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Rousseau J, Desforges SM, Jabbour G, Lemieux B, Lapointe S, Bélanger K, Moumdjian R, Cayrol R, Florescu M, Masucci GL, Berthelet F, Lemieux-Blanchard É, Bahary JP. BIOS-02. CLINICAL OUTCOMES OF OVER 600 PATIENTS WITH GLIOBLASTOMA TREATED AT A CANADIAN TERTIARY CENTER IN THE PAST 15 YEARS: A COMPARATIVE ANALYSIS WITH THE PIVOTAL STUPP TRIAL. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.078] [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: 11/16/2022] Open
Abstract
Abstract
Glioblastoma is the most common malignant primary central nervous system tumor in adults and is associated with a poor prognosis. The benefit of adding concomitant followed by adjuvant temozolomide to radiotherapy after maximal safe resection was demonstrated by Stupp and colleagues in 2005 and has since remained the standard of care. This regimen conferred a statistically significant benefit with a 2-year survival rate of 26.5% compared to 10.4% in patients treated with radiotherapy alone. Our primary goal was to retrospectively assess the clinical outcomes of patients with glioblastoma treated at our institution over the past 15 years by comparing the overall survival (OS) and progression-free survival (PFS) from our cohort to data from the pivotal trial. Our secondary objective was to create a comprehensive database with clinical and pathological information in order to identify predictive and prognostic factors. We reviewed the clinical records of patients treated for glioblastoma from January 2005 to November 2019 at our center. We extracted data on survival and calculated OS and PFS using the Kaplan-Meier method. 617 patient charts were reviewed, out of which 17 were excluded because of missing data. The remaining 600 patients were included. Baseline demographic information was similar to that of the Stupp cohort, with the exception of a larger proportion of patients aged 50 or above (76% versus 69%, respectively). The median OS at our center was 14.3 months, 95% confidence interval [12.8-15.2], which was comparable to that of the original trial (14.6 months [13.2-16.8]). PFS was better in our cohort at 6 months (74.2% [70.7-77.7] versus 53.9% [48.1-59.6]) and 12 months (36.3% [32.5-40.2] versus 26.9% [21.8-32.1]), and comparable thereafter. Our study confirms that the data from the Stupp trial are reproducible in a Canadian academic center setting. Our database will allow us to explore potentially new predictive factors.
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Affiliation(s)
| | | | | | | | - Sarah Lapointe
- University of Montreal Health Center , Montreal , Canada
| | - Karl Bélanger
- University of Montreal Health Center , Montreal , Canada
| | | | - Romain Cayrol
- University of Montreal Health Center , Montreal , Canada
| | - Marie Florescu
- University of Montreal Health Center , Montreal , Canada
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Rousseau J, Labidi M, Bahary JP, Bélanger K, Berthelet F, Lapointe S. PATH-10. A CASE OF ADULT THALAMIC DIFFUSE MIDLINE GLIOMA, H3 K27-ALTERED WITH AN IMPRESSIVE RESPONSE TO RADIOTHERAPY AND CONCOMITANT PLUS ADJUVANT TEMOZOLOMIDE. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.583] [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: 11/16/2022] Open
Abstract
Abstract
Diffuse midline glioma (DMG), H3 K27-altered is a newly defined diagnosis in the 2021 WHO Classification of Tumors of the Central Nervous System. H3 K27 alterations are associated with a uniformly poor prognosis in children with DMG, but they have been linked to improved survival in adults. Clinical experience in adults with DMG, H3 K27M-altered remains limited. Consequently, there exists a knowledge gap regarding the optimal management and responsiveness to chemoradiation therapy, which translates into the current absence of standard treatment. Here we present the case of an 18-year-old female patient treated for a thalamic DMG, H3 K27-altered at a Canadian tertiary center. The patient first presented with headache, dysarthria, and signs of increased intracranial pressure. Her initial brain magnetic resonance imaging demonstrated a right thalamo-mesencephalic lesion with central nodular enhancement and secondary hydrocephalus. She underwent an endoscopic third ventriculostomy followed by a subtotal resection, and pathology confirmed the presence of a DMG, H3 K27-altered, WHO grade 4. She was treated with combined radiotherapy and concomitant plus adjuvant (12 cycles) temozolomide. The Stupp regimen induced a spectacular response with a reduction in tumor dimensions on T2/FLAIR (20 x 18 mm versus 60 x 51 mm), > 50% decrease in size of the enhancing component, complete resolution of mass effect, and return to functional independence (KPS = 100%). Unfortunately, her disease progressed 16 months after diagnosis and she passed away 8 months later, despite having received 3 cycles of ONC201 through a clinical trial. Her progression-free survival (16 months) was superior to that reported in the literature, which could be related to her young age, subtotal resection status, and thalamic location. Although the addition of chemotherapy to adjuvant radiotherapy has not been shown to improve survival in children with DMG, the Stupp regimen may provide a survival benefit in adults.
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Affiliation(s)
| | | | | | - Karl Bélanger
- University of Montreal Health Center , Montreal , Canada
| | | | - Sarah Lapointe
- University of Montreal Health Center , Montreal , Canada
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3
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Tonneau M, Nolin-Lapalme A, Kazandjian S, Auclin E, Panasci J, Benlaifaoui M, Ponce M, Al-Saleh A, Belkaid W, Naimi S, Mihalcioiu C, Watson I, Bouin M, Miller W, Hudson M, Wong MK, Pezo RC, Turcotte S, Bélanger K, Jamal R, Oster P, Velin D, Richard C, Messaoudene M, Elkrief A, Routy B. Helicobacter pylori serology is associated with worse overall survival in patients with melanoma treated with immune checkpoint inhibitors. Oncoimmunology 2022; 11:2096535. [PMID: 35832043 PMCID: PMC9272833 DOI: 10.1080/2162402x.2022.2096535] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The microbiome is now regarded as one of the hallmarks of cancer and several strategies to modify the gut microbiota to improve immune checkpoint inhibitor (ICI) activity are being evaluated in clinical trials. Preliminary data regarding the upper gastro-intestinal microbiota indicated that Helicobacter pylori seropositivity was associated with a negative prognosis in patients amenable to ICI. In 97 patients with advanced melanoma treated with ICI, we assessed the impact of H. pylori on outcomes and microbiome composition. We performed H. pylori serology and profiled the fecal microbiome with metagenomics sequencing. Among the 97 patients, 22% were H. pylori positive (Pos). H. pylori Pos patients had a significantly shorter overall survival (p = .02) compared to H. pylori negative (Neg) patients. In addition, objective response rate and progression-free survival were decreased in H. pylori Pos patients. Metagenomics sequencing did not reveal any difference in diversity indexes between the H. pylori groups. At the taxa level, Eubacterium ventriosum, Mediterraneibacter (Ruminococcus) torques, and Dorea formicigenerans were increased in the H. pylori Pos group, while Alistipes finegoldii, Hungatella hathewayi and Blautia producta were over-represented in the H. pylori Neg group. In a second independent cohort of patients with NSCLC, diversity indexes were similar in both groups and Bacteroides xylanisolvens was increased in H. pylori Neg patients. Our results demonstrated that the negative impact of H. pylori on outcomes seem to be independent from the fecal microbiome composition. These findings warrant further validation and development of therapeutic strategies to eradicate H. pylori in immuno-oncology arena.
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Affiliation(s)
- Marion Tonneau
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Université de Médecine, Lille, France
| | - Alexis Nolin-Lapalme
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | | | - Edouard Auclin
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Justin Panasci
- Department of Oncology, McGill University Health Center, QC, Canada
| | - Myriam Benlaifaoui
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Mayra Ponce
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Afnan Al-Saleh
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Wiam Belkaid
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Sabrine Naimi
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | | | - Ian Watson
- Rosalind and Morris Goodman Cancer Institute, Montréal, QC, Canada
| | - Mickael Bouin
- Department of Gastroenterology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Wilson Miller
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Marie Hudson
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Matthew K. Wong
- Division of Medical Oncology, Sunnybrook Health Sciences Center, Odette Cancer Center, QC, Canada
| | - Rossanna C. Pezo
- Division of Medical Oncology, Sunnybrook Health Sciences Center, Odette Cancer Center, QC, Canada
| | - Simon Turcotte
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Surgery, Centre Hospitalier de l’Université de Montréal, QC, Canada
| | - Karl Bélanger
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Division of Hemato-Oncology, Centre Hospitalier de l’Université de Montréal (CHUM)Montreal, QC, Canada
| | - Rahima Jamal
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Division of Hemato-Oncology, Centre Hospitalier de l’Université de Montréal (CHUM)Montreal, QC, Canada
| | - Paul Oster
- Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Dominique Velin
- Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Corentin Richard
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Meriem Messaoudene
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Arielle Elkrief
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Bertrand Routy
- Axe Cancer, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Division of Hemato-Oncology, Centre Hospitalier de l’Université de Montréal (CHUM)Montreal, QC, Canada
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4
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Quinones MC, Bélanger K, Lemieux Blanchard É, Lemieux B, Bahary JP, Masucci LG, Roberge D, Menard C, Lambert C, Berthelet F, Moumdjian R, Florescu M. Adult Medulloblastoma Demographic, Tumor and Treatment Impact since 2006: A Canadian University Experience. ACTA ACUST UNITED AC 2021; 28:3104-3114. [PMID: 34436037 PMCID: PMC8395420 DOI: 10.3390/curroncol28040271] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
Medulloblastoma is an aggressive primary brain tumor that is extremely rare in adults; therefore, prospective studies are limited. We reviewed the information of all MB patients treated at the CHUM between 2006 and 2017. We divided our cohort by age and further divided adult patients (53%) in two groups, those diagnosed between 2006–2012 and 2013–2017. In our adult population, median follow up was 26 months and SHH-activated MB comprised 39% of tumors. Adult 5yOS was 80% and first-line therapy led to a 5yPFS of 77%. The absence of radiosensitizing chemotherapy (100% vs. 50%; p = 0.033) negatively influenced 5yPFS. 96% of adult patients received radiotherapy and 48% of them received concomitant radiosensitizing chemotherapy. Complete surgical resection was performed on 85% of adults, but the extent of resection did not have a discernable impact on survival and did not change with time. Adjuvant chemotherapy did not clearly affect prognosis (5yOS 80% vs. 67%, p = 0.155; 5yPFS 78% vs. 67%, p = 0.114). From 2006–2012, the most common chemotherapy regimen (69%) was Cisplatinum, Lomustine and Vincristine, which was replaced in 2013 by Cisplatinum, Etoposide and Cyclophosphamide (77%) with a trend for worse survival. Nine patients recurred and seven of these (78%) were treated with palliative chemotherapy. In conclusion, we did not identify prognostic demographic or tumor factors in our adult MB population. The presence of radiosensitizing chemotherapy was associated with a more favorable PFS. Cisplatinum, Lomustine and Vincristine regimen might be a better adjuvant chemotherapy regimen.
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Affiliation(s)
| | - Karl Bélanger
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Émilie Lemieux Blanchard
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Bernard Lemieux
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Jean-Paul Bahary
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Laura G. Masucci
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - David Roberge
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Cynthia Menard
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Carole Lambert
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - France Berthelet
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Robert Moumdjian
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Marie Florescu
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
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5
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Taillefer VT, Pigeon M, Chen M, Larochelle C, Florescu M, Bélanger K, Adam JP. Very high-dose methylprednisolone for treatment of nivolumab-induced limbic encephalitis: A case report. J Oncol Pharm Pract 2020; 26:1538-1543. [DOI: 10.1177/1078155220904147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction Nivolumab is a programmed death 1 (PD-1) inhibitor approved by the Food and Drug Administration (FDA) for the treatment of eight different cancers including metastatic melanoma. Immune checkpoint blockade may lead to a range of neurologic immune-related adverse events (irAEs) with severity varying from mild to life-threatening, including encephalitis. Case report We describe a case of a 68-year-old man who developed alteration in mental status, physical weakness and fatigue after nine cycles of nivolumab 3 mg/kg every two weeks. These symptoms were compatible with a clinical diagnosis of autoimmune limbic encephalitis, although no specific antibodies were detected and the initial MRI was normal. Management and outcome The patient received intravenous methylprednisolone 1 g daily for 5 days, which was then converted to a maintenance dose of oral prednisone. The patient made a full clinical recovery but relapsed clinically upon steroid tapering, while hypersignal in the left mesial temporal suggestive of limbic encephalitis was observed on repeated MRI. Discussion Because of the prevailing usage of nivolumab in many cancer protocols, this case highlights the importance of rapidly recognising neurological impairment in patients treated with nivolumab and of initiating very high doses of corticosteroids.
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Affiliation(s)
- Vincent-Thierry Taillefer
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
- Department of Pharmacy, Centre hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Marjorie Pigeon
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
| | - Michelle Chen
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
| | - Catherine Larochelle
- Department of Neurosciences, Centre hospitalier de l’Université de Montréal, Montréal, Canada
- CHUM Research Center, CHUM, Montréal, Canada
| | - Marie Florescu
- CHUM Research Center, CHUM, Montréal, Canada
- Division of Hematology-Oncology, CHUM, Montréal, Canada
| | - Karl Bélanger
- CHUM Research Center, CHUM, Montréal, Canada
- Division of Hematology-Oncology, CHUM, Montréal, Canada
| | - Jean-Philippe Adam
- Department of Pharmacy, Centre hospitalier de l'Universite de Montreal, Montreal, Canada
- CHUM Research Center, CHUM, Montréal, Canada
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6
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Jutras G, Bélanger K, Letarte N, Adam JP, Roberge D, Lemieux B, Lemieux-Blanchard É, Masucci L, Ménard C, Bahary JP, Moumdjian R, Berthelet F, Florescu M. Procarbazine, lomustine and vincristine toxicity in low-grade gliomas. ACTA ACUST UNITED AC 2018; 25:e33-e39. [PMID: 29507493 DOI: 10.3747/co.25.3680] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Procarbazine, lomustine, and vincristine (pcv) significantly improve survival outcomes in lgg (low-grade gliomas). Administration of pcv to lgg patients increased tremendously over the past years as it went from 2 patients per year between 2005 and 2012 to 23 patients in 2015 only in our centre. However, serious hematological and non-hematological adverse events may occur. The purpose of this study was to evaluate the toxicity of pcv and its clinical relevance in our practice. Methods We retrospectively reviewed the charts of 57 patients with lgg who received pcv at the Centre hospitalier de l'Université de Montréal between 1 January 2005 and 27 July 2016. Results Procarbazine, lomustine, and vincristine were associated with severe hematological toxicity as clinically significant grade 3 anemia, neutropenia, and thrombocytopenia occurred in 7%, 10%, and 28% of patients, respectively. Other frequent adverse events such as the increase of liver enzymes, cutaneous rash, neurotoxicity, and vomiting occurred in 65%, 26%, 60%, and 40% of patients, respectively. Patients with prophylactic trimethoprim/sulfamethoxazole had more grade 3 hematological toxicity with pcv, especially anemia (p = 0.040) and thrombocytopenia (p = 0.003) but we found no increase in pcv toxicity in patients on concurrent anticonvulsants. Patients with grade 3 neutropenia had a significantly lower survival (median survival 44.0 months vs. 114.0 months, p = 0.001). Patients who were given pcv at diagnosis had more grade 3 anemia than those who received it at subsequent lines of treatment (p = 0.042). Conclusion Procarbazine, lomustine, and vincristine increase survival in lgg but were also associated with major hematologic, hepatic, neurologic, and cutaneous toxicity. Anti-Pneumocystis jiroveci pneumonia (pjp) prophylaxis, but not anticonvulsants, enhances hematologic toxicity.
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Affiliation(s)
- G Jutras
- Faculty of Medicine, Université de Montréal, Montréal, QC
| | - K Bélanger
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - N Letarte
- Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC.,Faculty of Pharmacy, University of Montreal, Montreal, QC; and.,Department of Pharmacy at chum, Montréal, QC
| | - J-P Adam
- Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC.,Department of Pharmacy at chum, Montréal, QC
| | - D Roberge
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - B Lemieux
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - É Lemieux-Blanchard
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - L Masucci
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - C Ménard
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - J P Bahary
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - R Moumdjian
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - F Berthelet
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - M Florescu
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
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7
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Jamal R, Lapointe R, Cocolakis E, Thébault P, Kazemi S, Friedmann JE, Dionne J, Cailhier JF, Bélanger K, Ayoub JP, Le H, Lambert C, El-Hajjar J, van Kempen LC, Spatz A, Miller WH. Peripheral and local predictive immune signatures identified in a phase II trial of ipilimumab with carboplatin/paclitaxel in unresectable stage III or stage IV melanoma. J Immunother Cancer 2017; 5:83. [PMID: 29157311 PMCID: PMC5696743 DOI: 10.1186/s40425-017-0290-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/04/2017] [Indexed: 12/22/2022] Open
Abstract
Background Checkpoint blockade with ipilimumab provides long-term survival to a significant proportion of patients with metastatic melanoma. New approaches to increase survival and to predict which patients will benefit from treatment are needed. This phase II trial combined ipilimumab with carboplatin/paclitaxel (CP) to assess its safety, efficacy, and to search for peripheral and tumor-based predictive biomarkers. Methods Thirty patients with untreated unresectable/metastatic melanoma were treated with ipilimumab and CP. Adverse events (AEs) were monitored and response to treatment was evaluated. Tumor tissue and peripheral blood were collected at specified time points to characterize tumor immune markers by immunohistochemistry and systemic immune activity by multiplex assays and flow cytometry. Results Eighty three percent of patients received all 5 cycles of CP and 93% completed ipilimumab induction. Serious AEs occurred in 13% of patients, and no treatment-related deaths were observed. Best Overall Response Rate (BORR) and Disease Control Rate (DCR) were 27 and 57%, respectively. Median overall survival was 16.2 months. Response to treatment was positively correlated with a higher tumor CD3+ infiltrate (immune score) at baseline. NRAS and BRAF mutations were less frequent in patients who experienced clinical benefit. Assessment of peripheral blood revealed that non-responders had elevated baseline levels of CXCL8 and CCL4, and a higher proportion of circulating late differentiated B cells. Pre-existing high levels of chemokines (CCL3, CCL4 and CXCL8) and advanced B cell differentiation were strongly associated with worse patient overall survival. Elevated proportions of circulating CD8+/PD-1+ T cells during treatment were associated with worse survival. Conclusions The combination of ipilimumab and CP was well tolerated and revealed novel characteristics associated with patients likely to benefit from treatment. A pre-existing systemic inflammatory state characterized by elevation of selected chemokines and advanced B cell differentiation, was strongly associated with poor patient outcomes, revealing potential predictive circulating biomarkers. Trial registration Clinicaltrials.gov, NCT01676649, registered on August 29, 2012. Electronic supplementary material The online version of this article (10.1186/s40425-017-0290-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rahima Jamal
- Hôpital Notre-Dame, Centre de recherche du CHUM, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Réjean Lapointe
- Centre de recherche du CHUM, Institut du Cancer de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Eftihia Cocolakis
- Segal Cancer Center, Jewish General Hospital, Rossy Cancer Network, McGill University, 3755 Côte-St-Catherine, suite E670, Montreal, Québec, Canada
| | - Paméla Thébault
- Centre de recherche du CHUM, Institut du Cancer de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Shirin Kazemi
- Segal Cancer Center, Jewish General Hospital, Rossy Cancer Network, McGill University, 3755 Côte-St-Catherine, suite E670, Montreal, Québec, Canada
| | - Jennifer E Friedmann
- Segal Cancer Center, Jewish General Hospital, Rossy Cancer Network, McGill University, 3755 Côte-St-Catherine, suite E670, Montreal, Québec, Canada
| | - Jeanne Dionne
- Hôpital Notre-Dame, Centre de recherche du CHUM, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Jean-François Cailhier
- Centre de recherche du CHUM, Institut du Cancer de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Karl Bélanger
- Hôpital Notre-Dame, Centre de recherche du CHUM, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Jean-Pierre Ayoub
- Hôpital Notre-Dame, Centre de recherche du CHUM, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Huy Le
- Segal Cancer Center, Jewish General Hospital, Rossy Cancer Network, McGill University, 3755 Côte-St-Catherine, suite E670, Montreal, Québec, Canada
| | - Caroline Lambert
- Segal Cancer Center, Jewish General Hospital, Rossy Cancer Network, McGill University, 3755 Côte-St-Catherine, suite E670, Montreal, Québec, Canada
| | - Jida El-Hajjar
- Segal Cancer Center, Jewish General Hospital, Rossy Cancer Network, McGill University, 3755 Côte-St-Catherine, suite E670, Montreal, Québec, Canada
| | - Léon C van Kempen
- Department of Pathology, Molecular Pathology Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alan Spatz
- Department of Pathology, Molecular Pathology Center, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Wilson H Miller
- Segal Cancer Center, Jewish General Hospital, Rossy Cancer Network, McGill University, 3755 Côte-St-Catherine, suite E670, Montreal, Québec, Canada.
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Lapointe S, Florescu M, Nguyen DK, Djeffal C, Bélanger K. Prophylactic anticonvulsants for gliomas: a seven-year retrospective analysis. Neurooncol Pract 2015; 2:192-198. [PMID: 31386083 DOI: 10.1093/nop/npv018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 02/23/2015] [Indexed: 11/14/2022] Open
Abstract
Background The American Academy of Neurology (AAN) does not recommend routine use of prophylactic antiepileptic drugs (pAEDs) in patients with newly diagnosed brain tumors. If used in the perioperative setting, discontinuation is suggested after the first postoperative week. It is unclear whether such recommendations are followed. Our objective was to compare our perioperative and long-term pAED use in glioma patients with AAN practice parameters. Methods Retrospective chart review was performed on 578 glioma patients from 2006 to 2013. Seizures and AED use were assessed at surgery, 3 months postoperatively and death, last visit or 16 months postoperatively. Patients were divided into three groups at surgery: seizure-free with pAED, seizure-free without pAED, and seizure patients. Long-term pAED use was defined as continued use at 3 months postsurgery without seizures. pAEDs efficacy, factors influencing its use, and survival were examined. Results Out of 578 patients identified, 330 (57.1%) were seizure-naïve preoperatively. There were no significant differences in age, histology, tumor location or resection status between seizure-free populations with and without prophylaxis. Of 330 seizure-naïve patients, 205 (62.1%) received pAEDs at surgery. Ninety-six (46.9%) of those patients were still on pAEDs 3 months postsurgery (median use = 58 days). Rate of long-term prophylaxis use decreased by 13.5% over 6 years (70.3% in 2006; 56.8% in 2012). Phenytoin was preferred in 2006 (98.2%) with increasing use of levetiracetam over 6 years (44.6% in 2012). The only predictive factor for pAED use was complete resection (P = .0069). First seizure prevalence was similar in both seizure-free populations (P = .91). The seizure population had more men (P = .007), younger patients (P < .0001), lower-grade gliomas (P = .0003) and survived longer (P = .001) compared with seizure-free populations. Conclusions In our center, long-term prophylactic AED use is high, deviating from current AAN Guidelines. Corrective measures are warranted.
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Affiliation(s)
- Sarah Lapointe
- Neurology Division, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (S.L., D.K.N.); Hematology and Oncology Department, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (M.F., C.D., K.B.)
| | - Marie Florescu
- Neurology Division, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (S.L., D.K.N.); Hematology and Oncology Department, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (M.F., C.D., K.B.)
| | - Dang K Nguyen
- Neurology Division, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (S.L., D.K.N.); Hematology and Oncology Department, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (M.F., C.D., K.B.)
| | - Chanez Djeffal
- Neurology Division, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (S.L., D.K.N.); Hematology and Oncology Department, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (M.F., C.D., K.B.)
| | - Karl Bélanger
- Neurology Division, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (S.L., D.K.N.); Hematology and Oncology Department, CHUM Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke East, Montreal, CanadaH2L 4M1 (M.F., C.D., K.B.)
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Easaw JC, Mason WP, Perry J, Laperrière N, Eisenstat DD, Del Maestro R, Bélanger K, Fulton D, Macdonald D. Canadian recommendations for the treatment of recurrent or progressive glioblastoma multiforme. ACTA ACUST UNITED AC 2012; 18:e126-36. [PMID: 21655151 DOI: 10.3747/co.v18i3.755] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recommendation 1: Multidisciplinary ApproachTo optimize treatment outcomes, the management of patients with recurrent glioblastoma should be individualized and should involve a multidisciplinary team approach, including neurosurgery, neuropathology, radiation oncology, neuro-oncology, and allied health professions.Recommendation 2: ImagingThe standard imaging modality for assessment of recurrent glioblastoma is Gd-enhanced magnetic resonance imaging (mri). Tumour recurrence should be assessed according to the criteria set out by the Response Assessment in Neuro-Oncology Working Group. The optimal timing and frequency of mri after chemoradiation and adjunctive therapy have not been established.Recommendation 3: Pseudo-progressionProgression observed by mri after chemoradiation can be pseudo-progression. Accordingly, treated patients should not be classified as having progressive disease by Gd-enhancing mri within the first 12 weeks after the end of radiotherapy unless new enhancement is observed outside the radiotherapy field or viable tumour is confirmed by pathology at the time of a required re-operation. Adjuvant temozolomide should be continued and follow-up imaging obtained.Recommendation 4: Repeat SurgerySurgery can play a role in providing symptom relief and confirming tumour recurrence, pseudo-progression, or radiation necrosis. However, before surgical intervention, it is essential to clearly define treatment goals and the expected impact on prognosis and the patient's quality of life. In the absence of level 1 evidence, the decision to re-operate should be made according to individual circumstances, in consultation with the multidisciplinary team and the patient.Recommendation 5: Re-irradiationRe-irradiation is seldom recommended, but can be considered in carefully selected cases of recurrent glioblastoma.Recommendation 6: Systemic TherapyClinical trials, when available, should be offered to all eligible patients. In the absence of a trial, systemic therapy, including temozolomide rechallenge or anti-angiogenic therapy, may be considered. Combination therapy is still experimental; optimal drug combinations and sequencing have not been established.
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Affiliation(s)
- J C Easaw
- Department of Oncology, Tom Baker Cancer Centre and the University of Calgary, Calgary, AB.
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10
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Amato RJ, Stephenson J, Hotte S, Nemunaitis J, Bélanger K, Reid G, Martell RE. MG98, a second-generation DNMT1 inhibitor, in the treatment of advanced renal cell carcinoma. Cancer Invest 2012; 30:415-21. [PMID: 22571342 DOI: 10.3109/07357907.2012.675381] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In carcinogenesis, methylation of DNA promoter regions results in inactivation of tumor-suppressing genes. MG98 was designed to inhibit DNA methyltransferases enzyme 1 production. METHODS This multicenter study explored two schedules of MG98 with Interferon-α-2β to identify schedule and dose for patients with metastatic RCC. RESULTS Doses of IFN 9 MIU/MG98 125 mg/m(2) for a continuous schedule and IFN 9 MIU/MG98 200 mg/m(2) for an intermittent schedule were considered the MTDs. Treatment resulted in one PR and eight SD. CONCLUSION MG98 combined with IFN was safe and resulted in clinical activity.
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Affiliation(s)
- Robert J Amato
- Department of Internal Medicine, The University of Texas Medical School/ Memorial Hermann Cancer Center, Houston, Texas 77030, USA.
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11
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Perry JR, Bélanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF. Phase II Trial of Continuous Dose-Intense Temozolomide in Recurrent Malignant Glioma: RESCUE Study. J Clin Oncol 2010; 28:2051-7. [PMID: 20308655 DOI: 10.1200/jco.2009.26.5520] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Concomitant temozolomide (TMZ)/radiotherapy followed by adjuvant TMZ has increased survival in patients with glioblastoma multiforme (GBM). However, few options are effective for patients who experience treatment failure. We conducted a multicenter, phase II study to assess the efficacy and safety of continuous dose-intense TMZ for recurrent GBM. Patients and Methods Patients with malignant glioma at progression after standard TMZ 150 to 200 mg/m2 × 5 days in a 28-day cycle for three or more cycles were stratified by tumor type (anaplastic glioma group A, GBM, group B). Ninety-one patients with GBM were prospectively divided into three groups (early [B1], extended [B2], and rechallenge [B3]) according to the timing of progression during adjuvant therapy. All patients received continuous dose-intense TMZ 50 mg/m2/d for up to 1 year or until progression occurred. Response was assessed by using RECIST (Response Evaluation Criteria in Solid Tumors). Results A total of 116 of 120 patients were evaluable for efficacy. For patients with GBM, 6-month progression-free survival (PFS) was 23.9% (B1, 27.3%; B2, 7.4%; B3, 35.7%). One-year survival from time of study entry was 27.3%, 14.8%, and 28.6% for the B1, B2 and B3 groups, respectively. For patients with anaplastic glioma, 6-month PFS was 35.7%; 1-year survival was 60.7%. The most common grades 3 and 4 nonhematologic toxicities were nausea/vomiting (6.7%) and fatigue (5.8%). Grades 3 and 4 hematologic toxicities were uncommon. Conclusion Rechallenge with continuous dose-intense TMZ 50 mg/m2/d is a valuable therapeutic option for patients with recurrent GBM. Patients who experience progression during the first six cycles of conventional adjuvant TMZ therapy or after a treatment-free interval get the most benefit from therapy.
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Affiliation(s)
- James R. Perry
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Karl Bélanger
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Warren P. Mason
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Dorcas Fulton
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Petr Kavan
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Jacob Easaw
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Claude Shields
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Sarah Kirby
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - David R. Macdonald
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - David D. Eisenstat
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Brian Thiessen
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Peter Forsyth
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
| | - Jean-François Pouliot
- From the Odette Cancer Centre and Sunnybrook Health Sciences Centre; Princess Margaret Hospital, Toronto; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Hôpital Notre-Dame; Royal Victoria Hospital, Montreal; Hôpital de l'Enfant-Jésus, Quebec City; Schering-Plough Canada, Kirkland, Quebec; Cross Cancer Institute, Edmonton; Tom Baker Cancer Center, Calgary, Alberta; Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Cancer Care Manitoba, Winnipeg, Manitoba
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12
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Lee CW, Bélanger K, Rao SC, Petrella TM, Tozer RG, Wood L, Savage KJ, Eisenhauer EA, Synold TW, Wainman N, Seymour L. A phase II study of ispinesib (SB-715992) in patients with metastatic or recurrent malignant melanoma: a National Cancer Institute of Canada Clinical Trials Group trial. Invest New Drugs 2007; 26:249-55. [PMID: 17962907 DOI: 10.1007/s10637-007-9097-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 10/10/2007] [Indexed: 01/08/2023]
Abstract
To assess the response rate and toxicity of the kinesin spindle protein (KSP) inhibitor, ispinesib, in malignant melanoma. Seventeen patients were enrolled from April to November 2005. Ispinesib was administered as a 1-hour infusion at a dose of 18 mg/m2 once every 3 weeks until disease progression. No objective responses were seen. Six patients (35%) had a best response of stable disease for a median duration of 2.8 months. Disease progression was documented in 9 (53%) after 1 or 2 cycles. Eighty-eight percent of patients received > or =90% of planned dose intensity. Grade 3 non-hematologic toxicities included dizziness (1) and blurred vision (1). There was one episode of febrile neutropenia, but no grade 3 or 4 biochemical adverse events. Pharmacokinetics was consistent with prior studies. KSP immunoreactivity was seen in 14 of 16 available archival tissue samples (88%). Ispinesib can be safely administered using the dose and schedule employed, with mild hematologic and non-hematologic toxicity. No objective responses were observed, and further development of single-agent ispinesib in malignant melanoma is not recommended. Although KSP expression appears to be common in melanoma, KSP may not be a suitable target for its treatment.
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Affiliation(s)
- Christopher W Lee
- BC Cancer Agency - Fraser Valley Centre, 13750 96th Avenue, Surrey, BC, Canada V3V 1Z2.
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Stephenson J, Amato RJ, Hotte S, Nemunaitis J, Berman B, Bélanger K, Patterson TA, Macleod AR, Reid GK, Martell RE. A dose and schedule optimizing evaluation of MG98 given as either a 2 hour IV infusion twice weekly or as a 7 day continuous infusion in combination with interferon alpha (INF) in nephrectomized patients (pts) with advanced renal cell carcinoma (RCC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14557] [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
14557 Background: RCC is often associated with hypermethylated and silenced tumour suppressor genes. The enzyme DNMT1 is responsible for the majority of cellular DNA methylating capacity. MG98 is a second generation antisense inhibitor of DNMT1 which has been shown to reduce DNMT1 mRNA and protein. Methods: A trial of MG98 given as a 2 hour IV infusion twice weekly (Intermittent Schedule, IS) or as a 7 day continuous infusion (CI) in combination with INF has been conducted with nephrectomized pts with advanced RCC. Main endpoints: identification of the optimum regimen, safety, tolerability, pharmacokinetics (PK) and the degree of PBL DNMT1 mRNA suppression. Results: CI schedule: dose levels of 125mg of MG98 combined with 12 MIU of INF (125/12) and 125/9 have been evaluated (9 pts). The MTD has been reached; thrombocytopenia is dose limiting at 125/12. Pt demographics: M:F= 6:3, mean age of 63.2y (52–71). Most common Adverse Events (AEs): fever and chills (gr.1), fatigue (gr.1–2; 100% of pts), nausea and anorexia (gr.1–2), vomiting (gr.2; 66%). Best response: Stable Disease (SD) =3; Partial Response (PR) =1. Currently within the IS schedule, 3 dose levels (9 pts) have been evaluated: 160/12, 200/12 and 200/9, totaling 26 cycles. The MTD has been reached, with GI/constitutional symptoms being dose limiting at 200/12. Demographics: M:F= 7:2 median age 59.8y (40–76). Most common AEs in the first 3 pts are nausea and chills (100% of patients); fatigue (gr.1–2) and fever (66%; gr. 1–3). Best responses: 3 SD, 1 PR. PK evaluation on both schedules revealed no interaction between INF and MG98. DNMT1 inhibition data will be presented. Conclusions: Combination of INF and MG98 exhibits clinical activity and acceptable safety. [Table: see text]
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Affiliation(s)
- J. Stephenson
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - R. J. Amato
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - S. Hotte
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - J. Nemunaitis
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - B. Berman
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - K. Bélanger
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - T. A. Patterson
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - A. R. Macleod
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - G. K. Reid
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
| | - R. E. Martell
- Cancer Treatment Center, Greenville, SC; Methodist Hospital, Houston, TX; Juravinski Cancer Centre, Hamilton, ON, Canada; Mary Crowley Medical Research Center, Dallas, TX; Cancer Centers of Florida, Ocoee, FL; Hôpital Notre Dame du CHUM, Montreal, PQ, Canada; MethylGene Inc., Montreal, PQ, Canada
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Bélanger K, MacDonald D, Cairncross G, Gertler S, Forsyth P, Burdette-Radoux S, Bergeron J, Soulières D, Ludwin S, Wainman N, Eisenhauer E. A phase II study of topotecan in patients with anaplastic oligodendroglioma or anaplastic mixed oligoastrocytoma. Invest New Drugs 2003; 21:473-80. [PMID: 14586216 DOI: 10.1023/a:1026211620793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine the efficacy and toxicity of a novel chemotherapeutic approach with topotecan, a camptothecin analog, for progressive or recurring anaplastic oligodendroglioma or mixed oligoastrocytoma.Patients from seven centers with recurrent or progressive disease were treated with topotecan, 1.5 mg/m(2) intravenously (i.v.), 30 min dailyx5 days every 3 weeks. Efficacy and toxicity were assessed clinically and radiologically. The study was planned to accrue up to 30 evaluable patients if there was at least one response among the first 15 patients treated. Sixteen eligible patients entered the study. No response was documented in 14 evaluable patients. Eleven patients had stable disease of a median of 3.8 months and three had progressive disease. Sixteen patients were evaluable for toxicity. The most significant toxic effect was myelosuppression. Grade 3 or 4 granulocytopenia was experienced by 15 of 16 patients and led to dose reduction in nearly half of the cycles delivered. Other adverse effects were fatigue, nausea, stomatitis, alopecia, and vomiting.Topotecan, delivered in the dailyx5 regimen, is relatively well tolerated. We could not demonstrate significant activity among the population studied to justify completing accrual to 30 patients. Topotecan did not demonstrate, with this small sample size, efficacy as a salvage chemotherapy monotherapy after exposure to procarbazine, CCNU and vincristine. Further trials with different agents in this indication are certainly warranted.
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Affiliation(s)
- Karl Bélanger
- Department of Hematology, CHUM-Hôpital Notre-Dame, Montreal, Quebec, Canada.
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Bélanger K, Moore M, Baker SD, Dionne J, Maclean M, Jolivet J, Siu L, Soulières D, Wainman N, Seymour L. Phase I and pharmacokinetic study of novel L-nucleoside analog troxacitabine given as a 30-minute infusion every 21 days. J Clin Oncol 2002; 20:2567-74. [PMID: 12011137 DOI: 10.1200/jco.2002.12.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Troxacitabine (Troxatyl, BCH-4556; BioChem Pharma Inc, Basingstoke, United Kingdom) is a novel synthetic L-nucleoside analog with activity against a broad range of human tumors in preclinical models. Preclinical toxicity suggested a predictable toxicity profile consistent with an agent of this class, with evidence of interspecies differences. We conducted a phase I study of troxacitabine given as a 30-minute infusion once every 21 days. PATIENTS AND METHODS The starting dose of troxacitabine was 0.025 mg/m(2), based on toxicology data from the most sensitive species studied (cynomolgus monkey). Doses were doubled until grade 1 skin or mucosal or grade 2 other toxicity was encountered. A modified Fibonacci scale was used. RESULTS A total of 45 patients were enrolled at 13 dose levels. Most common nonhematologic side effects were skin rash (44%), lethargy (29%), nausea (24%), alopecia, dry skin (18%), anorexia (13%), neurosensory symptoms (13%), and hand-foot syndrome (13%). In patients treated with prednisone 25 mg/d orally for 5 days, starting on day 1, skin rash was less problematic. Two patients at 12.5 mg/m(2) experienced dose-limiting (grade 4) granulocytopenia. Confirmed partial responses were documented in one patient with previously untreated renal cell carcinoma with metastatic lung and bone lesions and in one patient with an unknown primary tumor. Eighteen patients had a best response of stable disease with a median duration of 5.1 months (range, 2.1 to 18.7 months). CONCLUSION When given in this schedule, the maximum-tolerated dose of troxacitabine is 12.5 mg/m(2), and the recommended dose for additional phase II studies is 10 mg/m(2) once every 21 days with steroid premedication.
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Affiliation(s)
- Karl Bélanger
- Centre Hospitalier de l'Universite de Montreal (CHUM), Hôpital Notre-Dame, 1560 Sherbrooke Street East, Montreal, Québec, Canada H2L 4M1. [corrected]
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Fortin M, Bahary J, Bourgouin P, Bélanger K, Jolicoeur M, Dumont M, Moumdjian R. 2087 Value of surveillance imaging in the management of patients with high grade gliomas. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jolivet J, Bélanger K, Yelle L, Guévin R, Potvin M, Wilson J, Rudinskas L, Latreille J, Dionne J, Gagné L. The importance of dose scheduling with mitoxantrone, 5-fluorouracil and leucovorin in metastatic breast cancer. Eur J Cancer 1994; 30A:626-8. [PMID: 8080677 DOI: 10.1016/0959-8049(94)90533-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We have studied a mitoxantrone, 5-fluorouracil (5-FU) and leucovorin chemotherapy regimen in metastatic breast cancer. 8 patients received mitoxantrone 10 mg/m2 on day 1, leucovorin 200 mg/m2 and 5-FU 300 mg/m2 on days 1-5 by intravenous bolus every 28 days in a pilot study. Grades 3-4 granulocytopenia followed 55% of the courses, with 2 patients admitted for febrile neutropenia. Only a 29% objective response rate was seen in a subsequent phase II trial using reduced mitoxantrone doses. Comparison with other trials suggested that 5-day bolus 5-FU administration adversely affects the combination's therapeutic index.
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Affiliation(s)
- J Jolivet
- Institut du Cancer de Montréal, Québec, Canada
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Bélanger K, Jolivet J, Maroun J, Stewart D, Grillo-Lopez A, Whitfield L, Wainman N, Eisenhauer E. Phase I pharmacokinetic study of DUP-937, a new anthrapyrazole. Invest New Drugs 1993; 11:301-8. [PMID: 8157472 DOI: 10.1007/bf00874428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
DUP-937 is a new anthrapyrazole intercalator that inhibits DNA synthesis. A phase I trial was conducted in which DUP-937 was given in an intravenous bolus weekly for 3 weeks. Cycles were repeated every 5 weeks. Twenty men and 13 women with median ECOG performance status of 1 completed 74 cycles. The starting dose was 0.55 mg/m2/week and doses were escalated to 16 mg/m2/week. Non-hematological toxicity was generally mild or moderate and consisted mainly of gastro-intestinal effects, fatigue, alopecia and local reactions. Grade 3 neutropenia was first documented at 7.36 mg/m2 and became more common at higher dose levels. Three of four patients had > or = grade 3 neutropenia at the 16 mg/m2 dose level. Thrombocytopenia was minimal. The dose-limiting toxicity was neutropenia and the maximum tolerated dose was 16 mg/m2 weekly for 3 weeks. Mean area under the curve (AUC) values increased with dose. Linear pharmacokinetics were observed as total body clearance (CLtb), half-life (t1/2) and volume of distribution (Vss) did not change with increasing doses. One partial remission in a patient with prostate carcinoma was documented.
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Affiliation(s)
- K Bélanger
- Department of Medicine, Hôpital Notre-Dame, University of Montréal, Canada
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