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Bergmann L, Maute L, Heil G, Rüssel J, Weidmann E, Köberle D, Fuxius S, Weigang-Köhler K, Aulitzky WE, Wörmann B, Hartung G, Moritz B, Edler L, Burkholder I, Scheulen ME, Richly H. A prospective randomised phase-II trial with gemcitabine versus gemcitabine plus sunitinib in advanced pancreatic cancer: a study of the CESAR Central European Society for Anticancer Drug Research-EWIV. Eur J Cancer 2014; 51:27-36. [PMID: 25459392 DOI: 10.1016/j.ejca.2014.10.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is one of the most common malignant tumours and is still associated with a poor prognosis in advanced disease. To improve the standard therapy with gemcitabine, we initiated a prospective randomised phase-II trial with gemcitabine (GEM) versus gemcitabine plus sunitinib (SUNGEM) based on data of in vitro trials and phase-I data for the combination treatment. The rational of adding sunitinib was its putative antiangiogenic mechanism of action. METHODS A total of 106 eligible patients with locally advanced, unresectable or metastatic PDAC without previous system therapy were randomised to receive GEM at a dosage of 1.000mg/m(2) d1, 8, 15 q28 versus a combination of SUNGEM at a dosage of GEM 1.000mg/m(2) d1+8 and sunitinib 50mg p.o. d1-14, q21d. The primary end-point was progression free survival (PFS), secondary end-points were overall survival (OS), toxicity and overall response rate (ORR). RESULTS The confirmatory analysis of PFS was based on the intend-to-treat (ITT) population (N=106). The median PFS was 13.3 weeks (95% confidence interval (95%-CI): 10.4-18.1 weeks) for GEM and 11.6 weeks for SUNGEM (95%-CI: 7.0-18.0 weeks; p=0.78 one-sided log-rank). The ORR was 6.1% (95%-CI: 0.7-20.2%) for GEM and for 7.1% (95%-CI: 0.9-23.5%) for SUNGEM (p=0.87). The median time to progression (TTP) was 14.0 weeks (95%-CI: 12.4-22.3 weeks) for GEM and 18.0 weeks (95%-CI: 11.3-19.3 weeks) for SUNGEM (p=0.60; two-sided log-rank). The median OS was 36.7 weeks (95%-CI: 20.6-49.0 weeks) for the GEM arm and 30.4 weeks (95%-CI: 18.1-37.6 weeks) for the SUNGEM (p=0.78, one-sided log-rank). In regard to toxicities, suspected SAEs were reported in 53.7% in the GEM arm and 71.2% in the SUNGEM arm. Grade 3 and 4 neutropenia was statistically significantly higher in the SUNGEM arm with 48.1% versus 27.8% in the GEM arm (p=0.045, two sided log-rank). CONCLUSIONS The combination SUNGEM was not sufficient superior in locally advanced or metastatic PDAC compared to GEM alone in regard to efficacy but was associated with more toxicity.
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Affiliation(s)
- L Bergmann
- Medical Clinic II, University Hospital Frankfurt, Frankfurt/Main, Germany.
| | - L Maute
- Medical Clinic II, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - G Heil
- Klinik für Hämatologie und Onkologie, Märkische Kliniken Lüdenscheid, Lüdenscheid, Germany
| | - J Rüssel
- Department of Oncology and Hematology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - E Weidmann
- Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt/Main, Germany
| | - D Köberle
- Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - S Fuxius
- Onkologische Schwerpunktpraxis, Heidelberg, Germany
| | | | - W E Aulitzky
- Hämatologie, Onkologie, Klinische Immunologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - B Wörmann
- Medizinisches Versorgungszentrum Onkologie, Charité - Campus Virchow-Klinikum, Berlin, Germany
| | - G Hartung
- Onkologische Schwerpunktpraxis, Groß-Gerau, Germany
| | - B Moritz
- CESAR Central European Society for Anticancer Drug Research-EWIV, Vienna, Austria
| | - L Edler
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - I Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbruecken, Germany
| | - M E Scheulen
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - H Richly
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Mueller F, Büchel B, Köberle D, Schürch S, Pfister B, Krähenbühl S, Froehlich TK, Largiader CR, Joerger M. Gender-specific elimination of continuous-infusional 5-fluorouracil in patients with gastrointestinal malignancies: results from a prospective population pharmacokinetic study. Cancer Chemother Pharmacol 2012; 71:361-70. [PMID: 23139054 DOI: 10.1007/s00280-012-2018-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 10/21/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study was initiated to assess the quantitative impact of patient anthropometrics and dihydropyrimidine dehydrogenase (DPYD) mutations on the pharmacokinetics (PK) of 5-fluorouracil (5FU) and to explore limited sampling strategies of 5FU. PATIENTS AND METHODS We included 32 patients with gastrointestinal malignancies, receiving 46-h continuous-infusional 5FU and performed PK-sampling at baseline, 15, 30, 45 min, 1 and 2 h after the start of infusion and at the end of infusion, for 2 subsequent cycles. Plasma concentrations of 5FU, 5-fluorodihydrouracil (5FUH2), uracil (U) and 5,6-dihydrouracil (UH2) were determined using LC-MS/MS and submitted to population PK analysis using nonlinear mixed-effects modeling. Broad genotyping of DPYD was performed, and the potential impact of the DPYD genotype on the elimination of 5FU was assessed. Limited sampling strategies were evaluated for their accuracy to predict steady-state concentrations of 5FU (CSS(5FU)), using data simulations based on the final PK-model. RESULTS The area-under-the concentration-time curve of 5FU (AUC(5FU)) was found to be <20 mg h/L in 33 occasions (58 %), between 20 and 30 mg h/L in 17 occasions (30 %) and >30 mg h/L in 7 occasions (12 %). Men had a 26 % higher elimination of 5FU and a 18 % higher apparent elimination of 5FUH2. Accordingly, women had a higher AUC(5FU) compared to men (22 vs. 18 mg h/L, p = 0.04). No DPYD risk variants were found, and the DPYD variants detected (c.496A>G, c.1601G>A, c.1627A>G) were not significantly associated with the elimination of 5FU. Individual baseline UH(2)/U ratio was significantly associated with AUC(5FU) (R = -0.49, p < 0.001). Limited sampling strategies with time-points <3 h after the start of infusion were not adequate to predict CSS(5FU). Female gender was the only predictor of nausea/emesis in the multivariate model. CONCLUSIONS Gender-specific elimination of 5FU is supported by the present data and may partly explain the gender-specific association between DPYD risk variants and 5FU-specific toxicity.
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Affiliation(s)
- F Mueller
- Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland
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Perey L, Paridaens R, Hawle H, Zaman K, Nolé F, Wildiers H, Fiche M, Dietrich D, Clément P, Köberle D, Goldhirsch A, Thürlimann B. Clinical benefit of fulvestrant in postmenopausal women with advanced breast cancer and primary or acquired resistance to aromatase inhibitors: final results of phase II Swiss Group for Clinical Cancer Research Trial (SAKK 21/00). Ann Oncol 2006; 18:64-69. [PMID: 17030543 DOI: 10.1093/annonc/mdl341] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and tolerability of fulvestrant, an estrogen receptor antagonist, in postmenopausal women with hormone-responsive tumors progressing after aromatase inhibitor (AI) treatment. PATIENTS AND METHODS This is a phase II, open, multicenter, noncomparative study. Two patient groups were prospectively considered: group A (n=70) with AI-responsive disease and group B (n=20) with AI-resistant disease. Fulvestrant 250 mg was administered as intramuscular injection every 28 (+/-3) days. RESULTS All patients were pretreated with AI and 84% also with tamoxifen or toremifene; 67% had bone metastases and 45% liver metastases. Fulvestrant administration was well tolerated and yielded a clinical benefit (CB; defined as objective response or stable disease [SD] for >or=24 weeks) in 28% (90% confidence interval [CI] 19% to 39%) of patients in group A and 37% (90% CI 19% to 58%) of patients in group B. Median time to progression (TTP) was 3.6 (95% CI 3.0 to 4.8) months in group A and 3.4 (95% CI 2.5 to 6.7) months in group B. CONCLUSIONS Overall, 30% of patients who had progressed following prior AI treatment gained CB with fulvestrant, thereby delaying indication to start chemotherapy. Prior response to an AI did not appear to be predictive for benefit with fulvestrant.
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Affiliation(s)
- L Perey
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R Paridaens
- Department of General Medical Oncology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven, Belgium
| | - H Hawle
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - K Zaman
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland.
| | - F Nolé
- Unit for Medical Care, Department of Medicine, European Institute of Oncology, Milan, Italy
| | - H Wildiers
- Department of General Medical Oncology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven, Belgium
| | - M Fiche
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D Dietrich
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - P Clément
- Department of General Medical Oncology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven, Belgium
| | - D Köberle
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - A Goldhirsch
- Unit for Medical Care, Department of Medicine, European Institute of Oncology, Milan, Italy
| | - B Thürlimann
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
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Steinbild S, Mross K, Morant D, Köberle D, Dittrich C, Strumberg D, Hochhaus A, Hanauske A, Burkholder I, Scheulen ME. Phase II study of Sorafenib (BAY 43–9006) in hormone-refractory patients with prostate cancer: A study of the Central European Society for Anticancer Drug Research—EWIV (CESAR). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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
3094 Background: Sorafenib (BAY 43–9006) is a novel, orally active multi-kinase inhibitor with anti-angiogenic and anti-proliferative activity, blocking both Raf/MEK/ERK pathway and receptor tyrosine kinases VEGFR-2 and PDGFR. Activity of sorafenib in hormone-refractory progressive patients (pts) with prostate cancer (PC) was investigated in a Phase II clinical study. Methods: Pts received sorafenib 400 mg bid by continuous oral dosing. Pts with progressive disease during hormonal treatment and no prior chemotherapy therapy for advanced prostate cancer, and either one uni-dimensional measurable lesion according to RECIST-criteria or increasing PSA values reflecting a hormone-refractory situation, were eligible for study entry. Tumor PSA-based response was defined as: increase of PSA from baseline or lowest measured value by 100% = progressive disease (PD); decrease of PSA by >50% in two consecutive measurements = responder; PSA levels in between the two definitions above = stable disease (SD). Primary study objective was the proportion of patients with time to progression of ≥12 weeks (PP-TTP-12) using target lesions and PSA based response evaluation. At least 45 evaluable pts were required to detect an increase in PP-TTP-12 from 20 to 40% in a one stage design. Secondary endpoints were overall response and survival, and toxicity according to Common Toxicity Criteria (CTC v3.0). Results: A total of 55 pts with PC were enrolled between October 2004 and June 2005. The majority of pts (40/55, 72.7%) were treated for at least 6 weeks. Among the 42 pts evaluable for PP-TTP-12, 2 pts (4.8%) had a response and 15 pts (35.7 %) showed SD ≥12 weeks and 25 pts (59.5 %) showed PD. The one-sided binomial test of the null-hypthesis of PP-TTP-12 = 20% can be rejected at a significance level of 5% (p= 0.0019). All 55 pts were included in the evaluation of adverse events. Drug-related serious adverse events (diarrhea (1), constipation (1), fatigue (1), skin (1) cardiac (2) were seen in six patients. Conclusions: These results of a PSA-based evaluation indicate that sorafenib has some clinically useful activity in PC. Further investigations are necessary to evaluate the clinical benefit. Final results will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- S. Steinbild
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - K. Mross
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - D. Morant
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - D. Köberle
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - C. Dittrich
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - D. Strumberg
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - A. Hochhaus
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - A. Hanauske
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - I. Burkholder
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
| | - M. E. Scheulen
- Tumor Biology Center, Freiburg, Germany; Center for Tumordiagnostics and Prevention, St. Gallen, Switzerland; LBI-ACR, Vienna, Austria; Marienhospital, Herne, Germany; Department of Internal Medicine, Mannheim, Germany; German Cancer Research Center, Heidelberg, Germany; West German Cancer Center, Essen, Germany
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