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Gillessen S, Armstrong A, Attard G, Beer TM, Beltran H, Bjartell A, Bossi A, Briganti A, Bristow RG, Bulbul M, Caffo O, Chi KN, Clarke CS, Clarke N, Davis ID, de Bono JS, Duran I, Eeles R, Efstathiou E, Efstathiou J, Ekeke ON, Evans CP, Fanti S, Feng FY, Fizazi K, Frydenberg M, George D, Gleave M, Halabi S, Heinrich D, Higano C, Hofman MS, Hussain M, James N, Jones R, Kanesvaran R, Khauli RB, Klotz L, Leibowitz R, Logothetis C, Maluf F, Millman R, Morgans AK, Morris MJ, Mottet N, Mrabti H, Murphy DG, Murthy V, Oh WK, Ost P, O'Sullivan JM, Padhani AR, Parker C, Poon DMC, Pritchard CC, Rabah DM, Rathkopf D, Reiter RE, Rubin M, Ryan CJ, Saad F, Sade JP, Sartor O, Scher HI, Shore N, Skoneczna I, Small E, Smith M, Soule H, Spratt DE, Sternberg CN, Suzuki H, Sweeney C, Sydes MR, Taplin ME, Tilki D, Tombal B, Türkeri L, Uemura H, Uemura H, van Oort I, Yamoah K, Ye D, Zapatero A, Omlin A. Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021. Eur Urol 2022; 82:115-141. [PMID: 35450732 DOI: 10.1016/j.eururo.2022.04.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [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: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but various areas of management still lack high-level evidence to inform clinical practice. The 2021 Advanced Prostate Cancer Consensus Conference (APCCC) addressed some of these questions to supplement guidelines that are based on level 1 evidence. OBJECTIVE To present the voting results from APCCC 2021. DESIGN, SETTING, AND PARTICIPANTS The experts identified three major areas of controversy related to management of advanced prostate cancer: newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the use of prostate-specific membrane antigen ligands in diagnostics and therapy, and molecular characterisation of tissue and blood. A panel of 86 international prostate cancer experts developed the programme and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted publicly but anonymously on 107 pre-defined questions, which were developed by both voting and non-voting panel members prior to the conference following a modified Delphi process. RESULTS AND LIMITATIONS The voting reflected the opinions of panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results reported in the Supplementary material. CONCLUSIONS These voting results from a panel of experts in advanced prostate cancer can help clinicians and patients to navigate controversial areas of management for which high-level evidence is scant. However, diagnostic and treatment decisions should always be individualised according to patient characteristics, such as the extent and location of disease, prior treatment(s), comorbidities, patient preferences, and treatment recommendations, and should also incorporate current and emerging clinical evidence and logistic and economic constraints. Enrolment in clinical trials should be strongly encouraged. Importantly, APCCC 2021 once again identified salient questions that merit evaluation in specifically designed trials. PATIENT SUMMARY The Advanced Prostate Cancer Consensus Conference is a forum for discussing current diagnosis and treatment options for patients with advanced prostate cancer. An expert panel votes on predefined questions focused on the most clinically relevant areas for treatment of advanced prostate cancer for which there are gaps in knowledge. The voting results provide a practical guide to help clinicians in discussing treatment options with patients as part of shared decision-making.
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Affiliation(s)
- Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Universita della Svizzera Italiana, Lugano, Switzerland; University of Berne, Berne, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK.
| | - Andrew Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | - Gert Attard
- University College London Cancer Institute, London, UK
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Himisha Beltran
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Alberto Bossi
- Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Robert G Bristow
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Christie NHS Trust and CRUK Manchester Institute and Cancer Centre, Manchester, UK
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Kim N Chi
- BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Caroline S Clarke
- Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
| | - Noel Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Johann S de Bono
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Ros Eeles
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Onyeanunam Ngozi Ekeke
- Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | | | - Stefano Fanti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Felix Y Feng
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Mark Frydenberg
- Department of Surgery, Prostate Cancer Research Program, Monash University, Melbourne, Australia
| | - Dan George
- Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Martin Gleave
- Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Daniel Heinrich
- Department of Oncology and Radiotherapy, Innlandet Hospital Trust, Gjøvik, Norway
| | | | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Nick James
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Robert Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Raja B Khauli
- Department of Urology and the Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Raya Leibowitz
- Oncology Institute, Shamir Medical Center and Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Chris Logothetis
- Department of Genitourinary Medical Oncology, David H. Koch Centre, MD Anderson Cancer Centre, Houston, TX, USA; Department of Clinical Therapeutics, University of Athens Alexandra Hospital, Athens, Greece
| | - Fernando Maluf
- Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brazil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Alicia K Morgans
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Hind Mrabti
- National Institute of Oncology, Mohamed V University, Rabat, Morocco
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - William K Oh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Joe M O'Sullivan
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Anwar R Padhani
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK; Mount Vernon Cancer Centre, London, UK
| | - Chris Parker
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Danny M Rabah
- The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Dana Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rob E Reiter
- University of California-Los Angeles, Los Angeles, CA, USA
| | - Mark Rubin
- Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland
| | - Charles J Ryan
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Fred Saad
- Centre Hospitalier de Université de Montréal, Montreal, Canada
| | - Juan P Sade
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | | | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Iwona Skoneczna
- Rafal Masztak Grochowski Hospital and Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| | - Matthew Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Daniel E Spratt
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine Division of Hematology and Oncology, Meyer Cancer Center, New York Presbyterian Hospital, New York, NY, USA
| | | | - Christopher Sweeney
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mary-Ellen Taplin
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | | | - Levent Türkeri
- Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Inge van Oort
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kosj Yamoah
- Department of Radiation Oncology & Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Health Research Institute, Madrid, Spain
| | - Aurelius Omlin
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Hahn A, Tidwell R, Surasi D, Msaouel P, Efstathiou E, Zurita-Saavedra A, Tu SM, McQuade J, Fogelman D, Starbuck M, Subudhi S, Corn P, Pilie P, Aparicio A, Logothetis C. 669P Body composition and clinical outcomes in men with metastatic castration-resistant prostate cancer (mCRPC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.928] [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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Halabi S, Dutta S, Tangen CM, Rosenthal M, Petrylak DP, Thompson IM, Chi KN, De Bono JS, Araujo JC, Logothetis C, Eisenberger MA, Quinn DI, Fizazi K, Morris MJ, Higano CS, Tannock IF, Small EJ, Kelly WK. Clinical outcomes in men of diverse ethnic backgrounds with metastatic castration-resistant prostate cancer. Ann Oncol 2020; 31:930-941. [PMID: 32289380 DOI: 10.1016/j.annonc.2020.03.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We have shown previously in multivariable analysis that black men had 19% lower risk of death than white men with metastatic castration-resistant prostate cancer (mCRPC) treated with a docetaxel and prednisone (DP)-based regimen. The primary goal of this analysis was to compare progression-free survival (PFS), biochemical PFS, ≥50% decline in prostate-specific antigen (PSA) from baseline and objective response rate (ORR) in white, black and Asian men with mCRPC treated with a DP-based regimen. PATIENTS AND METHODS Individual patient data from 8820 mCRPC men randomized on nine phase III trials to a DP-containing regimen were combined. Race used in the analysis was based on self-report. End points were PFS, biochemical PSA, ≥50% decline in PSA from baseline and ORR. The proportional hazards and the logistic regression models were employed to assess the prognostic importance of race in predicting outcomes adjusting for established prognostic factors. RESULTS Of 8820 patients, 7528 (85%) were white, 500 (6%) were black, 424 were Asian (5%) and 368 (4%) had race unspecified. Median PFS were 8.3 [95% confidence interval (CI) 8.2-8.5], 8.2 (95% CI 7.4-8.8) and 8.3 (95% CI 7.6-8.8) months in white, black and Asian men, respectively. Median PSA PFS were 9.9 (95% CI 9.7-10.4), 8.5 (95% CI 8.0-10.3) and 11.1 (95% CI 9.9-12.5) months in white, black and Asian men, respectively. CONCLUSIONS We observed no differences in clinical outcomes by race and ethnic groups in men with mCRPC enrolled on these phase III clinical trials with DP.
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Affiliation(s)
- S Halabi
- Duke University Medical Center and Duke University, Durham, USA.
| | - S Dutta
- Old Dominion University, Norfolk, USA
| | - C M Tangen
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | - M Rosenthal
- The Royal Melbourne Hospital, Parkville, Australia
| | | | - I M Thompson
- Christus San Rosa Hospital Medical Center, San Antonio, USA
| | - K N Chi
- British Columbia Cancer Agency - Vancouver Centre, Vancouver, Canada
| | - J S De Bono
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J C Araujo
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C Logothetis
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Eisenberger
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, USA
| | - D I Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA
| | - K Fizazi
- Gustave Roussy, Villejuif, France
| | - M J Morris
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - C S Higano
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, USA
| | - I F Tannock
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - E J Small
- University of California, San Francisco, San Francisco, USA
| | - W K Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
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Gillessen S, Attard G, Beer TM, Beltran H, Bjartell A, Bossi A, Briganti A, Bristow RG, Chi KN, Clarke N, Davis ID, de Bono J, Drake CG, Duran I, Eeles R, Efstathiou E, Evans CP, Fanti S, Feng FY, Fizazi K, Frydenberg M, Gleave M, Halabi S, Heidenreich A, Heinrich D, Higano CTS, Hofman MS, Hussain M, James N, Kanesvaran R, Kantoff P, Khauli RB, Leibowitz R, Logothetis C, Maluf F, Millman R, Morgans AK, Morris MJ, Mottet N, Mrabti H, Murphy DG, Murthy V, Oh WK, Ost P, O'Sullivan JM, Padhani AR, Parker C, Poon DMC, Pritchard CC, Reiter RE, Roach M, Rubin M, Ryan CJ, Saad F, Sade JP, Sartor O, Scher HI, Shore N, Small E, Smith M, Soule H, Sternberg CN, Steuber T, Suzuki H, Sweeney C, Sydes MR, Taplin ME, Tombal B, Türkeri L, van Oort I, Zapatero A, Omlin A. Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019. Eur Urol 2020; 77:508-547. [PMID: 32001144 DOI: 10.1016/j.eururo.2020.01.012] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but there are still many aspects of management that lack high-level evidence to inform clinical practice. The Advanced Prostate Cancer Consensus Conference (APCCC) 2019 addressed some of these topics to supplement guidelines that are based on level 1 evidence. OBJECTIVE To present the results from the APCCC 2019. DESIGN, SETTING, AND PARTICIPANTS Similar to prior conferences, experts identified 10 important areas of controversy regarding the management of advanced prostate cancer: locally advanced disease, biochemical recurrence after local therapy, treating the primary tumour in the metastatic setting, metastatic hormone-sensitive/naïve prostate cancer, nonmetastatic castration-resistant prostate cancer, metastatic castration-resistant prostate cancer, bone health and bone metastases, molecular characterisation of tissue and blood, inter- and intrapatient heterogeneity, and adverse effects of hormonal therapy and their management. A panel of 72 international prostate cancer experts developed the programme and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted publicly but anonymously on 123 predefined questions, which were developed by both voting and nonvoting panel members prior to the conference following a modified Delphi process. RESULTS AND LIMITATIONS Panellists voted based on their opinions rather than a standard literature review or formal meta-analysis. The answer options for the consensus questions had varying degrees of support by the panel, as reflected in this article and the detailed voting results reported in the Supplementary material. CONCLUSIONS These voting results from a panel of prostate cancer experts can help clinicians and patients navigate controversial areas of advanced prostate management for which high-level evidence is sparse. However, diagnostic and treatment decisions should always be individualised based on patient-specific factors, such as disease extent and location, prior lines of therapy, comorbidities, and treatment preferences, together with current and emerging clinical evidence and logistic and economic constraints. Clinical trial enrolment for men with advanced prostate cancer should be strongly encouraged. Importantly, APCCC 2019 once again identified important questions that merit assessment in specifically designed trials. PATIENT SUMMARY The Advanced Prostate Cancer Consensus Conference provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference, which has been held three times since 2015, aims to share the knowledge of world experts in prostate cancer management with health care providers worldwide. At the end of the conference, an expert panel discusses and votes on predefined consensus questions that target the most clinically relevant areas of advanced prostate cancer treatment. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients as part of shared and multidisciplinary decision making.
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Affiliation(s)
- Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Universita della Svizzera Italiana, Lugano, Switzerland; Cantonal Hospital, St. Gallen, Switzerland; University of Bern, Bern, Switzerland; Division of Cancer Science, University of Manchester, Manchester, UK.
| | | | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Himisha Beltran
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Alberto Bossi
- Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Rob G Bristow
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Christie NHS Trust, Manchester, UK; CRUK Manchester Institute and Cancer Centre, Manchester, UK
| | - Kim N Chi
- BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noel Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Ian D Davis
- Monash University and Eastern Health, Victoria, Australia
| | - Johann de Bono
- The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Charles G Drake
- Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Ros Eeles
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Felix Y Feng
- University of California San Francisco, San Francisco, CA, USA
| | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia; Prostate Cancer Research Program, Monash University, Melbourne, Australia; Department Anatomy & Developmental Biology, Faculty of Nursing, Medicine & Health Sciences, Monash University, Melbourne, Australia
| | - Martin Gleave
- Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany; Department of Urology, Medical University, Vienna, Austria
| | - Daniel Heinrich
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Celestia Tia S Higano
- University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael S Hofman
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Maha Hussain
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | | | | | - Philip Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Raja B Khauli
- Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon; Naef K. Basile Cancer Institute (NKBCI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Raya Leibowitz
- Oncology institute, Shamir Medical Center and Faculty of medicine, Tel-Aviv University, Israel
| | - Chris Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA; Department of Clinical Therapeutics, David H. Koch Centre, University of Athens Alexandra Hospital, Athens, Greece
| | - Fernando Maluf
- Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brazil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Alicia K Morgans
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | | | | | - Hind Mrabti
- National Institute of Oncology, University hospital, Rabat, Morocco
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - William K Oh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK; Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Anwar R Padhani
- Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Chris Parker
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mark Rubin
- Bern Center for Precision Medicine, Bern, Switzerland; Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Charles J Ryan
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Fred Saad
- Centre Hospitalier de Université de Montréal, Montreal, Canada
| | | | | | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Eric Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Smith
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Cora N Sternberg
- Division of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christopher Sweeney
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mary-Ellen Taplin
- Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Levent Türkeri
- Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey
| | - Inge van Oort
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Almudena Zapatero
- Department of Radiation Oncology, University Hospital La Princesa, Health Research Institute, Madrid, Spain
| | - Aurelius Omlin
- University of Bern, Bern, Switzerland; Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Sternberg C, Tombal B, Miller K, Saad F, Sartor O, Sade J, Logothetis C, Bellmunt J, Dizdarevic S, Harshman L, Logue J, Baldari S, Richardson T, Bottomley D, Schostak M, Bayh I, Kalinovsky J, Higano C. Use of bone health agents (BHAs) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) treated with radium-223 (Ra-223) after abiraterone (Abi): An interim review of REASSURE. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.035] [Citation(s) in RCA: 3] [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: 11/13/2022] Open
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6
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Sakellakis M, Ramachandran S, Zhang X, Logothetis C, Titus M. PO-017 Androgen deprivation and oxidative phosporylation inhibition pose synergistic antitumor effects in subsets of prostate tumours in vitro. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.552] [Citation(s) in RCA: 1] [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: 11/03/2022] Open
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7
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Sakellakis M, Ramachandran S, Efstathiou E, Mao X, Hoang A, Navone N, Logothetis C, Titus M. PO-259 Identification of a clinically meaningful site-specific steroid roadmap in prostate cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.774] [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: 11/03/2022] Open
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8
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Gillessen S, Attard G, Beer TM, Beltran H, Bossi A, Bristow R, Carver B, Castellano D, Chung BH, Clarke N, Daugaard G, Davis ID, de Bono J, Borges Dos Reis R, Drake CG, Eeles R, Efstathiou E, Evans CP, Fanti S, Feng F, Fizazi K, Frydenberg M, Gleave M, Halabi S, Heidenreich A, Higano CS, James N, Kantoff P, Kellokumpu-Lehtinen PL, Khauli RB, Kramer G, Logothetis C, Maluf F, Morgans AK, Morris MJ, Mottet N, Murthy V, Oh W, Ost P, Padhani AR, Parker C, Pritchard CC, Roach M, Rubin MA, Ryan C, Saad F, Sartor O, Scher H, Sella A, Shore N, Smith M, Soule H, Sternberg CN, Suzuki H, Sweeney C, Sydes MR, Tannock I, Tombal B, Valdagni R, Wiegel T, Omlin A. Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017. Eur Urol 2018; 73:178-211. [PMID: 28655541 DOI: 10.1016/j.eururo.2017.06.002] [Citation(s) in RCA: 364] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. OBJECTIVE To present the report of APCCC 2017. DESIGN, SETTING, AND PARTICIPANTS Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. RESULTS AND LIMITATIONS Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. CONCLUSIONS The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. PATIENT SUMMARY The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.
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Affiliation(s)
- Silke Gillessen
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland.
| | - Gerhardt Attard
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Tomasz M Beer
- Oregon Health & Science University Knight Cancer Institute, OR, USA
| | - Himisha Beltran
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Bossi
- Department of Radiation Oncology, Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Rob Bristow
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, USA
| | - Brett Carver
- Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY, USA
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Medical Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian D Davis
- Monash University and Eastern Health, Eastern Health Clinical School, Box Hill, Australia
| | - Johann de Bono
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Rodolfo Borges Dos Reis
- Department of Urology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Charles G Drake
- Department of Medical Oncology, Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | - Ros Eeles
- Department of Clinical Oncology and Genetics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Eleni Efstathiou
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, TX, USA
| | - Christopher P Evans
- Department of Urology, University of California, Davis School of Medicine, CA, USA
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Italy
| | - Felix Feng
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Karim Fizazi
- Department of Medical Oncology, Gustave Roussy, University of Paris Sud, Paris, France
| | - Mark Frydenberg
- Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Martin Gleave
- Department of Urology, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Susan Halabi
- Department of Clinical trials and Statistics, Duke University, Durham, NC, USA
| | | | - Celestia S Higano
- Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, WA, USA
| | - Nicolas James
- Department of Clinical Oncology, Clinical Oncology Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Philip Kantoff
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Department of Clinical Oncology, Tampere University Hospital, Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Raja B Khauli
- Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chris Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | - Fernando Maluf
- Department of Medical Oncology Hospital Israelita Albert Einstein and Department of Medical Oncology Beneficência Portuguesa de São Paulo
| | - Alicia K Morgans
- Department of Medical Oncology and Epidemiology, Vanderbilt University Medical Center, Division of Hematology/Oncology, Nashville, TN, USA
| | - Michael J Morris
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicolas Mottet
- Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - William Oh
- Department of Medical Oncology, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anwar R Padhani
- Department of Radiology, Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Chris Parker
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Mark A Rubin
- Department of Pathology, University of Bern and the Inselspital, Bern (CH)
| | - Charles Ryan
- Department of Medical Oncology, Clinical Medicine and Urology at the Helen Diller Family Comprehensive Cancer Center at the University of, California, San Francisco, CA, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Oliver Sartor
- Department of Medical Oncology, Tulane Cancer Center, New Orleans, LA, USA
| | - Howard Scher
- Department of Medical Oncology, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Avishay Sella
- Department of Medical Oncology, Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine, Zerifin, Israel
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Matthew Smith
- Department of Medical Oncology, Massachusetts General Hospital Cancer Centre, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Japan
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian Tannock
- Department of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Riccardo Valdagni
- Department of Oncology and Haemato-oncology, Università degli Studi di Milano. Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thomas Wiegel
- Department of Radiation Oncology, Klinik für Strahlentherapie und Radioonkologie des Universitätsklinikum Ulm, Albert-Einstein-Allee, Ulm, Germany
| | - Aurelius Omlin
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland
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Loriot Y, Pagliaro L, Fléchon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard J, Malhaire J, Linassier C, Habibian M, Martin A, Journeau F, Reckova M, Logothetis C, Laplanche A, Le Teuff G, Culine S, Fizazi K. Patterns of relapse in poor-prognosis germ-cell tumours in the GETUG 13 trial: Implications for assessment of brain metastases. Eur J Cancer 2017; 87:140-146. [DOI: 10.1016/j.ejca.2017.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
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10
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Efstathiou E, Tsikkinis A, Wen S, Tapia ELN, Hoang A, Aparicio A, Tu SM, Rangel G, Troncoso P, Corn P, Araujo J, Logothetis C. Abiraterone acetate (AA) followed by randomization to dasatinib (D) or sunitinib malate (S) in metastatic castrate resistant prostate cancer (mCRPC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.11] [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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11
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Efstathiou E, Li Ning Tapia E, Aparicio A, Tu S, Wen S, Hoang A, Pagliaro L, Harmon C, Troncoso P, Araujo J, Logothetis C. Maximal Androgen Depletion with Abiraterone Acetate (Aa) Followed By Randomization of Maximal Androgen Ablation with Molecular Targeted Therapies Dasatinib or Sunitinib Malate in Metastatic Castrate Resistant Prostate Cancer (Mcrpc). Report on Candidate Predictive Androgen Signaling Signature. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.21] [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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12
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Fizazi K, Drake C, Kwon E, Bossi A, van den Eertwegh A, Scher H, Beer T, McHenry M, Liu D, Gerritsen W, Logothetis C. Updated Overall Survival (Os) from the Phase 3 Trial, Ca184-043: Ipilimumab (Ipi) Vs Placebo (Pbo) in Patients with Post-Docetaxel Metastatic Castration-Resistant Prostate Cancer (Mcrpc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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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13
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Arora VK, Schenkein E, Murali R, Subudhi SK, Wongvipat J, Balbas MD, Shah N, Cai L, Efstathiou E, Logothetis C, Zheng D, Sawyers CL. Glucocorticoid receptor confers resistance to antiandrogens by bypassing androgen receptor blockade. Cell 2014; 155:1309-22. [PMID: 24315100 DOI: 10.1016/j.cell.2013.11.012] [Citation(s) in RCA: 708] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 08/16/2013] [Accepted: 11/02/2013] [Indexed: 12/18/2022]
Abstract
The treatment of advanced prostate cancer has been transformed by novel antiandrogen therapies such as enzalutamide. Here, we identify induction of glucocorticoid receptor (GR) expression as a common feature of drug-resistant tumors in a credentialed preclinical model, a finding also confirmed in patient samples. GR substituted for the androgen receptor (AR) to activate a similar but distinguishable set of target genes and was necessary for maintenance of the resistant phenotype. The GR agonist dexamethasone was sufficient to confer enzalutamide resistance, whereas a GR antagonist restored sensitivity. Acute AR inhibition resulted in GR upregulation in a subset of prostate cancer cells due to relief of AR-mediated feedback repression of GR expression. These findings establish a mechanism of escape from AR blockade through expansion of cells primed to drive AR target genes via an alternative nuclear receptor upon drug exposure.
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Affiliation(s)
- Vivek K Arora
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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14
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Som A, Tu SM, Liu J, Wang X, Qiao W, Logothetis C, Corn PG. Response in bone turnover markers during therapy predicts overall survival in patients with metastatic prostate cancer: analysis of three clinical trials. Br J Cancer 2012; 107:1547-53. [PMID: 23033003 PMCID: PMC3493771 DOI: 10.1038/bjc.2012.436] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The bone-forming metastases of prostate cancer result from complex stromal–epithelial interactions within the tumour microenvironment. Autocrine–paracrine signalling pathways between prostate cancer epithelial cells, osteoblasts, and osteoclasts stimulate aberrant bone remodelling, and the activity of these three cell populations can be quantitatively measured using prostate-specific antigen (PSA), bone-specific alkaline phosphatase (BAP) and urine N-telopeptide (uNTx), respectively. The purpose of the present study was to test the hypothesis that serial measurements of BAP and uNTx during therapy would facilitate monitoring of disease activity and predict the overall survival (OS) in patients with metastatic prostate cancer receiving therapy. Methods: Radionuclide bone scan, PSA, BAP, and uNTx data were retrospectively analysed from three clinical trials in patients with metastatic prostate cancer conducted at our institution. Qualitative changes in bone scans and quantitative changes in PSA, BAP, and uNTx concentrations during therapy were correlated with OS. Results: Baseline levels of BAP, but not PSA, were prognostic for OS in both androgen-dependent and castrate-resistant disease. A reduction in PSA, BAP, uNTx, or BAP/uNTx on therapy was predictive of improved OS in both patient groups. Conversely, an increase in PSA, or BAP on therapy was predictive of worse OS in both patient groups. Baseline number of lesions and response on bone scan during therapy were neither prognostic nor predictive of OS in either patient group. Conclusion: These observations support the concept that serial measurements of bone turnover metabolites during therapy function as clinically informative predictive biomarkers in patients with advanced prostate cancer and skeletal metastases. PSA measurements and bone scans remain essential to monitor the overall disease activity and determine the anatomic distribution of skeletal metastases.
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Affiliation(s)
- A Som
- Department of Genitourinary Medical Oncology, Unit 1374, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler, Houston, TX 77230, USA
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15
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Scher HI, Heller G, Molina A, Kheoh TS, Attard G, Moreira J, Sandhu SK, Parker C, Logothetis C, McCormack RT, Fizazi K, Anand A, Danila DC, Fleisher M, Olmos D, Haqq CM, De Bono JS. Evaluation of circulating tumor cell (CTC) enumeration as an efficacy response biomarker of overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC): Planned final analysis (FA) of COU-AA-301, a randomized, double-blind, placebo-controlled, phase III study of abiraterone acetate (AA) plus low-dose prednisone (P) post docetaxel. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba4517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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
LBA4517 Background: A preplanned interim analysis of COU-AA-301 showed that AA, a selective androgen biosynthesis (CYP17) inhibitor, significantly improves OS in mCRPC. This is the first phase III study to prospectively assess CTC as a surrogate biomarker as part of a regulatory qualification process, here using updated OS data. Methods: 1,195 patients (pts) with mCRPC post docetaxel were randomized 2:1 to AA (1 g QD) + P (5 mg BID) (n = 797) or placebo + P (n = 398). CTCs (screening and baseline [BL]; post BL at weeks 4, 8 and 12) were enumerated (cells/7.5 mL) at MSKCC and The ICR using CellSearch and analyzed with other prognostic covariates as dichotomous and continuous variables using updated OS data at 775 events (prior to crossover from placebo to AA). CTC (as part of a biomarker panel - LDH, PSA, Hg, AlkPhos) was examined as a surrogate for OS. Multivariate (Cox model) analyses were conducted. Results: At median follow up (FU) of 20.2 mo, the difference in median OS between the 2 groups improved from 3.9 to 4.6 mo (AA 15.8 mo vs placebo 11.2 mo; HR = 0.74; p < .0001). CTC counts were evaluated in 972 pts at screening and BL, 838 at 4 wks, 783 at 8 wks and 723 pts at 12 wks. High concordance between screening and BL values was observed (r = 0.83). CTC conversion using standard definition for unfavorable (CTC ≥ 5) and favorable (CTC < 5) counts was predictive of OS as early as 4 wks after treatment and its inclusion significantly reduced the treatment effect at all post-treatment time points (HR: from 0.74 to 0.97). A reduced model incorporating CTCs and LDH was developed. Conclusions: The magnitude of the treatment effect of AA on OS increased with longer FU. Using standard definition of CTC conversion, the biomarker panel demonstrated a level of surrogacy for OS by correlating well with survival and in a model-adjusted analysis dramatically attenuating the treatment effect. BL CTCs and CTC conversion, along with LDH, were key predictors of OS. Future trials will further evaluate the CTC-based surrogate developed from COU-AA-301.
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Affiliation(s)
- H. I. Scher
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - G. Heller
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - A. Molina
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - T. S. Kheoh
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - G. Attard
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - J. Moreira
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - S. K. Sandhu
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - C. Parker
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - C. Logothetis
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - R. T. McCormack
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - K. Fizazi
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - A. Anand
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - D. C. Danila
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - M. Fleisher
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - D. Olmos
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - C. M. Haqq
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
| | - J. S. De Bono
- Memorial Sloan-Kettering Cancer Center, New York, NY; OrthoBiotech Oncology Research and Development, Los Angeles, CA; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; University of Texas M. D. Anderson Cancer Center, Houston, TX; Veridex LLC, Raritan, NJ; Institut Gustave Roussy, Villejuif, France
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Pagliaro LC, Zurita AJ, Araujo JC, Ward JF, Davis JW, Pettaway CA, Tu S, Kim J, Dieringer P, Logothetis C, Pisters LL. Presurgical docetaxel (Doc) and androgen deprivation therapy (ADT) in lymph node-positive prostate cancer (PCa). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4619] [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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17
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Dayyani F, Parikh N, Song JH, Araujo JC, Carboni JM, Gottardis MM, Trudel GC, Logothetis C, Gallick GE. Antitumor effects of dual inhibition of the Src and insulin-like growth factor-1 receptor (IGF-1R) pathways in prostate cancer (PCa). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15004] [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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Bilen MA, Liu D, Mathew P, Pagliaro LC, Logothetis C, Araujo JC, Aparicio A, Corn PG, Hajdenberg J, Dakhil SR, Tu S. A randomized phase II study of bone-targeted therapy in advanced androgen-dependent prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4649] [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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Scher HI, Heller G, Molina A, Kheoh TS, Attard G, Moreira J, Sandhu SK, Parker C, Logothetis C, McCormack RT, Fizazi K, Anand A, Danila DC, Fleisher M, Olmos D, Haqq CM, De Bono JS. Evaluation of circulating tumor cell (CTC) enumeration as an efficacy response biomarker of overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC): Planned final analysis (FA) of COU-AA-301, a randomized double-blind, placebo-controlled phase III study of abiraterone acetate (AA) plus low-dose prednisone (P) post docetaxel. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba4517] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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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Aparicio A, Harzstark AL, Lin E, Corn PG, Araujo JC, Tu S, Pagliaro LC, Millikan RE, Arap W, Kim J, Ryan CJ, Zurita AJ, Tannir NM, Lin AM, Small EJ, Mathew P, Jones DM, Troncoso P, Thall PF, Logothetis C. Characterization of the anaplastic prostate carcinomas: A prospective two-stage phase II trial of frontline carboplatin and docetaxel (CD) and salvage etoposide and cisplatin (EP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4666] [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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Logothetis C, De Bono JS, Molina A, Basch EM, Fizazi K, North SA, Chi KN, Jones RJ, Goodman OB, Mainwaring PN, Sternberg CN, Gagnon DD, Dhawan R, Rothman M, Hao Y, Liu CS, Kheoh TS, Scher HI, Haqq CM. Effect of abiraterone acetate (AA) on pain control and skeletal-related events (SRE) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) post docetaxel (D): Results from the COU-AA-301 phase III study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4520] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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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22
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Efstathiou E, Titus MA, Tsavachidou D, Hoang A, Karlou M, Wen S, Troncoso P, Ashe R, Berman CJ, Mohler J, Logothetis C. MDV3100 effects on androgen receptor (AR) signaling and bone marrow testosterone concentration modulation: Apreliminary report. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4501] [Citation(s) in RCA: 12] [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: 11/20/2022] Open
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23
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Beer TM, Logothetis C, Sharma P, Gerritsen WR, Ezzeddine R, Fairchild JP, Gagnier P, Chin KM, Cuillerot J. Randomized, double-blind, phase III trial to compare the efficacy of ipilimumab (Ipi) versus placebo in asymptomatic or minimally symptomatic patients (pts) with metastatic chemotherapy-naïve castration-resistant prostate cancer (CRPC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps182] [Citation(s) in RCA: 5] [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: 11/20/2022] Open
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24
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Scher HI, Logothetis C, Molina A, Goodman OB, Sternberg CN, Chi KN, Kheoh TS, Haqq CM, Fizazi K, De Bono JS. Improved survival outcomes in clinically relevant patient subgroups from COU-AA-301, a phase III study of abiraterone acetate (AA) plus prednisone (P) in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing after docetaxel-based chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4 Background: AA is a selective androgen biosynthesis inhibitor that blocks the action of CYP17. Preclinical and early clinical studies suggest that AA potently inhibits persistent androgen synthesis from adrenal and intratumoral sources, thus suppressing an important growth stimulus for mCRPC. Methods: COU-AA-301 ( NCT00638690 ) is an international, randomized, double blind study of AA (1,000 mg + P 5 mg po BID) vs placebo + P administered to men with mCRPC progressing after docetaxel-based chemo. OS is the primary endpoint. Patients treated with previous ketoconazole or > 2 prior chemo regimens were excluded. Results: Data are drawn from a planned, stratified interim analysis, unblinded in August 2010, based on significant OS improvement in the AA + P treatment group compared to the placebo + P group [median OS 14.8 vs.10.9 months; HR = 0.646 (0.54-0.77), P < 0.0001]. A subgroup analysis for OS is presented in the table. Mineralocorticoid- related AEs were more common in the AA arm vs placebo: fluid retention 30.5% vs 22.3%, hypokalemia 17.1% vs 8.4%; but grade 3/4 hypokalemia (3.8% vs 0.8%), and grade 3/4 hypertension (1.3% vs 0.3%) were infrequent. LFT abnormalities were observed in 10.4% AA vs 8.1% placebo; and cardiac disorders were observed in 13.3% AA vs 10.4% placebo. Conclusions: AA significantly prolongs OS in patients with mCRPC who have progressed after docetaxel-based chemo. AA's favorable treatment effect on OS, observed across multiple patient subgroups (HR range 0.59 – 0.74 vs placebo + P), was consistent with the survival benefit for the overall study population. [Table: see text] [Table: see text]
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Affiliation(s)
- H. I. Scher
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - C. Logothetis
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - A. Molina
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - O. B. Goodman
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - C. N. Sternberg
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - K. N. Chi
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - T. S. Kheoh
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - C. M. Haqq
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - K. Fizazi
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
| | - J. S. De Bono
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Texas M. D. Anderson Cancer Center, Houston, TX; Ortho Biotech Oncology Research and Development, Los Angeles, CA; Nevada Cancer Institute Medical Group, Las Vegas, NV; San Camillo and Forlanini Hospitals, Rome, Italy; British Columbia Cancer Agency, Vancouver, BC, Canada; Cougar Biotechnology, Los Angeles, CA; Institut Gustave Roussy, Villejuif, France; The Royal Marsden Hospital, Sutton, United Kingdom
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Zurita AJ, Ward JF, Araujo JC, Pettaway CA, Dieringer P, Wang X, Troncoso P, Logothetis C. Neoadjuvant trial of sunitinib malate and androgen ablation (ADT) in patients with localized prostate cancer (PCa) at high risk for recurrence. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.143] [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
143 Background: Presurgical ADT does not improve long-term outcomes in patients (pts) with high-risk localized PCa. Since the VEGF and PDGF signaling pathways have been implicated in PCa progression, and ADT results in endothelial cell apoptosis in the prostate by a VEGF-mediated mechanism, we hypothesized that combined treatment with sunitinib malate (SU), an oral inhibitor of the tyrosine kinases of VEGFR and PDGFR, might improve the efficacy of ADT in this pt population. Methods: Pts with no radiological evidence of metastases and either PCa ≥ clinical (c)T3 disease or Gleason grade 8-10 or serum prostate-specific antigen (PSA) ≥ 20 ng/mL or cT2b-c and Gleason 7 and PSA ≥10 ng/mL (AJCC, 1992), received i.m. leuprolide and oral SU for three 30-day cycles followed by surgery. SU was administered continuously at 37.5 mg daily (25 mg daily in the initial 6 pts). The primary endpoint of this phase II trial was rate of pathologic complete response (pCR). Secondary endpoints included safety and time to progression (TTP). Unresectable pelvic nodal disease, confirmed post-operative PSA ≥ 0.2 ng/mL, or administration of post-operative radiation or ADT, defined treatment failure. Results: Forty-four pts completed accrual, with a median age of 58 years (range 47-72); 34 Caucasian, 5 African-American, 4 Hispanic, and 1 Indian. High-risk criteria included cT3 (24/44), Gleason 8-10 (30/44), PSA ≥ 20 ng/mL (16/44). Two men were ineligible/declined therapy and one postponed surgery. No grade 4 toxicities or related discontinuations were observed. Thirty-five pts completed 3 months on 37.5 mg daily SU plus ADT and surgery with no unexpected complications. Of these, 2 pts experienced a pCR. Twenty (57%) pts have failed treatment or died, with a median TTP 27 months (95% CI: 12 – not estimable). The median follow-up of the remaining event-free pts is 35 months (range 23-41). Conclusions: The 3-months preoperative combination of SU and ADT is safe and well tolerated in pts with high-risk primary PCa. We observed 2 complete remissions in 35 patients. Ongoing characterization of molecular changes in the epithelial and stromal compartments will help understand the mechanisms of SU activity in PCa. [Table: see text]
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Affiliation(s)
- A. J. Zurita
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. F. Ward
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. C. Araujo
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - C. A. Pettaway
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - P. Dieringer
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - X. Wang
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - P. Troncoso
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - C. Logothetis
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Dayyani F, Parikh N, Song JH, Araujo JC, Carboni JM, Gottardis MM, Trudel GC, Logothetis C, Gallick GE. Effect of dual inhibition of the Src and insulin-like growth factor-1 receptor (IGF-1R) pathways on antitumor effects in prostate cancer (PCa). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.21] [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
21 Background: The Src and IGF-1R axes are aberrantly activated in both PCa and the microenvironment of bone metastases. Dasatinib and BMS-754807 are clinically promising small molecule inhibitors with high potency against Src family kinases and IGF-1R, respectively. The aim of this study was to establish antitumor co-operativity by combining IGF-1R and Src blockade in a preclinical PCa model. Methods: LNCaP and PC3 cells were used as models for androgen-dependent and independent PCa, respectively. Inhibition of Src and IGF-1R pathways was accomplished by pharmacologic agents (dasatinib against Src and BMS-754807 against IGF-1R) as well as by shRNA. Serum IGF-1 levels were measured in patients (pts) with castration-resistant PCa (CRPC) treated with dasatinib and docetaxel in a phase II trial. Results: Src inhibition decreased proliferation of PCa cells, and migration in modified Boyden Chamber and wound assays. In contrast, IGF-1R blockade induced apoptosis (increased Sub-G1 fraction cells, Annexin-V(+) cells and PARP cleavage). Phosphorylation of Akt was partially inhibited by either drug alone and almost completely abrogated by the combination. Intraprostatic injection of shIGF-1R or shSrc PC3 cells in nude mice led to an 83% and 60% decrease in tumor size compared to control shRNA, respectively. In both cell lines, all observed antitumor effects were enhanced when dual blockade was used, relative to blocking the Src or IGF-1R pathway alone. In 9/19 (47%) pts with CRPC, treatment with dasatinib resulted in a compensatory increase of serum IGF-1 levels. Conclusions: Dual inhibition of Src and IGF-1R is effective and complementary in PCa, mediated, in part, through inhibition of the downstream target Akt. In about half of pts treated with dasatinib, an increase in soluble IGF-1 levels was observed, indicating there is a compensatory upregulation of survival pathways that might be abrogated by dual inhibition of Src and IGF-1R. The combination of dasatinib and BMS-754807 may be a rational therapeutic approach in PCa by blocking complementary processes of tumor growth and progression. [Table: see text]
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Affiliation(s)
- F. Dayyani
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - N. Parikh
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - J. H. Song
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - J. C. Araujo
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - J. M. Carboni
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - M. M. Gottardis
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - G. C. Trudel
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - C. Logothetis
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
| | - G. E. Gallick
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Bristol-Myers Squibb, Princeton, NJ; Bristol-Myers Squibb, Wallingford, CT
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Carthon BC, Tahir S, Araujo JC, Wen S, Gallick GE, Logothetis C, Thompson TC. Caveolin-1 as a biomarker of Src family kinase/Abl inhibition in castrate-resistant prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
45 Background: Bone metastases cause significant morbidity in men with castrate-resistant prostate cancer (CRPC). Caveolin-1 (Cav-1), a Src kinase substrate, is overexpressed in primary prostate cancer (PCa) and in PCa bone metastases. In addition, PCa-derived and secreted Cav-1 contributes to malignant progression. We reasoned that Cav-1 may serve as a biomarker of dasatinib (a Src family kinase [SFK]/Abl inhibitor) activity in CRPC patients enrolled in a phase II clinical trial of docetaxel plus dasatinib. Methods: Levels of prostate-specific antigen (PSA), Cav-1, and markers of bone turnover were measured from baseline and cycle-2, day-1 samples from patients (n = 32) enrolled in this trial. Changes in these markers were stratified by response (responders [R] vs. nonresponders [NR]) and by predominant disease site (lymph node vs. bone). We evaluated Cav-1 expression in human PCa bone metastases samples from trial patients by immunohistochemistry. In parallel, Cav-1 secretion in response to dasatinib treatment was analyzed in PCa cells and osteoblasts. Results: Serum Cav-1 levels correlated directly with PSA levels in responding patients with node-positive disease (R vs. NR, p = 0.08) but correlated inversely in responding patients with bone-predominant disease (R vs. NR, p = 0.001). Serum from a separate cohort of patients treated with docetaxel only showed no effect on serum Cav-1 levels (R vs. NR, p = 0.85). Levels of Cav-1 were high in the active OBLs in bone specimens with PCa metastases, but not in bone specimens without metastases. Dasatinib treatment led to reduced secretion of Cav-1 in PC-3 and DU145 PCa cells but to increased secretion of Cav-1 in primary mouse osteoblasts or pre-osteoblast MC3T3-E1 cells. Conclusions: Our results suggest that serum Cav-1 serves as a novel discriminating biomarker for SFK/Abl inhibition in both node-positive and bone-metastatic CRPC. The expression of Cav-1 in OBLs of patients with PCa bone metastases suggests that tumor-associated OBLs are an important source of Cav-1 production in bone marrow. Our data provide evidence that the increase in serum Cav-1 in these patients with bone disease likely occurs through a direct effect of dasatinib on osteoblasts. No significant financial relationships to disclose.
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Affiliation(s)
- B. C. Carthon
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - S. Tahir
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. C. Araujo
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - S. Wen
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - G. E. Gallick
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - C. Logothetis
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - T. C. Thompson
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Giralt SA, Dexeus F, Amato R, Sella A, Logothetis C. Hyperthyroidism in men with germ cell tumors and high levels of beta-human chorionic gonadotropin. Cancer 2010; 69:1286-90. [PMID: 1371235 DOI: 10.1002/cncr.2820690535] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [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: 11/08/2022]
Abstract
A retrospective review was done on all high volume choriocarcinomas and other germ cell tumors of men with serum beta-human chorionic gonadotropin (beta-HCG) levels greater than 50,000 mIU/ml to determine the incidence and characteristics of hyperthyroidism in this setting. Nineteen patients were identified with high beta-HCG levels, but because 2 did not have thyroid function tests performed, the cases of only 17 patients were evaluable. Of these, 14 (82%) had primary testicular carcinoma and 3 (18%) had extragonadal tumors. Beta-HCG levels on presentation ranged from 80,000 to 3,058,000 mIU/ml, with a median of 243,500 mIU/ml. Seven of the 17 evaluable cases (41%) had T4 serum levels higher than 12 micrograms/dl (normal level 4 to 12 micrograms/dl) with a median value of 15.4 micrograms/dl (range, 12.6 to 33.5 micrograms/dl); serum T4 levels correlated with beta-HCG levels (r = 0.84). All seven patients with elevated T4 levels had beta-HCG values greater than 200,000 mIU/ml, and three of these seven had clinical manifestations that could be attributed to an elevated serum T4; only one patient required specific antithyroid treatment; and after control of primary disease, all other patients had normalization of thyroid function. The most common manifestations of hyperthyroidism in our series were tachycardia, hypertension, and a systolic flow murmur; none of the patients had thyroid gland enlargement. We conclude that subclinical hyperthyroidism is a relatively common phenomenon in germ cell tumors of men with high levels of beta-HCG and that control of the primary disease results in serum T4 level normalization.
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Affiliation(s)
- S A Giralt
- Department of Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030
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Dayyani F, Gallick GE, Thompson JT, Trudel GC, Logothetis C, Araujo JC. Correlation of dasatinib (DAS) peak levels with interleukin-8 (IL-8) and monocyte chemotactic protein-1 (MCP-1) levels in patients with castration-resistant progressive prostate cancer (CRPC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4665] [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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30
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Efstathiou E, Tu S, Aparicio A, Hoang A, Wen S, Troncoso P, Smith LA, Chieffo N, Molina A, Logothetis C. Use of “intracrine androgen signaling signature'' to predict benefit from abiraterone acetate (AA) in patients with castrate-resistant prostate cancer (CRPC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4547] [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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31
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Tzelepi V, Efstathiou E, Troncoso P, Pettaway CA, Hoang A, Logothetis C, Pagliaro LC. Modulation of candidate therapy targets in regionally advanced prostate cancer by androgen ablation and docetaxel. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4663] [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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32
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Ryan CJ, Smith MR, Logothetis C, Koepfgen K, Taplin M, Harzstark AL, Kantoff P, Kheoh TS, Molina A, Small EJ. Median time to progression in chemotherapy (chemo)-naive patients with castration-resistant prostate cancer (CRPC) treated with abiraterone acetate and low-dose prednisone (Pred). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4671] [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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Ryan C, Efstathiou E, Smith M, Taplin M, Bubley G, Logothetis C, Kheoh T, Haqq C, Molina A, Small EJ. Phase II multicenter study of chemotherapy (chemo)-naive castration-resistant prostate cancer (CRPC) not exposed to ketoconazole (keto), treated with abiraterone acetate (AA) plus prednisone. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5046] [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: 11/20/2022] Open
Abstract
5046 Background: AA is a potent inhibitor of the enzyme CYP17, a major contributor to androgen biosynthesis. Keto is also known to inhibit this enzyme but AA is many-fold stronger in its action. 33 pts with progressive metastatic disease, normal organ function, ECOG performance status (PS) 0–1, and no prior chemo were enrolled. Pts with prior keto treatment were excluded. AA (1000 mg qd) plus prednisone (5mg bid) were administered orally in 28 day cycles. Methods: Results: At baseline median age was 71.0 (range 52–85) yrs and median PSA was 24.7 (range 7.1–1110.0) ng/mL;19/26 pts (73%) had an ECOG PS of 0 and 7/26 (27%) had PS of 1; the median number of prior hormonal therapies was 2; all pts were on LHRHa and 73% of pts had received anti-androgen, all of whom had undergone prior anti-androgen withdrawal. Pts were evaluated at each cycle for PSA response according to PSAWG criteria. 27 pts have available data for PSA response. Total maximal PSA declines of ≥30%, ≥50%, ≥90% were observed in 89% (24/27), 85% (23/27) and 41% (11/27) pts, respectively. Week 12 PSA declines displayed a similar and sustained trend: ≥30%, ≥50% and ≥90% PSA decline in 82%, 78%, and 26% of pts. Post-treatment ECOG PS score was 0 in 24 (92%) pts: 19% experienced improvement in PS (PS 1 to 0 in 5 pts) and 19/19 pts maintained a PS of 0; Median time to PSA progression has not been reached. Majority of adverse events were grades 1–2. Incidence of hypokalemia - 12%; HTN - 6%; edema - 15%. One pt experienced a grade 3 drug-related HTN. Conclusions: Abiraterone acetate plus prednisone has significant anti-cancer activity in patients with metastatic CRPC not previously treated with ketoconazole or chemotherapy, as demonstrated by declines in PSA and improvement in performance status, and is well-tolerated. [Table: see text]
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Affiliation(s)
- C. Ryan
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - E. Efstathiou
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - M. Smith
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - M. Taplin
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - G. Bubley
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - C. Logothetis
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - T. Kheoh
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - C. Haqq
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - A. Molina
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
| | - E. J. Small
- University of California, San Francisco, San Francisco, CA; M. D. Anderson Cancer Center, Houston, TX; Massachusetts General Hospital, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Cougar Biotechnology, Los Angeles, CA
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Aulitzky W, Aulitzky W, Ellerhorst J, Logothetis C, Gomahr A, Stöckle M, Thews O, Scheibenbogen C, Keilholz U, Huber C. Intermittent Low-Dose IFN Gamma Treatment for Metastatic Renal Cell Carcinoma: Analysis of Factors Predicting Clinical Response and Long-Term Survival. Oncol Res Treat 2009. [DOI: 10.1159/000218614] [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: 11/19/2022]
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Davis J, Troncoso P, Ward J, Babaian R, Pettaway C, Pisters L, Kuban D, Logothetis C, Kim J, Brown V. POD-5.08: Active Surveillance for Clinically-Localized Prostate Cancer at a High Volume Tertiary Referral Center. Urology 2008. [DOI: 10.1016/j.urology.2008.08.109] [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]
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Mohler J, Babaian RJ, Bahnson RR, Boston B, D'Amico A, Eastham JA, Hauke RJ, Huben RP, Kantoff P, Kawachi M, Kuettel M, Lange PH, Logothetis C, MacVicar G, Pollack A, Pow-Sang JM, Roach M, Sandler H, Shrieve D, Srinivas S, Twardowski P, Urban DA, Walsh PC. Prostate cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2007; 5:650-83. [PMID: 17692170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Kim J, Tsavachidou D, Do K, Wen S, Babaian R, Pisters L, Pettaway C, Troncoso P, Logothetis C, McDonnell T. Differential gene expression in preoperative study of selenium and vitamin E chemoprevention in prostate cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1523] [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
1523 Background: To identify genes that distinguish between treatments, tumor types, and their interaction, we undertook a microarray analysis of tissue in a preoperative chemoprevention study of L-selenomethionine (SeMet) and vitamin E (VE) in prostate cancer. Methods: Forty-eight men with prostate cancer were enrolled in a single-institution, double-blind, placebo-controlled trial that randomized patients into four groups receiving 200 μg SeMet, 400 IU VE, a combination of the two, or placebo (see 2006 ASCO abstract 1007). All patients also received a multivitamin and vitamin C (250 mg) daily. Modeled on the Selenium and Vitamin E Cancer Prevention Trial, this study included patients scheduled for prostatectomy within 3 to 6 wk of registration who had a prostate-specific antigen level <10 ng/mL within 3 mo of registration, clinical stage T1c/T2 disease, and a Gleason score =7. From core biopsy specimens, we isolated cancerous and noncancerous cells, tumor-adjacent stroma, and non-tumor adjacent stroma of 38 evaluable radical prostatectomy specimens using laser capture microdissection. The cDNA hybridized to oligonucleotide microarrays was generated from extracted RNA, which had undergone two rounds of linear amplification. Expression levels were extracted using the positional-dependent nearest-neighbor model, and after ANOVA model analysis, effects were contrasted using the approximate z-test with statistic z. The beta-uniform mixture model was used to analyze p values and control the false discovery rate. Ingenuity Pathway Analysis followed. Results: Differentially expressed genes were selected that were common in the combination and selenium arms or in the combination and VE arms: unique in tumor-69 in combination and selenium, 71 in combination and VE; unique in stroma-64 in combination and selenium, 45 in combination and VE; unique in normal tissue-48 in combination and selenium, 38 in combination and VE. Conclusions: This work demonstrates that gene expression may be correlated with specific therapeutic interventions, and this analysis indicates that dietary antioxidants modulate gene expression in human prostate cancer cells and pathways relevant to prostate carcinogenesis. No significant financial relationships to disclose.
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Affiliation(s)
- J. Kim
- UT M. D. Anderson Cancer Center, Houston, TX
| | | | - K. Do
- UT M. D. Anderson Cancer Center, Houston, TX
| | - S. Wen
- UT M. D. Anderson Cancer Center, Houston, TX
| | - R. Babaian
- UT M. D. Anderson Cancer Center, Houston, TX
| | - L. Pisters
- UT M. D. Anderson Cancer Center, Houston, TX
| | - C. Pettaway
- UT M. D. Anderson Cancer Center, Houston, TX
| | - P. Troncoso
- UT M. D. Anderson Cancer Center, Houston, TX
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Mathew P, Pettaway C, Pisters L, Williams D, Troncoso P, Logothetis C. Preoperative platelet-derived growth factor receptor inhibitor therapy combined with docetaxel and androgen ablation in high-risk localized prostate cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5141] [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
5141 Background: Reduction in tumor interstitial fluid pressure with platelet-derived growth factor receptor (PDGFR) inhibitor therapy in experimental systems improves drug delivery and the therapeutic index of taxane chemotherapy (Pietras, Cancer Research, 2002). We hypothesized that PDGFR inhibitor therapy with imatinib mesylate combined with androgen ablation (AA) and docetaxel (D) induces pathological complete responses (pCR) in high-risk localized prostate adenocarcinoma (PC) prior to radical prostatectomy and pelvic lymph node dissection (RP). Methods: Thirty six men with PC ≥T2 disease or Gleason grade 8–10 or serum prostate-specific antigen (PSA) > 20 ng/ml or cT2b and PSA >10 ng/ml and Gleason 7 disease (AJCC, 1992), without radiological evidence of metastases, were planned to receive intramuscular leuprolide, imatinib 600mg orally daily, and weekly D 30 mg/m2 on D1, 8, 15, 22 q42 for three cycles (18 weeks) before RP [β (0.02, 1.98) prior on the possibility of pCR]. Unresectable pelvic nodal disease, post-operative PSA > 0.2 ng/ml or administration of post-operative radiation or AA were defined as treatment failure. Results: Between 6–03 and 9–04, 39 men were registered; median age 57 years (range, 44–71); 35 Caucasian, 2 Hispanic, 4 African-American. Risk factors included T3 disease (22/39), Gleason 8–10 disease (31/39), PSA > 20 ng/ml (12/39). Three men were ineligible or declined therapy; 29/36 (80%) received three cycles of therapy; 7/36 (20%) discontinued therapy related to toxicity. Grade 3–4 toxicity included rash (n=3), diarrhea (n=5), fatigue (n=3), neutropenia (n=2), hepatic (n=1). Severe or unexpected surgical complications were not encountered. No pCRs were defined; 15/36 (42%) have PSA < 0.2 ng/ml [12/36 (33%), <0.1 ng/ml] at 24 months and 13/36 (36%) met definition for treatment failure. Conclusions: The addition of the PDGFR inhibitor imatinib to pre-operative AA and D, although feasible, did not induce pCR in PC. [Table: see text]
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Affiliation(s)
- P. Mathew
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - C. Pettaway
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - L. Pisters
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D. Williams
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - P. Troncoso
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - C. Logothetis
- University of Texas MD Anderson Cancer Center, Houston, TX
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Motzer RJ, Bolger GB, Boston B, Carducci MA, Fishman M, Hancock SL, Hauke RJ, Hudes GR, Jonasch E, Kantoff P, Kuzel TM, Lange PH, Levine EG, Logothetis C, Margolin KA, Pohar K, Redman BG, Robertson CN, Samlowski WE, Sheinfeld J. Kidney Cancer. J Natl Compr Canc Netw 2006; 4:1072-81. [PMID: 17112454 DOI: 10.6004/jnccn.2006.0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An estimated 38,890 Americans will be diagnosed with kidney cancer and 12,840 will die of this disease in the United States in 2006. Renal cell carcinoma (RCC) constitutes approximately 2% of all malignancies, with a median age at diagnosis of 65 years. Smoking and obesity are among the risk factors for RCC development, and tumor grade, local extent of the tumor, presence of regional nodal metastases, and evidence of metastatic disease at presentation are the most important prognostic determinants of 5-year survival. These guidelines discuss evaluation, staging, treatment, and management after treatment.
For the most recent version of the guidelines, please visit NCCN.org
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Motzer RJ, Bolger GB, Boston B, Carducci MA, Fishman M, Hancock SL, Hauke RJ, Hudes GR, Jonasch E, Kantoff P, Kuzel TM, Lange PH, Levine EG, Logothetis C, Margolin KA, Pohar KS, Redman BG, Robertson CN, Samlowski WE, Sheinfeld J. Testicular Cancer. J Natl Compr Canc Netw 2006; 4:1038-58. [PMID: 17112452 DOI: 10.6004/jnccn.2006.0087] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An estimated 8250 new cases of testicular cancer will be diagnosed in the United States in 2006, with germ cell tumors (GCTs) constituting 95% of the malignant tumors arising in the testes. Although GCTs are relatively uncommon tumors, they are the most common solid tumor in men between the ages of 15 and 34 years. The worldwide incidence of these tumors has more than doubled in the past 40 years. More than 90% of all patients diagnosed with GCTs are cured, including 70% to 80% of patients with advanced tumors who are treated with chemotherapy. Standard therapy has been established at essentially all stages of management and must be closely followed to ensure the potential for cure.
For the most recent version of the guidelines, please visit NCCN.org
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Kim J, Wang X, Babaian R, Pisters L, Pettaway C, Wood C, Sabichi A, McDonnell T, Logothetis C, Troncoso P. A preoperative model evaluating the tissue effects of chemopreventive agents in low-volume prostate cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.1007] [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
1007 Background: To identify and assess biomarkers modulated by prostate cancer chemopreventive agents, we created a model that, by exploiting the time between histologic diagnosis of prostate cancer and definitive therapy (prostatectomy), expedites tissue cross comparison and confronts the multifocality and multizonal heterogeneity of prostate cancer. Methods: Between February 2001 and April 2002, 48 presurgical patients were enrolled in a single-institution, randomized, double-blind trial of vitamin E (VE) and L-selenomethionine (SeMET) based on the framework of the ongoing Selenium and Vitamin E Cancer Prevention Trial. Patients were treated with 400 IU VE, 200 μg SeMET, a combination of VE and SeMET, or placebo for 3 to 6 weeks before prostatectomy. All patients also received a multivitamin and vitamin C 250 mg each day. Ex vivo simulated sextant biopsies on the radical prostatectomy specimen (RPS) were performed, and 36 of 39 evaluable patients had RPS sections that were suitable for pathologic evaluation. Blood components were collected at baseline and prior to prostatectomy. We derived an apoptotic index (AI) morphologically and a proliferation index (PI) by using immunohistochemistry and counting Ki-67-positive nuclei. Cells were counted and identified by cell type (normal and cancerous) and by zone (peripheral [PZ], transition [TZ], and central [CZ]). Results: In normal epithelial cells when the Wilcoxon rank sum test was used to compare AI and PI changes between groups, the AI was higher in the TZ than in the CZ, a difference independent of treatment effects (p = .01). Between the largest PZ and TZ tumor foci, a statistically significant difference in PI was observed (p = .006). Using a multiple linear regression model fitted for AI from the largest RPS PZ tumor focus, we found a statistically significant difference between the SeMET group and the placebo group (p = .02). Conclusions: Besides introducing new findings, the clinicopathologic model proved itself a platform for biomarker discovery by leveraging molecular technologies to full advantage, including serum protein profiling (Kim et al., CEBP 2005) and gene expression profiling of different cell types. Supported by NIH grant CA88761. No significant financial relationships to disclose.
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Affiliation(s)
- J. Kim
- UT M. D. Anderson Cancer Center, Houston, TX
| | - X. Wang
- UT M. D. Anderson Cancer Center, Houston, TX
| | - R. Babaian
- UT M. D. Anderson Cancer Center, Houston, TX
| | - L. Pisters
- UT M. D. Anderson Cancer Center, Houston, TX
| | - C. Pettaway
- UT M. D. Anderson Cancer Center, Houston, TX
| | - C. Wood
- UT M. D. Anderson Cancer Center, Houston, TX
| | - A. Sabichi
- UT M. D. Anderson Cancer Center, Houston, TX
| | | | | | - P. Troncoso
- UT M. D. Anderson Cancer Center, Houston, TX
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Fizazi K, Hudes GR, Berry WR, Kelly WK, Eymard JC, Logothetis C, Le Maitre A, Pignon JP, Michiels S. A meta-analysis of individual patient data from randomized trials assessing chemotherapy with and without estramustine in patients with castration-refractory prostate cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4561 Background: Estramustine phosphate is a mustard-estradiol conjugate, with evidence of both hormonal and non-hormonal effects. In phase II trials, the response rates of microtubule inhibitors are increased when combined with estramustine. Morbidity includes notably thrombosis in about 7% of cases. Whether combining estramustine with chemotherapy increases survival in castration-refractory prostate cancer (CRPC) is still controversial. Methods: Data from all published and unpublished prospective randomized trials assessing chemotherapy + estramustine versus chemotherapy alone in CRPC were sought using electronic database searching, hand searching, and by contacting experts in the field. The primary endpoint was overall survival (OS). The analysis was performed on an intention-to-treat basis. The stratified logrank test was used and an overall hazard ratio (HR) was computed using a fixed effect model. χ2 heterogeneity tests were used to test for statistical heterogeneity. All p-values were two-sided. Multivariate analysis was performed using a Cox model stratified by trial. Results: Individual data were obtained from all 5 randomized trials conducted in the PSA era that had been identified (n = 610). The control arms consisted of docetaxel (1), paclitaxel (1), ixabepilone (1), and vinblastine (2). With a median follow-up of 2.8 years, 510 deaths had occurred. OS was significantly better in the estramustine arm (HR = 0.82 [95% CI: 0.69–0.97]; p = 0.02). Overall, the risk reduction (RR) of death related to estramustine was 18% (± 8). There was no significant interaction (p = 0.66) between the RR of trials using vinblastine (RR = 15% [± 12]) and in those using taxanes or ixabepilone (RR = 21% [± 11]). The estimated 1-year OS rate was 57% and 50% in the estramustine arm and in the control arm, respectively. The 18-months OS rate was 43% and 35%, respectively. There was no interaction between the effect of estramustine and age, performance status, or serum PSA in the Cox model. Conclusions: Combining estramustine with chemotherapy increases OS over chemotherapy alone in patients with castration-refractory prostate cancer. [Table: see text]
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Affiliation(s)
- K. Fizazi
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - G. R. Hudes
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - W. R. Berry
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - W. K. Kelly
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - J. C. Eymard
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - C. Logothetis
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - A. Le Maitre
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - J. P. Pignon
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
| | - S. Michiels
- Institut Gustave Roussy, Villejuif, France; Fox Chase Cancer Center, Philadelphia, PA; Cancer Centers of North Carolina, Cary, NC; Yale School of Medicine, New Haven, CT; Centre Jean Godinot, Reims, France; UT M. D. Anderson Cancer Center, Houston, TX
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Motzer RJ, Carducci MA, Fishman M, Hancock SL, Hauke RJ, Hudes GR, Kantoff P, Kuzel TM, Lange PH, Levine EG, Logothetis C, Margolin KA, Pili R, Pohar KS, Redman BG, Richey S, Robertson CN, Samlowski WE, Sheinfeld J, Urban DA. Kidney cancer. Clinical practice guidelines. J Natl Compr Canc Netw 2005; 3:84-93. [PMID: 19813325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Motzer RJ, Bahnson RR, Boston B, Carducci MA, Fishman M, Hancock SL, Hauke RJ, Hudes GR, Kantoff P, Kuzel TM, Lange PH, Levine EG, Logothetis C, Margolin KA, Redman BG, Richey S, Robertson CN, Samlowski WE, Sheinfeld J, Urban DA. Testicular cancer. Clinical practice guidelines. J Natl Compr Canc Netw 2005; 3:52-76. [PMID: 19813323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Millikan RE, Thall P, Pagliaro L, Williams D, Brown M, Logothetis C. Randomized, adaptive, phase II selection trial of four chemotherapy regimens in androgen independent prostate cancer (AIPC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - P. Thall
- M. D. Anderson Cancer Center, Houston, TX
| | | | | | - M. Brown
- M. D. Anderson Cancer Center, Houston, TX
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Mathew P, Yang J, Kim SJ, Fidler I, Bucana C, Troncoso P, Wang X, Thall P, Logothetis C, Navone N. Inhibition of functional osteoblasts with the platelet-derived growth factor receptor (PDGFR) inhibitor imatinib mesylate in androgen-independent prostate cancer (PCa). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. Mathew
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J. Yang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S.-J. Kim
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - I. Fidler
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - C. Bucana
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - P. Troncoso
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - X. Wang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - P. Thall
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - C. Logothetis
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - N. Navone
- University of Texas MD Anderson Cancer Center, Houston, TX
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Helbig M, Logothetis C, Dietz A, Bosch FX. Prognostische Betrachtung des Nasopharynxkarzinoms unter besonderer Berücksichtigung des Latenten Membranprotein 1 (LMP1). Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823505] [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: 10/19/2022]
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Millikan R, Dinney C, Swanson D, Sweeney P, Ro JY, Smith TL, Williams D, Logothetis C. Integrated therapy for locally advanced bladder cancer: final report of a randomized trial of cystectomy plus adjuvant M-VAC versus cystectomy with both preoperative and postoperative M-VAC. J Clin Oncol 2001; 19:4005-13. [PMID: 11600601 DOI: 10.1200/jco.2001.19.20.4005] [Citation(s) in RCA: 249] [Impact Index Per Article: 10.8] [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: 11/20/2022] Open
Abstract
PURPOSE We conducted a phase III trial to investigate the timing of chemotherapy with respect to surgery for patients with resectable but high-risk urothelial cancer. The trial was also designed to evaluate the accuracy of clinical staging in patients with locally advanced cancer and the prognostic significance of chemotherapy-induced downstaging. PATIENTS AND METHODS A total of 140 uniformly evaluated patients with locally advanced urothelial cancer were studied. Planned treatment was five cycles of chemotherapy (M-VAC: methotrexate, vinblastine, doxorubicin, and cisplatin) plus radical cystectomy and pelvic lymph node dissection. Patients were randomly assigned to receive either two courses of neoadjuvant M-VAC followed by surgery plus three additional cycles of chemotherapy, or, alternatively, to have initial cystectomy followed by five cycles of adjuvant chemotherapy. RESULTS There were no significant differences in outcome between the two groups. By intent-to-treat, 81 patients (58%) remain disease-free, with median follow-up of 6.8 years. We confirmed a high rate of clinical understaging in this cohort, especially among patients showing lymphovascular invasion on biopsy. Patients with no residual muscle-invasive disease at cystectomy after neoadjuvant chemotherapy were likely to be cured. CONCLUSION These results lend further support to the impression from small randomized trials that, in a high-risk cohort, there is an improved cure fraction by the combination of multiagent chemotherapy and surgery, although we found no preferred sequence. Importantly, it is possible to select appropriate patients for such therapy on the basis of clinical staging information. These results establish a benchmark of outcome for this cohort.
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Affiliation(s)
- R Millikan
- Center for Genitourinary Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Honda T, Gjertsen BT, Spurgers KB, Briones F, Lee SJ, Hobbs ML, Meyn RE, Roth JA, Logothetis C, McDonnell TJ. Restoration of bax in prostate cancer suppresses tumor growth and augments therapeutic cell death induction. Anticancer Res 2001; 21:3141-6. [PMID: 11848465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Cancer cells are characterized by multiple genetic defects which result in altered rates of cell division, cell death and ability to differentiate. These same molecular alterations may also contribute to therapeutic resistance. We examined the potential contribution of the pro-apoptotic gene, bax, to suppressing the growth of prostate cancer cells. MATERIALS AND METHODS The bax-deficient DU145 prostate cancer cell line was transfected with a hemagluttinin-tagged bax (HA-bax) vector to generate stable expressing bax clones. RESULTS Ha-bax clones exhibited a significant reduction in tumor growth compared to vector control and parental cells when xenografted into nude mice. HA-bax clones were significantly more sensitive to cell death induction by cis-diamminedichloroplatinum, etoposide, doxorubicin and gamma-radiation than vector control cells. Sensitivity to paclitaxel remained unaltered in the Ha-bax cells. CONCLUSION These findings suggest that bax may possess a tumor suppressor function in prostatic glandular epithelial cells and be an important determinant of sensitivity to therapeutic cell death induction.
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Affiliation(s)
- T Honda
- Department of Molecular Pathology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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Millikan R, Baez L, Banerjee T, Wade J, Edwards K, Winn R, Smith TL, Logothetis C. Randomized phase 2 trial of ketoconazole and ketoconazole/doxorubicin in androgen independent prostate cancer. Urol Oncol 2001; 6:111-115. [PMID: 11344001 DOI: 10.1016/s1078-1439(00)00123-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Eighty-nine patients with progressive prostate cancer despite suppression of testosterone and withdrawal of anti-androgens were studied. This was a relatively advanced population, with 63 of 89 having either osseous metastases (mets) beyond the axial skeleton or visceral mets. Patients were randomly assigned to receive either ketoconazole alone, or ketoconazole with weekly doxorubicin. All patients received replacement hydrocortisone. The primary endpoints were response and survival. Based on PSA reduction criteria (>/= 80% maintained for at least 8 weeks), 14 of 45 patients (31%) in the single-agent ketoconazole arm responded. Sixteen of 44 patients (36%) in the combination ketoconazole/doxorubicin arm responded. There were no important differences between the two treatments in any outcome measure. The median overall survival for all patients was 12.5 months; median time to progression was 3.3 months. Toxicity was significant with both regimens, and more severe in the doxorubicin arm. Fully 20% of patients in each arm discontinued therapy due to intolerable side effects.Each of these regimens is toxic, and produced responses in fewer than half of treated patients. Although the observed median survival does compare favorably with reports from similar cohorts treated in the community, the potential benefit is only modest. In our view, neither of these regimens is sufficiently promising to justify phase 3 evaluation.
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Affiliation(s)
- R Millikan
- Center for Genitourinary Oncology, Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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