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Kröning H, Göhler T, Decker T, Grundeis M, Kojouharoff G, Lipke J, Semsek D, Moorahrend E, Sauer A, Bruch HR, Liersch R, Nusch A, Vehling-Kaiser U, Welslau M, Grunewald R, Harich HD, Stephany M, Uhlig J, de Buhr R, Frank M, Hogrefe C, Marschner N, Potthoff K, Hartmann F, Reisländer T, Schwaner I. Effectiveness, safety and quality of life of trifluridine/tipiracil in pretreated patients with metastatic colorectal cancer: Real-world data from the noninterventional TACTIC study in Germany. Int J Cancer 2023. [PMID: 37260368 DOI: 10.1002/ijc.34603] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 06/02/2023]
Abstract
The prospective, multicenter, noninterventional TACTIC study assessed effectiveness and safety of trifluridine/tipiracil (FTD/TPI) in patients with metastatic colorectal cancer (mCRC) in a real-world setting in Germany, thus evaluating the external validity of the findings from the pivotal RECOURSE trial. Primary endpoint was overall survival (OS). Secondary objectives included progression-free survival (PFS), safety, and quality of life (QoL). Subgroups comprised patients with good (<3 metastatic sites at inclusion, ≥18 months from diagnosis of first metastasis to inclusion) or poor (remaining patients) prognostic characteristics (GPC/PPC). GPC without liver metastases was considered best prognostic characteristics (BPC). In total, 307 eligible patients (pretreated or not suitable for other available therapies) were treated with FTD/TPI. Overall, median [95%-CI] OS was 7.4 months [6.4-8.6], median PFS was 2.9 months [2.8-3.3]. In BPC (n = 65) and GPC (n = 176) compared to PPC (n = 124) subgroup, median OS (13.3 [9.1-17.6] vs 8.9 [7.6-9.8] vs 5.1 [4.4-7.0] months) and median PFS (4.0 [3.3-5.3] vs 3.4 [3.0-3.7] vs 2.6 [2.4-2.8] months) were longer. Patient-reported QoL, assessed by validated questionnaires (EQ-5D-5L, PRO-CTCAE), was stable throughout FTD/TPI treatment. Predominant FTD/TPI-related adverse events of grades 3 or 4 were neutropenia (13.0%), leukopenia (7.5%), and anemia (5.2%). Altogether, palliative FTD/TPI therapy in patients with pretreated mCRC was associated with prolonged survival, delayed progression, maintained health-related QoL, and manageable toxicity. Low metastatic burden and indolent disease were favorable prognostic factors for survival. TACTIC confirms the effectiveness and safety of FTD/TPI, highlighting its value in routine clinical practice.
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Affiliation(s)
- Hendrik Kröning
- Schwerpunktpraxis für Hämatologie und Onkologie, Magdeburg, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Marc Grundeis
- Onkologische Gemeinschaftspraxis Dr. med. Grundeis, Dr. med. Teich, Chemnitz, Germany
| | | | - Jörg Lipke
- Gemeinschaftspraxis für Hämatologie und Onkologie, Dortmund, Germany
| | - Dieter Semsek
- Praxis für interdisziplinäre Onkologie, Freiburg im Breisgau, Germany
| | - Enno Moorahrend
- Zentrum für Hämatologie und Onkologie MVZ GmbH, Porta Westfalica, Germany
| | - Annette Sauer
- Medizinisches Versorgungszentrum für Blut-und Krebserkrankungen, Potsdam, Germany
| | | | - Rüdiger Liersch
- Gemeinschaftspraxis für Hämatologie und Onkologie, Münster, Germany
| | - Arnd Nusch
- Praxis für Hämatologie und internistische Onkologie, Ratingen, Germany
| | | | | | - Ralf Grunewald
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Marcel Stephany
- MVZ Onkologie am Elisabeth-Krankenhaus Rheydt, Mönchengladbach, Germany
| | - Jens Uhlig
- Praxis Dr. med. Jens Uhlig, Naunhof, Germany
| | | | | | | | | | | | | | | | - Ingo Schwaner
- Onkologische Schwerpunktpraxis Kurfürstendamm, Berlin, Germany
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Nöpel-Dünnebacke S, Jütte H, Denz R, Feder IS, Kraeft AL, Lugnier C, Teschendorf C, Collette D, Böhner H, Engel L, Mueller L, Hartmann F, Kaiser U, Bruch HR, Hollerbach S, Arnold D, Timmesfeld N, Tannapfel A, Reinacher-Schick A. Causes of mortality in elderly UICC stage III colon cancer (CC) patients--Tumor-related death and competing risks from the German AIO colorectal study group Colopredict Plus (CPP) registry. Cancer Med 2022; 11:1735-1744. [PMID: 35146948 PMCID: PMC9041084 DOI: 10.1002/cam4.4540] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/21/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background Colon cancer (CC) is a disease of elderly patients (pts.) with a median age of 73 years (yrs.). Lack of data about the effects of adjuvant chemotherapy (ACT) is caused by underrepresentation of this clinically relevant cohort in interventional trials. We analyzed real‐world data from the German CPP registry with regard to a possible benefit of ACT in elderly (70+ yrs.) versus younger pts. (50 to <70 yrs.) taking cause‐specific deaths into account. Methods We analyzed the effect of age and ACT on overall survival (OS) and cause‐specific death of stage III pts. using Cox regression. Results In total, 1558 pts. were analyzed and follow‐up was 24.6 months. 62.6% of the elderly received ACT whereas 91.1% of younger pts. (p < 0.001). Oxaliplatin combinations were significantly less often given to older than younger pts. (38.8% vs. 88.9%; p < 0.001). Mean Charlson comorbidity score was significantly lower in pts. that received ACT (0.61) than in those without ACT (1.16; p < 0.001). ACT was an independent positive prognostic factor for cancer‐related death in elderly pts. even in pts. 75+ yrs. No significant difference in the effect of ACT could be observed between age groups (interaction: cancer‐specific death HR = 1.7948, p = 0.1079; death of other cause HR = 0.7384, p = 0.6705). Conclusion ACT was an independent positive prognostic factor for OS. There may be a cohort of elderly with less co‐morbidities who benefit from ACT.
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Affiliation(s)
- Stefanie Nöpel-Dünnebacke
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Hendrick Jütte
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - Robin Denz
- Department of Medical Informatics, Biometrics and Epidemiology, Ruhr-University, Bochum, Germany
| | | | - Anna-Lena Kraeft
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Celine Lugnier
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
| | | | - Daniela Collette
- Joint Practice of Hematology and Oncology, Catholic Hospital Dortmund West, Dortmund, Germany
| | - Hinrich Böhner
- Department of General and Visceral Surgery, Catholic Hospital Dortmund West, Germany
| | - Lars Engel
- Department of General and Visceral Surgery, Paracelsus Medical University, Hospital Nürnberg Nord, Nürnberg, Germany
| | | | - Frank Hartmann
- Department of Oncology and Hematology, Klinikum Lippe, Lemgo, Germany
| | - Ulrich Kaiser
- Department of Hematology, Oncology and Palliative Care, St. Bernsward Hospital, Hildesheim, Germany
| | | | | | - Dirk Arnold
- Department of Oncology, Hematology and Palliative Care, Asklepios Hospital, Cancer Center Altona, Hamburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometrics and Epidemiology, Ruhr-University, Bochum, Germany
| | | | - Anke Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital Bochum, Ruhr-University, Bochum, Germany
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Müller V, Ruhnke M, Hoffmann O, Grafe A, Tomé O, Fett W, Bruch HR, Sommer-Joos AK, Schneeweiss A. First-line bevacizumab-containing therapy for HER2-negative locally advanced/metastatic breast cancer: Real-world experience from >2000 patients treated in the multicentre AVANTI study. Breast 2021; 60:70-77. [PMID: 34488065 PMCID: PMC8424587 DOI: 10.1016/j.breast.2021.08.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022] Open
Abstract
Aim The multicentre non-interventional AVANTI study assessed safety, effectiveness and patient-reported outcomes with approved first-line bevacizumab-containing regimens for HER2-negative locally recurrent/metastatic breast cancer (LR/MBC) in German routine oncology practice. Methods Eligible patients had HER2-negative LR/MBC, no bevacizumab contraindications and no prior chemotherapy for LR/MBC. Chemotherapy schedule, diagnostics and follow-up were at physicians’ discretion. Data were collected for 1 year after starting bevacizumab, then every 6 months for 1.5 years (maximum follow-up: 2.5 years). Patients and physicians rated treatment satisfaction. Subgroup analyses were prespecified in clinically relevant populations, including triple-negative breast cancer (TNBC). Results Between November 1, 2009 and April 30, 2016, 2065 eligible patients at 346 centres received bevacizumab with paclitaxel or capecitabine. Patients receiving bevacizumab–capecitabine were less likely to have de novo disease and more likely to have TNBC, age ≥60 years and prior anthracycline/taxane and/or endocrine therapy. Median PFS was 12.6 (95% CI 11.9–13.2) months (12.8 with bevacizumab–paclitaxel, 10.5 with bevacizumab–capecitabine); median OS was 23.9 (95% CI 22.2–25.1) months. Outcomes were worse in patients with TNBC, prior anthracycline/taxane or prior endocrine therapy. Grade ≥3 adverse events occurred in 27% of patients. Treatment was discontinued for adverse events in 15%. Treatment satisfaction was rated as good or better by 304/394 responding patients (77%) at week 54 and in 1393/2065 patients (67%) by physicians overall. Conclusions In routine clinical practice, effectiveness and safety of first-line bevacizumab-containing therapy for LR/MBC were consistent with experience from phase III trials. Patient and physician treatment satisfaction showed high concordance. AVANTI assessed 1st-line bevacizumab-based therapy for LR/MBC in routine practice. Median progression-free and overall survival were 12.6 and 23.9 months respectively. Treatment satisfaction was rated as good or better by 77% of patients at week 54. Physician- and patient-rated treatment satisfaction showed high concordance. Effectiveness and safety were consistent with experience from phase III trials.
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Affiliation(s)
- Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Oliver Hoffmann
- Universitätsklinikum Essen, Westdeutsches Tumorzentrum Essen (WTZ), Comprehensive Cancer Center, Nationales Centrum für Tumorerkrankungen, Klinik für Frauenheilkunde und Geburtshilfe, Essen, Germany.
| | - Andrea Grafe
- MVZ Nordhausen gGmbh, Praxis Dr Grafe/Brustzentrum der Frauenklinik, Südharz-Klinikum Nordhausen gGmbh, Nordhausen, Germany.
| | - Oliver Tomé
- St. Vincentius-Kliniken gAG, Karlsruhe, Germany.
| | | | | | | | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany.
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Bruch HR, Dencausse Y, Heßling J, Michl G, Schlag R, Skorupa A, Schneider-Schranz C, Wolf S, Schulte C, Tesch H. CONIFER - Non-Interventional Study to Evaluate Therapy Monitoring During Deferasirox Treatment of Iron Toxicity in Myelodysplastic Syndrome Patients with Transfusional Iron Overload. Oncol Res Treat 2016; 39:424-31. [PMID: 27486873 DOI: 10.1159/000447035] [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] [Received: 03/24/2016] [Accepted: 05/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The non-interventional study CONIFER was designed to assess the safety and clinical practicability of deferasirox for the treatment of transfusional iron overload in myelodysplastic syndrome (MDS) patients. METHODS Patients included in the study were diagnosed with MDS and received at least 1 treatment with deferasirox. The observation period covered the time from the initial visit until the last follow-up. RESULTS The data of 99 patients with MDS scored mainly as International Prognostic Scoring System (IPSS) low and intermediate 1 were evaluated. The mean age of the participants was 75 years and 58% of the patients were male. Iron overload was assessed by serum ferritin level (mean baseline serum ferritin 2,080 ± 1,244 µg/l). Patients were treated for a mean duration of 16 months (mean daily dose at baseline 11.8 ± 7.0 mg/kg). Stratification of serum ferritin levels by deferasirox dose showed a reduction at the higher but no reduction at the lower dose (< 15 mg/kg vs. ≥ 15 mg/kg and < 20 mg/kg vs. ≥ 20 mg/kg). The majority of patients (81%) were affected by at least 1 adverse event, with decreased renal creatinine clearance being the most frequent. CONCLUSION Higher doses (≥ 15 mg/kg) of deferasirox effectively and safely reduced serum ferritin levels in MDS patients with transfusional iron overload.
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Stahmeyer JT, Rossol S, Bert F, Böker KHW, Bruch HR, Eisenbach C, Link R, John C, Mauss S, Heyne R, Schott E, Pfeiffer-Vornkahl H, Hüppe D, Krauth C. Outcomes and Costs of Treating Hepatitis C Patients in the Era of First Generation Protease Inhibitors - Results from the PAN Study. PLoS One 2016; 11:e0159976. [PMID: 27467772 PMCID: PMC4964984 DOI: 10.1371/journal.pone.0159976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/19/2016] [Accepted: 07/11/2016] [Indexed: 12/16/2022] Open
Abstract
1 OBJECTIVE Chronic hepatitis C virus infections (HCV) cause a significant public health burden. Introduction of telaprevir (TVR) and boceprevir (BOC) has increased sustained virologic response rates (SVR) in genotype 1 patients but were accompanied by higher treatment costs and more side effects. Aim of the study was to assess outcomes and costs of treating HCV with TVR or BOC in routine care. 2 MATERIAL AND METHODS Data was obtained from a non-interventional study. This analysis relates on a subset of 1,786 patients for whom resource utilisation was documented. Sociodemografic and clinical parameters as well as resource utilisation were collected using a web-based data recording system. Costs were calculated using official remuneration schemes. 3 RESULTS Mean age of patients was 49.2 years, 58.6% were male. In treatment-naive patients SVR-rates of 62.2% and 55.7% for TVR and BOC were observed (prior relapser: 68.5% for TVR and 63.5% for BOC; prior non-responder: 45.6% for TVR and 39.1% for BOC). Treatment costs are dominated by costs for pharmaceuticals and range between €39,081 and €53,491. We calculated average costs per SVR of €81,347 (TVR) and €70,163 (BOC) in treatment-naive patients (prior relapser: 78,089 €/SVR for TVR and 82,077 €/SVR for BOC; prior non-responder: 116,509 €/SVR for TVR and 110,156 €/SVR for BOC). Quality of life data showed a considerable decrease during treatment. 4 CONCLUSION Our study is one of few investigating both, outcomes and costs, of treating HCV in a real-life setting. Data can serve as a reference in the discussion of increasing costs in recently introduced agents.
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Affiliation(s)
- Jona T. Stahmeyer
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Siegbert Rossol
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt a.M., Germany
| | - Florian Bert
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt a.M., Germany
| | | | | | - Christoph Eisenbach
- University Hospital Heidelberg, Dept. of Gastroenterology, Heidelberg, Germany
| | | | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | | | - Eckart Schott
- Dept. of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | | | | | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Bruch HR, Höhner U, Müller R. [Hepatitis B and C: current therapy]. Praxis (Bern 1994) 1998; 87:1408-1412. [PMID: 9824948] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Treatment of acute viral hepatitis B is symptomatic, fulminant cases may require liver transplantation. In chronic hepatitis B interferon (IFN)-alpha will induce sustained response rates of 30-40%. Nucleoside analogues such as famciclovir or lamivudine appear to be promising for treatment in non-responders or cirrhotic and immunosuppressed patients. IFN-alpha may reduce the rate of chronic courses in acute hepatitis C infections. Chronic hepatitis C patients with elevated ALT activities, positive serum HCV RNA and portal or bridging fibrosis on biopsy are recommended for treatment with IFN-alpha. Sustained responses are observed in less than 20% of treated patients. Retreatment with IFN-alpha may be indicated in non-responders or in case of relapse. Combination therapy of IFN-alpha plus ribavirin may emerge as treatment of choice for patients with a relapse in the near future.
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Affiliation(s)
- H R Bruch
- Medizinische Klinik, Gastroenterologie-Hepatologie, Krankenhaus Siegburg
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Abstract
A total of 37 patients with histologically confirmed chronic viral hepatitis B and presence of HBV-DNA and HBsAg in the serum were treated in a randomized, prospectively controlled multicenter trial either with recombinant IFN alpha-2b alone or a combination of IFN alpha-2b and recombinant IL-2. Twenty-two patients from group A were treated with 3 MU of IFN alpha-2b s.c. thrice weekly for 5 months. Starting at month 2 IL-2 was added: priming doses of 1.5 million CU were given s.c. on the first 2 days of each of the remaining 3 months, followed by maintenance doses of 0.3 million CU daily for 5 days per week. Fifteen patients from group B received 5 MU of IFN alpha-2b s.c. thrice weekly for 5 months. Five patients from group A (24%) and 4 patients from group B (28%) cleared HBV-DNA and HBeAg from the serum, and normalized elevated serum aminotransferase activities. The response rate in both groups did not differ significantly. Since side effects were more pronounced during combination therapy than in IFN alpha-2b monotherapy, it is suggested that treatment with IFN alpha-2b alone is preferable to a regimen of IFN alpha-2b/IL-2 applied according to the above schedule.
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Affiliation(s)
- H R Bruch
- Medizinische Klinik/Gastroenterologie-Hepatologie, Krankenhaus Siegburg, Germany
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Abstract
Bone is a target organ of androgens. The mechanism by which these steroids exert their action within bone cells is still poorly understood. The metabolism of androstenedione, the major circulating androgen in women, was, therefore, assessed in osteoblast-like bone cells cultured from bone of 16 postmenopausal women (mean age, 69 yr; range, 56-80) and 3 elderly men (mean age, 71 yr; range, 69-73) undergoing total hip replacement. Each cell strain was incubated under standardized conditions with varying concentrations of [1,2,6,7-3H]androstenedione (0.05-5 microM). In every instance 5 alpha-reduced metabolites and 17 beta-hydroxysteroids were formed. There was no correlation between the volumetric density of the resected bone and androstenedione metabolism of the corresponding cultured bone cell strains. The apparent Km for the 5 alpha-reductase activity (sum of androstanedione and dihydrotestosterone) of all 19 cell strains was 0.7 +/- 0.1 microM (mean +/- SEM), and the apparent Km for 17 beta-hydroxysteroid dehydrogenase (sum of testosterone and dihydrotestosterone) was 2.3 +/- 0.8 microM (mean +/- SEM), values similar to those reported for other androgen target organs. Our results demonstrate that human osteoblast-like cells have the capacity to transform androstenedione into the more potent biological androgens testosterone and dihydrotestosterone. Since the Km values of both 5 alpha-reductase and 17 beta-hydroxysteroid dehydrogenase exceed the serum androstenedione concentration, the formation of testosterone and dihydrotestosterone appears to be mainly a function of substrate availability.
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Affiliation(s)
- H R Bruch
- Department of Internal Medicine, University of Bonn, Germany
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