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Schmoll HJ, Mann J, Meinert F, Garlipp B, Borchert K, Vogel A, Goekkurt E, Kaiser U, Hoeffkes HG, Rüssel J, Kanzler S, Edelmann T, Forstbauer H, Göhler T, Hannig C, Hildebrandt B, Roll C, Bokemeyer C, Steighardt J, Cygon F, Ibach S, Stein A, Tintelnot J. Efficacy and quality of life for FOLFOX/bevacizumab +/- irinotecan in first-line metastatic colorectal cancer-final results of the AIO CHARTA trial. Br J Cancer 2024; 130:233-241. [PMID: 37996507 PMCID: PMC10803799 DOI: 10.1038/s41416-023-02496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND FOLFOXIRI plus bevacizumab has demonstrated benefits for metastatic colorectal cancer (mCRC) patients. However, challenges arise in its clinical implementation due to expected side effects and a lack of stratification criteria. METHODS The AIO "CHARTA" trial randomised mCRC patients into clinical Group 1 (potentially resectable), 2 (unresectable/risk of rapid progression), or 3 (asymptomatic). They received FOLFOX/bevacizumab +/- irinotecan. The primary endpoint was the 9-month progression-free survival rate (PFSR@9). Secondary endpoints included efficacy in stratified groups, QoL, PFS, OS, ORR, secondary resection rate, and toxicity. RESULTS The addition of irinotecan to FOLFOX/bevacizumab increased PFSR@9 from 56 to 67%, meeting the primary endpoint. The objective response rate was 61% vs. 69% (P = 0.21) and median PFS was 10.3 vs. 12 months (HR 0.83; P = 0.17). The PFS was (11.4 vs. 12.9 months; HR 0.83; P = 0.46) in potentially resectable patients, with a secondary resection rate of 37% vs. 51%. Moreover, Group 3 (asymptomatic) patients had a PFS of 11.1 vs. 16.1 months (HR 0.6; P = 0.14). The addition of irinotecan did not diminish QoL. CONCLUSION The CHARTA trial, along with other studies, confirms the efficacy and tolerability of FOLFOXIRI/bevacizumab as a first-line treatment for mCRC. Importantly, clinical stratification may lead to its implementation. TRIAL REGISTRATION The trial was registered as NCT01321957.
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Affiliation(s)
- Hans-Joachim Schmoll
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Julia Mann
- Department of Medicine, Hematology and BMT with section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Meinert
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Benjamin Garlipp
- Department for Surgery, Oberhavel Kliniken Oranienburg, Oranienburg, Germany
| | - Kersten Borchert
- Clinic for Oncology/Hematology Klinikum Magdeburg, Magdeburg, Germany
| | - Arndt Vogel
- Clinic for Gastroenterology, Medical University Hannover, Hannover, Germany
| | - Eray Goekkurt
- Department of Medicine, Hematology and BMT with section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Kaiser
- Clinic for Hematology/Oncology, St. Bernward Krankenhaus, Hildesheim, Germany
| | | | - Jörn Rüssel
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Stephan Kanzler
- Medical Clinic II, Leopoldina Clinic Schweinfurt, Schweinfurt, Germany
| | | | | | | | | | - Bert Hildebrandt
- Clinic for Gastroenterology, Hematology and Medical Oncology, Klinikum Barnim, Eberswalde, Germany
| | - Carsten Roll
- Clinic for Oncology/Hematology Klinikum Magdeburg, Magdeburg, Germany
| | - Carsten Bokemeyer
- Department of Medicine, Hematology and BMT with section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Steighardt
- Coordination Center for Clinical Trials Halle, Medical Faculty, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Franziska Cygon
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Stefan Ibach
- X-act Cologne Clinical Research GmbH, Köln, Germany
| | - Alexander Stein
- Department of Medicine, Hematology and BMT with section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joseph Tintelnot
- Department of Medicine, Hematology and BMT with section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Ou FS, Ahn DH, Dixon JG, Grothey A, Lou Y, Kasi PM, Hubbard JM, Van Cutsem E, Saltz LB, Schmoll HJ, Goldberg RM, Venook AP, Hoff P, Douillard JY, Hecht JR, Hurwitz H, Punt CJA, Koopman M, Bokemeyer C, Fuchs CS, Diaz-Rubio E, Tebbutt NC, Cremolini C, Kabbinavar FF, Bekaii-Saab T, Chibaudel B, Yoshino T, Zalcberg J, Adams RA, de Gramont A, Shi Q. Evaluation of Intratumoral Response Heterogeneity in Metastatic Colorectal Cancer and Its Impact on Patient Overall Survival: Findings from 10,551 Patients in the ARCAD Database. Cancers (Basel) 2023; 15:4117. [PMID: 37627145 PMCID: PMC10452983 DOI: 10.3390/cancers15164117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Metastatic colorectal cancer (mCRC) is a heterogeneous disease that can evoke discordant responses to therapy among different lesions in individual patients. The Response Evaluation Criteria in Solid Tumors (RECIST) criteria do not take into consideration response heterogeneity. We explored and developed lesion-based measurement response criteria to evaluate their prognostic effect on overall survival (OS). PATIENTS AND METHODS Patients enrolled in 17 first-line clinical trials, who had mCRC with ≥ 2 lesions at baseline, and a restaging scan by 12 weeks were included. For each patient, lesions were categorized as a progressing lesion (PL: > 20% increase in the longest diameter (LD)), responding lesion (RL: > 30% decrease in LD), or stable lesion (SL: neither PL nor RL) based on the 12-week scan. Lesion-based response criteria were defined for each patient as follows: PL only, SL only, RL only, and varied responses (mixture of RL, SL, and PL). Lesion-based response criteria and OS were correlated using stratified multivariable Cox models. The concordance between OS and classifications was measured using the C statistic. RESULTS Among 10,551 patients with mCRC from 17 first-line studies, varied responses were noted in 51.6% of patients, among whom, 3.3% had RL/PL at 12 weeks. Among patients with RL/SL, 52% had stable disease (SD) by RECIST 1.1, and they had a longer OS (median OS (mOS) = 19.9 months) than those with SL only (mOS = 16.8 months, HR (95% CI) = 0.81 (0.76, 0.85), p < 0.001), although a shorter OS than those with RL only (mOS = 25.8 months, HR (95% CI) = 1.42 (1.32, 1.53), p < 0.001). Among patients with SL/PL, 74% had SD by RECIST 1.1, and they had a longer OS (mOS = 9.0 months) than those with PL only (mOS = 8.0 months, HR (95% CI) = 0.75 (0.57, 0.98), p = 0.040), yet a shorter OS than those with SL only (mOS = 16.8 months, HR (95% CI) = 1.98 (1.80, 2.18), p < 0.001). These associations were consistent across treatment regimen subgroups. The lesion-based response criteria showed slightly higher concordance than RECIST 1.1, although it was not statistically significant. CONCLUSION Varied responses at first restaging are common among patients receiving first-line therapy for mCRC. Our lesion-based measurement criteria allowed for better mortality discrimination, which could potentially be informative for treatment decision-making and influence patient outcomes.
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Affiliation(s)
- Fang-Shu Ou
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel H Ahn
- Division of Medical Oncology, Mayo Clinic, Phoenix, AZ 85259, USA
| | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Axel Grothey
- West Cancer Center, University of Tennessee, Memphis, TN 38104, USA
| | - Yiyue Lou
- Vertex Pharmaceuticals, Boston, MA 02210, USA
| | - Pashtoon M Kasi
- Division of Hematology and Oncology, University of Iowa, Iowa City, IA 52242, USA
| | | | - Eric Van Cutsem
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, 3000 Leuven, Belgium
| | - Leonard B Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hans-Joachim Schmoll
- Department of Internal Medicine, Clinic for Internal Medicine IV, Martin-Luther-University Halle/Saale, 06120 Halle, Germany
| | - Richard M Goldberg
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Alan P Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA 94143, USA
| | - Paulo Hoff
- Department of Clinical Oncology, University of Sao Paulo, Sao Paulo 05508-010, Brazil
| | - Jean-Yves Douillard
- Department of Medical Oncology, University of Nantes Medical School, 44035 Nantes, France
| | | | - Herbert Hurwitz
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
| | - Cornelis J A Punt
- Julius Center, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | - Eduardo Diaz-Rubio
- Department of Oncology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Niall C Tebbutt
- Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Richard A Adams
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
- Velindre Cancer Center, Velindre NHS Trust, Cardiff CF14 2TL, UK
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
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Sur D, Lungulescu C, Dumitrescu EA, Afrăsânie V, Spînu Ș, Lungulescu CV, Schmoll HJ. A systematic review of clinical trials of treatment regimens in HER2-amplified metastatic colorectal cancer. Expert Rev Anticancer Ther 2023; 23:633-641. [PMID: 37127555 DOI: 10.1080/14737140.2023.2207830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Targeting HER2 has led to a revolution in therapy for cancers such as breast and gastric cancer, HER2 amplification is rarer (just 2-6%) in colorectal cancer (CRC) and efforts to target this receptor have lagged. Despite recent FDA approval for the first directed therapy combination for HER2 amplified metastatic CRC, the EMA has not yet authorized any such treatment and this represents a persistent unmet need in Europe and beyond. Here, we review data from trials targeting HER2 amplification, the latest target for CRC therapy. AREAS COVERED PubMed, Cochrane Library, EMBASE, and clinicaltrials.gov were reviewed systematically for possible manuscripts from inception to 1 July 2022. Results: A total of seven studies comprised of 284 locally advanced/mCRC patients receiving HER2 targeting agents were included in this systematic review. Most of the studies (n = 5) were non-randomized phase 2 trials, one phase 2/3 randomized controlled trial, and one phase 2a multiple-basket study. The outcomes consisted in the analysis of HER2 targeting agents and ORR, PFS, OS benefit, and toxicities of the therapy. EXPERT OPINION Anti-HER2 therapy exhibits a favorable toxicity profile compared with other targeted approaches; however, there is work to be done on optimizing patient selection and understanding resistance mechanisms.
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Affiliation(s)
- Daniel Sur
- 11th Department of Medical Oncology, University of Medicine and Pharmacy" Iuliu Hațieganu", Cluj-Napoca, Romania
| | - Cristina Lungulescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Elena Adriana Dumitrescu
- Department of Medical Oncology, The Oncology Institute"Prof. Dr. Alexandru Trestioreanu", Bucharest, Romania
| | - Vlad Afrăsânie
- University of Medicine and Pharmacy"Grigore T. Popa", Iași, Romania
| | - Ștefan Spînu
- Department of Medical Oncology, The Oncology Institute "Prof. Dr. Ion Chiricuţă", Cluj-Napoca, Romania
| | | | - Hans-Joachim Schmoll
- Department of Hematology/Oncology, Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University Halle-Wittenberg Germany
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Ducreux M, Tabernero J, Grothey A, Arnold D, O'Dwyer PJ, Gilberg F, Abbas A, Thakur MD, Prizant H, Irahara N, Tahiri A, Schmoll HJ, Van Cutsem E, de Gramont A. Clinical and exploratory biomarker findings from the MODUL trial (Cohorts 1, 3 and 4) of biomarker-driven maintenance therapy for metastatic colorectal cancer. Eur J Cancer 2023; 184:137-150. [PMID: 36921494 DOI: 10.1016/j.ejca.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE MODUL is an adaptable, signal-seeking trial of biomarker-driven maintenance therapy following first-line induction treatment in patients with metastatic colorectal cancer (mCRC). We report findings from Cohorts 1 (BRAFmut), 3 (human epidermal growth factor 2 [HER2]+) and 4 (HER2‒/high microsatellite instability, HER2‒/microsatellite stable [MSS]/BRAFwt or HER2‒/MSS/BRAFmut/RASmut). METHODS Patients with unresectable, previously untreated mCRC without disease progression following standard induction treatment (5-fluorouracil/leucovorin [5-FU/LV] plus oxaliplatin plus bevacizumab) were randomly assigned to control (fluoropyrimidine plus bevacizumab) or cohort-specific experimental maintenance therapy (Cohort 1: vemurafenib plus cetuximab plus 5-FU/LV; Cohort 3: capecitabine plus trastuzumab plus pertuzumab; Cohort 4: cobimetinib plus atezolizumab). The primary efficacy end-point was progression-free survival (PFS). RESULTS Cohorts 1, 3 and 4 did not reach target sample size because of early study closure. In Cohort 1 (n = 60), PFS did not differ between treatment arms (hazard ratio, 0.95; 95% confidence intervals 0.50-1.82; P = 0.872). However, Cohort 1 exploratory biomarker data showed preferential selection for mitogen-activated protein kinase (MAPK) pathway mutations (mainly KRAS, NRAS, MAP2K1 or BRAF) in the experimental arm but not the control arm. In Cohort 3 (n = 5), PFS ranged from 3.6 to 14.7 months versus 4.0 to 5.4 months in the experimental and control arms, respectively. In Cohort 4 (n = 99), PFS was shorter in the experimental arm (hazard ratio, 1.44; 95% confidence intervals 0.90-2.29; P = 0.128). CONCLUSIONS Vemurafenib plus cetuximab plus 5-FU/LV warrants further investigation as first-line maintenance treatment for BRAFmut mCRC. MAPK-pathway emergent genomic alterations may offer novel therapeutic opportunities in BRAFmut mCRC. Cobimetinib plus atezolizumab had an unfavourable benefit:risk ratio in HER2‒/MSS/BRAFwt mCRC. New strategies are required to increase the susceptibility of MSS mCRC to immunotherapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT02291289.
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Affiliation(s)
- Michel Ducreux
- Université Paris-Saclay, Gustave Roussy, Villejuif, France.
| | - Josep Tabernero
- Vall D'Hebron Hospital Campus and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain.
| | | | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany.
| | - Peter J O'Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | - Hen Prizant
- F. Hoffmann-La Roche Ltd, Basel, Switzerland.
| | | | | | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium.
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Goldberg RM, Adams R, Buyse M, Eng C, Grothey A, André T, Sobrero AF, Lichtman SM, Benson AB, Punt CJA, Maughan T, Burzykowski T, Sommeijer D, Saad ED, Shi Q, Coart E, Chibaudel B, Koopman M, Schmoll HJ, Yoshino T, Taieb J, Tebbutt NC, Zalcberg J, Tabernero J, Van Cutsem E, Matheson A, de Gramont A. Clinical Trial Endpoints in Metastatic Cancer: Using Individual Participant Data to Inform Future Trials Methodology. J Natl Cancer Inst 2022; 114:819-828. [PMID: 34865086 PMCID: PMC9194619 DOI: 10.1093/jnci/djab218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Meta-analysis based on individual participant data (IPD) is a powerful methodology for synthesizing evidence by combining information drawn from multiple trials. Hitherto, its principal application has been in questions of clinical management, but an increasingly important use is in clarifying trials methodology, for instance in the selection of endpoints, as discussed in this review. In oncology, the Aide et Recherche en Cancérologie Digestive (ARCAD) Metastatic Colorectal Cancer Database is a leader in the use of IPD-based meta-analysis in methodological research. The ARCAD database contains IPD from more than 38 000 patients enrolled in 46 studies and continues to collect phase III trial data. Here, we review the principal findings of the ARCAD project in respect of endpoint selection and examine their implications for cancer trials. Analysis of the database has confirmed that progression-free survival (PFS) is no longer a valid surrogate endpoint predictive of overall survival in the first-line treatment of colorectal cancer. Nonetheless, PFS remains an endpoint of choice for most first-line trials in metastatic colorectal cancer and other solid tumors. Only substantial PFS effects are likely to translate into clinically meaningful benefits, and accordingly, we advocate an oncology research model designed to identify highly effective treatments in carefully defined patient groups. We also review the use of the ARCAD database in assessing clinical response including novel response metrics and prognostic markers. These studies demonstrate the value of IPD as a tool for methodological studies and provide a reference point for the expansion of this approach within clinical cancer research.
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Affiliation(s)
| | | | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Hasselt University, Hasselt, Belgium
| | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Axel Grothey
- West Cancer Center and Research Institute, Germantown, TN, USA
| | | | | | | | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | | - Tim Maughan
- Gray Institute of Radiation Oncology and Biology, University of Oxford, UK
| | - Tomasz Burzykowski
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Hasselt University, Hasselt, Belgium
| | - Dirkje Sommeijer
- University of Amsterdam Academic Medical Centre and Flevohospital, Almere, the Netherlands
| | - Everardo D Saad
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Dendrix Research, Sao Paulo, Brazil
| | | | - Elisabeth Coart
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | | | | | | | | | - Julien Taieb
- Georges Pompidou European Hospital, Paris, France
| | | | - John Zalcberg
- Monash University, School of Public Health, Australia
| | - Josep Tabernero
- Vall d’Hebron Hospital Campus and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Aimery de Gramont
- Hôpital Franco-Britannique, Paris, France
- Fondation ARCAD , Paris, France
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6
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Cohen R, Raeisi M, Yothers G, Schmoll HJ, Haller DG, Bachet JB, Chibaudel B, Wolmark N, Yoshino T, Goldberg RM, Kerr R, Lonardi S, George TJ, Shmueli ES, Sharara L, Andre T, Shi Q, De Gramont A. Using T stage to predict outcomes of adjuvant oxaliplatin (OX)-based chemotherapy (CT) in stage III colon cancer (CC): An ACCENT pooled analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3606] [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
3606 Background: Standard adjuvant CT for stage III CC are FOLFOX and CAPOX. Recently, IDEA study separated stage III patients (pts) into low risk (T1 to 3, N1) and high risk (T4 or N2). We recently confirmed benefit of OX in both risk groups. However, we observed a difference in the two high-risk subgroups, with benefit in N2 but not in T4 (Margalit O et al; Clin Colorectal Cancer 2021). This prompted us to compare outcomes (OS/TTR) between treatment with OX vs. without OX within sub-stage III CC groups defined by T and N. Methods: We pooled 4941 stage III CC pts from the three studies evaluating 6 months of CT with fluoropyrimidine (FP) ± OX: MOSAIC, C-07 and XELOXA. Baseline characteristics were compared using χ2 and t-test. OS was compared between OX and no OX in T and N subgroups. Kaplan-Meier analyses, adjusted and unadjusted Cox models stratified by study were used. Sub-groups classification was done according to OX benefit and verified by interaction test (Int) considered as significant with a P<0.1. We considered for recommendation of using OX-based adjuvant CT, 1) significant benefit in OS, 2) significant Int between substage and adjuvant therapy, and 3) the three individual trials showing similar results (benefit or non-benefit of OX). Results: In stage III population, T3 pts were 74.9%, T1-2 12.4%, T4 13.1%, while N stage was N1 64.7% and N2 35.3%. Population was well balanced according to treatment allocation in most subgroups. A significant benefit of OX was only observed in T3N1 and T3N2 (OS HR 0.76). Whatever N stage, there was no significant benefit of OX in the T1-2 and T4 subgroups. The effect of OX+FP vs FP alone in OS of the three studies differed between T3 and T1-2 subgroups (P = 0.047). Interaction was borderline between T3 and T4 subgroups (P = 0.10) but there was no interaction between T1-2 and T4 subgroups (P = 0.429). A benefit of OX in TTR remained in the T4 population. Discrepancy between advantage in time to relapse (TTR) and no advantage in OS was not explained by survival post relapse. Conclusions: Our analysis suggested that pts with T1-2N1-2 and T4N1-2 disease had no OS benefit of addition of OX to FP. The good survival achieved with FP alone in T1-2N1-2 pts (5-yr OS 89%) question the addition of OX. In the T4 population our results suggested that benefit of OX was limited and that further studies should assess this issue or at least stratify pts on T stage in the future adjuvant trials in CC. [Table: see text]
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Affiliation(s)
- Romain Cohen
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Morteza Raeisi
- Statistical Unit, Fondation A.R.CA.D - Aide et Recherche en CAncérologie Digestive, Levallois-Perret, France
| | - Greg Yothers
- The Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | | | - Daniel G. Haller
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jean-Baptiste Bachet
- Sorbonne University, Hepatogastroenterology and Digestive Oncology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Hospital, Fondation Cognacq-Jay, Levallois-Perret, France
| | - Norman Wolmark
- NRG Oncology and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Rachel Kerr
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Sara Lonardi
- Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Thomas J. George
- NRG Oncology, and The University of Florida Health Cancer Center, Gainesville, FL
| | - Einat Shacham Shmueli
- Cancer center, The Chaim Sheba Medical Center, Ramat Gan, Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Lama Sharara
- Fondation A.R.CA.D.-Aide et Recherche en Cancérologie Digestive, Levallois-Perret, France
| | - Thierry Andre
- Sorbonne University, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Hospital, Levallois-Perret, France
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7
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McCleary NJ, Harmsen WS, Haakenstad E, Cleary JM, Meyerhardt JA, Zalcberg J, Adams R, Grothey A, Sobrero AF, Van Cutsem E, Goldberg RM, Peeters M, Tabernero J, Seymour M, Saltz LB, Giantonio BJ, Arnold D, Rothenberg ML, Koopman M, Schmoll HJ, Pitot HC, Hoff PM, Tebbutt N, Masi G, Souglakos J, Bokemeyer C, Heinemann V, Yoshino T, Chibaudel B, deGramont A, Shi Q, Lichtman SM. Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials. JNCI Cancer Spectr 2022; 6:pkac014. [PMID: 35603849 PMCID: PMC8935011 DOI: 10.1093/jncics/pkac014] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/09/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We evaluated the time to progression (TTP) and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared with younger adults following progression on first-line clinical trials. METHODS Associations between clinical and disease characteristics, time to initial progression, and rate of receipt of second-line therapy were evaluated. TTP and overall survival (OS) were compared between older and younger adults in first- and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status, number of metastatic sites and presence of metastasis in the lung, liver, or peritoneum. All statistical tests were 2-sided. RESULTS Older adults comprised 16.4% of patients on first-line trials (870 total older adults aged >70 years; 4419 total younger adults aged ≤70 years, on first-line trials). Older adults and those with Eastern Cooperative Oncology Group Performance Status >0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio = 1.11, 95% confidence interval = 1.02 to 1.21, P = .01). Older and younger adults enrolled in second-line trials experienced similar median TTP and median OS (median TTP = 5.1 vs 5.2 months, respectively; median OS = 11.6 vs 12.4 months, respectively). CONCLUSIONS Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs younger adults following second-line therapy. Further study should examine factors affecting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.
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Affiliation(s)
- Nadine J McCleary
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William S Harmsen
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Ellana Haakenstad
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - James M Cleary
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Axel Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, TN, USA
| | | | | | - Richard M Goldberg
- West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Institute of Oncology Barcelona-Quiron, UVic-UCC, Barcelona, Spain
| | - Matt Seymour
- NIHR Clinical Research Network, Leeds, UK
- St. James’s Hospital and University of Leeds, Leeds, UK
| | | | - Bruce J Giantonio
- Perelman School of Medicine Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Dirk Arnold
- Instituto CUF de Oncologia, Lisbon, Portugal
- Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Urtrecht, Utrecht, Netherlands
| | - Hans-Joachim Schmoll
- Klinik fur Innere Med IV, University Clinic Halle (Saale), Halle, Germany
- Martin Luther University, Halle, Germany
| | - Henry C Pitot
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Paulo M Hoff
- Centro de Oncologia de Brasilia do Sirio Libanes-Unidade Lago Sul, Siro Libanes, Brazil
- Universidade de São Paulo Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Niall Tebbutt
- University of Sydney Medical School, Sydney, Australia
- Austin Health, Heidelberg, Victoria, Australia
| | - Gianluca Masi
- Department of Oncology, University of Pisa, Pisa, Italy
| | - John Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | | | - Volker Heinemann
- Department of Hematology/Oncology, Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Germany
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Institut Franco-Britannique, Levallois-Perret, France
| | - Aimery deGramont
- Department of Medical Oncology, Institut Franco-Britannique, Levallois-Perret, France
| | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
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8
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Jin Z, Dixon JG, Hubbard JM, Eng C, Lieu CH, Fiskum J, Saltz LB, Hurwitz HI, Venook AP, Schmoll HJ, Fuchs CS, Hecht JRR, Cremolini C, Diaz-Rubio E, Punt CJA, Tebbutt NC, Heinemann V, Yoshino T, De Gramont A, Shi Q. Efficacy of bevacizumab-based treatment in early-onset treatment-naïve metastatic colorectal cancer patients: An ARCAD database analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.101] [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
101 Background: Colorectal cancer (CRC) incidence and mortality have decreased since the 1970s, but the incidence in young adults (20-49 years, named early-onset CRC, eoCRC) has been increasing. eoCRC patients with metastatic disease are treated with the same standard regimens as late-onset CRC (loCRC, age ≥ 50 years) although detailed response data for eoCRC are largely missing. Methods: Individual patient data on 7,604 subjects with metastatic eoCRC from 11 first line randomized bevacizumab studies between 2000 and 2012 in the ARCAD advanced colorectal cancer database were pooled. The distributions of demographics, clinicopathological features, biomarkers, and outcome data were summarized by age groups. Progression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier curves and Cox models stratified by treatment arms within studies, adjusting for potential confounders. Predictive value of age group was evaluated by testing interaction effect between treatment and age variables. Results: Female eoCRC are more commonly seen compared to loCRC (46.8% vs. 38.7%, p<0.0001). Patients with eoCRC (n=1,289) were significantly more likely to have had prior metastasectomy (17.5% vs. 13.5%, p=0.043) and lung metastatic disease (67% vs. 59.8%, p<0.001), but less likely to have distant lymph node metastatic disease (58.8 vs. 62.9%, p=0.036) or KRAS mutation (29.2% vs. 34.4%, p=0.042) compared to those with loCRC (n=6,315). eoCRC and loCRC patients had similar distributions according to PS, primary tumor sidedness, prior primary tumor resection, liver involvement, peritoneal involvement, number of metastatic sites, NRAS and BRAF. Age of disease onset was not a statistically significant prognostic factor for PFS in univariate and multivariate analysis (seen in table). Bevacizumab in addition to chemo improved PFS in eoCRC population (9.9 vs. 6.8 months, HR = 0.66, p<0.001), which was similar to the findings in loCRC population (9.4 vs. 7.3 months, HR= 0.73, p<0.001, interaction p=0.54). By multivariate analysis, a greater improvement in PFS was noted for the addition of bevacizumab in eoCRC relative to LoCRC patients (HR = 0.62 vs. HR = 0.82). Conclusions: Treatment naive eoCRC patients with metastatic disease derive similar benefit from bevacizumab relative to their average age counterparts.[Table: see text]
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Affiliation(s)
| | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | - Jack Fiskum
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alan P. Venook
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Chiara Cremolini
- Azienda Ospedaliero Universitaria Pisana-Ospedale Santa Chiara, Pisa, Italy
| | | | - Cornelis J. A. Punt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Niall C. Tebbutt
- Olivia Newton-John Cancer, Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
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9
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Jin Z, Dixon JG, Fiskum JM, Parekh HD, Sinicrope FA, Yothers G, Allegra CJ, Wolmark N, Haller D, Schmoll HJ, de Gramont A, Kerr R, Taieb J, Van Cutsem E, Tweleves C, O’Connell M, Saltz LB, Sadahiro S, Blanke CD, Tomita N, Seitz JF, Erlichman C, Yoshino T, Yamanaka T, Marsoni S, Andre T, Mahipal A, Goldberg RM, George TJ, Shi Q. Clinicopathological and Molecular Characteristics of Early-Onset Stage III Colon Adenocarcinoma: An Analysis of the ACCENT Database. J Natl Cancer Inst 2021; 113:1693-1704. [PMID: 34405233 PMCID: PMC8634466 DOI: 10.1093/jnci/djab123] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Colon cancer (CC) incidence in young adults (age 20-49 years), termed early-onset CC (EO-CC), is increasing. METHODS Individual patient data on 35 713 subjects with stage III colon cancer from 25 randomized studies in the Adjuvant Colon Cancer ENdpoint database were pooled. The distributions of demographics, clinicopathological features, biomarker status, and outcome data were summarized by age group. Overall survival, disease-free survival, time to recurrence, and survival after recurrence were assessed by Kaplan-Meier curves and Cox models stratified by treatment arms within studies, adjusting for sex, race, body mass index, performance status, disease stage, grade, risk group, number of lymph nodes examined, disease sidedness, and molecular markers. All statistical tests were 2-sided. RESULTS Using a 5% difference between age groups as the clinically meaningful cutoff, patients with stage III EO-CC had similar sex, race, performance status, risk group, tumor sidedness, and T stage compared with patients with late-onset CC (age 50 years and older). EO-CC patients were less likely to be overweight (30.2% vs 36.2%) and more commonly had 12 or more lymph nodes resected (69.5% vs 58.7%). EO-CC tumors were more frequently mismatch repair deficient (16.4% vs 11.5%) and less likely to have BRAFV600E (5.6% vs 14.0%), suggesting a higher rate of Lynch syndrome in EO-CC. Patients with EO-CC had statistically significantly better overall survival (hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.74 to 0.89; P < .001), disease-free survival (HR = 0.91, 95% CI = 0.84 to 0.98; P = .01), and survival after recurrence (HR = 0.88, 95% CI = 0.80 to 0.97; P = .008) in the analysis without molecular markers; however, age at onset of CC lost its prognostic value when outcome was adjusted for molecular markers. CONCLUSION Tumor biology was found to be a more important prognostic factor than age of onset among stage III colon cancer patients in the Adjuvant Colon Cancer ENdpoint database.
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Affiliation(s)
- Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jack M Fiskum
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Hiral D Parekh
- Cancer Specialists of North Florida, Jacksonville, FL, USA
| | | | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen J Allegra
- Department of Medicine, Shands Cancer Center, University of Florida, Gainesville, FL, USA
| | | | - Daniel Haller
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hans-Joachim Schmoll
- Department of Internal Medicine IV-Hematology-Oncology, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Julien Taieb
- Sorbonne Paris Cité, Paris Descartes University Georges Pompidou European Hospital, Paris, France
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Christopher Tweleves
- University of Leeds and St. James’s Institute of Oncology, Tom Connors Cancer Research Center, University of Bradford, Bradford, UK
| | | | | | | | | | - Naohiro Tomita
- Cancer Treatment Center, Toyonaka Municipal Hospital, Toyonaka, Japan
| | | | | | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Kanagawa, Japan
| | | | - Thierry Andre
- Medical Oncology Department in St. Antoine Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Richard M Goldberg
- West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Thomas J George
- University of Florida, Health Cancer Center, Gainesville, FL, USA
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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10
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Yin J, Salem ME, Dixon JG, Jin Z, Cohen R, DeGramont A, Van Cutsem E, Taieb J, Alberts SR, Wolmark N, Schmoll HJ, Saltz LB, George TJ, Goldberg RRM, Kerr R, Lonardi S, Yoshino T, Yothers G, Grothey A, Andre T, Shi Q. Reevaluating Disease-Free Survival as an Endpoint vs Overall Survival in Stage III Adjuvant Colon Cancer Trials. J Natl Cancer Inst 2021; 114:60-67. [PMID: 34505880 PMCID: PMC8755492 DOI: 10.1093/jnci/djab187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Disease-free survival (DFS) with a 3-year median follow-up (3-year DFS) was validated as a surrogate for overall survival (OS) with a 5-year median follow-up (5-year OS) in adjuvant chemotherapy colon cancer (CC) trials. Recent data show further improvements in OS and survival after recurrence in patients who received adjuvant FOLFOX. Hence, reevaluation of the association between DFS and OS and determination of the optimal follow-up duration of OS to aid its utility in future adjuvant trials are needed. METHODS Individual patient data from 9 randomized studies conducted between 1998 and 2009 were included; 3 trials tested biologics. Trial-level surrogacy examining the correlation of treatment effect estimates of 3-year DFS with 5 to 6.5-year OS was evaluated using both linear regression (RWLS2) and Copula bivariate (RCopula2) models and reported with 95% confidence intervals (CIs). For R2, a value closer to 1 indicates a stronger correlation. RESULTS Data from a total of 18 396 patients were analyzed (median age = 59 years; 54.0% male), with 54.1% having low-risk tumors (T1-3 and N1), 31.6% KRAS mutated, 12.3% BRAF mutated, and 12.4% microsatellite instability high or deficient mismatch repair tumors. Trial-level correlation between 3-year DFS and 5-year OS remained strong (RWLS2 = 0.82, 95% CI = 0.67 to 0.98; RCopula2 = 0.92, 95% CI = 0.83 to 1.00) and increased as the median follow-up of OS extended. Analyses limited to trials that tested biologics showed consistent results. CONCLUSIONS Three-year DFS remains a validated surrogate endpoint for 5-year OS in adjuvant CC trials. The correlation was likely strengthened with 6 years of follow-up for OS.
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Affiliation(s)
- Jun Yin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Romain Cohen
- Department of Medical Oncology, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Aimery DeGramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and University of Leuven, Leuven, Belgium
| | - Julien Taieb
- Sorbonne Paris Cité, Paris Descartes University Georges Pompidou European Hospital, Paris, France
| | | | - Norman Wolmark
- Department of Clinical Trials, Alleghany Health Network, Pittsburgh, PA, USA
| | | | | | - Thomas J George
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Richard R M Goldberg
- West Virginia University Cancer Institute, the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Rachel Kerr
- Adjuvant Colorectal Cancer Group, University of Oxford, Oxford, UK
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IRCCS, Padova PD, Italy
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center, Tokyo, Japan
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Thierry Andre
- Department of Medical Oncology, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,Correspondence to: Qian Shi, PhD, Department of Quantitative Health Sciences, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA (e-mail: )
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11
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Yin J, Dawood S, Cohen R, Meyers J, Zalcberg J, Yoshino T, Seymour M, Maughan T, Saltz L, Van Cutsem E, Venook A, Schmoll HJ, Goldberg R, Hoff P, Hecht JR, Hurwitz H, Punt C, Diaz Rubio E, Koopman M, Cremolini C, Heinemann V, Tournigard C, Bokemeyer C, Fuchs C, Tebbutt N, Souglakos J, Doulliard JY, Kabbinavar F, Chibaudel B, de Gramont A, Shi Q, Grothey A, Adams R. Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis. Ther Adv Med Oncol 2021; 13:17588359211020547. [PMID: 34262614 PMCID: PMC8252342 DOI: 10.1177/17588359211020547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs). DESIGN Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions. RESULTS Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland (p = 0.0034 and p < 0.001, respectively), with median difference of 3-4 months. The survival deficits in the UK and Ireland cohorts were, at most, 15% at 1 year. No evidence of a regional disparity was observed for PFS. Among those treated without biological therapies, patients from the UK and Ireland had shorter OS than central Europe patients (p < 0.001). CONCLUSIONS Significant international disparities in the OS of cohorts of mCRC patients enrolled in RCTs were found. Survival of mCRC patients included in RCTs was consistently lower in the UK and Ireland regions than in central Europe, southern Europe, and the USA, potentially attributed to greater overall population representation, delayed diagnosis, and reduced availability of therapies.
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Affiliation(s)
- Jun Yin
- Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA
| | - Shaheenah Dawood
- Mediclinic City Hospital: North Wing, Dubai Health Care City, Dubai UAE
| | - Romain Cohen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeff Meyers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | | | - Tim Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Leonard Saltz
- Memory Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Alan Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA, USA
| | | | - Richard Goldberg
- Department of Oncology, West Virginia University, Morgantown, WV, USA
| | - Paulo Hoff
- Centro de Oncologia de Brasilia do Sirio Libanes: Unidade Lago Sul, Siro Libanes, Brazil
| | - J. Randolph Hecht
- Ronald Reagan UCLA Medical Center, UCLS Medical Center, Santa Monica, CA, USA
| | | | - Cornelis Punt
- Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany
| | | | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Niall Tebbutt
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Center, Cardiff, UK
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12
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Tabernero J, Grothey A, Arnold D, Ducreux M, O'Dwyer PJ, Perdicchio M, Abbas A, Das Thakur M, Irahara N, Tahiri A, Schmoll HJ, Van Cutsem E. Exploratory biomarker findings from cohort 2 of MODUL: An adaptable, phase 2, signal-seeking trial of fluoropyrimidine + bevacizumab ± atezolizumab maintenance therapy for BRAFwt metastatic colorectal cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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
3570 Background: MODUL is an adaptable, phase 2, signal-seeking trial testing novel agents as first-line therapy for predefined subgroups of patients with metastatic colorectal cancer (mCRC). Previously reported findings demonstrated that adding atezolizumab to fluoropyrimidine (FP)/bevacizumab as first-line maintenance treatment after induction with FOLFOX + bevacizumab did not improve efficacy outcomes in BRAFwt mCRC. Given these efficacy results, exploratory assessments on tumour samples were conducted to provide insights into factors that might affect efficacy of maintenance treatment and provide guidance on appropriate therapeutic strategies for BRAFwt mCRC. Methods: In patients with BRAFwt tumours (Cohort 2), experimental treatment was FP/bevacizumab + atezolizumab. Primary efficacy endpoint: progression-free survival (PFS). Overall survival (OS) was a secondary endpoint. Archival tissue samples from 104 patients were analysed by immunohistochemistry (IHC) at HistoGeneX (PD-L1; CD8/GrB/FoxP3). SP142 antibody was used for PD-L1 IHC analysis, which evaluated PD-L1low (IC 0–1) vs PD-L1high (IC > 1) in correlation with PFS and OS in the control and experimental arms. CD8/GrB/FoxP3 triplex staining was also performed to evaluate potential correlations with efficacy. Results: 445 patients with BRAFwt mCRC were randomised (2:1 ratio) to maintenance treatment in Cohort 2. Archival samples from 104 patients were analysed: FP/bevacizumab + atezolizumab (n = 82); FP/bevacizumab (n = 22). The biomarker evaluable population (BEP) for PD-L1 was n = 81 for FP/bevacizumab + atezolizumab [PD-L1low n = 35 (43%); PD-L1high n = 46 (57%)] and n = 22 for FP/bevacizumab [PD-L1low n = 16 (72%); PD-L1high n = 6 (28%)]. The BEP for CD8/GrB was n = 50 for FP/bevacizumab + atezolizumab and n = 16 for FP/bevacizumab. No difference in PFS or OS was observed in the FP/bevacizumab + atezolizumab vs FP/bevacizumab arms for PD-L1high [PFS: HR = 1.5 (95% CI 0.45−4.8), p = 0.51; OS: HR = 1.3 (95% CI 0.38−4.1), p = 0.71] or PD-L1low [PFS: HR = 0.92 (95% CI 0.47−1.8), p = 0.81; OS: HR = 0.78 (95% CI 0.4−1.5), p = 0.48]. Similar results were observed with CD8/GrBhigh [PFS: HR = 0.73 (95% CI 0.27−2.0), p = 0.55; OS: HR = 0.66 (95% CI 0.24−1.8), p = 0.44], CD8/GrBlow [PFS: HR = 1.0 (95% CI 0.42–2.5), p = 0.96; OS: HR = 0.73 (95% CI 0.3–1.8), p = 0.5], FoxP3high [PFS: HR = 0.97 (95% CI 0.37−2.5), p = 0.95; OS: HR = 0.95 (95% CI 0.36−2.5), p = 0.91] and FoxP3low [PFS: HR = 0.73 (95% CI 0.29−1.9), p = 0.53; OS: HR = 0.5 (95% CI 0.19−1.3), p = 0.18]. Conclusions: These findings suggest that PD-L1, CD8/GrB and FoxP3 might not be predictive biomarkers in BRAFwt mCRC. Further analyses are needed to further evaluate potential predictive and prognostic factors of response in this setting. Clinical trial information: NCT02291289.
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Affiliation(s)
- Josep Tabernero
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | | | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
| | - Michel Ducreux
- Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Peter J. O'Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
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13
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Gulhati P, Yin J, Pederson L, Schmoll HJ, Hoff P, Douillard JY, Hecht JR, Tournigand C, Tebbut N, Chibaudel B, Gramont AD, Shi Q, Overman MJ. Threshold Change in CEA as a Predictor of Non-Progression to First-Line Systemic Therapy in Metastatic Colorectal Cancer Patients With Elevated CEA. J Natl Cancer Inst 2021; 112:1127-1136. [PMID: 32191317 DOI: 10.1093/jnci/djaa020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/17/2019] [Accepted: 01/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Carcinoembryonic antigen (CEA) levels are used in conjunction with imaging to monitor response to systemic therapy in metastatic colorectal cancer (mCRC). We sought to identify a threshold for CEA change from baseline to predict progressive disease (PD) in mCRC patients receiving first-line therapy. METHODS Patients from trials collected in the ARCAD database were included if baseline CEA was at least 10 ng/mL and repeat CEA was available within 14 days of first restaging scan. Optimal cutoffs for CEA change were identified by receiver operating characteristic analysis. Prediction performance of cutoffs was evaluated by sensitivity, specificity, and negative predictive value. Analyses were conducted by treatment class: chemotherapy alone, chemotherapy with anti-VEGF antibody, and chemotherapy with anti-EGFR antibody. RESULTS A total of 2643 mCRC patients treated with systemic therapy were included. Median percent change of CEA from baseline to first restaging for patients with complete response, partial response, or stable disease (non-PD) and PD was -53.1% and +23.6% for chemotherapy alone (n = 957) and -71.7% and -45.3% for chemotherapy with anti-VEGF antibody (n = 1355). The optimal area under the curve cutoff for differentiating PD from non-PD on first restaging was -7.5% for chemotherapy alone and -62.0% for chemotherapy with anti-VEGF antibody; chemotherapy alone, adjusted odds ratio = 6.51 (95% CI = 3.31 to 12.83, P < .001), chemotherapy with anti-VEGF antibody, adjusted odds ratio = 3.45 (95% CI = 1.93 to 6.18, P < .001). A 99% negative predictive value clinical cutoff for prediction of non-PD would avoid CT scan at first restaging in 21.0% of chemotherapy alone and 16.2% of chemotherapy with anti-VEGF antibody-treated patients. Among patients with stable disease on first restaging, those with decreased CEA from baseline had statistically significantly improved progression-free and overall survival. CONCLUSIONS Change in CEA from baseline to first restaging can accurately predict non-progression and correlates with long-term outcomes in patients receiving systemic chemotherapy.
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Affiliation(s)
- Pat Gulhati
- Department of Medical Oncology, Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Jun Yin
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Levi Pederson
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Paulo Hoff
- Centro de Oncologia de Brasilia do Sirio Libanes-Unidade Lago Sul, Sao Paulo, Brazil
| | - Jean-Yves Douillard
- Integrated Centres for Oncology, Department of Medical Oncology, St-Herblain, France
| | - J Randolph Hecht
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Niall Tebbut
- Department of Oncology, Olivia Newton John Cancer Research Institute, Heidelberg, VIC, Australia
| | | | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Michael James Overman
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Affiliation(s)
- Hans-Joachim Schmoll
- Hans-Joachim Schmoll, MD, Martin Luther University, Halle, Germany; Murielle E. Mauer, PhD, and Sandrine Marreaud, PhD, EORTC Headquarters, Brussels, Belgium; and Alexander Stein, MD, Hematology-Oncolology Practice Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Murielle E Mauer
- Hans-Joachim Schmoll, MD, Martin Luther University, Halle, Germany; Murielle E. Mauer, PhD, and Sandrine Marreaud, PhD, EORTC Headquarters, Brussels, Belgium; and Alexander Stein, MD, Hematology-Oncolology Practice Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Sandrine Marreaud
- Hans-Joachim Schmoll, MD, Martin Luther University, Halle, Germany; Murielle E. Mauer, PhD, and Sandrine Marreaud, PhD, EORTC Headquarters, Brussels, Belgium; and Alexander Stein, MD, Hematology-Oncolology Practice Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
| | - Alexander Stein
- Hans-Joachim Schmoll, MD, Martin Luther University, Halle, Germany; Murielle E. Mauer, PhD, and Sandrine Marreaud, PhD, EORTC Headquarters, Brussels, Belgium; and Alexander Stein, MD, Hematology-Oncolology Practice Eppendorf, University Cancer Center Hamburg, Hamburg, Germany
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15
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Margalit O, Boursi B, Rakez M, Thierry A, Yothers G, Wolmark N, Haller DG, Schmoll HJ, Shi Q, Shacham-Shmueli E, de Gramont A. Benefit of Oxaliplatin in Stage III Colon Cancer According to IDEA Risk Groups: Findings from the ACCENT Database of 4934 Patients. Clin Colorectal Cancer 2021; 20:130-136. [PMID: 33775561 DOI: 10.1016/j.clcc.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/19/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) pooled analysis compared 3 to 6 months of adjuvant chemotherapy for stage III colon cancer. Patients were classified into low risk and high risk, suggesting low-risk patients may be offered only 3 months of treatment. In this study, we aimed to assess the benefit of oxaliplatin in the adjuvant setting per IDEA risk groups, using data from 3 large adjuvant phase III studies, namely Multicenter International Study of Oxaliplatin/Fluorouracil/ Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC), C-07, and XELOXA. METHODS Using the MOSAIC, C-07, and XELOXA previously published studies, we identified 2810 low-risk and 2124 high-risk patients with stage III colon cancer. We used Cox regression model to evaluate the magnitude of survival differences between IDEA risk groups, according to oxaliplatin use. Based on design similarity and equivalent follow-up data, MOSAIC and C-07 were pooled, whereas XELOXA was analyzed separately. Subgroup analyses were also performed for T4 and/or N2 patients. RESULTS Individuals with IDEA low and high risk derived overall survival benefit from the addition of oxaliplatin to adjuvant chemotherapy, with adjusted hazard ratios of 0.79 (0.66-0.95) and 0.84 (0.71-0.99), respectively. Among individuals with IDEA high risk, those with T4 disease did not gain overall survival benefit from addition of oxaliplatin with hazard ratio of 0.95 (0.71-1.27). Similar results were demonstrated using data from the XELOXA study. CONCLUSION IDEA risk classification per se does not predict benefit from addition of oxaliplatin to adjuvant chemotherapy in stage III colon cancer. T4 disease may predict lack of benefit from oxaliplatin addition.
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Affiliation(s)
- Ofer Margalit
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Manel Rakez
- Statistical Unit, Fondation A.R.CA.D - Aide et Recherche en CAncérologie Digestive, Levallois-Perret, France
| | - André Thierry
- Sorbonne University and Department of Medical Oncology, Saint-Antoine Hospital, Paris, France
| | - Greg Yothers
- NRG Oncology and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Norman Wolmark
- NRG Oncology and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA; NRG Oncology and the NSABP Foundation, Pittsburgh, PA, USA
| | - Daniel G Haller
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aimery de Gramont
- Statistical Unit, Fondation A.R.CA.D - Aide et Recherche en CAncérologie Digestive, Levallois-Perret, France; Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France.
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16
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Schmoll HJ, Lindner LH, Reichardt P, Heißner K, Kopp HG, Kessler T, Mayer-Steinacker R, Rüssel J, Egerer G, Crysandt M, Kasper B, Niederwieser D, Kunitz A, Eigendorff E, Petersen I, Steighardt J, Cygon F, Meinert F, Stein A. Efficacy of Pazopanib With or Without Gemcitabine in Patients With Anthracycline- and/or Ifosfamide-Refractory Soft Tissue Sarcoma: Final Results of the PAPAGEMO Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:255-262. [PMID: 33355646 DOI: 10.1001/jamaoncol.2020.6564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pazopanib and gemcitabine have shown good tolerability, albeit modest single-agent activity in pretreated soft tissue sarcoma. A combined regimen to improve outcomes is required. Objective To determine the efficacy of gemcitabine and pazopanib compared with pazopanib alone. Design, Setting, and Participants This multicenter, randomized phase 2 clinical trial was conducted in Germany from September 2011 to July 2014 and included patients with an Eastern Cooperative Oncology Group performance status score of 0 to 2, adequate organ function, measurable lesion, and progression after at least 1 prior treatment with anthracyclines and/or ifosfamide. Data analysis was performed during 2019 and 2020. Interventions Patients were randomized to pazopanib with gemcitabine (A) or without gemcitabine (B). Main Outcomes and Measures The primary end point was progression-free survival rate (PFSR) at 12 weeks; secondary end points included toxicity, quality of life, overall survival, and response rates. Results A total of 90 patients were randomized, and 86 eligible patients (43 women [50%]) were evaluable, with a median age of 57 (range, 22-84) years and Eastern Cooperative Oncology Group performance status score of 0/1 in 77 participants (90%). The predominant histological subtypes were leiomyosarcoma (22 [26%]) and liposarcoma (16 [19%]). After a median follow-up of 12.4 (range, 1-48) months, the primary end point was met, with a PFSR at 12 weeks of 74% (A) vs 47% (B) (hazard ratio [HR], 1.60; 90% CI, 1.15-2.23; P = .01). In the combination arm, PFSR was significantly longer, with a median of 5.6 vs 2.0 months (HR, 0.58; 95% CI, 0.36-0.92; P = .02) compared with single-agent pazopanib, whereas overall survival was similar, with 13.1 vs 11.2 months (HR, 0.98; 95% CI, 0.60-1.58; P = .83). The objective response rate was overall low, with 11% (A) vs 5% (B) (P = .10). The toxicity of the combination of pazopanib and gemcitabine was increased, but it was manageable and mainly hematological. Conclusions and Relevance This phase 2 randomized clinical trial of patients with soft tissue sarcoma found that the addition of gemcitabine to pazopanib was tolerable, and PFSR at 12 weeks was significantly higher compared with pazopanib alone. These results suggest clinical activity of the combination, but they should be confirmed in a phase 3 trial in a more homogeneous population (eg, leiomyosarcoma). Trial Registration German Clinical Trials Identifier: DRKS00003139.
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Affiliation(s)
- Hans-Joachim Schmoll
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, Ludwig Maximilians University, Munich, Germany
| | | | | | | | | | | | - Jörn Rüssel
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Gerlinde Egerer
- Department of Internal Medicine V, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen University, Aachen, Germany
| | - Bernd Kasper
- Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, Mannheim, Germany
| | | | | | | | - Iver Petersen
- University Hospital Jena, Jena, Germany.,SRH Wald Klinikum, Gera, Germany
| | - Jörg Steighardt
- Coordination Center for Clinical Trials Halle, Martin Luther University, Halle-Wittenberg, Germany
| | - Franziska Cygon
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Fabian Meinert
- Clinic for Internal Medicine IV-Hematology/Oncology, University Clinic, Martin Luther University, Halle-Wittenberg, Germany
| | - Alexander Stein
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Pietrantonio F, Fucà G, Rossini D, Schmoll HJ, Bendell JC, Morano F, Antoniotti C, Corallo S, Borelli B, Raimondi A, Marmorino F, Niger M, Boccaccino A, Masi G, Lonardi S, Boni L, de Braud F, Di Bartolomeo M, Falcone A, Cremolini C. FOLFOXIRI-Bevacizumab or FOLFOX-Panitumumab in Patients with Left-Sided RAS/BRAF Wild-Type Metastatic Colorectal Cancer: A Propensity Score-Based Analysis. Oncologist 2021; 26:302-309. [PMID: 33336844 DOI: 10.1002/onco.13642] [Citation(s) in RCA: 4] [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: 08/11/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Doublets plus anti-epidermal growth factor receptors (EGFRs) are the preferred upfront option for patients with left-sided RAS/BRAF wild-type metastatic colorectal cancer (mCRC). Initial therapy with FOLFOXIRI-bevacizumab is superior to doublets plus bevacizumab independently from primary tumor sidedness and RAS/BRAF status. No randomized comparison between FOLFOXIRI-bevacizumab versus doublets plus anti-EGFRs is available in left-sided RAS/BRAF wild-type mCRC. MATERIALS AND METHODS We selected patients with left-sided RAS and BRAF wild-type mCRC treated with first-line FOLFOX-panitumumab or FOLFOXIRI-bevacizumab in five randomized trials: Valentino, TRIBE, TRIBE2, STEAM, and CHARTA. A propensity score-based analysis was performed to compare FOLFOXIRI-bevacizumab with FOLFOX-panitumumab. RESULTS A total of 185 patients received FOLFOX-panitumumab and 132 received FOLFOXIRI-bevacizumab. Median progression-free survival (PFS) and median overall survival (OS) were 13.3 and 33.1 months in the FOLFOXIRI-bevacizumab group compared with 11.4 and 30.3 months in the FOLFOX-panitumumab group (propensity score-adjusted hazard ratio (HR) for PFS, 0.82; 95% confidence interval (CI), 0.64-1.04; p = .11; propensity score-adjusted HR for OS, 0.80; 95% CI, 0.59-1.08; p = .14). No significant differences in overall response rate and disease control rate were observed. A statistically nonsignificant difference in favor of FOLFOXIRI-bevacizumab was observed for OS after secondary resection of metastases. Chemotherapy-related adverse events were more frequent in the FOLFOXIRI-bevacizumab group, with specific regard to grade 3 and 4 neutropenia (48% vs. 26%, adjusted p = .001). CONCLUSION Although randomized comparison is lacking, both FOLFOXIRI-bevacizumab and FOLFOX-panitumumab are valuable treatment options in left-sided RAS/BRAF wild-type mCRC. IMPLICATIONS FOR PRACTICE A propensity score-based analysis of five trials was performed to compare FOLFOX-panitumumab versus FOLFOXIRI-bevacizumab in left-sided RAS/BRAF wild-type metastatic colorectal cancer (mCRC). No significant differences were observed, but FOLFOXIRI-bevacizumab achieved numerically superior survival outcomes versus FOLFOX-panitumumab. Chemotherapy-related adverse events were more frequent in the FOLFOXIRI-bevacizumab group. These observations suggest that although doublet chemotherapy plus anti-EGFRs remains the preferred treatment in patients with left-sided RAS/BRAF wild-type mCRC, FOLFOXIRI-bevacizumab is a valuable option able to provide similar, if not better, outcomes at the price of a moderate increase in toxicity and may be adopted based on patients' preference and potential impact on quality of life.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | - Giovanni Fucà
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Johanna C Bendell
- GI Oncology, Sarah Cannon Research Institute, Nashville, Tennessee, USA
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Salvatore Corallo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Lonardi
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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18
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Schmoll HJ, Stein A, Van Cutsem E, Price T, Hofheinz RD, Nordlinger B, Daisne JF, Janssens J, Brenner B, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig CV, Zalcberg J, Tebbutt N, Mauer ME, Marreaud S, Lutz MP, Haustermans K. Pre- and Postoperative Capecitabine Without or With Oxaliplatin in Locally Advanced Rectal Cancer: PETACC 6 Trial by EORTC GITCG and ROG, AIO, AGITG, BGDO, and FFCD. J Clin Oncol 2020; 39:17-29. [PMID: 33001764 DOI: 10.1200/jco.20.01740] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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
PURPOSE The PETACC 6 trial investigates whether the addition of oxaliplatin to preoperative capecitabine-based chemoradiation and postoperative capecitabine improves disease-free survival (DFS) in locally advanced rectal cancer. METHODS Between November 2008 and September 2011, patients with rectal adenocarcinoma within 12 cm from the anal verge, T3/4 and/or node positive, were randomly assigned to 5 weeks preoperative capecitabine-based chemoradiation (45-50.4 Gy) followed by six cycles of adjuvant capecitabine, both without (control arm, 1) or with (experimental arm, 2) oxaliplatin. The primary end point was improvement of 3-year DFS by oxaliplatin from 65% to 72% (hazard ratio [HR], 0.763). RESULTS A total of 1,094 patients were randomly assigned (intention to treat), and 1,068 eligible patients started their allocated treatment (arm 1, 543; arm 2, 525), with completion of protocol treatment in 68% (arm 1) v 54% (arm 2). A higher rate of grade 3/4 adverse events was reported in the experimental arm (14.4% v 37.3% and 23.4% v 46.6% for neoadjuvant and adjuvant treatment, respectively). At a median follow-up of 68 months (interquartile range, 58-74 months), 157 and 156 DFS events were observed in arms 1 and 2, respectively (adjusted HR, 1.02; 95% CI, 0.82 to 1.28; P = .835). Three-year DFS rate was not different, with 76.5% (95% CI, 72.7% to 79.9%) in arm 1, which is higher than anticipated, and 75.8% (95% CI, 71.9% to 79.3%) in arm 2. The 7-year DFS and overall survival (OS) rates were not different as well, with DFS of 66.1% v 65.5% (HR, 1.02) and OS of 73.5% v 73.7% (HR, 1.19) in arms 1 and 2, respectively. Subgroup analyses revealed heterogeneity in treatment effect according to German versus non-German site location, without detectable confounding factors in multivariable analysis. CONCLUSION The addition of oxaliplatin to preoperative capecitabine-based chemoradiation and postoperative adjuvant chemotherapy impairs tolerability and feasibility and does not improve efficacy.
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Affiliation(s)
| | - Alexander Stein
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Timothy Price
- Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | | | - Bernard Nordlinger
- CHU Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Jean-François Daisne
- Université Catholique de Louvain, CHU-UCL-Namur (Sainte-Elisabeth), Namur, Belgium
| | | | - Baruch Brenner
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hans Reinel
- Leopoldina-Krankenhaus der Stadt Schweinfurt gGmbH, Schweinfurt, Germany
| | | | - Karel Caca
- Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Carla V Hannig
- Gemeinschaftspraxis Haematologie und Onkologie, Bottrop, Germany
| | - John Zalcberg
- Alfred Health and School of Public Health, Monash University, Melbourne, Victoria, Australia
| | | | - Murielle E Mauer
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Sandrine Marreaud
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
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19
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Chibaudel B, Henriques J, Rakez M, Brenner B, Kim TW, Martinez-Villacampa M, Gallego-Plazas J, Cervantes A, Shim K, Jonker D, Guerin-Meyer V, Mineur L, Banzi C, Dewdney A, Dejthevaporn T, Bloemendal HJ, Roth A, Moehler M, Aranda E, Van Cutsem E, Tabernero J, Schmoll HJ, Hoff PM, André T, de Gramont A. Association of Bevacizumab Plus Oxaliplatin-Based Chemotherapy With Disease-Free Survival and Overall Survival in Patients With Stage II Colon Cancer: A Secondary Analysis of the AVANT Trial. JAMA Netw Open 2020; 3:e2020425. [PMID: 33074326 PMCID: PMC7573695 DOI: 10.1001/jamanetworkopen.2020.20425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE In the pivotal Bevacizumab-Avastin Adjuvant (AVANT) trial, patients with high-risk stage II colon cancer (CC) had 5-year and 10-year overall survival (OS) rates of 88% and 75%, respectively, with adjuvant fluorouracil and oxaliplatin-based chemotherapy; however, the trial did not demonstrate a disease-free survival (DFS) benefit of adding bevacizumab to oxaliplatin-based chemotherapy in stage III CC and suggested a detrimental effect on OS. The Long-term Survival AVANT (S-AVANT) study was designed to collect extended follow-up for patients in the AVANT trial. OBJECTIVE To explore the efficacy of adjuvant bevacizumab combined with oxaliplatin-based chemotherapy in patients with high-risk, stage II CC. DESIGN, SETTING, AND PARTICIPANTS This prespecified secondary end point analysis of the AVANT and S-AVANT studies included 573 patients with curatively resected high-risk stage II CC and at least 1 of the following criteria: stage T4, bowel obstruction or perforation, blood and/or lymphatic vascular invasion and/or perineural invasion, age younger than 50 years, or fewer than 12 nodes analyzed. The AVANT study was a multicenter randomized stage 3 clinical trial. Data were collected from December 2004 to February 2019, and data for this study were analyzed from March to September 2019. INTERVENTION Patients were randomly assigned to receive 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX4), FOLFOX4 with bevacizumab, or capecitabine and oxaliplatin (XELOX) with bevacizumab. MAIN OUTCOMES AND MEASURES The primary end points of this secondary analysis were DFS and OS in patients with high-risk stage II CC. RESULTS The AVANT study included 3451 patients, of whom 573 (16.6%) had high-risk stage II CC (192 [33.5%] randomized to FOLFOX4 group; 194 [33.9%] randomized to FOLFOX4 with bevacizumab group; 187 [32.6%] randomized to XELOX with bevacizumab group). With a median (interquartile range) age of 57.0 (47.2-65.7) years, the study population comprised 325 men (56.7%) and 248 women (43.3%). After a median (interquartile range) follow-up of 6.9 (6.1-11.3) years, the 3-year DFS and 5-year OS rates were 88.2% (95% CI, 83.7%-93.0%) and 89.7% (95% CI, 85.4%-94.2%) in the FOLFOX4 group, 86.6% (95% CI, 81.8%-91.6%) and 89.7% (95% CI, 85.4%-94.2%) in the FOLFOX4 with bevacizumab group, and 86.7% (95% CI, 81.8%-91.8%) and 93.2% (95% CI, 89.6%-97.0%) in the XELOX with bevacizumab group, respectively. The DFS hazard ratio was 0.94 (95% CI, 0.59-1.48; P = .78) for FOLFOX4 with bevacizumab vs FOLFOX4 and 1.07 (95% CI, 0.69-1.67; P = .76) for XELOX with bevacizumab vs FOLFOX4. The OS hazard ratio was 0.92 (95% CI, 0.55-1.55; P = .76) for FOLFOX4 with bevacizumab vs FOLFOX4 and 0.85 (95% CI, 0.50-1.44; P = .55) for XELOX with bevacizumab vs FOLFOX4. CONCLUSIONS AND RELEVANCE In this secondary analysis of data from the AVANT trial, adding bevacizumab to oxaliplatin-based chemotherapy was not associated with longer DFS or OS in patients with high-risk stage II CC. The findings suggest that the definition of high-risk stage II CC needs to be revisited. TRIAL REGISTRATION ClinicalTrial.gov Identifiers: AVANT (NCT00112918); S-AVANT (NCT02228668).
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Affiliation(s)
- Benoist Chibaudel
- Department of Medical Oncology, Franco-British Hospital–Fondation Cognacq-Jay, Levallois-Perret, France
- Statistical Unit, Aide et Recherche en Cancérologie Digestive, Foundation, Levallois-Perret, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1098, Besançon, France
| | - Manel Rakez
- Statistical Unit, Aide et Recherche en Cancérologie Digestive, Foundation, Levallois-Perret, France
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tiqva, Tel Aviv University, Tel Aviv, Israel
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mercedes Martinez-Villacampa
- Department of Medical Oncology, Institut Català d'Oncologia-Bellvitge Institute for Biomedical Research, L’Hospitalet, Barcelona, Spain
| | - Javier Gallego-Plazas
- Department of Medical Oncology, General Universitario de Elche Hospital, Elche, Spain
| | - Andres Cervantes
- Department of Medical Oncology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Katharine Shim
- Department of Medical Oncology, Lakeridge Health R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Derek Jonker
- Division of Medical Oncology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Veronique Guerin-Meyer
- Department of Gastroenterology and Hepatology, Institut de Cancérologie de l’Ouest Paul Papin, Angers, France
| | - Laurent Mineur
- Department of Radiotherapy and Oncology Gastrointestinal and Liver, Institut Sainte Catherine, Avignon, France
| | - Chiara Banzi
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Alice Dewdney
- Department of Oncology, Weston Park Hospital Cancer Research Centre, Sheffield, United Kingdom
| | | | - Haiko J. Bloemendal
- Department of Internal Medicine and Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Arnaud Roth
- Digestive Tumor Unit, Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Markus Moehler
- First Department of Internal Medicine, University Hospital of Mainz, Mainz, Germany
| | - Enrique Aranda
- Department of Medical Oncology, Reina Sofía University Hospital, Córdoba, Spain
| | - Eric Van Cutsem
- Department of Gastroenterology and Digestive Oncology, University Hospitals Gasthuisberg/Leuven and KULeuven, Leuven, Belgium
| | - Josep Tabernero
- Department of Medical Oncology, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Universitat de Vic–Universitat Central de Catalunya, International Oncology Bureau–Quiron, Barcelona, Spain
| | | | - Paulo M. Hoff
- Department of Radiology and Oncology, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Thierry André
- Department of Medical Oncology, Hôpital Saint-Antoine, Assitance Publique des Hôpitaux de Paris, Paris, France
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Hospital–Fondation Cognacq-Jay, Levallois-Perret, France
- Statistical Unit, Aide et Recherche en Cancérologie Digestive, Foundation, Levallois-Perret, France
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Abstract
Hans Schmoll speaks to Rachel Jenkins, Managing Commissioning Editor. Over four decades of professional activity, Hans has become one of the most highly esteemed and influential medical oncologists in Germany. As Editor of the German standard reference book for medical and multidisciplinary oncology (6000 pages) [1], he has defined treatment standards and education in medical oncology in the German speaking countries. His work as a research scientist has covered numerous fields in medical oncology, in particular, genitourinary and gastrointestinal cancers, where he has defined worldwide standards for the management of germ-cell cancer and early and late stages of colon cancer. Within the European Society of Medical Oncology, he served on the Executive Board as founding chair of the Multidisciplinary Oncology Committee and as scientific chair of the Istanbul European Society of Medical Oncology Congress 2006.
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Affiliation(s)
- Hans-Joachim Schmoll
- Clinic of Internal medicine IV, Department Internal Medicine, University Clinic Halle, Martin-Luther University, Halle, Germany
- EORTC GI Study Group, AIO Colorectal Cancer Group, Martin-Luther University, Halle, Germany
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Cremolini C, Antoniotti C, Stein A, Bendell J, Gruenberger T, Rossini D, Masi G, Ongaro E, Hurwitz H, Falcone A, Schmoll HJ, Di Maio M. Individual Patient Data Meta-Analysis of FOLFOXIRI Plus Bevacizumab Versus Doublets Plus Bevacizumab as Initial Therapy of Unresectable Metastatic Colorectal Cancer. J Clin Oncol 2020; 38:JCO2001225. [PMID: 32816630 DOI: 10.1200/jco.20.01225] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A proper estimation of the magnitude of the overall survival (OS) benefit from infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus bevacizumab versus doublets + bevacizumab is lacking because all trials that have investigated this regimen had primary end points other than OS. To test OS with higher power and to explore the interaction of treatment effect with main patient and disease characteristics, we performed an individual patient data (IPD) meta-analysis. PATIENTS AND METHODS IPD from 5 eligible trials were collected: CHARTA (ClinicalTrials.gov identifier: NCT01321957), OLIVIA (ClinicalTrials.gov identifier: NCT00778102), STEAM (ClinicalTrials.gov identifier: NCT01765582), TRIBE (ClinicalTrials.gov identifier: NCT00719797), and TRIBE2 (ClinicalTrials.gov identifier: NCT02339116). The primary end point was OS. Secondary end points were progression-free survival (PFS), objective response rate (ORR), R0 resection rate, grade 3/4 adverse events, and subgroup analyses according to clinical and molecular characteristics. RESULTS A total of 1,697 patients were randomly assigned to FOLFOXIRI + bevacizumab (n = 846) or doublets + bevacizumab (n = 851). Most (78%) had an Eastern Cooperative Oncology Group performance status of 0, and the median age was 61 years. After a median follow-up of 39.9 months, patients assigned to FOLFOXIRI + bevacizumab had significantly longer OS than those assigned to doublets + bevacizumab (median, 28.9 v 24.5 months; hazard ratio [HR], 0.81; 95% CI, 0.72 to 0.91; P < .001), with no significant heterogeneity among trials (P = .39; I2 = 2%). No significant interaction effect between treatment arm and investigated characteristics was demonstrated. Patients assigned to FOLFOXIRI + bevacizumab had longer PFS (median, 12.2 v 9.9 months; HR, 0.74; 95% CI, 0.67 to 0.82; P < .001), higher ORR (64.5% v 53.6%; P < .001), higher R0 resection rate (16.4% v 11.8%; P = .007), and higher rates of grade 3/4 neutropenia (45.8% v 21.5%; P < .001), febrile neutropenia (6.3% v 3.7%; P = .019), and diarrhea (17.8% v 8.4%; P < .001). CONCLUSION FOLFOXIRI + bevacizumab significantly and meaningfully improves survival of patients with metastatic colorectal cancer compared with doublets + bevacizumab and provides advantage in PFS, ORR, and R0 resection rate at the price of a moderate increase in toxicity. No increased benefit is observed among patients with BRAF-mutant tumors.
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Affiliation(s)
- Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Alexander Stein
- Hematology-Oncology Practice Hamburg (HOPE), University Cancer Center Hamburg, Hamburg, Germany
| | - Johanna Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Thomas Gruenberger
- Social Medical Center South, Department of Surgery, HPB Center Vienna Clinics and Sigmund Freud University, Medical School, Vienna, Austria
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Elena Ongaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano (PN), Italy
| | | | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Hans-Joachim Schmoll
- Department Internal Medicine IV-Hematology-Oncology, Martin-Luther-University, Halle (Saale), Germany
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Mauriziano Hospital, Turin, Italy
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Cremolini C, Antoniotti C, Stein A, Bendell JC, Gruenberger T, Masi G, Ongaro E, Hurwitz H, Falcone A, Schmoll HJ, Di Maio M. FOLFOXIRI/bevacizumab (bev) versus doublets/bev as initial therapy of unresectable metastatic colorectal cancer (mCRC): A meta-analysis of individual patient data (IPD) from five randomized trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4015 Background: Several randomized trials demonstrated that intensifying the upfront chemotherapy in combination with bev is beneficial for mCRC patients with an increased incidence of some adverse events. All trials had primary endpoints other than OS, and a proper estimation of the magnitude of the OS benefit from FOLFOXIRI/bev versus doublets (FOLFIRI or FOLFOX)/bev is currently lacking. Within each trial, subgroup analyses failed to identify predictors of benefit from the intensified therapy. To test OS with higher power compared to single trials, and to explore interaction of treatment effect with main patients’ and disease characteristics, we performed an IPD meta-analysis. Methods: IPD were collected from 5 randomized trials: CHARTA (NCT01321957), OLIVIA (NCT00778102), STEAM (NCT01765582, only combined FOLFOXIRI/bev and FOLFOX/bev arms), TRIBE (NCT00719797) and TRIBE2 (NCT02339116). Primary endpoint was OS. Secondary endpoints included PFS, objective response rate (ORR), R0 resection rate, G3/4 adverse events, and subgroup analyses. All statistical analyses were by intention-to-treat, stratified by trial. Results: 1697 pts randomized to FOLFOXIRI/bev (N=846) or doublets/bev (N=851) were included. Among pts in the doublets/bev group, 595 (70%) received FOLFOX/bev and 256 (30%) FOLFIRI/bev. At a median follow up of 39.9 mos, pts assigned to FOLFOXIRI/bev reported significantly longer OS than those assigned to doublets/bev (median OS 28.9 vs 24.5 months; HR 0.81 [95%CI 0.72-0.91], p<0.001), with no significant heterogeneity among trials (p=0.39; I2=2%). The estimated 5-yr OS was 22.3% vs 10.7% (p<0.001). No significant interaction effect between treatment arm and OS was demonstrated in terms of metastatic spread (liver-limited vs. not liver-limited p=0.665), primary side (p=0.656), and RAS/BRAF status (p=0.337). Pts assigned to FOLFOXIRI/bev achieved longer PFS (median PFS 12.2 vs 9.9 months; HR 0.74 [95%CI 0.67-0.82], p<0.001), higher ORR (64.5% vs 53.6%, p<0.001), higher R0 resection rate (16.4% vs 11.8%, p=0.007), and experienced higher rates of G3/4 neutropenia (p<0.001), febrile neutropenia (p=0.019), mucositis (p=0.024), nausea (p=0.016), and diarrhea (p<0.001). Conclusions: FOLFOXIRI/bev determines a clinically and statistically significant improvement of mCRC patients’ OS vs doublets/bev with a meaningful effect also on 5-yr OS, PFS, ORR and R0 resection rate. No significant heterogeneity among explored subgroups was found.
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Affiliation(s)
- Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alexander Stein
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Haematology, Stem Cell Transplantation and Pneumology, Hamburg, Germany
| | | | - Thomas Gruenberger
- Department of Surgery, Hepato-Pancreato-Biliary Center, Vienna Clinics, Social Mdical Center South - KFJ, Wien, Austria
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elena Ongaro
- Department of Oncology, Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | | | | | | | - Massimo Di Maio
- Department of Oncology, A.O. Ordine Mauriziano Hospital, University of Turin, Turin, Italy
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Fontana E, Zichi C, Smyth EC, Mauer ME, Roedel C, Fokas E, Hofheinz RD, Arnold D, Schmoll HJ, Van Cutsem E, Haustermans K, Stein A, Gerard JP, Conroy T, Jouffroy-Zeller C, Moehler MH, Lordick F, Ben-Aharon I, Di Maio M. Neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer (LARC) with or without oxaliplatin (OX): Individual patient data (IPD) meta-analysis of three randomized controlled trials (RCTs) with subgroup analyses of age cohorts. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4074 Background: Neoadjuvant CRT with fluoropyrimidine (FP) is standard treatment for LARC, which is increasing in younger patients (pts). RCTs examining the addition of OX are still controversial. A post hoc analysis of the CAO/ARO/AIO-04 trial showed significant benefit in pts < 60y. We hypothesised that younger pts with LARC might have improved outcomes with OX-CRT. Methods: Systematic review and IPD meta-analysis were performed. Data from 3 RCTs (CAO/ARO/AIO-04, ACCORD-12, PETACC-6) testing the addition of OX to standard FP-based CRT in LARC were available (of 9 RCTs identified). Primary endpoint: disease-free survival (DFS), secondary endpoints: pathologic complete response (pCR), overall survival (OS). Analyses were by intention to treat (ITT), stratified by trial. Age cut-offs were 60y and 50y. Given the focus on young age a multivariate analysis evaluating all possible confounders was not intended in the current work. Results: IPD from 2914 pts were included (48.5% of available literature). Median age was 63; 70% were male; 79% had a performance status = 0; 72% were stage ≥III. In ITT (Hazard Ratio [HR] 0.88, 95%CI 0.77-1.01, p = 0.06), DFS was not significantly improved by the addition of OX (Table). In < 60y (n = 1166, 40% total), DFS was significantly improved by OX (HR 0.77, 95%CI 0.62-0.96, p = 0.02). In < 50y (n = 350, 12% total) there was a numerically better DFS, although not significant (HR 0.73, 95%CI 0.49-1.08, p = 0.12). Interaction test between age and DFS was non-significant (60y p = 0.11; 50y p = 0.44). In ITT, OX increased pCR from 13% to 16% (Odds Ratio [OR] 1.28, 95%CI 1.04-1.57, p = 0.024 [stratified by trial]), without significant interaction with age (60y p = 0.11, 50y p = 0.74). No OS benefit was demonstrated (HR 0.97, 95%CI 0.82-1.15, p = 0.75). Conclusions: This first IPD meta-analysis of three RCTs evaluating the addition of OX to CRT did not show significant interaction of OX with age. However, we confirm a signal for DFS benefit in pts < 60y and a non-significant increment in DFS in < 50 y although this analysis may be underpowered. Stage-stratified analyses and feasibility/toxicity data in age cohorts will be presented. [Table: see text]
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Affiliation(s)
- Elisa Fontana
- Sarah Cannon Research Institute, London, United Kingdom
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | | | | | - Claus Roedel
- Department of Radiation Oncology, University Hospital Frankfurt, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Emmanouil Fokas
- German Cancer Consortium (DKTK) Core Center Heidelberg and DKTK Partner Site Frankfurt, Oxford, United Kingdom
| | - Ralf Dieter Hofheinz
- University Medical Center Mannheim, Tagestherapiezentrum am ITM, Mannheim, Germany
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
| | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven, KU Leuven, Leuven, Belgium
| | | | - Alexander Stein
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Haematology, Stem Cell Transplantation and Pneumology, Hamburg, Germany
| | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | | | - Markus H. Moehler
- University Medical Center Mainz, I. Dept. of Internal Medicine, Mainz, Germany
| | | | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Center, Haifa, Israel
| | - Massimo Di Maio
- Department of Oncology, A.O. Ordine Mauriziano Hospital, University of Turin, Turin, Italy
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McCleary NJ, Harmsen WS, VanCutsem E, Sobrero AF, Goldberg RM, Tabernero J, Seymour M, Saltz LB, Giantonio BJ, Dirk A, Rothenberg ML, Koopman M, Schmoll HJ, Pitot HC, Hoff PM, Falcone A, De Gramont A, Shi Q. Survival outcomes among older adults (OA) receiving second-line therapy for metastatic CRC (mCRC): 5,289 patients (pts) from the ARCAD Clinical Trials Program. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7009] [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
7009 Background: Survival outcomes of 2nd line mCRC therapy for OA are poorly understood. We evaluated the rates and survival outcomes of 2nd line therapy among OA age 70+ compared to younger adults (YA) age < 70 following progression on 1st line clinical trials. Methods: Associations between clinical characteristics of pts with available treatment data after progression on 10 of 23 1st line ARCAD trials, time to initial progression (TTiP) and 2nd line therapy were evaluated. Time to progression (TTP) and overall survival (OS) were compared between OA and YA enrolled on 2nd line trials by Cox regression, adjusting for age, sex, ECOG PS, number of metastatic sites, presence of metastasis in lung/liver/peritoneum. Results: Sixteen percent of 1st line ARCAD trial participants were age 70+ (n = 870). Data for 2nd line therapy was available for 60.6% pts (3206/5289). Each additional decade of life was associated with 11% lower odds of receiving 2nd line therapy in multivariate analysis (p = 0.0117). OA participating in 2nd line trials (7.9% age 75+ of 7921) experience similar TTP and OS to YA (mTTP: 5.1 vs. 5.2mos; mOS 11.6 vs 12.4mos, respectively). Conclusions: We did not observe a statistical difference in survival outcomes by age following 2nd line mCRC therapy. Further study is needed to examine unmeasured comorbidity and use of geriatric assessment to select OA likely to benefit from 2nd line therapy. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Matt Seymour
- NIHR Clinical Research Network, Leeds UK St James's Hospital, and University of Leeds, Leeds, United Kingdom
| | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Arnold Dirk
- Instituto CUF de Oncologia, Lisbon, Portugal
| | | | | | | | | | - Paulo Marcelo Hoff
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Wagner AD, Rakez M, Chibaudel B, Adams R, Zalcberg JR, Saltz LB, Venook AP, Schmoll HJ, Douillard JY, Tournigand C, Heinemann V, Goldberg RM, Hecht JR, Cremolini C, Diaz-Rubio E, Grothey A, Shi Q, De Gramont A. Sex differences in efficacy and toxicity of first-line treatment of metastatic colorectal cancer (CRC): An analysis of 18,399 patients in the ARCAD database. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
4029 Background: The clearance of 5-FU differs significantly between men (M) and women (W). Adjuvant chemotherapy (CT) for CRC has a higher toxicity in W. The impact of sex on efficacy and toxicity in first-line trials of metastatic CRC (mCRC) is unknown. Methods: We analyzed patient (pt) and tumor characteristics, toxicities (nausea (AE1), vomiting (AE2), diarrhea, neutropenia (AE3)) and efficacy (overall survival (OS), progression-free survival (PFS)) according to sex in the following treatment groups: A: CT alone, B: CT + bevacizumab, C: CT + EGFR-antibodies, with subgroup analyses in the CT alone group for single-agent, doublets and triplets, as well as irinotecan- and oxaliplatin-based regimens. Pts from trials with treatments still used today and all relevant data available were eligible. OS and PFS were assessed using Kaplan-Meier and Cox models adjusted for primary tumor location and performance status (PS). Results: We included 28 trials with 18.399 pts (11.352 M and 7.047 W). W were younger (61 vs. 63 years), had more often a PS of 1 (49 vs 45%), BRAF mutations (10 vs. 7%), right-sided tumors (42 vs. 35%) and less often rectal tumors (26 vs. 32%). Significant differences in toxicity are reported in table. Rates of diarrhea were similar. There was no sex disparity in OS in the predefined subgroups except for pts receiving triplets where OS was better in M (HRadj=1.39 (1.05 - 1.85)). Median (interquartile range) OS in months for M and W was 16.7 (9.2-27.4) and 16.2 (8.9-27.2) in group 1, 21.9 (12.7-37.5) and 22.3 (12.9 – 39.0) in group 2, and 26.8 (14.6-45.3) and 24.8 (12.3-49.2) in group 3. HRsadj (W vs M) (95% CI), p values for OS were 1.02 (0.96-1.09), .557, 0.92 (0.83-1.03), .142, 0.99 (0.85-1.14), .866. Conclusions: M and W with mCRC differ significantly regarding patient and tumor characteristics. The significant higher toxicity in W does not translate in a higher treatment efficacy. Apart from known sex differences in pharmacokinetics of 5-FU, differences in pharmacodynamics must be postulated. [Table: see text]
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Affiliation(s)
| | - Manel Rakez
- Fondation A.R.CA.D-Aide et Recherche en CAncérologie Digestive, Levallois-Perret, France
| | | | | | | | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan P. Venook
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Cohen R, Vernerey D, Bellera C, Meurisse A, Henriques J, Paoletti X, Rousseau B, Alberts S, Aparicio T, Boukovinas I, Gill S, Goldberg RM, Grothey A, Hamaguchi T, Iveson T, Kerr R, Labianca R, Lonardi S, Meyerhardt J, Paul J, Punt CJA, Saltz L, Saunders MP, Schmoll HJ, Shah M, Sobrero A, Souglakos I, Taieb J, Takashima A, Wagner AD, Ychou M, Bonnetain F, Gourgou S, Yoshino T, Yothers G, de Gramont A, Shi Q, André T. Guidelines for time-to-event end-point definitions in adjuvant randomised trials for patients with localised colon cancer: Results of the DATECAN initiative. Eur J Cancer 2020; 130:63-71. [PMID: 32172199 DOI: 10.1016/j.ejca.2020.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The variability of definitions for time-to-event (TTE) end-points impacts the conclusions of randomised clinical trials (RCTs). The Definition for the Assessment of Time-to-event Endpoints in CANcer (DATECAN) initiative aims to provide consensus definitions for TTE end-points used in RCTs. Here, we formulate guidelines for adjuvant colon cancer RCTs. METHODS We performed a literature review to identify TTE end-points and events included in their definition in RCT publications. Then, a consensus was reached among a panel of international experts, using a formal modified Delphi method, with 2 rounds of questionnaires and an in-person meeting. RESULTS Twenty-four experts scored 72 events involved in 6 TTE end-points. Consensus was reached for 24%, 57% and 100% events after the first round, second round and in-person meeting. For RCTs not using overall survival as their primary end-point, the experts recommend using disease-free survival (DFS) rather than recurrence-free survival (RFS) or time to recurrence (TTR) as the primary end-point. The consensus definition of DFS includes all causes of death, second primary colorectal cancers (CRCs), anastomotic relapse and metastatic relapse as an event, but not second primary non-CRCs. Events included in the RFS definition are the same as for DFS with the exception of second primary CRCs. The consensus definition of TTR includes anastomotic or metastatic relapse, death with evidence of recurrence and death from CC cause. CONCLUSION Standardised definitions of TTE end-points ensure the reproducibility of the end-points between RCTs and facilitate cross-trial comparisons. These definitions should be integrated in standard practice for the design, reporting and interpretation of adjuvant CC RCTs.
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Affiliation(s)
- Romain Cohen
- Sorbonne Université, Department of Medical Oncology, AP-HP, Hôpital Saint-Antoine, F-7512, Paris, France; Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA.
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, F-33000, Bordeaux, France
| | - Aurélia Meurisse
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Xavier Paoletti
- Université de Versailles-St Quentin & Institut Curie, INSERM U900, équipe Biostatistique, France
| | | | | | - Thomas Aparicio
- Service de Gastroentérologie et Cancérologie Digestive, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | | | | | | | - Axel Grothey
- West Cancer Center and Research Institute, Germantown, TN, USA
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rachel Kerr
- Adjuvant Colorectal Cancer Group, University of Oxford, UK
| | | | | | - Jeffrey Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - James Paul
- Cancer Research UK Clinical Trials Unit (CTU), Institute of Cancer Sciences, University of Glasgow, UK
| | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marck P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Hans-Joachim Schmoll
- EORTC GI Study Group, AIO Colorectal Cancer Group, Martin Luther University, Halle, Germany
| | - Manish Shah
- Department of Medicine, Division of Hematology and Medical Oncology, Center for Advanced Digestive Care, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Alberto Sobrero
- Medical Oncology Unit at Ospedale San Martino, Genova, Italy
| | | | - Julien Taieb
- Sorbonne Paris Cité, Paris Descartes University, Department of Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | | | - Anna Dorothea Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Marc Ychou
- Department of Medical Oncology, Institut Régional Du Cancer de Montpellier (ICM), France
| | - Franck Bonnetain
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, F-25000, Besançon, France
| | - Sophie Gourgou
- Biometrics Unit, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | | | | | - Aimery de Gramont
- Department of Medical Oncology, Institut Hospitalier Franco Britannique, Levallois-Perret, France
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Thierry André
- Sorbonne Université, Department of Medical Oncology, AP-HP, Hôpital Saint-Antoine, F-7512, Paris, France
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Burzykowski T, Coart E, Saad ED, Shi Q, Sommeijer DW, Bokemeyer C, Díaz-Rubio E, Douillard JY, Falcone A, Fuchs CS, Goldberg RM, Hecht JR, Hoff PM, Hurwitz H, Kabbinavar FF, Koopman M, Maughan TS, Punt CJA, Saltz L, Schmoll HJ, Seymour MT, Tebbutt NC, Tournigand C, Van Cutsem E, de Gramont A, Zalcberg JR, Buyse M. Evaluation of Continuous Tumor-Size-Based End Points as Surrogates for Overall Survival in Randomized Clinical Trials in Metastatic Colorectal Cancer. JAMA Netw Open 2019; 2:e1911750. [PMID: 31539075 PMCID: PMC6755539 DOI: 10.1001/jamanetworkopen.2019.11750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Tumor measurements can be used to estimate time to nadir and depth of nadir as potential surrogates for overall survival (OS). OBJECTIVE To assess time to nadir and depth of nadir as surrogates for OS in metastatic colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS Pooled analysis of 20 randomized clinical trials within the Aide et Recherche en Cancerologie Digestive database, which contains academic and industry-sponsored trials, was conducted. Three sets of comparisons were performed: chemotherapy alone, antiangiogenic agents, and anti-epidermal growth factor receptor agents in first-line treatment for patients with metastatic colorectal cancer. MAIN OUTCOMES AND MEASURES Surrogacy of time to nadir and depth of nadir was assessed at the trial level based on joint modeling of relative tumor-size change vs baseline and OS. Treatment effects on time to nadir and on depth of nadir were defined in terms of between-arm differences in time to nadir and in depth of nadir, and both were assessed in linear regressions for their correlation with treatment effects (hazard ratios) on OS within each set. The strengths of association were quantified using sample-size-weighted coefficients of determination (R2), with values closer to 1.00 indicating stronger association. At the patient level, the correlation was assessed between modeled relative tumor-size change and OS. RESULTS For 14 chemotherapy comparisons in 4289 patients, the R2 value was 0.63 (95% CI, 0.30-0.96) for the association between treatment effects on time to nadir and OS and 0.08 (95% CI, 0-0.37) for depth of nadir and OS. For 11 antiangiogenic agent comparisons (4854 patients), corresponding values of R2 were 0.25 (95% CI, 0-0.72) and 0.06 (95% CI, 0-0.35). For 8 anti-epidermal growth factor receptor comparisons (2684 patients), corresponding values of R2 were 0.24 (95% CI, 0-0.83) and 0.21 (95% CI, 0-0.78). CONCLUSIONS AND RELEVANCE In contrast with early reports favoring depth of response as a surrogate, these results suggest that neither time to nadir nor depth of nadir is an acceptable surrogate for OS in the first-line treatment of metastatic colorectal cancer.
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Affiliation(s)
- Tomasz Burzykowski
- International Drug Development Institute, Louvain-la-Neuve, Belgium
- Hasselt University, Diepenbeek, Belgium
| | - Elisabeth Coart
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Everardo D. Saad
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Dirkje W. Sommeijer
- The University of Sydney, Camperdown, New South Wales, Australia
- Academic Medical Centre, Amsterdam, the Netherlands
- Flevohospital, Almere, the Netherlands
| | - Carsten Bokemeyer
- Department of Internal Medicine II and Clinic, University of Hamburg, Hamburg, Germany
| | - Eduardo Díaz-Rubio
- Hospital Clinico San Carlos and Centro de Investigación Biomédica en Red Cáncer, CIBERONC, Madrid, Spain
| | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine, University of California, Los Angeles
| | - Paulo M. Hoff
- Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Timothy S. Maughan
- Cancer Research UK and the Medical Research Council Oxford Institute for Radiation Oncology, Oxford, United Kingdom
| | - Cornelis J. A. Punt
- Amsterdam University Medical Centrum, Department of Medical Oncology, University of Amsterdam, Amsterdam, the Netherlands
| | - Leonard Saltz
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | | | | | - Eric Van Cutsem
- Division of Digestive Oncology, University Hospitals Gasthuisberg Leuven, Leuven, Belgium
| | - Aimery de Gramont
- Katholieke Universiteit, Leuven, Belgium
- Franco-British Institute, Levallois-Perret, France
| | - John R. Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Marc Buyse
- Hasselt University, Diepenbeek, Belgium
- International Drug Development Institute Inc, San Francisco, California
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28
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Goey KKH, Sørbye H, Glimelius B, Adams RA, André T, Arnold D, Berlin JD, Bodoky G, de Gramont A, Díaz-Rubio E, Eng C, Falcone A, Grothey A, Heinemann V, Hochster HS, Kaplan RS, Kopetz S, Labianca R, Lieu CH, Meropol NJ, Price TJ, Schilsky RL, Schmoll HJ, Shacham-Shmueli E, Shi Q, Sobrero AF, Souglakos J, Van Cutsem E, Zalcberg J, van Oijen MGH, Punt CJA, Koopman M. Consensus statement on essential patient characteristics in systemic treatment trials for metastatic colorectal cancer: Supported by the ARCAD Group. Eur J Cancer 2018; 100:35-45. [PMID: 29936065 DOI: 10.1016/j.ejca.2018.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 03/25/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient characteristics and stratification factors are key features influencing trial outcomes. However, there is substantial heterogeneity in reporting of patient characteristics and use of stratification factors in phase 3 trials investigating systemic treatment of metastatic colorectal cancer (mCRC). We aimed to develop a minimum set of essential baseline characteristics and stratification factors to include in such trials. METHODS We performed a modified, two-round Delphi survey among international experts with wide experience in the conduct and methodology of phase 3 trials of systemic treatment of mCRC. RESULTS Thirty mCRC experts from 15 different countries completed both consensus rounds. A total of 14 patient characteristics were included in the recommended set: age, performance status, primary tumour location, primary tumour resection, prior chemotherapy, number of metastatic sites, liver-only disease, liver involvement, surgical resection of metastases, synchronous versus metachronous metastases, (K)RAS and BRAF mutation status, microsatellite instability/mismatch repair status and number of prior treatment lines. A total of five patient characteristics were considered the most relevant stratification factors: RAS/BRAF mutation status, performance status, primary tumour sidedness and liver-only disease. CONCLUSIONS This survey provides a minimum set of essential baseline patient characteristics and stratification factors to include in phase 3 trials of systemic treatment of mCRC. Inclusion of these patient characteristics and strata in study protocols and final study reports will improve interpretation of trial results and facilitate cross-study comparisons.
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Affiliation(s)
- Kaitlyn K H Goey
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Halfdan Sørbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Thierry André
- Department of Medical Oncology, Hôpital St Antoine; Sorbonne Universités, UMPC Paris 06, Paris, France
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | - Jordan D Berlin
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | - György Bodoky
- Department of Medical Oncology, St. Laszlo Hospital, Budapest, Hungary
| | - Aimery de Gramont
- Department of Medical Oncology, Institut Hospitalier Franco Britannique, Levallois-Perret, Paris, France
| | - Eduardo Díaz-Rubio
- Department of Medical Oncology, Hospital Clínico San Carlos, Universidad Complutense, CIBERONC, Madrid, Spain
| | - Cathy Eng
- Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Alfredo Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy
| | - Axel Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Volker Heinemann
- Medical Department III, Comprehensive Cancer Center, University Clinic Munich, Munich, Germany
| | | | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Scott Kopetz
- Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Neal J Meropol
- Flatiron Health, New York, NY, USA; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Australia
| | | | - Hans-Joachim Schmoll
- Division Clinical Oncology Research, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - John Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | - Eric Van Cutsem
- Department of Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Martijn G H van Oijen
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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29
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Sjoquist KM, Renfro LA, Simes RJ, Tebbutt NC, Clarke S, Seymour MT, Adams R, Maughan TS, Saltz L, Goldberg RM, Schmoll HJ, Van Cutsem E, Douillard JY, Hoff PM, Hecht JR, Tournigand C, Punt CJA, Koopman M, Hurwitz H, Heinemann V, Falcone A, Porschen R, Fuchs C, Diaz-Rubio E, Aranda E, Bokemeyer C, Souglakos I, Kabbinavar FF, Chibaudel B, Meyers JP, Sargent DJ, de Gramont A, Zalcberg JR. Personalizing Survival Predictions in Advanced Colorectal Cancer: The ARCAD Nomogram Project. J Natl Cancer Inst 2018; 110:638-648. [PMID: 29267900 PMCID: PMC6005015 DOI: 10.1093/jnci/djx253] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/09/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
Background Estimating prognosis on the basis of clinicopathologic factors can inform clinical practice and improve risk stratification for clinical trials. We constructed prognostic nomograms for one-year overall survival and six-month progression-free survival in metastatic colorectal carcinoma by using the ARCAD database. Methods Data from 22 674 patients in 26 randomized phase III clinical trials since 1997 were used to construct and validate Cox models, stratified by treatment arm within each study. Candidate variables included baseline age, sex, body mass index, performance status, colon vs rectal cancer, prior chemotherapy, number and location of metastatic sites, tumor mutation status (BRAF, KRAS), bilirubin, albumin, white blood cell count, hemoglobin, platelets, absolute neutrophil count, and derived neutrophil-to-lymphocyte ratio. Missing data (<11%) were imputed, continuous variables modeled with splines, and clinically relevant pairwise interactions tested if P values were less than .001. Final models were internally validated via bootstrapping to obtain optimism-corrected calibration and discrimination C-indices, and externally validated on a 10% holdout sample from each trial (n = 2257). Results In final models, all included variables were associated with overall survival except for lung metastases, and all but total white cell count associated with progression-free survival. No clinically relevant pairwise interactions were identified. Final nomogram calibration was good (C = 0.68 for overall and C = 0.62 for progression-free survival), as was external validity (concordance between predicted >50% vs < 50% probability) and actual (yes/no) survival (72.8% and 68.2% concordance, respectively, for one-year overall and six-month progression-free survival, between predicted [>50% vs < 50% probability] and actual [yes/no] overall and progression-free survival). Median survival predictions fell within the actual 95% Kaplan-Meier confidence intervals. Conclusions The nomograms are well calibrated and internally and externally valid. They have the potential to aid prognostication and patient-physician communication and balance risk in colorectal cancer trials.
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Affiliation(s)
- Katrin M Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | | | - R John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | | | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | | | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Jean-Yves Douillard
- European Society for Medical Oncology (ESMO) Chief Medical Officer (CMO), Institut de Cancérologie de l'Ouest (ICO) René Gauducheau, Saint-Herblain, France
| | - Paulo M Hoff
- Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paolo, Sao Paolo, Brazil
| | - Joel Randolph Hecht
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Christophe Tournigand
- University of Paris Est Creteil, Paris, France
- Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Creteil, France
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Miriam Koopman
- University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Volker Heinemann
- University of Munich, Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | | | - Rainer Porschen
- Klinikum Bremen-Ost Klinik fur Innere Medizin, Bremen, Germany
| | | | - Eduardo Diaz-Rubio
- Department of Oncology, Hospital Clínico San Carlos, CIBERONC Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Aranda
- Department of Medical Oncology IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC Instituto de Salud Carlos III, Córdoba, Spain
| | | | | | - Fairooz F Kabbinavar
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | | | | | | | | | - John R Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
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30
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Gulhati P, Yin J, Pederson L, Schmoll HJ, Hoff PM, Douillard JY, Hecht JR, Tournigand C, Tebbut N, Chibaudel B, De Gramont A, Shi Q, Overman MJ. Change in CEA as an early predictor of progression to first-line systemic therapy in metastatic colorectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
- Pat Gulhati
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Niall Tebbut
- University of Sydney Medical School, Sydney, Australia
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31
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Schmoll HJ, Haustermans K, Price TJ, Nordlinger B, Hofheinz R, Daisne JF, Janssens J, Brenner B, Schmidt P, Reinel H, Hollerbach S, Caca K, Fauth FW, Hannig C, Zalcberg JR, Tebbutt NC, Mauer ME, Marreaud S, Lutz MP, Van Cutsem E. Preoperative chemoradiotherapy and postoperative chemotherapy with capecitabine +/- oxaliplatin in locally advanced rectal cancer: Final results of PETACC-6. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3500] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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)
| | | | - Timothy Jay Price
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | | | - Ralf Hofheinz
- University Medical Center Mannheim, Mannheim, Germany
| | | | | | | | | | - Hans Reinel
- Leopoldina Krankenhaus, Schweinfurt, Germany
| | | | - Karel Caca
- Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Carla Hannig
- Schwerpunktpraxis fur Hamatologie und Onkologie, Bottrop, Germany
| | | | - Niall C. Tebbutt
- Heidelberg Repatriation Hospital, Olivia Newton-John Cancer and Wellness Centre, Heidelberg, Australia
| | | | - Sandrine Marreaud
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, Belgium
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32
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Ou FS, Lou Y, Van Cutsem E, Saltz L, Schmoll HJ, Goldberg RM, Hoff P, Douillard JY, Hecht JR, Hurwitz H, Punt CJA, Bokemeyer C, Fuchs CS, Diaz-Rubio E, Tebbut N, Falcone A, Kabbinavar FF, De Gramont A, Grothey A, Shi Q. Evaluation of lesion-based response at 12 weeks (LBR12) of treatment (Rx) in metastatic colorectal cancer (mCRC): Findings from 9,092 patients (pts) in the ARCAD database. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.612] [Citation(s) in RCA: 2] [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
612 Background: mCRC is a heterogeneous disease leading to possible disparate responses among lesions in a single pt. This study assesses the heterogeneity of lesion responses and evaluates the prognostic value of LBR12 and its mortality risk discrimination beyond RECIST responses. Methods: Pts with ≥ 2 lesions and no new lesions at 12 weeks (wks) were eligible. For each pt, after 12 wks of Rx, each lesion was categorized as progressive disease (L-PD: ≥20% increase in the longest diameter [LD]), partial response (L-PR: ≥30% decrease in LD), or stable disease (L-SD: neither L-PD nor L-PR). LBR12 was defined, per patient, by the combination of lesion responses: homogeneous LBR12 (L-PD, L-SD, L-PR only) and heterogeneous LBR12 (mixture of L-PD/L-SD, L-PD/L-PR, L-SD/L-PR). LBR12 and overall survival (OS) were correlated using stratified multivariate Cox models after adjusting for age, gender, and ECOG PS. Results: Among 9,092 mCRCs (Rx: chemo alone 44%; chemo + VEGF inhibitor [VEGFi] 42%; chemo + EGFR inhibitor [EGFRi] 10%) from 16 1st-line studies. Median OS: 2.2 years. Per RECIST at 12 wks, CR 0%; PR 36.1%; SD 60.9%; PD 3.0%. Responses in 52% were heterogeneous (Table). VEGFi and EGFRi treated pts had the highest rate of L-SD/L-PR (45%) and L-PR only (22%) status, respectively. Median OS increased monotonically across pts with more L-PRs and fewer L-PDs (Table). Pts with L-SD/L-PR status, among which 51% had SD per RECIST, had longer OS than those with L-SD only status (HRadj.= .81, padj.< .0001), but shorter OS than those with L-PR only status (HRadj.= 1.46, padj.< .0001). Pts with L-PD/L-SD status, among which 71% were SD per RECIST, had shorter OS than those with L-SD only status (HRadj.= 2.22, padj.< .0001). These associations were consistent across treatment regimens. Conclusions: The lesion-based response captures the heterogeneity of within pt lesion responses and provides refinement in predicting outcome beyond RECIST response at 12 wks. [Table: see text]
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Affiliation(s)
| | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Paulo Hoff
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Niall Tebbut
- University of Sydney Medical School, Sydney, Australia
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Affiliation(s)
- Iris D Nagtegaal
- Department of Pathology, Nijmegen Medical Centre, Radboud University, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Hans-Joachim Schmoll
- Division of Clinical Oncology Research, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
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Van Cutsem E, Joulain F, Hoff PM, Mitchell E, Ruff P, Lakomý R, Prausová J, Moiseyenko VM, van Hazel G, Cunningham D, Arnold D, Schmoll HJ, Ten Tije AJ, McKendrick J, Kröning H, Humblet Y, Grávalos C, Le-Guennec S, Andria M, Dochy E, Vishwanath RL, Macarulla T, Tabernero J. Aflibercept Plus FOLFIRI vs. Placebo Plus FOLFIRI in Second-Line Metastatic Colorectal Cancer: a Post Hoc Analysis of Survival from the Phase III VELOUR Study Subsequent to Exclusion of Patients who had Recurrence During or Within 6 Months of Completing Adjuvant Oxaliplatin-Based Therapy. Target Oncol 2017; 11:383-400. [PMID: 26706237 DOI: 10.1007/s11523-015-0402-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of this post hoc analysis of the VELOUR study (ClinicalTrials.gov NCT00561470) was to investigate the treatment effect of adding aflibercept to second-line infusional 5-fluorouracil (5-FU), leucovorin and irinotecan (FOLFIRI) in patients with metastatic colorectal cancer (mCRC) who had failed any prior oxaliplatin-containing regimen. Adjuvant rapid relapsers (ARR), who were enrolled directly following relapse during or within 6 months of completion of oxaliplatin-containing adjuvant chemotherapy (N = 124, including 17 patients who also received bevacizumab as part of their adjuvant therapy), were excluded from the original VELOUR intention-to-treat (ITT) population (N = 1226). After exclusion of the ARR, overall survival (OS) in the ITT minus ARR (ITT-ARR) population (N = 1102) was longer in the aflibercept plus FOLFIRI arm than in the placebo plus FOLFIRI arm [hazard ratio (HR) 0.78, 95 % confidence interval (CI) 0.68-0.90; median survival difference 1.87 months]. In the subgroup of patients assigned to the prior bevacizumab stratum at randomization, OS was numerically longer in the aflibercept plus FOLFIRI arm than in the placebo plus FOLFIRI arm (HR 0.81; 95 % CI 0.63-1.04; median survival difference 2.14 months). Comparison of the post hoc analysis results with the primary analysis from VELOUR suggests that the inclusion of the directly enrolled ARR may have understated the aflibercept treatment benefit for both bevacizumab-pretreated and bevacizumab-naïve patients in the strictly second-line setting although no definitive conclusion may be inferred. The benefit associated with the addition of aflibercept to second-line FOLFIRI in patients with mCRC was observed whatever the timing of first-line disease progression. There were no unexpected safety concerns.
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Affiliation(s)
- Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg/Leuven, Leuven, Belgium.
| | | | - Paulo M Hoff
- Centro De Oncologia, Hospital Sirio Libanes, São Paulo, Brazil
| | - Edith Mitchell
- Kimmel Cancer Center at Jefferson, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Paul Ruff
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Radek Lakomý
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | - Vladimir M Moiseyenko
- Scientific Research Institute of Oncology n.a. N.N.Petrov, St-Petersburg, Russian Federation
| | - Guy van Hazel
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Dirk Arnold
- Department of Medical Oncology, Tumor Biology Center, Freiburg, Germany
| | | | | | | | - Hendrik Kröning
- Schwerpunktpraxis für Hämatologie und Onkologie, Magdeburg, Germany
| | | | - Cristina Grávalos
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Teresa Macarulla
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
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Bonnetain F, Borg C, Adams RR, Ajani JA, Benson A, Bleiberg H, Chibaudel B, Diaz-Rubio E, Douillard JY, Fuchs CS, Giantonio BJ, Goldberg R, Heinemann V, Koopman M, Labianca R, Larsen AK, Maughan T, Mitchell E, Peeters M, Punt CJA, Schmoll HJ, Tournigand C, de Gramont A. How health-related quality of life assessment should be used in advanced colorectal cancer clinical trials. Ann Oncol 2017; 28:2077-2085. [PMID: 28430862 DOI: 10.1093/annonc/mdx191] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Traditionally, the efficacy of cancer treatment in patients with advance or metastatic disease in clinical studies has been studied using overall survival and more recently tumor-based end points such as progression-free survival, measurements of response to treatment. However, these seem not to be the relevant clinical end points in current situation if such end points were no validated as surrogate of overall survival to demonstrate the clinical efficacy. Appropriate, meaningful, primary patient-oriented and patient-reported end points that adequately measure the effects of new therapeutic interventions are then crucial for the advancement of clinical research in metastatic colorectal cancer to complement the results of tumor-based end points. Health-related quality of life (HRQoL) is effectively an evaluation of quality of life and its relationship with health over time. HRQoL includes the patient report at least of the way a disease or its treatment affects its physical, emotional and social well-being. Over the past few years, several phase III trials in a variety of solid cancers have assessed the incremental value of HRQoL in addition to the traditional end points of tumor response and survival results. HRQoL could provide not only complementary clinical data to the primary outcomes, but also more precise predictive and prognostic value. This end point is useful for both clinicians and patients in order to achieve the dogma of precision medicine. The present article examines the use of HRQoL in phase III metastatic colorectal cancer clinical trials, outlines the importance of HRQoL assessment methods, analysis, and results presentation. Moreover, it discusses the relevance of including HRQoL as a primary/co-primary end point to support the progression-free survival results and to assess efficacy of treatment in the advanced disease setting.
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Affiliation(s)
- F Bonnetain
- Methodology and Quality of Life Unit, Oncology Department (INSERM UMR 1098), Quality of Life and Cancer Clinical Research Platform
| | - C Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon
- Centre d'Investigation Clinique en Biothérapie, CIC-1431, Nantes
- 11UMR1098 INSERM/Université de Franche Comté/Etablissement Français du Sang, Besançon
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - R R Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - J A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - A Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - H Bleiberg
- Montagne de Saint Job, Brussels, Belgium
| | - B Chibaudel
- Institut Hospitalier Franco-Britannique, Levallois-Perret, France
| | - E Diaz-Rubio
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J Y Douillard
- Medical Oncology, Institut de Cancérologie de l'Ouest (ICO), Nantes St-Herblain, France
| | - C S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - B J Giantonio
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia
| | - R Goldberg
- Department of Medicine, The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, USA
| | - V Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - A K Larsen
- Cancer Biology and Therapeutics, INSERM and Université Pierre et Marie Curie, Hôpital Saint-Antoine, Paris, France
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - E Mitchell
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - M Peeters
- Department of Oncology, Center for Oncological Research Antwerp, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H J Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - C Tournigand
- Department of Oncology, University of Paris Est Creteil; APHP, Henri-Mondor Hospital, Créteil, France
| | - A de Gramont
- Institut Hospitalier Franco-Britannique, Levallois-Perret, France
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Emile JF, Julié C, Le Malicot K, Lepage C, Tabernero J, Mini E, Folprecht G, Van Laethem JL, Dimet S, Boulagnon-Rombi C, Allard MA, Penault-Llorca F, Bennouna J, Laurent-Puig P, Taieb J, Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Keil F, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Jagdt B, Lang A, Fridrik M, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, Kalantari HR, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, Budnik TM, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, Derigs HG, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ciuffreda L, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, Ayerbes MV, Batlle JF, Gil S, Esteve AA, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, Nogueras LC, Merino BQ, Castro CG, de Prado PM, Pericay CP, Figueiras MC, Jordan IG, Gome Reina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, Gaspar EM, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, Morales MG, Muñoz ML, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, Busquier IH, Ruiz TC, Muñoa AL, Aliguer MN, de Taranco AVO, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, Brotons AG, Rodriguez SA, Martinez JA, Ruiz LC, Ruiz MC, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prospective validation of a lymphocyte infiltration prognostic test in stage III colon cancer patients treated with adjuvant FOLFOX. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.04.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Renfro LA, Goldberg RM, Grothey A, Sobrero A, Adams R, Seymour MT, Heinemann V, Schmoll HJ, Douillard JY, Hurwitz H, Fuchs CS, Diaz-Rubio E, Porschen R, Tournigand C, Chibaudel B, Hoff PM, Kabbinavar FF, Falcone A, Tebbutt NC, Punt CJ, Hecht JR, Souglakos J, Bokemeyer C, Van Cutsem E, Saltz L, de Gramont A, Sargent DJ. Clinical Calculator for Early Mortality in Metastatic Colorectal Cancer: An Analysis of Patients From 28 Clinical Trials in the Aide et Recherche en Cancérologie Digestive Database. J Clin Oncol 2017; 35:1929-1937. [PMID: 28414610 PMCID: PMC5466009 DOI: 10.1200/jco.2016.71.5771] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Factors contributing to early mortality after initiation of treatment of metastatic colorectal cancer are poorly understood. Materials and Methods Data from 22,654 patients enrolled in 28 randomized phase III trials contained in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were pooled. Multivariable logistic regression models for 30-, 60-, and 90-day mortality were constructed, including clinically and statistically significant patient and disease factors and interaction terms. A calculator (nomogram) for 90-day mortality was developed and validated internally using bootstrapping methods and externally using a 10% random holdout sample from each trial. The impact of early progression on the likelihood of survival to 90 days was examined with time-dependent Cox proportional hazards models. Results Mortality rates were 1.4% at 30 days, 3.4% at 60 days, and 5.5% at 90 days. Among baseline factors, advanced age, lower body mass index, poorer performance status, increased number of metastatic sites, BRAF mutant status, and several laboratory parameters were associated with increased likelihood of early mortality. A multivariable model for 90-day mortality showed strong internal discrimination (C-index, 0.77) and good calibration across risk groups as well as accurate predictions in the external validation set, both overall and within patient subgroups. Conclusion A validated clinical nomogram has been developed to quantify the risk of early death for individual patients during initial treatment of metastatic colorectal cancer. This tool may be used for patient eligibility assessment or risk stratification in future clinical trials and to identify patients requiring more or less aggressive therapy and additional supportive measures during and after treatment.
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Affiliation(s)
- Lindsay A. Renfro
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard M. Goldberg
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Axel Grothey
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alberto Sobrero
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard Adams
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew T. Seymour
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Volker Heinemann
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hans-Joachim Schmoll
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jean-Yves Douillard
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Herbert Hurwitz
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles S. Fuchs
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eduardo Diaz-Rubio
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rainer Porschen
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christophe Tournigand
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Benoist Chibaudel
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paulo M. Hoff
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fairooz F. Kabbinavar
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alfredo Falcone
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niall C. Tebbutt
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cornelis J.A. Punt
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J. Randolph Hecht
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John Souglakos
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carsten Bokemeyer
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Van Cutsem
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leonard Saltz
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aimery de Gramont
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel J. Sargent
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - on behalf of the ARCAD Clinical Trials Program
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
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Schaffrath J, Schmoll HJ, Voigt W, Müller LP, Müller-Tidow C, Mueller T. Efficacy of targeted drugs in germ cell cancer cell lines with differential cisplatin sensitivity. PLoS One 2017; 12:e0178930. [PMID: 28591197 PMCID: PMC5462387 DOI: 10.1371/journal.pone.0178930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/22/2017] [Indexed: 12/25/2022] Open
Abstract
Testicular germ cell tumors (TGCTs) are the most common malignancies in men between the age of 15 and 35. Although cisplatin-based chemotherapy is highly effective in advanced disease, approximately 20% of patients have an unfavorable prognosis due to primary or acquired cisplatin resistance. For these patients, new therapeutic options are urgently needed. In numerous tumor entities, combinations of monoclonal antibodies or kinase inhibitors with chemotherapy exerted promising preclinical or clinical results, which have led to new treatment concepts. This prompted us to investigate the activity of different targeted agents alone or in combination with cisplatin in a panel of TGCT cell lines.
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Affiliation(s)
- Judith Schaffrath
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Hans-Joachim Schmoll
- Workgroup Clinical Studies in Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wieland Voigt
- Medical Innovations and Management, Innovation in Oncology, Steinbeis University, Berlin, Germany
| | - Lutz P. Müller
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Mueller
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
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Schmoll HJ, Garlipp B, Junghanß C, Leithäuser M, Vogel A, Schaefers M, Kaiser U, Hoeffkes HG, Florschütz A, Rüssel J, Kanzler S, Edelmann T, Forstbauer H, Göhler T, Hannig C, Hildebrandt B, Steighardt J, Cygon F, Meinert F, Stein A. FOLFOX/Bevacizumab +/− Irinotecan in advanced colorectal cancer (AIO) “CHARTA”: Final results and multivariate prognostic factor analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx302.006] [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: 11/13/2022] Open
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Quidde J, Schmoll HJ, Garlipp B, Junghanss C, Leithaeuser M, Vogel A, Schaefers M, Kaiser U, Hoeffkes HG, Florschütz A, Rüssel J, Kanzler S, Edelmann T, Forstbauer H, Goehler T, Hannig C, Hildebrandt B, Bokemeyer C, Steighardt J, Stein A. Impact of FOLFOXIRI and bevacizumab (bev) compared to FOLFOX and bev on health related quality of life (HRQOL) in patients with metastatic colorectal cancer (MCRC): Analysis of the CHARTA-AIO 0209 trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3544] [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
3544 Background: FOLFOXIRI/bev is a highly efficacious first line regimen in MCRC. Despite higher rates of neutropenia, diarrhea and stomatitis, FOLFOXIRI/bev is tolerable and feasible in MCRC patients. To date nothing is known about the impact of this regimen on HRQOL. Methods: 250 patients were randomized to FOLFOX/bev (arm A) or FOLFOXIRI/bev (arm B). HRQOL were assessed at baseline, every 8 weeks during induction treatment (6 months) and every 12 weeks during maintenance treatment, using the EORTC QLQ-C30, QLQ-CR29 and QLQ-CIPN20. The mean values of every score were calculated as the average of week 8, 16 and 24 assessment. Test concerning mean values were performed as t-test, with global type I error set at 0.05. HRQOL deterioration and improvement rates were analyzed and compared between treatment groups using chi² tests. Results: For HRQOL analysis, 237 patients were eligible (arm A: 118; arm B: 119). Compliance rate with the HRQOL questionnaires was 95.4% at baseline, 72.6% at week 8, 59.5 % at week 16 and 43.5% at week 24. Whereas mean global quality of life score (GHS/QOL) was similar between arm A and B (59.8 vs. 58.8; p = 0.726), mean scores for nausea/vomiting (9.4 vs. 16.0; p = 0.015) and diarrhea (23.7 vs. 32.1; p = 0.051) significantly or borderline significantly favored arm A during induction period. Furthermore, at week 8 scores of nausea/vomiting (9.2 versus 17.3, p = 0.006) appetite loss (19.5 vs. 29.4; p = 0.035) and financial problems (18.3 vs. 29.5; p = 0.021) and at the end of treatment physical functioning (75.0 vs. 65.8; p = 0.048) were significantly better for arm A compared to arm B. No significant differences were observed in the remaining EORTC scores. The rates of deterioration and improvement between baseline and week 8 of at least 10 points in the EORTC scores were similar (e.g. deterioration-rate GHS/QOL score 21.5% vs. 26.5% for arm A vs. B; p = 0.461). Conclusions: Although no remarkable detriment in HRQOL was noted, the better efficacy of FOLFOXIRI/bev compared to FOLFOX/bev is associated with a decrease in mainly gastrointestinal QOL scores. Further subgroup-analyses will be presented at the meeting. Clinical trial information: NCT01321957.
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Affiliation(s)
- Julia Quidde
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald-Tumor Zentrum (UCCH), University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hans-Joachim Schmoll
- Martin Luther University, Division Clinical Oncology, University Hospital, Halle, Germany
| | | | - Christian Junghanss
- Department of Hematology and Oncology, University Hospital, Rostock, Germany
| | | | - Arndt Vogel
- Clinic of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Jörn Rüssel
- Department of Oncology and Hematology, Martin Luther University, Halle-Wittenberg, Halle, Germany
| | - Stephan Kanzler
- Department of Internal Medicine II, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Thomas Edelmann
- Schwerpunktpraxis fur Hamatologie und Onkologie, Schkeuditz, Germany
| | | | | | - Carla Hannig
- Schwerpunktpraxis fur Hamatologie und Onkologie, Bottrop, Germany
| | | | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Alexander Stein
- University Cancer Center Hamburg, University of Hamburg, Hamburg, Germany
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Kegel T, Cygon F, Meinert FM, Hammad K, Steinbach F, Seseke F, Schmoll HJ. Phase II-study of sequential high-dose-chemotherapy with paclitaxel, ifosfamide, carboplatin, etoposide( P-ICE) in patients with relapsed or refractory germ cell tumors (GCT). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4552] [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
4552 Background: High-dose chemotherapy (HD-CTx) is an active option for salvage chemotherapy in patients (pts) with refractory or relapsed GCT. All previous trials with HD-CTx used one or two cycles of high dose chemotherapy (CTx) including 2 or a maximum of 3 drugs. Another potentially more active option is the application of four sequential HD-CTx cycles (Schmoll et al, JCO 2003). Methods: We conducted a phase II trial of 1(-2) cycle(s) induction CTx with standard dose P-ICE (Paclitaxel 135mg/m² d1, Ifosfamide 1500mg/m² d1-3, Carboplatin 150mg/m² d1-3, Etoposide 150mg/m² d1-3), followed by 4 sequential cycles of HD-P-ICE (Paclitaxel 200mg/m² d1, Ifosfamide 3300mg/m² d1-3, Carboplatin 330mg/m² d1-3, Etoposide 330mg/m² d1-3). Eligibility criteria: relapse or progression under one or more induction CTx, ECOG PS (0-1), Creatinine-clearance > 30ml/min, adaequate liver function, measurable tumor or at least marker-elevation. Results: 37 pts entered the trial and 33 are evaluable (4 pts never received HD-CTx due to lack of stem cells (3) or medical reasons (1)). Prior CTx:1 (N = 26), 2 (N = 4), 3 (N = 3); primary extragonadal: 6; seminoma/ non-seminoma 5/28; ECOG-PS: 0 (19), 1 (14). Response rate: CR/NED 17 (51.5%), CR/NED/PR-/SD- with marker normalization 21 (63.6%), PD 12 (36.4%). DFS of CR/NED: median 59 (8-105) months; RFS of all favourable responders 60 (8-105) months, PFS total 46 (2-105) months. OS for all pts. 51 (6-105) months, OS Favourable Responders: 65 (23 – 105), Nonfavourable Responders: 11 (6-27) months,. Toxicity was tolerable without treatment related death, with mainly grade 4 bone-marrow toxicity and grade 2 mucositis and/or diarrhea. Conclusions: Sequential HD-CTx with one cycle of SD-P-ICE and four cycles HD-CTx is feasible with acceptable toxicity and favourable efficacy. Sequential HD-CTx using the four most active drugs might be a potentially option for this pts-population due to good tolerability, applicability and interesting long-term outcome. Comparison of the standard approach with 1 to 3 sequential high dose cycles of Carboplatin/Etoposide is ongoing (TIGER-Trial). Clinical trial information: EUDRA-CT: 2006-006004-11.
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Affiliation(s)
| | - Franziska Cygon
- University Clinic Halle, Div. Clinical Oncology Research, Halle, Germany
| | | | - Khaled Hammad
- Martin Luther University, Halle-Wittenberg, Halle, Germany
| | - Frank Steinbach
- Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Germany
| | - Florian Seseke
- Städtisches Krankenhaus Martha-Maria Halle-Dölau, Halle, Germany
| | - Hans-Joachim Schmoll
- Martin Luther University, Division Clinical Oncology, University Hospital, Halle, Germany
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Schmoll HJ, Meinert FM, Cygon F, Garlipp B, Junghanss C, Leithäuser M, Vogel A, Schaefers M, Kaiser U, Hoeffkes HG, Florschütz A, Rüssel J, Kanzler S, Edelmann T, Forstbauer H, Goehler T, Hannig C, Hildebrandt B, Steighardt J, Stein A. “CHARTA”: FOLFOX/Bevacizumab vs. FOLFOXIRI/Bevacizumab in advanced colorectal cancer—Final results, prognostic and potentially predictive factors from the randomized Phase II trial of the AIO. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3533] [Citation(s) in RCA: 14] [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: 12/11/2022] Open
Abstract
3533 Background: FOLFOXIRI/Bevacizumab (Bev) is superior to FOLFIRI/Bev in the TRIBE trial (F Loupakis, NEJM 2014). The CHARTA trial was developed parallel to TRIBE with the same 4-drug-protocol but vs. FOLFOX/B ev as control arm. Methods: From 7/11 to 12/14 250 patients were randomized, including ECOG 0-2, ≥ 1 measurable lesion > 1cm, stratified by ESMO-Group 1,2,3 (HJ Schmoll, Ann Oncol 2012). Induction: 6 months, maintenance Capecitabine+Bev until progression or max.12 months, at P reinduction by investigators decision. 25% dose reduction was allowed in cycle 1 + 2 on the investigator’s discretion. Primary EP: significant improvement of PFS-rate @ 9 months (p<0.1, 2-sided Fisher’s-exact test); secondary EP: RR, PFS, OS, toxicity. Results: 241 pts. (1 not elig., 8 prot. violation) are evaluable after a follow up of 31.4 (0.1-51) months. m/f: 65%/35%, age 61y (21-82), ECOG 0-1/2: 96%/4%. The Primary Endpoint was met: PFS @ 9 months 56% vs. 68%, p= 0.086. PFS was improved: 9.8 vs. 12.0 months, HR 0.7 (ns.), identical to TRIBE with 9.7 vs. 12.1 months. Response rate (A/B): CR: 5%/5%, CR/PR 60%/70%, SD 25%/21%, PD 14%/9%. Final OS will be available at the meeting. Toxicity was low to moderate without major differences except ° ¾ diarrhea (12%/16%) and neutrophils (14%/20%). Clinical/molecular prognostic or predictive factors are equally distributed (stratification by ESMO groups) (see table). There are major, but mostly not significant differences in RR/ PFS in most subgroups, however, not strong enough to safely identify patients with high potential to benefit from the 4-drug combination. Therefore, a multivariate analysis to model a common prognostic and predictive risk score is ongoing and will be presented at the meeting. Conclusion: “CHARTA” supports the superiority of FOLFOXIRI/Bev. A combined prognostic and predictive classification is required to better select those patients with most potential benefit from the 4-drug combination. Clinical trial information: NCT01321957. [Table: see text]
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Affiliation(s)
- Hans-Joachim Schmoll
- Martin Luther University, Division Clinical Oncology, University Hospital, Halle, Germany
| | | | - Franziska Cygon
- University Clinic Halle, Div. Clinical Oncology Research, Halle, Germany
| | | | - Christian Junghanss
- Department of Hematology and Oncology, University Hospital, Rostock, Germany
| | | | - Arndt Vogel
- Clinic of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Jörn Rüssel
- Department of Oncology and Hematology, Martin Luther University, Halle-Wittenberg, Halle, Germany
| | | | - Thomas Edelmann
- Schwerpunktpraxis fur Hamatologie und Onkologie, Schkeuditz, Germany
| | | | | | - Carla Hannig
- Schwerpunktpraxis fur Hamatologie und Onkologie, Bottrop, Germany
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Ou FS, Hubbard JM, Kasi PM, Dixon J, Van Cutsem E, Saltz L, Schmoll HJ, Punt CJA, Goldberg RM, Hoff P, Douillard JY, Hecht JR, Hurwitz H, Bokemeyer C, Fuchs C, Diaz-Rubio E, Sargent DJ, De Gramont A, Shi Q, Grothey A. Heterogeneity in early lesion changes on treatment as a marker of poor prognosis in patients (pts) with metastatic colorectal cancer (mCRC) treated with first line systemic chemotherapy ± biologic: Findings from 9,092 pts in the ARCAD database. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3535] [Citation(s) in RCA: 6] [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
3535 Background: CRC is known to be a heterogeneous disease. This study quantifies within pt heterogeneity in early lesion change rate (LCR) in the era of targeted agents compared to chemo alone and its potential impact on survival. Methods: Pts with 2-10 lesions measured at baseline were included. For each lesion, the early LCR was defined as the change in size (shrinking or growing) from baseline to 12 weeks on treatment. Within pt heterogeneity in early LCR among lesions was estimated by standard deviation (STD). A larger value of STD indicates larger variation of LCR per pt. Stratified multivariate Cox models were used to assess the associations between LCR STD with overall survival (OS). Adjusted hazard ratios (HRadj) and 95% confidence intervals (CIs) are reported. Results: Data were available on 9,092 mCRC pts (median age 61; 60% male, 55% ECOG PS 0; 61% 2+ metastatic sites) enrolled in 16 1st-line randomized trials, with 44%, 42%, and 10% of pts received chemo alone, + a VEGF inhibitor (VEGFi) or an EGFR inhibitor (EGFRi), respectively. LCR heterogeneity is the highest among pts received EGFRi but lowest among pts received VEGFi (Table). Overall, higher heterogeneity is associated with worst OS (HRadj1.22, 95% CI (1.16, 1.27)). The effect is most pronounced in pts received VEGFi (interaction p=0.0012). Conclusions: There was heterogeneity observed in lesion size changes within pts. Its magnitude varies across treatment approaches, and was associated with poor survival. This preliminary result reveals the great potentials to define novel response endpoint and refine treatment decision-making by incorporating heterogeneities in lesion changes. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Leonard Saltz
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Hans-Joachim Schmoll
- Martin Luther University, Division Clinical Oncology, University Hospital, Halle, Germany
| | - Cornelis J. A. Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Paulo Hoff
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | - J. Randolph Hecht
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | | | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charles Fuchs
- Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA
| | | | | | | | - Qian Shi
- Mayo Clinic Cancer Center, Rochester, MN
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Schmoll HJ, Garlipp B, Junghanss C, Leithaeuser M, Vogel A, Schaefers M, Kaiser U, Hoeffkes HG, Florschütz A, Rüssel J, Kanzler S, Edelmann T, Forstbauer H, Goehler T, Hannig C, Hildebrandt B, Steighardt J, Meinert FM, Cygon F, Stein A. CHARTA: FOLFOX+bevacizumab +/- irinotecan in advanced colorectal cancer (CRC)—Final results of the randomized phase II trial of the AIO (KRK 0209). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
658 Background: The 4-drug-regimen FOLFOXIRI+Bevacizumab (Bev) was superior to FOLFIRI+Bev (TRIBE F.Loupakis, NEJM 2014). CHARTA investigates the same 4-drug-regimen vs. FOLFOX+Bev. Methods: 250 patients were randomized from 7/11 to 12/14 to standard FOLFOX+Bev (A) vs. FOLFOXIRI+Bev (B), with dose/schedule as in TRIBE, 25% dose reduction in cycle 1 + 2, if necessary. Incl.criteria: ECOG 0-2, ≥ 1 measurable lesion > 1cm; stratified by ESMO-Group 1, 2, 3 (HJ Schmoll et. al., Ann Oncol 2012). Induction: 6 months, maintenance Capecitabine+Bev until progression or max. of 12 months, with reinduction by individual decision. Primary EP: significant improvement of PFS-rate at 9 months (p<0.1, 2-sided Fisher’s-exact test); secondary EP: RR- rate, PFS, OS, sec. resection. Results: Evaluable 241 pts. (1 not elig., 8 prot. violation); m/f: 65%/35%, age 61 yrs. (21-82), left/right: left A: 51, 5%, B: 48, 5%; right A: 45%, B: 55%; ECOG 0-1/2: 96% / 4%, ESMO-group 1/2/3: 29%/ 55%/ 16%. Primary endpoint was met: significantly improved PFS at 9 months 56% vs. 68% (p= 0,086). Preliminary PFS 9,76 vs. 12,0 months (HR 0.77, p=0.61), identical to TRIBE: 9.7 vs. 12.1. Response (A/B): CR: 5/5%, CR/PR 60/70%, SD 25/21%, PD 14/9%; sec. resection: 21/23%. Subgroup - analyses did not show significant differences, except CR / PR left/right (A/B): left 59/68%, right 63/73%; PFS (months) left 10.4/12 (HR 0.69, p=0.03), right: 8.2 /10.7); non-significant improvement in ESMO-group 3 (HR 0.51), RAS-wt (HR 0.67), Koehne-Score High risk HR 0.58; ECOG 1: HR 0.69. QL-Global- Health-Score: slightly worse in A, vs. improved in B. Dose-intensity <70%/ 70-90%/ >90% (A/B): 39/37%/ 18/26%/ 41%/36%; initial dose-reduction 17% of pts. Toxicity: low to moderate without major differences between A &B, except grade ¾ diarrhea 12/16%, neutrophils 14/20%, GI 12/20%. Conclusions: The 4-drug-regimen has superior activity with the same outcome as TRIBE and is well tolerated, without a negative effect of initial dose-reduction, and an improvement of global QoL-Score. Final PFS, OS data and detailed subgroup/multivariate analysis, including Quality of life data, will be presented. Clinical trial information: NCT01321957.
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Affiliation(s)
- Hans-Joachim Schmoll
- Martin Luther University, Division Clinical Oncology, University Hospital, Halle, Germany
| | | | | | | | | | | | | | | | | | - Jörn Rüssel
- Department of Oncology and Hematology, Martin Luther University, Halle-Wittenberg, Halle, Germany
| | - Stephan Kanzler
- Department of Internal Medicine II, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Thomas Edelmann
- Schwerpunktpraxis fur Hamatologie und Onkologie, Schkeuditz, Germany
| | | | | | - Carla Hannig
- Schwerpunktpraxis fur Hamatologie und Onkologie, Bottrop, Germany
| | | | | | | | - Franziska Cygon
- University Clinic Halle, Div. Clinical Oncology Research, Halle, Germany
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Dittrich C, Kosty M, Jezdic S, Pyle D, Berardi R, Bergh J, El-Saghir N, Lotz JP, Österlund P, Pavlidis N, Purkalne G, Awada A, Banerjee S, Bhatia S, Bogaerts J, Buckner J, Cardoso F, Casali P, Chu E, Close JL, Coiffier B, Connolly R, Coupland S, De Petris L, De Santis M, de Vries EGE, Dizon DS, Duff J, Duska LR, Eniu A, Ernstoff M, Felip E, Fey MF, Gilbert J, Girard N, Glaudemans AWJM, Gopalan PK, Grothey A, Hahn SM, Hanna D, Herold C, Herrstedt J, Homicsko K, Jones DV, Jost L, Keilholz U, Khan S, Kiss A, Köhne CH, Kunstfeld R, Lenz HJ, Lichtman S, Licitra L, Lion T, Litière S, Liu L, Loehrer PJ, Markham MJ, Markman B, Mayerhoefer M, Meran JG, Michielin O, Moser EC, Mountzios G, Moynihan T, Nielsen T, Ohe Y, Öberg K, Palumbo A, Peccatori FA, Pfeilstöcker M, Raut C, Remick SC, Robson M, Rutkowski P, Salgado R, Schapira L, Schernhammer E, Schlumberger M, Schmoll HJ, Schnipper L, Sessa C, Shapiro CL, Steele J, Sternberg CN, Stiefel F, Strasser F, Stupp R, Sullivan R, Tabernero J, Travado L, Verheij M, Voest E, Vokes E, Von Roenn J, Weber JS, Wildiers H, Yarden Y. ESMO / ASCO Recommendations for a Global Curriculum in Medical Oncology Edition 2016. ESMO Open 2016; 1:e000097. [PMID: 27843641 PMCID: PMC5070299 DOI: 10.1136/esmoopen-2016-000097] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 12/05/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) are publishing a new edition of the ESMO/ASCO Global Curriculum (GC) thanks to contribution of 64 ESMO-appointed and 32 ASCO-appointed authors. First published in 2004 and updated in 2010, the GC edition 2016 answers to the need for updated recommendations for the training of physicians in medical oncology by defining the standard to be fulfilled to qualify as medical oncologists. At times of internationalisation of healthcare and increased mobility of patients and physicians, the GC aims to provide state-of-the-art cancer care to all patients wherever they live. Recent progress in the field of cancer research has indeed resulted in diagnostic and therapeutic innovations such as targeted therapies as a standard therapeutic approach or personalised cancer medicine apart from the revival of immunotherapy, requiring specialised training for medical oncology trainees. Thus, several new chapters on technical contents such as molecular pathology, translational research or molecular imaging and on conceptual attitudes towards human principles like genetic counselling or survivorship have been integrated in the GC. The GC edition 2016 consists of 12 sections with 17 subsections, 44 chapters and 35 subchapters, respectively. Besides renewal in its contents, the GC underwent a principal formal change taking into consideration modern didactic principles. It is presented in a template-based format that subcategorises the detailed outcome requirements into learning objectives, awareness, knowledge and skills. Consecutive steps will be those of harmonising and implementing teaching and assessment strategies.
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Affiliation(s)
- Christian Dittrich
- 3rd Medical Department , Centre for Oncology and Haematology, Kaiser Franz Josef-Spital , Vienna , Austria
| | - Michael Kosty
- Division of Hematology/Oncology , Scripps Green Cancer Center, Scripps Clinic , La Jolla, California , USA
| | - Svetlana Jezdic
- European Society for Medical Oncology (ESMO) , Lugano , Switzerland
| | - Doug Pyle
- American Society of Clinical Oncology (ASCO) , Alexandria, Virginia , USA
| | - Rossana Berardi
- Department of Medical Oncology , Università Politecnica delle Marche, Ospedali Riuniti Ancona , Ancona , Italy
| | - Jonas Bergh
- The Strategic Research Programme in Cancer, Karolinska Institutet and University Hospital , Stockholm , Sweden
| | - Nagi El-Saghir
- Department of Internal Medicine , NK Basile Cancer Institute, American University of Beirut Medical Center , Beirut , Lebanon
| | - Jean-Pierre Lotz
- Department of Medical Oncology and Cellular Therapy, Medical Oncology Department , Tenon Assistance Publique-Hôpitaux de Paris , Paris , France
| | - Pia Österlund
- Department of Oncology , HUCH Helsinki University Central Hospital and University of Helsinki , Helsinki, Finland
| | - Nicholas Pavlidis
- Department of Medical Oncology , University of Ioannina , Ioannina , Greece
| | - Gunta Purkalne
- Clinic of Oncology , Pauls Stradins Clinical University Hospital , Riga , Latvia
| | - Ahmad Awada
- Medical Oncology Clinic , Jules Bordet Institute, Université Libre de Bruxelles , Brussels , Belgium
| | | | - Smita Bhatia
- Division of Pediatric Hematology/Oncology, Department of Pediatrics , Institute of Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, UAB Comprehensive Cancer Center , Birmingham, Alabama , USA
| | - Jan Bogaerts
- The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Jan Buckner
- Department of Oncology , Cancer Practice-Mayo Clinic Cancer Center , Rochester, Minnesota , USA
| | - Fatima Cardoso
- Breast Unit , Champalimaud Clinical Center , Lisbon , Portugal
| | - Paolo Casali
- Medical Oncology Unit 2 (Adult Mesenchymal Tumours and Rare Cancers) , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Edward Chu
- University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA
| | - Julia Lee Close
- UF Department of Medicine Division of Hematology/Oncology, UF Hematology/Oncology Fellowship Program, Gainesville, Florida, USA; Medical Service, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Bertrand Coiffier
- Department of Hematology , University Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud , Lyon , France
| | - Roisin Connolly
- Breast and Ovarian Cancer Program , Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore, Maryland , USA
| | - Sarah Coupland
- Pathology, Molecular and Clinical Cancer Medicine , University of Liverpool , Liverpool , UK
| | - Luigi De Petris
- Department of Oncology , Radiumhemmet, Karolinska Institutet and University Hospital , Stockholm , Sweden
| | - Maria De Santis
- University of Warwick, Cancer Research Centre , Coventry , UK
| | - Elisabeth G E de Vries
- Department of Medical Oncology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Don S Dizon
- The Oncology Sexual Health Clinic, Harvard Medical School, Department of Medicine , Massachusetts General Hospital , Boston, Massachusetts , USA
| | - Jennifer Duff
- Department of Medicine , University of Florida , Gainesville, Florida , USA
| | - Linda R Duska
- Division of Gynecologic Oncology , University of Virginia School of Medicine , Charlottesville, Virginia , USA
| | - Alexandru Eniu
- Department of Breast Tumors , Cancer Institute "Ion Chiricuta" , Cluj-Napoca , Romania
| | - Marc Ernstoff
- Department of Medicine , Roswell Park Cancer Institute , Buffalo, New York , USA
| | - Enriqueta Felip
- Medical Oncology Department , Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Martin F Fey
- Inselspital and University Hospital of Bern , Bern , Switzerland
| | - Jill Gilbert
- Vanderbilt University School of Medicine , Nashville, Tennessee , USA
| | - Nicolas Girard
- Department of Respiratory Medicine, Thoracic Oncology , Institute of Oncology, Hospices Civils de Lyon , Lyon , France
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine & Molecular Imaging , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Priya K Gopalan
- Department of Medicine , University of Florida and Section of Medicine, Malcom Randall VA Medical Center , Gainesville, Florida , USA
| | - Axel Grothey
- Mayo Clinic Rochester , Rochester, Minnesota , USA
| | - Stephen M Hahn
- Division of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Diana Hanna
- Division of Medical Oncology , University of Southern California, Hoag Family Cancer Institute , Newport Beach, California , USA
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy , Medical University Vienna, Vienna General Hospital , Vienna , Austria
| | - Jørn Herrstedt
- Department of Oncology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Krisztian Homicsko
- Department of Oncology , University Hospital of Lausanne , Lausanne , Switzerland
| | - Dennie V Jones
- Department of Medicine, Division of Hematology/Oncology/Stem Cell Transplant, University of Florida, Gainesville, Florida, USA; Section of Hematology and Oncology, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Lorenz Jost
- Cantonal Hospital Baselland , Bruderholz , Switzerland
| | | | - Saad Khan
- Hematology and Oncology, Internal Medicine , UT Southwestern Medical Center , Dallas, Texas , USA
| | - Alexander Kiss
- Department of Psychosomatic Division , University Hospital Basel , Basel , Switzerland
| | - Claus-Henning Köhne
- University Clinic for Internal Medicine-Oncology and Hematology, Klinikum Oldenburg , Oldenburg , Germany
| | - Rainer Kunstfeld
- Clinic of Dermatology/Vienna General Hospital, Medical University Vienna , Vienna , Austria
| | - Heinz-Josef Lenz
- Department of Medical Oncology , Norris Comprehensive Cancer Center, University of Southern California , Los Angeles, California , USA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York, New York , USA
| | | | - Thomas Lion
- Division for Molecular Microbiology, Children'sCancer Research Institute (CCRI), Vienna, Austria; LabDia Laboratoriumsdiagnostik GmbH, Vienna, Austria
| | - Saskia Litière
- The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Lifang Liu
- Department of Statistics , The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Patrick J Loehrer
- Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine , Indianapolis, Indiana , USA
| | - Merry Jennifer Markham
- Division of Hematology & Oncology , University of Florida College of Medicine , Gainesville, Florida , USA
| | - Ben Markman
- Monash Cancer Centre, Monash Health , Melbourne , Australia
| | - Marius Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy , Medical University of Vienna, Vienna General Hospital , Vienna , Austria
| | - Johannes G Meran
- Internal Department, Krankenhaus Barmherzige Brüder , Vienna , Austria
| | | | | | | | - Timothy Moynihan
- Department of Medical Oncology , Mayo Clinic , Rochester, Minnesota , USA
| | - Torsten Nielsen
- University of British Columbia , Vancouver, British Columbia , Canada
| | - Yuichiro Ohe
- Department of Thoracic Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - Kjell Öberg
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | | | - Fedro Alessandro Peccatori
- Fertility & Procreation Unit, Gynecologic Oncology Department , European Institute of Oncology , Milan , Italy
| | | | - Chandrajit Raut
- Division of Surgical Oncology, Department of Surgery , Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital , Boston, Massachusetts , USA
| | - Scot C Remick
- Department of Medicine , Maine Medical Center Cancer Institute , Scarborough, Maine , USA
| | - Mark Robson
- Clinical Genetics Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York, New York , USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma , Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw , Poland
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory, Jules Bordet Institute, Brussels, Belgium; Department of Pathology, TCRU, GZA Antwerp, Antwerp, Belgium
| | - Lidia Schapira
- Harvard Medical School , Massachusetts General Hospital , Boston, Massachusetts , USA
| | - Eva Schernhammer
- Department of Epidemiology , Center for Public Health, Medical University of Vienna , Vienna , Austria
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology , Institut Gustave Roussy, Université Paris-Sud , Villejuif , France
| | - Hans-Joachim Schmoll
- Division Clinical Oncology Research , University Clinic Halle (Saale), Martin-Luther-University, Halle-Wittenberg , Halle , Germany
| | - Lowell Schnipper
- Department of Medicine , Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA
| | - Cristiana Sessa
- Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
| | - Charles L Shapiro
- Dubin Breast Center, Division of Hematology/Medical Oncology , Tisch Cancer Center, Mount Sinai Health System , New York, New York , USA
| | - Julie Steele
- Anatomic Pathology, Scripps Clinic Department of Pathology , Scripps Green Hospital , La Jolla, California , USA
| | - Cora N Sternberg
- Department of Medical Oncology , San Camillo Forlanini Hospital , Rome , Italy
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Department of Psychiatry , University Hospital of Lausanne-CHUV , Lausanne , Switzerland
| | - Florian Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department Internal Medicine & Palliative Centre , Cantonal Hospital St.Gallen , St. Gallen , Switzerland
| | - Roger Stupp
- University Hospital Zürich , Zürich , Switzerland
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict & Health Research Program, London , UK
| | - Josep Tabernero
- Medical Oncology Department , Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Luzia Travado
- Psycho-Oncology Service, Clinical Centre of the Champalimaud Centre for the Unknown, Champalimaud Foundation , Lisbon , Portugal
| | - Marcel Verheij
- Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Emile Voest
- The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Everett Vokes
- Department of Medicine , University of Chicago Medical Center , Chicago, Illinois , USA
| | - Jamie Von Roenn
- Education, Science, and Professional Development, American Society of Clinical Oncology (ASCO) , Alexandria, Virginia , USA
| | - Jeffrey S Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center , New York, New York , USA
| | - Hans Wildiers
- Department of General Medical Oncology , University Hospitals Leuven , Leuven , Belgium
| | - Yosef Yarden
- Department of General Medical Oncology , University Hospitals Leuven , Leuven , Belgium
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Moehler M, Gepfner-Tuma I, Maderer A, Thuss-Patience PC, Ruessel J, Hegewisch-Becker S, Wilke H, Al-Batran SE, Rafiyan MR, Weißinger F, Schmoll HJ, Kullmann F, von Weikersthal LF, Siveke JT, Weusmann J, Kanzler S, Schimanski CC, Otte M, Schollenberger L, Koenig J, Galle PR. Sunitinib added to FOLFIRI versus FOLFIRI in patients with chemorefractory advanced adenocarcinoma of the stomach or lower esophagus: a randomized, placebo-controlled phase II AIO trial with serum biomarker program. BMC Cancer 2016; 16:699. [PMID: 27582078 PMCID: PMC5006426 DOI: 10.1186/s12885-016-2736-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/20/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As a multi-targeted anti-angiogenic receptor tyrosine kinase (RTK) inhibitor sunitinib (SUN) has been established for renal cancer and gastrointestinal stromal tumors. In advanced refractory esophagogastric cancer patients, monotherapy with SUN was associated with good tolerability but limited tumor response. METHODS This double-blind, placebo-controlled, multicenter, phase II clinical trial was conducted to evaluate the efficacy, safety and tolerability of SUN as an adjunct to second and third-line FOLFIRI (NCT01020630). Patients were randomized to receive 6-week cycles including FOLFIRI plus sodium folinate (Na-FOLFIRI) once every two weeks and SUN or placebo (PL) continuously for four weeks followed by a 2-week rest period. The primary study endpoint was progression-free survival (PFS). Preplanned serum analyses of VEGF-A, VEGF-D, VEGFR2 and SDF-1α were performed retrospectively. RESULTS Overall, 91 patients were randomized, 45 in each group (one patient withdrew). The main grade ≥3 AEs were neutropenia and leucopenia, observed in 56 %/20 % and 27 %/16 % for FOLFIRI + SUN/FOLFIRI + PL, respectively. Median PFS was similar, 3.5 vs. 3.3 months (hazard ratio (HR) 1.11, 95 % CI 0.70-1.74, P = 0.66) for FOLFIRI + SUN vs. FOLFIRI + PL, respectively. For FOLFIRI + SUN, a trend towards longer median overall survival (OS) compared with placebo was observed (10.4 vs. 8.9 months, HR 0.82, 95 % CI 0.50-1.34, one-sided P = 0.21). In subgroup serum analyses, significant changes in VEGF-A (P = 0.017), VEGFR2 (P = 0.012) and VEGF-D (P < 0.001) serum levels were observed. CONCLUSIONS Although sunitinib combined with FOLFIRI did not improve PFS and response in chemotherapy-resistant gastric cancer, a trend towards better OS was observed. Further biomarker-driven studies with other anti-angiogenic RTK inhibitors are warranted. TRIAL REGISTRATION This study was registered prospectively in the NCT Clinical Trials Registry (ClinicalTrials.gov) under NCT01020630 on November 23, 2009 after approval by the leading ethics committee of the Medical Association of Rhineland-Palatinate, Mainz, in coordination with the participating ethics committees (see Additional file 2) on September 16, 2009.
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Affiliation(s)
- Markus Moehler
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Irina Gepfner-Tuma
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Annett Maderer
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | | | - Joern Ruessel
- University Hospital Halle (Saale), Halle (Saale), Germany
| | | | | | | | | | | | | | - Frank Kullmann
- Kliniken Nordoberpfalz - Klinikum Weiden, Weiden, Germany
| | | | - Jens T. Siveke
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jens Weusmann
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
| | | | | | - Melanie Otte
- Praxisgemeinschaft für Onkologie und Urologie, Wilhelmshaven, Germany
| | | | - Jochem Koenig
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) of the University Medical Center Mainz, Mainz, Germany
| | - Peter R. Galle
- University Medical Center, Johannes Gutenberg-University Mainz, I. Medizinische Klinik und Poliklinik, Langenbeckstraße 1, 55131 Mainz, Germany
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Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, Aranda Aguilar E, Bardelli A, Benson A, Bodoky G, Ciardiello F, D'Hoore A, Diaz-Rubio E, Douillard JY, Ducreux M, Falcone A, Grothey A, Gruenberger T, Haustermans K, Heinemann V, Hoff P, Köhne CH, Labianca R, Laurent-Puig P, Ma B, Maughan T, Muro K, Normanno N, Österlund P, Oyen WJG, Papamichael D, Pentheroudakis G, Pfeiffer P, Price TJ, Punt C, Ricke J, Roth A, Salazar R, Scheithauer W, Schmoll HJ, Tabernero J, Taïeb J, Tejpar S, Wasan H, Yoshino T, Zaanan A, Arnold D. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27:1386-422. [PMID: 27380959 DOI: 10.1093/annonc/mdw235] [Citation(s) in RCA: 2158] [Impact Index Per Article: 269.8] [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: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 02/11/2024] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.
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Affiliation(s)
- E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - A Cervantes
- Medical Oncology Department, INCLIVA University of Valencia, Valencia, Spain
| | - R Adam
- Hepato-Biliary Centre, Paul Brousse Hospital, Villejuif, France
| | - A Sobrero
- Medical Oncology, IRCCS San Martino Hospital, Genova, Italy
| | - J H Van Krieken
- Research Institute for Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - D Aderka
- Division of Oncology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - E Aranda Aguilar
- Medical Oncology Department, University Hospital Reina Sofia, Cordoba, Spain
| | - A Bardelli
- School of Medicine, University of Turin, Turin, Italy
| | - A Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - G Bodoky
- Department of Oncology, St László Hospital, Budapest, Hungary
| | - F Ciardiello
- Division of Medical Oncology, Seconda Università di Napoli, Naples, Italy
| | - A D'Hoore
- Abdominal Surgery, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - E Diaz-Rubio
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J-Y Douillard
- Medical Oncology, Institut de Cancérologie de l'Ouest (ICO), St Herblain
| | - M Ducreux
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - A Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy Division of Medical Oncology, Department of Oncology, University Hospital 'S. Chiara', Istituto Toscano Tumori, Pisa, Italy
| | - A Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, USA
| | - T Gruenberger
- Department of Surgery I, Rudolfstiftung Hospital, Vienna, Austria
| | - K Haustermans
- Department of Radiation Oncology, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium
| | - V Heinemann
- Comprehensive Cancer Center, University Clinic Munich, Munich, Germany
| | - P Hoff
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - C-H Köhne
- Northwest German Cancer Center, University Campus Klinikum Oldenburg, Oldenburg, Germany
| | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - P Laurent-Puig
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - B Ma
- Department of Clinical Oncology, Prince of Wales Hospital, State Key Laboratory in Oncology in South China, Chinese University of Hong Kong, Shatin, Hong Kong
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - K Muro
- Department of Clinical Oncology and Outpatient Treatment Center, Aichi Cancer Center Hospital, Nagoya, Japan
| | - N Normanno
- Cell Biology and Biotherapy Unit, I.N.T. Fondazione G. Pascale, Napoli, Italy
| | - P Österlund
- Helsinki University Central Hospital, Comprehensive Cancer Center, Helsinki, Finland Department of Oncology, University of Helsinki, Helsinki, Finland
| | - W J G Oyen
- The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - D Papamichael
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - P Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - T J Price
- Haematology and Medical Oncology Unit, Queen Elizabeth Hospital, Woodville, Australia
| | - C Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Ricke
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - A Roth
- Digestive Tumors Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - R Salazar
- Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - W Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - H J Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - J Tabernero
- Medical Oncology Department, Vall d' Hebron University Hospital, Vall d'Hebron Institute of Oncology (V.H.I.O.), Barcelona, Spain
| | - J Taïeb
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - S Tejpar
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - H Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - A Zaanan
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - D Arnold
- Instituto CUF de Oncologia (ICO), Lisbon, Portugal
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Gormly KL, Coscia C, Wells T, Tebbutt N, Harvey JA, Wilson K, Schmoll HJ, Price T. MRI rectal cancer in Australia and New Zealand: An audit from the PETACC-6 trial. J Med Imaging Radiat Oncol 2016; 60:607-615. [PMID: 27397855 DOI: 10.1111/1754-9485.12493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/16/2015] [Accepted: 05/28/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION An MRI audit substudy was conducted in patients who underwent an MRI prior to treatment in Australia and New Zealand as part of the PETACC-6 trial in locally advanced rectal cancer. METHODS A total of 82 patients from 15 centres had rectal MRI scans reviewed for technique, data included in reports and comparison of reports with blinded central reporting by two experienced radiologists. RESULTS In total, 82% performed minimum T2 sagittal and T2 axial oblique sequences. The high-resolution T2 sequence parameters varied significantly with only 33% obtaining a voxel size of <1.3 mm3 . The rate of inclusion of relevant findings in the reports was T3 distance in mm 21%, N stage 84%, circumferential resection margin (CRM) status 72%, extramural venous invasion (EMVI) status 29% and distance from the puborectalis sling 17%. In total, 31% reports included all of T stage with T3 substage, N stage and CRM involvement. In total, 17% reports included these 3 findings and EMVI. Eleven reports used a template with 82% of these including the first 3 findings. The agreement with central reporters was T stage 76%, N stage 70%, CRM status 57% and EMVI 16%. CONCLUSION There is significant variation in scan quality and low rates of including all relevant findings in rectal MRI reports in the audit. The authors recommend adoption of routine sequences and template reports in both trial settings and routine practice to improve scan technique and adequacy of reports in rectal cancer MRI staging scans across Australia and New Zealand.
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Affiliation(s)
- Kirsten L Gormly
- Dr Jones and Partners Medical Imaging, Adelaide, South Australia, Australia.
| | - Claudio Coscia
- Dr Jones and Partners Medical Imaging, Adelaide, South Australia, Australia
| | - Tim Wells
- Dr Jones and Partners Medical Imaging, Adelaide, South Australia, Australia
| | - Niall Tebbutt
- Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, Victoria, Australia
| | - Jennifer A Harvey
- Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Kate Wilson
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Timothy Price
- The Queen Elizabeth Hospital, University of Adelaide and AGITG, Adelaide, South Australia, Australia
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Modest DP, Ricard I, Heinemann V, Hegewisch-Becker S, Schmiegel W, Porschen R, Stintzing S, Graeven U, Arnold D, von Weikersthal LF, Giessen-Jung C, Stahler A, Schmoll HJ, Jung A, Kirchner T, Tannapfel A, Reinacher-Schick A. Outcome according to KRAS-, NRAS- and BRAF-mutation as well as KRAS mutation variants: pooled analysis of five randomized trials in metastatic colorectal cancer by the AIO colorectal cancer study group. Ann Oncol 2016; 27:1746-53. [PMID: 27358379 PMCID: PMC4999563 DOI: 10.1093/annonc/mdw261] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/20/2016] [Indexed: 02/06/2023] Open
Abstract
In this pooled analysis of metastatic colorectal cancer patients, mutations in KRAS, and BRAF were associated with inferior progression-free and overall survival compared with patients with non-mutated tumors. KRAS exon 2 mutation variants were associated with heterogeneous outcome compared with unmutated tumors with KRAS G12C and G13D being associated with rather poor survival. Background To explore the impact of KRAS, NRAS and BRAF mutations as well as KRAS mutation variants in patients with metastatic colorectal cancer (mCRC) receiving first-line therapy. Patients and methods A total of 1239 patients from five randomized trials (FIRE-1, FIRE-3, AIOKRK0207, AIOKRK0604, RO91) were included into the analysis. Outcome was evaluated by the Kaplan–Meier method, log-rank tests and Cox models. Results In 664 tumors, no mutation was detected, 462 tumors were diagnosed with KRAS-, 39 patients with NRAS- and 74 patients with BRAF-mutation. Mutations in KRAS were associated with inferior progression-free survival (PFS) and overall survival (OS) [multivariate hazard ratio (HR) for PFS: 1.20 (1.02–1.42), P = 0.03; multivariate HR for OS: 1.41 (1.17–1.70), P < 0.001]. BRAF mutation was also associated with inferior PFS [multivariate HR: 2.19 (1.59–3.02), P < 0.001] and OS [multivariate HR: 2.99 (2.10–4.25), P < 0.001]. Among specific KRAS mutation variants, the KRAS G12C-variant (n = 28) correlated with inferior OS compared with unmutated tumors [multivariate HR 2.26 (1.25–4.1), P = 0.001]. A similar trend for OS was seen in the KRAS G13D-variant [n = 71, multivariate HR 1.46 (0.96–2.22), P = 0.10]. More frequent KRAS exon 2 variants like G12D [n = 152, multivariate HR 1.17 (0.86–1.6), P = 0.81] and G12V [n = 92, multivariate HR 1.27 (0.87–1.86), P = 0.57] did not have significant impact on OS. Conclusion Mutations in KRAS and BRAF were associated with inferior PFS and OS of mCRC patients compared with patients with non-mutated tumors. KRAS exon 2 mutation variants were associated with heterogeneous outcome compared with unmutated tumors with KRAS G12C and G13D (trend) being associated with rather poor survival.
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Affiliation(s)
- D P Modest
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - I Ricard
- Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | | | - W Schmiegel
- Medizinische Klinik, Knappschaftskrankenhaus Ruhr-Universität Bochum, Bochum
| | - R Porschen
- Klinik für Innere Medizin, Klinikum Bremen-Ost, Bremen
| | - S Stintzing
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - U Graeven
- Kliniken Maria Hilf GmbH, Department of Hematology, Oncology and Gastroenterology, Mönchengladbach, Germany
| | - D Arnold
- Instituto CUF de Oncologia, Lisboa, Portugal
| | | | - C Giessen-Jung
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich
| | - A Stahler
- Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximilians-Universität, Munich Institute of Pathology University of Munich, Munich
| | - H J Schmoll
- Department of Hematology/Oncology, University Hospital Halle, Halle (Saale)
| | - A Jung
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg Institute of Pathology University of Munich, Munich
| | - T Kirchner
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg Institute of Pathology University of Munich, Munich
| | - A Tannapfel
- Institute for Pathology, Ruhr-University Bochum, Bochum
| | - A Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
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Schmoll HJ. Targeting HER2: precision oncology for colorectal cancer. Lancet Oncol 2016; 17:685-686. [DOI: 10.1016/s1470-2045(16)30039-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 03/19/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022]
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