- Flinders University, Adelaide, SA, Australia.
| | - H Liu
- Mayo Clinic, Rochester, NY, USA
| | - M J Sorich
- Flinders University, Adelaide, SA, Australia
| | | | - E Van Cutsem
- University Hospitals Gasthuisberg Leuven and University of Leuven, Leuven, Belgium
| | - T Maughan
- University of Liverpool, Liverpool, UK
| | - J Y Douillard
- University of Nantes and Integrated Centers of Oncology ICO Rene Gauducheau Cancer Nantes, Nantes, France
| | | | - D Jonker
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - C Bokemeyer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - B Chibaudel
- Franco-British Institute Levallois-Perre, Levallois-Perre, France
| | - J Zalcberg
- Dept of Medical Oncology, Alfred Health and School of Public Health, Monash University, Melbourne, VIC, Australia
| | - R Adams
- Velindre Cancer Centre Cardiff University, Cardiff, UK
| | - M Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - M Peeters
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - T Yoshino
- National Cancer Centre Hospital East, Kashiwa, Japan
| | - A de Gramont
- Franco-British Institute Levallois-Perre, Levallois-Perre, France
| | - Q Shi
- Mayo Clinic, Rochester, NY, USA
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Stocker G, Lorenzen S, Ettrich T, Herz AL, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Larcher-Senn J, Keller G, Lordick F, Haag GM. S-1 maintenance therapy in Caucasian patients with metastatic esophagogastric adenocarcinoma-final results of the randomized AIO MATEO phase II trial. ESMO Open 2023; 8:101572. [PMID: 37270871 PMCID: PMC10373924 DOI: 10.1016/j.esmoop.2023.101572] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Platinum-fluoropyrimidine combinations are standard of care for treatment of metastatic esophagogastric adenocarcinoma. The optimal duration of first-line chemotherapy is unknown, however, and maintenance strategies have not yet been established. DESIGN MATEO is an international randomized phase II trial exploring efficacy and safety of S-1 maintenance therapy in human epidermal growth factor receptor 2 (HER2)-negative advanced esophagogastric adenocarcinoma. After 3 months of first-line platinum-fluoropyrimidine-based induction therapy, patients without progression were randomized in a 2 : 1 allocation to receive S-1 monotherapy (arm A) or to continue combination chemotherapy (arm B). The primary objective was to show non-inferiority of overall survival in the S-1 maintenance group. Progression-free survival, adverse events, and quality of life were secondary endpoints. RESULTS From 2014 to 2019, 110 and 55 patients were randomized in arm A and arm B, respectively (recruitment closed prematurely). Median overall survival from randomization was 13.4 months for arm A and 11.4 months for arm B [hazard ratio 0.97 (80% confidence interval 0.76-1.23), P = 0.86]. Median progression-free survival from randomization was 4.3 and 6.1 months for arm A versus arm B, respectively [hazard ratio 1.10 (80% confidence interval 0.86-1.39), P = 0.62]. Patients in arm A had numerically fewer treatment-related adverse events (84.9% versus 93.9%) and significantly less peripheral sensory polyneuropathy ≥grade 2 (9.4% versus 36.7%). CONCLUSIONS S-1 maintenance following platinum-based induction therapy leads to non-inferior survival outcomes compared with the continuation of platinum-based combination. Toxicity patterns favor a fluoropyrimidine maintenance strategy. These data challenge the continued use of platinum combination chemotherapy after response to 3 months induction therapy in patients with advanced human epidermal growth factor receptor 2-negative esophagogastric adenocarcinoma.
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Affiliation(s)
- G Stocker
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - S Lorenzen
- Clinic and Policlinic for Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - T Ettrich
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - A-L Herz
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Longo
- Ramon y Cajal University Hospital, IRYCIS, CIBERONC, Madrid, Spain
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - J Trojan
- Medical Clinic 1, Goethe University Hospital, Frankfurt am Main, Germany
| | - R Mahlberg
- Department of Internal Medicine I, Klinikum Mutterhaus der Borromaerinnen, Trier, Germany
| | - N Moosmann
- Department of Hematology and Oncology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - B Chibaudel
- Department of Medical Oncology, Franco-British Hospital, Fondation Cognacq-Jay, Levallois-Perret, France
| | - S Kubicka
- Cancer Center Reutlingen, Reutlingen, Germany
| | - R Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - S Daum
- Department of Gastroenterology, Campus B. Franklin, Charité - Universitätsmedizin, Berlin, Germany
| | | | - J Larcher-Senn
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - G Keller
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Lordick
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - G M Haag
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor-Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Martinelli E, Cremolini C, Mazard T, Vidal J, Virchow I, Tougeron D, Cuyle PJ, Chibaudel B, Kim S, Ghanem I, Asselain B, Castagné C, Zkik A, Khan S, Arnold D. Real-world first-line treatment of patients with BRAF V600E-mutant metastatic colorectal cancer: the CAPSTAN CRC study. ESMO Open 2022; 7:100603. [PMID: 36368253 PMCID: PMC9832736 DOI: 10.1016/j.esmoop.2022.100603] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND BRAFV600E mutations occur in 8%-12% of metastatic colorectal cancer (mCRC) cases and are associated with poor survival. European guidelines recommend combination (doublet or triplet) chemotherapy plus bevacizumab in first line. However, an unmet need remains for more effective treatments for these patients. PATIENTS AND METHODS CAPSTAN CRC is a European, retrospective, multicenter, observational study evaluating real-world treatment practices for patients with BRAFV600E-mutant mCRC treated between 1 January 2016 and 31 January 2020. The primary objective was to describe first-line treatment patterns. Secondary objectives included describing baseline demographics, mutational testing procedures, treatment effectiveness, and safety. RESULTS In total, 255 patients (median age 66.0 years; 58.4% female) with BRAFV600E-mutant unresectable mCRC from seven countries were included. Most had right-sided tumors (52.5%) and presented with synchronous disease at diagnosis (66.4%). Chemotherapy plus targeted therapy (68.7%) was preferred at first line over chemotherapy alone (31.3%). The main first-line treatments were FOLFOX plus bevacizumab (27.1%) and FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin, irinotecan) with/without bevacizumab (27.1%/19.2%). Median duration of first-line treatment was 4.9 months. Overall, 52.5% received second-line treatment. Across all first-line regimens, progression-free survival (PFS) and overall survival were 6.0 [95% confidence interval (CI) 5.3-6.7] months and 12.9 (95% CI 11.6-14.1) months, respectively. Triplet plus targeted therapy was associated with more adverse events (75.0%) compared with triplet chemotherapy alone (50.0%) and doublet chemotherapy alone (36.1%). Multivariate analysis identified low body mass index and presence of three or more metastatic sites as significant prognostic factors for PFS. CONCLUSIONS This study is, to date, the largest real-world analysis of patients with BRAFV600E-mutant mCRC, providing valuable insights into routine first-line treatment practices for these patients. The data highlight the intrinsic aggressiveness of this disease subgroup, confirming results from previous real-world studies and clinical trials, and stressing the urgent need for more effective treatment options in this setting.
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Affiliation(s)
- E Martinelli
- Medical Oncology, Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy.
| | - C Cremolini
- Oncologia Medica, University of Pisa, Pisa, Italy
| | - T Mazard
- Institut de Recherche en Cancerologie de Montpellier, INSERM, Montpellier University, Institut du Cancer de Montpellier, Montpellier, France
| | - J Vidal
- Department of Medical Oncology, Hospital del Mar - IMIM, CIBERONC, Barcelona, Spain
| | - I Virchow
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D Tougeron
- Department of Hepato-gastroenterology, Poitiers University Hospital and University of Poitiers, Poitiers, France
| | - P-J Cuyle
- Gastroenterology and Digestive Oncology Department, Imelda General Hospital, Bonheiden, Belgium
| | - B Chibaudel
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois-Perret, France
| | - S Kim
- Department of Medical Oncology, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - I Ghanem
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | | | - C Castagné
- Pierre Fabre, Boulogne-Billancourt, France
| | - A Zkik
- Pierre Fabre, Boulogne-Billancourt, France
| | - S Khan
- Pierre Fabre, Boulogne-Billancourt, France
| | - D Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
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Tougeron D, Dahan L, El Hajbi F, Le Malicot K, Evesque L, Aparicio T, Bouche O, Bonichon Lamichhane N, Chibaudel B, Angelergues A, A. bodere, Phelip J, Mabro M, Artru P, Louvet C. 1204MO PRODIGE 59 - DURIGAST trial: A randomised phase II study evaluating FOLFIRI plus durvalumab and FOLFIRI plus durvalumab plus tremelimumab in second-line treatment of patients with advanced gastric or gastro-oesophageal junction adenocarcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1322] [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: 11/29/2022] Open
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Margalit O, Harmsen W, Shacham-Shmueli E, Voss M, Boursi B, Cohen R, Olswold C, Saltz L, Hurwitz H, Adams R, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, de Gramont A, Shi Q, Lenz H. P-106 Evaluating sex as a predictive marker for response to bevacizuamb in metastatic colorectal carcinoma: Pooled analysis of 3,369 patients in the ARCAD database. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.196] [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: 11/24/2022] Open
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Karapetis C, Liu H, Sorich M, Fiskum J, Grothey A, Adams R, Venook A, Heinemann V, Lenz H, Yoshino T, Zalcberg J, Chibaudel B, Buyse M, De Gramont A, Shi Q. 434P Impact of molecular markers status on treatment effects comparing EGFR and VEGF monoclonal antibodies (mAbs) in untreated metastatic colorectal cancer (mCRC): Pooled individual patient data (IPD) analysis of randomized trials from the ARCAD database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.545] [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: 10/23/2022] Open
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Haag G, Stocker G, Lorenzen S, Ettrich T, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Mann J, Lordick F. 1447P S-1 maintenance therapy in non-Asian patients with advanced, Her-2 negative esophagogastric adenocarcinoma – First results of the international MATEO trial initiated by the AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Papamichael D, Lopes G, Olswold C, Chibaudel B, Zalcberg J, Van Cutsem E, Venook A, Maughan T, Heinemann V, Kaplan R, Bokemeyer C, Lenz H, Yoshino T, Adams R, Grothey A, De Gramont A, Shi Q. 432P Toxicity and efficacy of 1st line cetuximab (cetux)-based therapy in RAS wildtype (WT) older patients (pts) with metastatic colorectal cancer (mCRC): A pooled analysis from 1,274 pts in the ARCAD database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.543] [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: 10/23/2022] Open
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Tournigand C, Flechon A, Oudard S, Saada-Bouzid E, Pouessel D, Tourneau CL, Augereau P, Beylot-Barry M, Grob J, Chibaudel B, Soria JC, Simon C, Couch D, Hoog-Labouret N, Tiffon C, Chevret S, Andre T, Marabelle A. High level of activity of nivolumab anti-PD-1 immunotherapy and favorable outcome in metastatic/refractory MSI-H non-colorectal cancer: Results of the MSI cohort from the French AcSé program. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Larsen A, van Dreden P, Chibaudel B, de Gramont A, Gerotziafas G, Thouroude S. Acquired chemoresistance of colorectal cancer (CRC) cells is accompanied by pro-invasive VEGF-signaling that can be attenuated by aflibercept. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.045] [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: 11/15/2022] Open
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Zaanan A, Samalin E, Louvet C, Montérymard C, Khemissa F, Bouche O, Louafi S, Ghiringhelli F, Bernard P, Chibaudel B, Artru P, Molin Y, Baba-Hamed N, Romano O, Aparicio T, Michel P, Rougier P, Tougeron D, Manfredi S, Taieb J. PRODIGE 51 - GASTFOX: Phase III randomised trial evaluating FOLFOX with or without DOCETAXEL (TFOX) as 1st line chemotherapy for locally advanced or metastatic oesophago-gastric adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.155] [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: 11/14/2022] Open
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Bonnetain F, Borg C, Adams RR, Ajani JA, Benson A, Bleiberg H, Chibaudel B, Diaz-Rubio E, Douillard JY, Fuchs CS, Giantonio BJ, Goldberg R, Heinemann V, Koopman M, Labianca R, Larsen AK, Maughan T, Mitchell E, Peeters M, Punt CJA, Schmoll HJ, Tournigand C, de Gramont A. How health-related quality of life assessment should be used in advanced colorectal cancer clinical trials. Ann Oncol 2017; 28:2077-2085. [PMID: 28430862 DOI: 10.1093/annonc/mdx191] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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] [Indexed: 12/31/2022] Open
Abstract
Traditionally, the efficacy of cancer treatment in patients with advance or metastatic disease in clinical studies has been studied using overall survival and more recently tumor-based end points such as progression-free survival, measurements of response to treatment. However, these seem not to be the relevant clinical end points in current situation if such end points were no validated as surrogate of overall survival to demonstrate the clinical efficacy. Appropriate, meaningful, primary patient-oriented and patient-reported end points that adequately measure the effects of new therapeutic interventions are then crucial for the advancement of clinical research in metastatic colorectal cancer to complement the results of tumor-based end points. Health-related quality of life (HRQoL) is effectively an evaluation of quality of life and its relationship with health over time. HRQoL includes the patient report at least of the way a disease or its treatment affects its physical, emotional and social well-being. Over the past few years, several phase III trials in a variety of solid cancers have assessed the incremental value of HRQoL in addition to the traditional end points of tumor response and survival results. HRQoL could provide not only complementary clinical data to the primary outcomes, but also more precise predictive and prognostic value. This end point is useful for both clinicians and patients in order to achieve the dogma of precision medicine. The present article examines the use of HRQoL in phase III metastatic colorectal cancer clinical trials, outlines the importance of HRQoL assessment methods, analysis, and results presentation. Moreover, it discusses the relevance of including HRQoL as a primary/co-primary end point to support the progression-free survival results and to assess efficacy of treatment in the advanced disease setting.
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Affiliation(s)
- F Bonnetain
- Methodology and Quality of Life Unit, Oncology Department (INSERM UMR 1098), Quality of Life and Cancer Clinical Research Platform
| | - C Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon
- Centre d'Investigation Clinique en Biothérapie, CIC-1431, Nantes
- 11UMR1098 INSERM/Université de Franche Comté/Etablissement Français du Sang, Besançon
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - R R Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - J A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - A Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - H Bleiberg
- Montagne de Saint Job, Brussels, Belgium
| | - B Chibaudel
- Institut Hospitalier Franco-Britannique, Levallois-Perret, France
| | - E Diaz-Rubio
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J Y Douillard
- Medical Oncology, Institut de Cancérologie de l'Ouest (ICO), Nantes St-Herblain, France
| | - C S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - B J Giantonio
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - R Goldberg
- Department of Medicine, The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, USA
| | - V Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - A K Larsen
- Cancer Biology and Therapeutics, INSERM and Université Pierre et Marie Curie, Hôpital Saint-Antoine, Paris, France
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - E Mitchell
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - M Peeters
- Department of Oncology, Center for Oncological Research Antwerp, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H J Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - C Tournigand
- Department of Oncology, University of Paris Est Creteil; APHP, Henri-Mondor Hospital, Créteil, France
| | - A de Gramont
- Institut Hospitalier Franco-Britannique, Levallois-Perret, France
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13
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Bleiberg H, Decoster G, de Gramont A, Rougier P, Sobrero A, Benson A, Chibaudel B, Douillard JY, Eng C, Fuchs C, Fujii M, Labianca R, Larsen AK, Mitchell E, Schmoll HJ, Sprumont D, Zalcberg J. A need to simplify informed consent documents in cancer clinical trials. A position paper of the ARCAD Group. Ann Oncol 2017; 28:922-930. [PMID: 28453700 PMCID: PMC5406755 DOI: 10.1093/annonc/mdx050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents. Methods The Aide et Recherche en Cancérologie Digestive (ARCAD) Group, an international scientific committee involving oncologists from all over the world, addressed these issues and developed and uniformly accepted a simplified informed consent documentation for future clinical research. Results A simplified form of informed consent with the leading part of 1200-1800 words containing all of the key information necessary to meet ethical and regulatory requirements and 'relevant supportive information appendix' of 2000-3000 words is provided. Conclusions This position paper, on the basis of the ARCAD Group experts discussions, proposes our informed consent model and the rationale for its content.
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Affiliation(s)
| | | | - A. de Gramont
- Department of Medical Oncology, Institut Hospitalier Franco-Britannique, Levallois Perret
| | - P. Rougier
- Gastroenterology and Digestive Oncology Department, European Hospital, Georges Pompidou, Paris, France
| | - A. Sobrero
- Medical Oncology Unit, Ospedale San Martino, Genova, Italy
| | - A. Benson
- Division of Hematology/Oncology, Robert H. Comprehensive Cancer Center Northwestern University, Chicago, USA
| | - B. Chibaudel
- Department of Medical Oncology, Institut Hospitalier Franco-Britannique, Levallois Perret
| | - J. Y. Douillard
- Department of Medical Oncology, Centre R. Gauducheau Université de Nantes, Saint Herblain, France
| | - C. Eng
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - C. Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M. Fujii
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - R. Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - A. K. Larsen
- Laboratory of Cancer Biology and Therapeutics, INSERM and Université Pierre et Marie Curie, Saint-Antoine Hospital, Paris, France
| | - E. Mitchell
- Kimmel Cancer Center at Jefferson, Jefferson University Hospitals, Philadelphia, USA
| | - H. J. Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - D. Sprumont
- Institute of Health Law, University of Neuchâtel, Neuchâtel, Switzerland
| | - J. Zalcberg
- Faculty of Medicine, Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Tijeras-Raballand A, De Gramont A, Chiron M, Bachet J, André T, Auby D, Desramé J, Baba-Ahmed N, Lecaille C, Lebrun V, Louvet C, Tournigand C, Benner S, Attia M, De Gramont A, Bonnetain F, Chibaudel B. Impact of circulating biomarkers in patients with metastatic colorectal cancer treated with first-line FOLFOX-aflibercept therapy. Results of the GERCOR VELVET Phase II study. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)33036-2] [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: 10/20/2022]
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Henriques J, Vernerey D, de Gramont A, Chibaudel B, Van Cutsem E, Falcone A, Goldberg R, Shi Q, Bonnetain F, Shmueli E. O-012 Prognosis of lung metastases in patients with metastatic colorectal cancer: an ARCAD meta analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Charton E, Bachet JB, Chibaudel B, Validire P, Hammel P, André T, Louvet C, Anota A, Bonnetain F. Impact sur le temps jusqu’à détérioration de la qualité de vie relative à la santé d’une chimiothérapie de première ligne associant ABI-007 et gemcitabine ou LV5FU2 simplifié chez des patients atteints d’un cancer du pancréas métastatique : résultats de l’essai de phase II AFUGEM. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.071] [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: 10/21/2022] Open
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17
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Anota A, Vernerey D, Tournigand C, Chibaudel B, Louvet C, Larsen A, André T, de Gramont A, Bonnetain F. Impact de l’ajout de l’erlotinib à un traitement de maintenance par bévacizumab sur la qualité de vie relative à la santé chez des patients atteints d’un cancer colorectal métastatique : résultats de l’essai de phase III DREAM. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.017] [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: 11/30/2022] Open
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18
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Gourgou-Bourgade S, Cameron D, Poortmans P, Asselain B, Azria D, Cardoso F, A'Hern R, Bliss J, Bogaerts J, Bonnefoi H, Brain E, Cardoso MJ, Chibaudel B, Coleman R, Cufer T, Dal Lago L, Dalenc F, De Azambuja E, Debled M, Delaloge S, Filleron T, Gligorov J, Gutowski M, Jacot W, Kirkove C, MacGrogan G, Michiels S, Negreiros I, Offersen BV, Penault Llorca F, Pruneri G, Roche H, Russell NS, Schmitt F, Servent V, Thürlimann B, Untch M, van der Hage JA, van Tienhoven G, Wildiers H, Yarnold J, Bonnetain F, Mathoulin-Pélissier S, Bellera C, Dabakuyo-Yonli TS. Guidelines for time-to-event end point definitions in breast cancer trials: results of the DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials). Ann Oncol 2015; 26:2505-6. [PMID: 26467471 DOI: 10.1093/annonc/mdv478] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Neuzillet C, Seitz J, Fartoux L, Malka D, Lledo G, Tijeras-Raballand A, De Gramont A, Ronot M, Bouattour M, Dreyer C, Granier M, Benner S, Amin A, Bourget P, Hadengue A, Roldan N, Chibaudel B, Raymond E, Faivre S. 2352 Sunitinib as second-line treatment in patients with advanced intrahepatic cholangiocarcinoma: Final results of the SUN-CK phase II trial from GERCOR IRC. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31268-0] [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: 11/16/2022]
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Bachet J, Hammel P, Desrame J, Chibaudel B, Debourdeau P, Dauba J, Lecomte T, Seitz J, Tournigand C, Aparicio T, Guerin Meyer V, Taieb J, Volet J, Bonnetain F, Louvet C. 2355 Nab-paclitaxel plus gemcitabine or plus simplified LV5FU2 as first- line therapy in patients with metastatic pancreatic adenocarcinoma. A GERCOR randomized phase II study (AFUGEM). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31271-0] [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: 11/30/2022]
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Sebbagh S, Roux J, Dreyer C, Neuzillet C, de Gramont A, Orbegoso C, Hentic O, Hammel P, de Gramont A, Raymond E, André T, Chibaudel B, Faivre S. P-139 Efficacy of a Sequential Treatment Strategy with GEMOX Followed by FOLFIRI in Advanced Cholangiocarcinoma. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.139] [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: 11/12/2022] Open
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Mésange P, Bouygues A, Muller D, Savina A, Chibaudel B, Tournigand C, André T, de Gramont A, Larsen A. PD-010 Erlotinib attenuates bevacizumab-mediated activation of EGFR-survival signaling in CRC models independent of KRAS status providing a rational basis for the DREAM phase III clinical trial. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv234.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Hebbar M, Chibaudel B, André T, Mineur L, Smith D, Louvet C, Dutel J, Ychou M, Legoux J, Mabro M, Faroux R, Auby D, Brusquant D, Khalil A, Truant S, Hadengue A, Dalban C, Gayet B, Paye F, Pruvot F, Bonnetain F, de Gramont A. FOLFOX4 versus sequential dose-dense FOLFOX7 followed by FOLFIRI in patients with resectable metastatic colorectal cancer (MIROX): a pragmatic approach to chemotherapy timing with perioperative or postoperative chemotherapy from an open-label, randomized phase III trial. Ann Oncol 2015; 26:1040. [DOI: 10.1093/annonc/mdv141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Gourgou-Bourgade S, Cameron D, Poortmans P, Asselain B, Azria D, Cardoso F, A'Hern R, Bliss J, Bogaerts J, Bonnefoi H, Brain E, Cardoso MJ, Chibaudel B, Coleman R, Cufer T, Dal Lago L, Dalenc F, De Azambuja E, Debled M, Delaloge S, Filleron T, Gligorov J, Gutowski M, Jacot W, Kirkove C, MacGrogan G, Michiels S, Negreiros I, Offersen BV, Penault Llorca F, Pruneri G, Roche H, Russell NS, Schmitt F, Servent V, Thürlimann B, Untch M, van der Hage JA, van Tienhoven G, Wildiers H, Yarnold J, Bonnetain F, Mathoulin-Pélissier S, Bellera C, Dabakuyo-Yonli TS. Guidelines for time-to-event end point definitions in breast cancer trials: results of the DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials)†. Ann Oncol 2015; 26:873-879. [PMID: 25725046 DOI: 10.1093/annonc/mdv106] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [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: 01/30/2014] [Accepted: 02/16/2015] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND Using surrogate end points for overall survival, such as disease-free survival, is increasingly common in randomized controlled trials. However, the definitions of several of these time-to-event (TTE) end points are imprecisely which limits interpretation and cross-trial comparisons. The estimation of treatment effects may be directly affected by the definitions of end points. The DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials) aims to provide recommendations for definitions of TTE end points. We report guidelines for randomized cancer clinical trials (RCTs) in breast cancer. PATIENTS AND METHODS A literature review was carried out to identify TTE end points (primary or secondary) reported in publications of randomized trials or guidelines. An international multidisciplinary panel of experts proposed recommendations for the definitions of these end points based on a validated consensus method that formalize the degree of agreement among experts. RESULTS Recommended guidelines for the definitions of TTE end points commonly used in RCTs for breast cancer are provided for non-metastatic and metastatic settings. CONCLUSION The use of standardized definitions should facilitate comparisons of trial results and improve the quality of trial design and reporting. These guidelines could be of particular interest to those involved in the design, conducting, reporting, or assessment of RCT.
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Affiliation(s)
- S Gourgou-Bourgade
- Biostatistic Unit, Montpellier Cancer Institute, Montpellier; Data Center for Cancer Clinical Trials, CTD-INCa, Montpellier, France.
| | - D Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - P Poortmans
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - B Asselain
- Department of Biostatistics, Institut Curie, Paris
| | - D Azria
- Department of Radiation Oncology, Montpellier Cancer Institute, Montpellier, France
| | - F Cardoso
- Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - R A'Hern
- Institute of Cancer Research, London, UK
| | - J Bliss
- Institute of Cancer Research, London, UK
| | - J Bogaerts
- EORTC Data Center (European Organization of Research and Treatment of Cancer - Statistics Department), Brussels, Belgium
| | - H Bonnefoi
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - E Brain
- Departments of Clinical Research and Medical Oncology, Institut Curie - Hôpital René Huguenin, Saint-Cloud
| | - M J Cardoso
- Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - B Chibaudel
- Department of Medical Oncology, Hôpital Saint-Antoine, Paris, France
| | - R Coleman
- FRCP, FRCPE YCR National Institute for Health Research Cancer Research Network (NCRN), Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield Cancer Research Centre, Sheffield, UK
| | - T Cufer
- University Clinic Golnik, Golnik, Slovenia
| | - L Dal Lago
- Institut Jules Bordet, University 'Libre' of Brussels, Brussels, Belgium
| | - F Dalenc
- Institut Claudius Régaud, Toulouse
| | - E De Azambuja
- Institut Jules Bordet, University 'Libre' of Brussels, Brussels, Belgium
| | - M Debled
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - S Delaloge
- Breast Cancer Group, Gustave Roussy Institute, Villejuif
| | | | - J Gligorov
- APHP Tenon - University Cancer Institute - Pierre & Marie Curie, Sorbonne University, Paris
| | | | - W Jacot
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - C Kirkove
- Université catholique Louvain, Louvain-la-Neuve, Belgium
| | - G MacGrogan
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - S Michiels
- Biostatistic and Epidemiology Unit, Gustave Roussy, Villejuif; University of Paris-Sud, Villejuif, France
| | - I Negreiros
- Breast Unit, Hospital CUF Descobertas, Lisbon, Portugal
| | - B V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - F Penault Llorca
- Centre Jean Perrin, Clermont-Ferrand; ERTICA EA4677, UFR Medicine, University of Clermont-Ferrand 1, Clermont-Ferrand, France
| | - G Pruneri
- European Institute of Oncology, Milan; University of Milan, School of Medicine, Milan, Italy
| | - H Roche
- Institut Claudius Régaud, Toulouse
| | - N S Russell
- Department of Radiotherapy, The Netherlands Cancer Institute - Antoni van Leeuwnhoek Hospital, Amsterdam, The Netherlands
| | - F Schmitt
- IPATIMUP (Institute of Molecular Pathology and Immunology of the University of Porto), Porto; Medical Faculty of Porto University, Porto, Portugal
| | - V Servent
- Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - B Thürlimann
- Kantonsspital St Gallen, Breast Center, St Gallen, Switzerland
| | - M Untch
- Clinic for Gynecology, Gynecologic Oncology and Obstetrics-Interdisciplinary Breast Cancer Center, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - J A van der Hage
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam
| | - G van Tienhoven
- Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - H Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven; Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium
| | - J Yarnold
- The Institute of Cancer Research, Royal Cancer Hospital, London, UK
| | - F Bonnetain
- Methodological and Quality of Life Unit in Oncology (EA3181), CHU Besançon, Besançon
| | - S Mathoulin-Pélissier
- Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux; Clinical Epidemiology Unit, INSERM CIC 14.01 (Clinical Epidemiology), Bordeaux
| | - C Bellera
- Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux; Clinical Epidemiology Unit, INSERM CIC 14.01 (Clinical Epidemiology), Bordeaux
| | - T S Dabakuyo-Yonli
- Biostatistics and Quality of Life Unit (EA4184), Centre Georges François Leclerc Comprehensive Cancer Centre, Dijon, France
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25
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Hebbar M, Chibaudel B, André T, Mineur L, Smith D, Louvet C, Dutel JL, Ychou M, Legoux JL, Mabro M, Faroux R, Auby D, Brusquant D, Khalil A, Truant S, Hadengue A, Dalban C, Gayet B, Paye F, Pruvot FR, Bonnetain F, Taieb J, Brucker P, Landi B, Flesch M, Carola E, Martin P, Vaillant E, de Gramont A. FOLFOX4 versus sequential dose-dense FOLFOX7 followed by FOLFIRI in patients with resectable metastatic colorectal cancer (MIROX): a pragmatic approach to chemotherapy timing with perioperative or postoperative chemotherapy from an open-label, randomized phase III trial. Ann Oncol 2014; 26:340-7. [PMID: 25403578 DOI: 10.1093/annonc/mdu539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/14/2022] Open
Abstract
BACKGROUND Perioperative FOLFOX4 (oxaliplatin plus 5-fluorouracil/leucovorin) chemotherapy is the current standard in patients with resectable metastases from colorectal cancer (CRC). We aimed to determine whether a sequential chemotherapy with dose-dense oxaliplatin (FOLFOX7) and irinotecan (FOLFIRI; irinotecan plus 5-fluorouracil/leucovorin) is superior to FOLFOX4. The chemotherapy timing was not imposed, and was perioperative or postoperative. PATIENTS AND METHODS In this open-label, phase III trial, patients with resectable or resected metastases were randomly assigned either to 12 cycles of FOLFOX4 (oxaliplatin 85 mg/m(2)) or 6 cycles of FOLFOX7 (oxaliplatin 130 mg/m(2)) followed by 6 cycles of FOLFIRI (irinotecan 180 mg/m(2)). Randomization was done centrally, with stratification by chemotherapy timing, type of local treatment (surgery versus radiofrequency ablation with/without surgery), and Fong's prognostic score. The primary end point was 2-year disease-free survival (DFS). RESULTS A total of 284 patients were randomized, 142 in each treatment group. Chemotherapy was perioperative in 168 (59.2%) patients and postoperative in 116 (40.8%) patients. Perioperative chemotherapy was preferentially proposed for synchronous metastases, whereas postoperative chemotherapy was more frequently used for metachronous metastases. Two-year DFS was 48.5% in the FOLFOX4 group and 50.0% in the FOLFOX7-FOLFIRI group. In the multivariable analysis, more than one metastasis [hazard ratio (HR) = 2.15] and synchronous metastases (HR = 1.63) were independent prognostic factors for shorter DFS. Five-year overall survival (OS) rate was 69.5% with FOLFOX4 versus 66.6% with FOLFOX7-FOLFIRI. CONCLUSIONS FOLFOX7-FOLFIRI is not superior to FOLFOX4 in patients with resectable metastatic CRC. Five-year OS rates observed in both groups are the highest ever reported in this setting, possibly reflecting the pragmatic approach to chemotherapy timing. CLINICAL TRIALS NUMBER NCT00268398.
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Affiliation(s)
- M Hebbar
- Department of Medical Oncology, University Hospital, Lille
| | - B Chibaudel
- Department of Medical Oncology, Hospital Saint-Antoine, Paris
| | - T André
- Department of Medical Oncology, Hospital Saint-Antoine, Paris
| | - L Mineur
- Department of Radiotherapy, Institute Sainte-Catherine, Avignon
| | - D Smith
- Department of Medical Oncology and Radiotherapy, Hospital Saint-André, Bordeaux
| | - C Louvet
- Department of Oncology, Institute Mutualiste Montsouris, Paris
| | - J L Dutel
- Department of Medical Oncology, Radiotherapy Service, Hospital Centre Beauvais, Beauvais
| | - M Ychou
- Regional Centre against Cancer, Val d'Aurelle-Paul Lamarque, Montpellier
| | - J L Legoux
- Department of Hepatology and Gastroenterology, Hospital de Haut-Lévêque, Pessac
| | - M Mabro
- Department of Medical Oncology, Hospital Foch, Suresnes
| | - R Faroux
- Department of Gastroenterology, Hospital La Roche-sur-Yon, La Roche-sur-Yon
| | - D Auby
- Department of Medicine, Hospital Libourne, Libourne
| | | | - A Khalil
- Department of Medical Oncology, Hospital Tenon, Paris
| | - S Truant
- Department of Digestive Surgery and Transplantation, University Hospital, Lille
| | | | - C Dalban
- Methodology and Quality of Life in Oncology Department EA 3181, Hospital Besançon, Besançon
| | - B Gayet
- Department of Surgery, Institute Mutualiste Montsouris, Paris
| | - F Paye
- Department of Digestive Surgery, Hospital Saint-Antoine, Paris
| | - F R Pruvot
- Department of Digestive Surgery and Transplantation, University Hospital, Lille
| | - F Bonnetain
- Methodology and Quality of Life in Oncology Department EA 3181, Hospital Besançon, Besançon
| | - J Taieb
- Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris
| | - P Brucker
- Department of Gastroenterology, Centre hospitalier François Maillot, Briey
| | - B Landi
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou Service Hépato-gastroentérologie; Paris
| | - M Flesch
- Department of Medical Oncology, Clinique Clément Drevon, Dijon
| | - E Carola
- Department of Medical Oncology, Centre Hospitalier, Senlis
| | - P Martin
- Department of Cancerology, Centre Bourgogne, Lille
| | - E Vaillant
- Department of Gastroenterology, Clinique Ambroise Paré, Lille, France
| | - A de Gramont
- Department of Medical Oncology, Hospital Saint-Antoine, Paris
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Larsen A, Poindessous V, Bouygues A, Muller D, Savina A, Chibaudel B, Tournigand C, André T, De Gramont A, Mesange P. Mouse-Dream: Vegf Inhibition is Accompanied By Egfr Activation in Colorectal Cancer Models Independent of Kras Status Providing a Rational for Combinations of Bevacizumab and Erlotinib in the Positive Gercor Phase III Dream Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu358.12] [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: 11/14/2022] Open
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Chibaudel B, Tournigand C, Samson B, Scheithauer W, Mesange P, Lledo G, Viret F, Ramée J, Tubiana-Mathieu N, Dauba J, Dupuis O, Rinaldi Y, Mabro M, Aucoin N, Latreille J, Bonnetain F, Louvet C, Larsen A, André T, De Gramont A. Bevacizumab-Erlotinib As Maintenance Therapy in Metastatic Colorectal Cancer. Final Results of the Gercor Dream Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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André T, De Gramont A, Chibaudel B, Raballand A, Duval A, Hickish T, Tabernero J, van Laethem J, Banzi M, Maartense E, Shani A, Carlsson G, Scheithauer W, Papamichael D, Moehler M, Landolfi S, Demetter P, Dumont S, Fléjou J, De Gramont A. Mosaic Study: Actualization of Overall Survival (Os) with 10 Years Follow Up and Evaluation of Braf. By Gercor and Mosaic Investigators. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.5] [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: 11/14/2022] Open
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Neuzillet C, Seitz J, Fartoux L, Malka D, Lledo G, Tijeras-Raballand A, De Gramont A, Ronot M, Bouattour M, Dreyer C, Amin A, Bourget P, Hadengue A, Roldan N, Chibaudel B, Raymond E, Faivre S. Second Line Therapy with Sunitinib As Single Agent in Patients with Advanced Intrahepatic Cholangiocarcinoma (Update on Sun-Ck Phase Ii Trial). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arrondeau J, Giacchetti S, Colle E, Chibaudel B. Revue de Presse de L’Aerio / Aerio Press Review. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2398-7] [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: 11/29/2022]
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Bidard FC, Huguet F, Louvet C, Mineur L, Bouché O, Chibaudel B, Artru P, Desseigne F, Bachet JB, Mathiot C, Pierga JY, Hammel P. Circulating tumor cells in locally advanced pancreatic adenocarcinoma: the ancillary CirCe 07 study to the LAP 07 trial. Ann Oncol 2013; 24:2057-61. [PMID: 23676420 DOI: 10.1093/annonc/mdt176] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic carcinoma is one of the leading causes of cancer-related mortality. At the time of diagnosis, 30% of patients present with a locally advanced pancreatic carcinoma (LAPC). As circulating tumor cells (CTCs) count may be a surrogate of the cancer metastatic abilities, CTC detection rates and prognostic value were studied in a prospective cohort of LAPC patients. PATIENTS AND METHODS An LAP07 international multicenter randomized study assesses in patients whose LAPC is controlled after 4 months of chemotherapy whether chemoradiotherapy could increase survival versus continuation of chemotherapy. A subgroup of patients included in the LAP07 trial was screened for CTCs (CellSearch®) before the start of the chemotherapy and after 2 months of treatment. Patient characteristics and survival were obtained prospectively and were correlated with CTC detection. RESULTS Seventy-nine patients were included. One or more CTCs/7.5 ml were detected in 5% of patients before treatment and in 9% of patients after 2 months of treatment (overall detection rate: 11% of patients). CTC positivity was associated with poor tumor differentiation (P = 0.04), and with shorter overall survival (OS) in multivariable analysis (RR = 2.5, P = 0.01), together with anemia. CONCLUSIONS The evaluation of micrometastatic disease using CTC detection appears as a promising prognostic tool in LAPC patients.
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Affiliation(s)
- F C Bidard
- Department of Medical Oncology, Institut Curie, Paris, France.
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André T, Blons H, Mabro M, Chibaudel B, Bachet JB, Tournigand C, Bennamoun M, Artru P, Nguyen S, Ebenezer C, Aissat N, Cayre A, Penault-Llorca F, Laurent-Puig P, de Gramont A. Panitumumab combined with irinotecan for patients with KRAS wild-type metastatic colorectal cancer refractory to standard chemotherapy: a GERCOR efficacy, tolerance, and translational molecular study. Ann Oncol 2013; 24:412-419. [PMID: 23041588 DOI: 10.1093/annonc/mds465] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the combination of panitumumab and irinotecan in patients with KRAS wild-type metastatic colorectal cancer refractory to standard chemotherapy (oxaliplatin, fluoropyrimidines-irinotecan and bevacizumab). PATIENTS AND METHODS KRAS status was first determined locally but subsequent validation of KRAS status and additional screenings (rare KRAS, NRAS, BRAF mutations and EGFR copy number) were centrally assessed. Patients received panitumumab (6 mg/kg) and irinotecan (180 mg/m²) every 2 weeks. RESULTS Sixty-five eligible patients were analyzed. The objective response rate (ORR) was 29.2% [95% confidence interval (95% CI) 18.2-40.3]. Median progression-free and overall survivals were 5.5 and 9.7 months, respectively. Most frequent grade 3/4 toxic effects were skin 32.3%, diarrhea 15.4% and neutropenia 12.3%. Tissue samples were available for 60 patients. For the confirmed KRAS wild-type population codon 12 or 13 mutation (n = 54), ORR was 35.2% (95% CI 22.4.1-47.9). Thirteen patients had a NRAS, a BRAF or a rare KRAS mutation, and no tumor response was observed in this subgroup when compared with 46.3% (95% CI 31.1-61.6) ORR in the subgroup of 41 patients with no identified mutation. CONCLUSION Panitumumab and irinotecan is an active third-line regimen in a well-defined population based on biomarkers. ClinicalTrials.gov Identifier NCT00655499.
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Affiliation(s)
- T André
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris.
| | - H Blons
- Université Paris Sorbonne Cité; Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) - S775 Molecular Basis of Xenobiotics Response; Assistance Publique Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris
| | - M Mabro
- Department of Clinical Research, GERCOR, Paris; Department of medical Oncology,Hôpital Foch, Suresnes, France
| | - B Chibaudel
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris
| | - J-B Bachet
- Department of Clinical Research, GERCOR, Paris; Department of Hepato-Gastro-Enterology, Hôpital La Pitié Salpetrière, Paris
| | - C Tournigand
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris
| | - M Bennamoun
- Department of Clinical Research, GERCOR, Paris; Department of medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | - P Artru
- Department of Clinical Research, GERCOR, Paris; Departement of Hepato-Gastro-Enterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - S Nguyen
- Department of medical Oncology, Centre Hospitalier de Beauvais, Beauvais, France
| | - C Ebenezer
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris
| | - N Aissat
- Department of Clinical Research, GERCOR, Paris
| | - A Cayre
- Biology and Tumor Pathology Department, Centre Jean-Perrin, Université d'Auvergne Equipe Associée EA4233 Centre Hospitalier Universitaire (CHU) Clermont-Ferrand
| | - F Penault-Llorca
- Biology and Tumor Pathology Department, Centre Jean-Perrin, Université d'Auvergne Equipe Associée EA4233 Centre Hospitalier Universitaire (CHU) Clermont-Ferrand
| | - P Laurent-Puig
- Université Paris Sorbonne Cité; Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR) - S775 Molecular Basis of Xenobiotics Response; Assistance Publique Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris
| | - A de Gramont
- Department of medical Oncology, Hôpital Saint-Antoine, Université Paris VI, Paris; Department of Clinical Research, GERCOR, Paris
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Chibaudel B, Lacave R, Belloc J, Banal A, Albert S, Chabolle F, Lefevre M, Soussan P, Moukoko R, Guily JLS. Induction Therapy with Cetuximab, Docetaxel, Cisplatin, and Fluorouracil in Patients with Resectable Non Metastatic Stage III or IV Squamous Cell Carcinoma of the Oropharynx. A Gercor Phase II Study. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33591-2] [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: 11/26/2022] Open
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Lledo G, Mammar V, Michel P, Dahan L, Mineur L, Galais MP, Dupuis O, Chibaudel B, Jovenin N, de Gramont A. Chimioradiothérapie concomitante par folfox–cetuximab dans les carcinomes du cardia et de l’œsophage de stade III : résultats définitifs de l’étude de phase II Erafox du groupe Gercor. Cancer Radiother 2011. [DOI: 10.1016/j.canrad.2011.07.018] [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: 11/29/2022]
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Andre T, Chibaudel B, Mabro M, Bennamoun M, Artru P, Bachet J, Hadengue A, Blons H, Laurent-Puig P, de Gramont A. 6144 POSTER Phase II Study of Panitumumab With Irinotecan for Patients With KRas Wild-type Metastatic Colorectal Cancer (MCRC) Refractory to Standard Chemotherapy – a GERCor Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71789-0] [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: 11/29/2022]
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Bengrine-Lefevre L, Viel E, Brugirard M, Tournigand C, Perez-Staub N, Chibaudel B, Teixeira L, Marijon H, Gervais H, Garcia ML, Bourges O, Maindrault-Goebel F, Andre T, De Gramont A. Survival according to residual disease after interval laparotomy in advanced epithelial ovarian cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15521] [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: 11/20/2022] Open
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Diouf M, Bonnetain F, Chibaudel B, Tournigand C, Teixeira L, Marijon H, Perez-Staub N, De Gramont A. Could baseline health-related quality of life (QoL) improve prognostication of overall survival in metastatic colorectal cancer? Results from GERCOR OPTIMOX 1 study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Marijon H, Chibaudel B, Bonnetain F, Tournigand C, Teixeira L, Bengrine-Lefèvre L, Bourges O, Louvet C, De Gramont A. Center impact on survival in metastatic colorectal cancer trials. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14062] [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: 11/20/2022] Open
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Hammel P, Huguet F, Van Laethem J, Goldstein D, Glimelius B, Moore MJ, Chibaudel B, Bonnetain F, Louvet C. Randomized multicenter phase III study in patients with locally advanced adenocarcinoma of the pancreas: Gemcitabine with or without chemoradiotherapy and with or without erlotinib—LAP 07 study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dahan L, Chibaudel B, Di Fiore F, Artru P, Mineur L, Galais M, Dupuis O, Blondin V, Abdiche S, Attia M, De Gramont A, Lledo G. Chemoradiation with FOLFOX plus cetuximab in locally advanced cardia or esophageal cancer: Final results of a GERCOR phase II trial (ERaFOX). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chibaudel B, Tournigand C, Mabro M, Bennamoun M, Artru P, Nguyen S, Bachet J, Aissat N, Blons H, Laurent-Puig P, De Gramont A, Andre T. Phase II study of panitumumab with irinotecan for patients with KRAS wild-type metastatic colorectal cancer (MCRC) refractory to standard chemotherapy: A GERCOR study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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42
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Lledo G, Michel P, Dahan L, Mineur L, Galais M, Dupuis O, Abdiche S, Jovenin N, Chibaudel B, De Gramont A. Chemoradiation with FOLFOX plus cetuximab in locally advanced cardia or esophageal cancer: Final results of a GERCOR phase II trial (ERaFOX). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
8 Background: Chemoradiotherapy (CRT) for locally advanced cardia and esophageal cancer is based on 5-FU combined with cisplatin, which could be favorably replaced by oxaliplatin (Ox). Cetuximab (C) has demonstrated synergism with both radiotherapy (RT) and platinum-based chemotherapy. ERaFOX trial was evaluating the safety and efficacy of the addition of C to CRT with FOLFOX. Methods: Main inclusion criteria were: stage III squamous cell or adenocarcinoma of the esophagus or gastroesophageal junction; WHO PS 0-1; age 18-80 years; weight loss <15% in the last 6 months. Patients (pts) received 2 cycles of FOLFOX induction therapy (Ox 85 mg/m2/d1, folinic acid 400 mg/m2/d1, 5-FU 2,400 mg/m2/d1-2, q2w) plus C (first infusion 400 mg/m2 then 250 mg/m2, q1w), then RT 50.4 Gy (1.8Gy/d x 28 fractions) with FOLFOX plus C (same doses, except 5-FU 1,800mg/m2/d1-2). Tumor evaluation was performed at the end of CRT (RECIST and endoscopic ultrasonography). The primary endpoint was overall response rate (ORR), with a 50% threshold for efficacy (Simon Minimax two-stage design). Results: From Nov 2007 to Feb 2010, 80 pts were enrolled in 12 centers. The characteristics of the 79 eligible pts were (1 ineligible pt for stage IV disease): male/female 60/19, median age 63 (23-79), PS 0/1/ND 47/31/1, squamous/adenocarcinoma/undifferentiated 53/25/1; esophagus/cardia 74/5; median daily caloric intake 1,720 Kcal (550-3160). 74 pts were treated by CRT (5 pts experienced anaphylaxis during the first cetuximab infusion). ORR (ITT) was achieved in 61 pts (77.2%), 6 pts (7.6%) had stable disease, and 9 pts (11.4%) had disease progression (3 pts were not evaluable). Grade 3-4 toxicities induction therapy/CRT were (%): neutropenia: 7.6/28.4; febrile neutropenia: 0.0/2.7; vomiting: 1.3/4.0; mucositis: 1.3/5.4; diarrhea: 3.8/2.7; dysphagia-esophagitis: 1.3/13.5; rash: 7.6/10.8; allergy 8.9/0.0. One toxic death (1.3%) occurred after CRT related to esophagitis with GI bleeding. Conclusions: Threshold for efficacy was reached with an ORR of 77.2%. Chemoradiotherapy with FOLFOX plus cetuximab is active and has an acceptable toxicity profile in patients with locally advanced cardia or esophageal cancer. No significant financial relationships to disclose.
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Affiliation(s)
- G. Lledo
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - P. Michel
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - L. Dahan
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - L. Mineur
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - M. Galais
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - O. Dupuis
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - S. Abdiche
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - N. Jovenin
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - B. Chibaudel
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
| | - A. De Gramont
- Hôpital Privá Jean Mermoz, Lyon, France; University Hospital, Rouen, France; La Timone University Hospital, Marseille, France; Institut Sainte Catherine, Avignon, France; Centre François Baclesse, Caen, France; Clinique Victor Hugo, Le Mans, France; Hopital Robert Boulin, Libourne, France; Institut Jean Godinot, Reims, France; GERCOR, Paris, France; Hôpital Saint-Antoine, Paris, France
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Bengrine-Lefevre L, Afchain P, Chibaudel B, Gervais H, Tournigand C, De Gramont A, Louvet C. [Nasal septum perforation and bevacizumab]. Rev Med Interne 2010; 32:e43-5. [PMID: 21470582 DOI: 10.1016/j.revmed.2010.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 02/10/2010] [Accepted: 04/10/2010] [Indexed: 11/17/2022]
Abstract
A 52-year-old woman, with a metastatic breast cancer, presented with a nasal septum perforation while receiving a treatment combining paclitaxel and bevacizumab. This is the fifth reported case of nasal septum perforation probably related to an anti-angiogenic therapy. A literature review and a discussion concerning the different causes of nasal septum perforation were performed.
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Affiliation(s)
- L Bengrine-Lefevre
- Service d'oncologie médicale, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France.
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Carola E, Chibaudel B, Mabro M, Kirscher S, Certain-Duclos M, Aparicio T, Mercier-Blas A, Trager-Maury S, Cudennec T, de Gramont A. Geriatric parameters to predict chemotherapy feasibility in elderly patients (≥75 years) with advanced colorectal cancer: Preliminary results of a GERCOR-GEPOG cohort study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19512] [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: 11/20/2022] Open
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Chibaudel B, Tournigand C, Bonnetain F, Andre T, Lledo G, Maindrault-Goebel F, Larsen AK, Louvet C, de Gramont A. Handy prognostic model in patients with oxaliplatin-based or irinotecan-based first-line chemotherapy for metastatic colorectal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chibaudel B, Tournigand C, Artru P, André T, Cervantes A, Figer A, Lledo G, Flesch M, Buyse M, Mineur L, Carola E, Rivera F, Perez-Staub N, Louvet C, de Gramont A. FOLFOX in patients with metastatic colorectal cancer and high alkaline phosphatase level: an exploratory cohort of the GERCOR OPTIMOX1 study. Ann Oncol 2009; 20:1383-6. [PMID: 19465426 DOI: 10.1093/annonc/mdp012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Alkaline phosphatase (ALP) is a strong prognostic factor in patients with metastatic colorectal cancer (MCRC). Patients with ALP more than three times the upper limit of normal (ULN) were excluded from our previous studies evaluating chemotherapy. An exploratory cohort of patients with ALP >3 ULN was included in the OPTIMOX1 study. PATIENTS AND METHODS Previously untreated patients with MCRC were randomized to FOLFOX4 until progression (arm A) or FOLFOX7 for six cycles, maintenance without oxaliplatin for 12 cycles and reintroduction of FOLFOX7 (arm B). Patients were stratified according to ALP level <or=3 ULN versus 3-5 ULN. RESULTS Among the 620 patients in OPTIMOX1 study, 63 had ALP 3-5 ULN; 33 in arm A and 30 in arm B. The response rate in these patients was 56% versus 59% in patients with ALP <or=3 ULN. Median progression-free survival and overall survival were, respectively, 6.4 and 11.5 months in patients with ALP 3-5 ULN and 9.0 and 21.1 months in patients with ALP <or=3 ULN. Thirty-three percent of the patients in the cohort experienced grade 3/4 toxicity. CONCLUSION Both FOLFOX regimens achieved high tumor response rates and offer good palliation in MCRC patients with a poor prognosis.
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Affiliation(s)
- B Chibaudel
- Department of Medical Oncology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
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Gligorov J, Cals L, Tournigand C, Merad Z, Dutel J, Selle F, Zeghib N, Chibaudel B, Cvitkovic F. Gemcitabine-oxaliplatin combination (SEGEMOX) in anthracycline (A) and taxanes (T) pretreated metastatic breast cancer (MBC): Results from the GERCOR-SEGEMOX phase II trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1108] [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
1108 Objectives: To evaluate efficacy and safety of SEGEMOX regimen for previously A and T pre-treated MBC patients. Methods: Forty-five women with MBC not eligible for A and/or T chemotherapy were enrolled on SEGEMOX study. SEGEMOX was delivered as follows: Gemcitabine was given at 1000 mg/m2/100min on day 1, followed by oxaliplatin at 100 mg/m2/120min iv on day 2 every 2 weeks. Efficacy results were analyzed and are presented in an intention to treat analysis and toxicity according to the total number of cycles regimen. Results: Forty-four of the 45 patients received at least 1 cycle of SEGEMOX. Fifty-eight perccent of the patients have received previous adjuvant chemo, 36% 1st line and 42% 2nd line for MBC before the protocol inclusion. Visceral metastases were dominant site of disease (44% liver; 36% lung; 44% bone). Median age of the population was 55.8 years (36–73). After a median of 7.7 cycles (3.5 months of treatment); the overall response rate (ORR) is 38% [95%CI; 23%-51%] [1 CR (2.2%) and 16 PR (35.6%)]; 33% of stable disease [95%CI; 17%-43%], 24.4% progressive disease with a clinical benefit (CB) of 71% [95%CI; 57%-85%]. The median progression free survival (PFS) is 7.1 months for responders and 4.8 months for patients with stable disease. The all population median overall survival (OS) is 21.4 months with 22.7 months MOS for responders. Concerning toxicity analysis: 339 cycles of gemcitabine and 312 of oxaliplatinum were delivered. Respectively, grade 3–4 neutropenia occurred in 43% of patients (febrile neutropenia in 7%), grade 3–4 thrombocytopenia in 41%, and anemia in 2.3%. The most frequent non hematologic toxicities were represented by grade 3 peripheral neuropathy (Levi Scale) in 11.4% of the patients and grade 2 alopecia in 11.4%. For the subgroup of hormone receptor negative MBC (n = 12) the ORR is 33% [95%CI; 2%-64%], CB 50% [95%CI; 16%-73%], PFS of 2.8 months and MOS of 12 months. Conclusions: The SEGEMOX combination has relevant activity in A and T not eligible MBC patients, with a manageable toxicity profile. In the limited number of patients with HRN MBC even if the response rate is close to the overall population the prognosis seems still worse. No significant financial relationships to disclose.
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Affiliation(s)
- J. Gligorov
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - L. Cals
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - C. Tournigand
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - Z. Merad
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - J. Dutel
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - F. Selle
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - N. Zeghib
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - B. Chibaudel
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
| | - F. Cvitkovic
- AP-HP, Tenon Cancer Est APREC, Paris, France; CH Toulon-La Seyne, Toulon, France; AP-HP, St Antoine CancerEst, Paris, France; CH Boulogne sur Mer, Boulogne sur Mer, France; CH Beauvais, Beauvais, France; GERCOR, Paris, France; Centre René Huguenin, Saint- Cloud, France
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Chibaudel B, Tournigand C, Perez-Staub N, Bourges O, Maindrault-Goebel F, André T, Lledo G, Louvet C, Bonnetain F, de Gramont A. Duration of disease control (DDC) or time to failure of strategy (TFS) to evaluate a chemotherapy strategy in advanced colorectal cancer (ACC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4073] [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
4073 Background: Progression-free survival (PFS) is not an optimal endpoint in therapeutic strategies evaluating either stop and go or alternated therapies, or a fixed sequence of two therapies. DDC (Tournigand, JCO 2006) and TFS (Allegra, JCO 2007) composite endpoints have been proposed to evaluate efficacy of these strategies in ACC. This study compared these two alternative endpoints. Methods: DDC is defined as the sum of the PFS of each sequence, except when progressive disease is observed at either reintroduction or second-therapy (DDC=PFS1+PFS2 if treatment 2 achieved stabilization or response). TFS is defined as the total PFS from the initiation of the strategy to disease progression while on all the planned agents, or disease progression during a treatment-free interval and no further therapy received within 1 month, or death (TFS=PFS 1+2). Both DDC and TFS have been calculated in three trials: OPTIMOX1 (oxaliplatin stop and go vs continuous administration, updated database, Tournigand, JCO 2006), OPTIMOX2 (oxaliplatin stop and go vs complete stop and go, updated database, Maindrault-Goebel, ASCO 2007) and C97–3 (FOLFIRI1- FOLFOX6 or reverse sequence, Tournigand 2004). Results: The median potential follow-up time was 39.8 months. There was a moderately shorter DDC than TFS in the two stop and go studies, but a much shorter DDC than TFS in the sequential therapy study. There was a significant correlation between DDC and OS (r=0.96, p=.002) but not between TFS and OS (r=0.71, p=.11) Conclusions: Two bias impacted TFS 1) the results of resuming the planned therapeutic strategy for progression after a chemotherapy-free interval of more than one month was not considered, 2) patients who were not progressive at the end of planned strategy could not be censored at that time. The shorter duration of DDC over TFS may have an advantage in terms of sample size for evaluation of therapeutic strategies. In case of drug registration, DDC does not increase in case of inactive second sequence. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- B. Chibaudel
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - C. Tournigand
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - N. Perez-Staub
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - O. Bourges
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - F. Maindrault-Goebel
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - T. André
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - G. Lledo
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - C. Louvet
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - F. Bonnetain
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
| | - A. de Gramont
- Hôpital Saint-Antoine, APHP, Paris, France; Hôpital La Pitié-Salpétrière, APHP, Paris, France; Hôpital Jean Mermoz, Lyon, France; Centre Georges-François Leclerc, Dijon, France
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Perez-Staub N, Chibaudel B, Paye F, Taieb J, Gayet B, Bourges O, André T, Tournigand C, Louvet C, de Gramont A. Survival after surgery in patients with initially resectable metastasis receiving adjuvant/neoadjuvant FOLFOX therapy and in patients who had surgery after FOLFOX therapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4118] [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
4118 Background: Surgery of metastases can cure approximately 20% of metastatic colorectal cancer (MCRC). About 15% of MCRC pts are resectable at presentation. Among the other pts, 10 to 30% can benefit from a salvage surgery after response to chemotherapy, improving their prognostic. We report here the results in pts resectable at presentation and in pts who underwent surgery after chemotherapy in phase 2 and 3 studies. Methods: We retrospectively analysed 167 pts who underwent R0/R1 surgery, 46 pts at presentation in a phase 2 study testing a combination of FOLFOX followed by FOLFIRI (MIROX, Taieb JCO 2005), and 121 pts who underwent a salvage surgery after FOLFOX treatment in OPTIMOX1 (Tournigand, JCO 2006) and OPTIMOX2 (Maindrault-Goebel, ASCO 2007) after updating the survival. Results: Patients’ baseline characteristics were (MIROX/OPTIMOX %): median age 56/62 yrs, PS 0 50/73, metachronous metastasis 41/21, ≥ 2 met sites 11/18, liver met 78/88, lung met 11/19, other met 17/10, two-stage surgery 9/10, second surgery after relapse 39/22, R0 resection 91/ 85. 114 among 142 evaluable patients had a response to FOLFOX (80%). Median time from randomisation to surgery was 8 mths in the OPTIMOX group. In the MIROX group, 46% had surgery of metastases before chemotherapy. Median disease-free survival from R0/R1 surgery was 18.6 months in MIROX group vs 9.4 months in OPTIMOX group (p=0.006).Median overall survival was 104.8 months in MIROX group vs 42.6 months in OPTIMOX group (p=0.02). Furthermore, initially resectable remained the strongest prognostic factor in this series. Conclusions: MCRC pts initially resectable at presentation have a better prognosis than pts who underwent a salvage surgery after FOLFOX chemotherapy. No significant financial relationships to disclose.
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Affiliation(s)
- N. Perez-Staub
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - B. Chibaudel
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - F. Paye
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - J. Taieb
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - B. Gayet
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - O. Bourges
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - T. André
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - C. Tournigand
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - C. Louvet
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
| | - A. de Gramont
- Hôpital St-Antoine, Paris, France; Hopital Pitie Salpetrière, Paris, France; Institut Mutualiste Montsouris, Paris, France
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Tournigand C, Samson B, Scheithauer W, Louvet C, Andre T, Lledo G, Latreille J, Viret F, Chibaudel B, de Gramont A. mFOLFOX-bevacizumab or XELOX-bevacizumab then bevacizumab (B) alone or with erlotinib (E) in first-line treatment of patients with metastatic colorectal cancer (mCRC): Interim safety analysis of DREAM study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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
4077 Background: Anti-VEGF or EGFR inhibitors demonstrated clinical activity in combination with chemotherapy (CT) in mCRC. The DREAM trial compares, after an induction CT of 6 cy of FOLFOX-B or XELOX-B, a maintenance with B ± E. We report here a pre-planned safety analysis of induction (I) and maintenance (M) phase for the first 200 patients. Methods: Patients (pts) with untreated mCRC were randomly assigned to 2 arms (I): mFOLFOX+B (n=100), or mXELOX+B (n=100). mFOLFOX-B: LV 400 mg/m2, Oxaliplatin (ox) 100 mg/m2, B 5 mg/kg d1, 5FU ci 2.4g/m2 46h, q2w, mXELOX-B: Ox 100 mg/m2 d1, capecitabine 2.5 g/m2 d1–7, B 5mg/kg, q2w. To date, 117 pts with a disease control after 6 cy have had a 2nd randomisation (M): B alone (7.5 mg/kg q3w, n=56) or B+E 150 mg/d (n=61) until PD. Results: Pts characteristics were: sex: 124M/76F, median age: 62.4 years (26–80), primary tumors: colon 152, rectum 53, synchronous metastases: 150 pts, > 1 metastase site: 115, PS 0/1: 134/66, Alk. Ph.>UNL: 87 pts, and LDH>UNL: 88pts. For I, 92 pts in mFOLFOX-B and 93 in XELOX-B were evaluable for toxicity (tox). Tox (%) for mFOLFOX-B/XELOX-B were: any toxicity grade (gr) 3 or 4: 21/30; neutropenia gr 3 6/1, gr 4 0/2; febrile neutropenia gr 3 1/1, gr 4 0/1; thrombopenia gr 3 0/1, gr 4 0/2; anemia gr 2 8/15, gr 3 2/1; nausea gr 2 17/15, gr 3 4/6; vomiting gr 2 10/12, gr 3 2/5; mucositis gr 2 6/6, gr 3 0/4; diarrhea gr 2 8/12, gr 3 5/20, gr 4 0/1; neuropathy gr 2 23/17 gr 3 3/1; HFS gr 2 0/7, gr 3 0/2; hypertension gr 2 2/3, gr 3 1/0; proteinuria gr 2 1/5; SAEs 14/25. For M, 56 pts in B and 61 pts in B+E were evaluable. Tox (% B/B+E) were: neutropenia gr 2 0/3; thrombopenia gr 2 2/0; nausea gr 2 2/2, gr 3 2/0; vomiting gr 3 2/0; mucositis gr 2 2/3; diarrhea gr 2 0/6, gr 3 2/6; skin tox gr 1 9/31, gr 2 0/38, gr 3 0/16, gr 4 0/2; proteinuria gr 2 5/5; hypertension gr 1 9/15, gr 2 3/8, gr 3 3/0. Conclusions: This interim safety analysis demonstrated that induction with mFOLFOX-B or XELOX-B as well as maintenance with B or B + E appears to be well-tolerated, without unexpected side effects. The DREAM study is ongoing, with a prolonged induction phase of 6 months (3 mo with ox then 3 mo with fluoropyrimidines-B) before randomisation for maintenance therapy. [Table: see text]
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Affiliation(s)
- C. Tournigand
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - B. Samson
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - W. Scheithauer
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - C. Louvet
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - T. Andre
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - G. Lledo
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - J. Latreille
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - F. Viret
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - B. Chibaudel
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
| | - A. de Gramont
- Hopital Saint Antoine, Paris, France; Hopital Charles Lemoyne, Greenfield Park, QC, Canada; University of Vienna, Vienna, Austria; Hopital Pitié-Salpetriere, Paris, France; Hopital Privé Jean Mermoz, Lyon, France; Institut Paoli Calmettes, Marseille, France; Gercor, Paris, France
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