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Grünwald V, Ivanyi P, Zschäbitz S, Wirth M, Staib P, Schostak M, Dargatz P, Müller L, Metz M, Bergmann L, Steiner T, Welslau M, Lorch A, Rafiyan R, Hellmis E, Darr C, Schütt P, Meiler J, Kretz T, Loidl W, Flörcken A, Mänz M, Hinke A, Hartmann A, Grüllich C. Nivolumab Switch Maintenance Therapy After Tyrosine Kinase Inhibitor Induction in Metastatic Renal Cell Carcinoma: A Randomized Clinical Trial by the Interdisciplinary Working Group on Renal Tumors of the German Cancer Society (NIVOSWITCH; AIO-NZK-0116ass). Eur Urol 2023; 84:571-578. [PMID: 37758574 DOI: 10.1016/j.eururo.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/31/2023] [Revised: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The role of immune checkpoint inhibitor (ICI) maintenance therapy in metastatic renal cell carcinoma (mRCC) is undefined. OBJECTIVE To determine whether switch maintenance therapy with nivolumab improves clinical outcomes in patients with mRCC with tyrosine kinase inhibitor (TKI) sensitivity. DESIGN, SETTING, AND PARTICIPANTS This open-label phase 2 trial randomized patients with a partial response or stable disease after 10-12-wk TKI induction therapy to either TKI or nivolumab maintenance. Key inclusion criteria were measurable disease, clear cell histology, Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2, and adequate organ function. INTERVENTION Intravenous nivolumab 8 × 240 mg every 2 wk, followed by 480 mg every 4 wk or sunitinib 50 mg (4-2 regimen) or pazopanib 800 mg once daily orally. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES The primary endpoint was overall survival (OS). Secondary endpoints were the objective response rate (ORR; Response Evaluation Criteria in Solid Tumors v1.1), progression-free survival (PFS), safety (Common Terminology Criteria for Adverse Events v4.03), and patient-reported outcomes (Functional Assessment of Cancer Therapy Kidney Symptom Index). The Kaplan-Meier method, two-sided log-rank tests, and Cox regression models were used for statistical analysis. RESULTS AND LIMITATIONS Maintenance therapy was nivolumab for 25 patients (51.0%) and TKI for 24 (48.9%). The median age was 65 yr (range 35-79). Nine patients (18.4%) were female, 31 (63.3%) had ECOG PS of 0, and 15 (30.6%) had favorable risk. OS data are immature (17 deaths, 34.7%). The ORR was 20.0% (n = 5) for nivolumab and 52.2% (n = 12) for TKI. PFS was worse with nivolumab (hazard ratio 2.57, 95% confidence interval 1.36-4.89; p = 0.003). Grade ≥3 adverse events occurred in 14 patients (56.0%) with nivolumab and 17 (70.8%) with TKI. A major limitation is early termination of our study. CONCLUSIONS TKI treatment achieved superior ORR and PFS in comparison to nivolumab maintenance therapy. Our data do not indicate a role for nivolumab switch maintenance in mRCC. PATIENT SUMMARY Patients with metastatic kidney cancer who experienced a tumor response or disease stabilization after a short period of targeted treatment with a tyrosine kinase inhibitor did not benefit from a switch to the immunotherapy drug nivolumab. Patients who continued their original treatment achieved better responses and a longer time without disease progression. This trial is registered on EudraCT as 2016-002170-13 and on ClinicalTrials.gov as NCT02959554.
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Affiliation(s)
- Viktor Grünwald
- Interdisciplinary Genitourinary Oncology, Internal Medicine (Tumor Research) and Urology Clinics, West-German Cancer Center, University Hospital Essen, Essen, Germany.
| | - Philipp Ivanyi
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Claudia von Schilling Cancer Center, Medical School Hannover, Hannover, Germany
| | - Stefanie Zschäbitz
- Department of Medical Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Staib
- Clinic for Hematology and Oncology, St. Antonius Hospital, Eschweiler, Germany
| | - Martin Schostak
- Department of Urology, Uro-Oncology, Robot-Assisted and Focal Therapy, University of Magdeburg, Magdeburg, Germany
| | | | | | - Michael Metz
- Onkologische Schwerpunktpraxis Göttingen, Göttingen, Germany
| | - Lothar Bergmann
- Medical Clinic II, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Martin Welslau
- Hemato-Oncology Practice, Aschaffenburg Hospital, Aschaffenburg, Germany
| | - Anja Lorch
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany; Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Reza Rafiyan
- Clinic for Oncology and Hematology, Krankenhaus Nordwest, Frankfurt, Germany
| | | | - Cristopher Darr
- Clinic for Urology, University Hospital Essen, Essen, Germany
| | | | | | | | - Wolfgang Loidl
- Department of Urology and Andrology, Ordensklinikum Linz, Linz, Austria
| | - Anne Flörcken
- Department of Hematology, Oncology and Tumorimmunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Axel Hinke
- Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Arndt Hartmann
- Institute for Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Carsten Grüllich
- Department of Hematology and Oncology, Caritas-Hospital Lebach, Lebach, Germany
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von der Heyde E, Bürkle D, Forstbauer H, Hübner G, Schmidt B, Schröder J, Distelrath A, Wierecky J, Stübs P, Kisro J, Welslau M, Müller-Huesmann H, Göhler T, Krammer-Steiner B, Schwaner I, Hering-Schubert C, Gerger A, Greil R, Jacobasch L, Reichenbach F, Stintzing S, Prager G. P-7 Encorafenib and cetuximab in patients with metastatic, BRAF V600E-mutated, colorectal cancer: Update on the first real-world study in Germany and Austria – BERING CRC. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.099] [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: 11/01/2022] Open
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Müller-Huesmann H, von der Heyde E, Hahn D, Langer C, Kubuschok B, Bockmühl U, Klautke G, Mauz PS, Reuter B, Beutner D, Büntzel J, von der Grün J, Busch CJ, Tamaskovics B, Riera-Knorrenschild J, Gutsche K, Welslau M, Gauler T, Waldenberger D, Dietz A. 924P HANNA: Effectiveness and quality-of-life data from a real-world study of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) treated with nivolumab in Germany. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1334] [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: 11/26/2022] Open
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Stintzing S, Hübner G, Schröder J, Kisro J, Welslau M, Bürkle D, Göhler T, Schmidt B, Müller-Huesmann H, Krammer-Steiner B, von der Heyde E, Reichenbach F, Arnold D, Gerger A, Hegewisch-Becker S, Vogel A, Winder T, Prager G. P-58 Encorafenib and cetuximab in patients with metastatic, BRAF V600E-mutated, colorectal carcinoma: A multi-centric, multi-national, prospective, longitudinal, non-interventional study in Germany and Austria – BERING CRC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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El-Balat A, Marmé F, Sehouli J, Welslau M, Grabowski J, Hartkopf A, Glowik R, Hilpert F. Olaparib routine clinical practice in Germany – Quality of life interim results of the non-interventional C-PATROL study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A El-Balat
- Universitätsklinikum Frankfurt, Klinik für Frauenheilkunde und Geburtshilfe
| | - F Marmé
- University Medical Centre Mannheim, Medical Faculty Mannheim, Department of Gynecology
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité Medical University, Berlin, Germany
| | - M Welslau
- Medical office for hemato-oncology, Aschaffenburg
| | - J.P Grabowski
- Department of Gynecology and Center for Oncological Surgery, Charité Medical University, Berlin, Germany
| | - A Hartkopf
- University Hospital of Tuebingen, Center for Women’s Health
| | | | - F Hilpert
- Oncology Centre at Jerusalem Hospital Hamburg
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Marmé F, Hilpert F, Welslau M, Grabowski J, Seitz J, El-Balat A, Hartkopf A, Glowik R, Sehouli J. Results of the second interim analysis of C-PATROL: A non-interventional study on olaparib within German routine clinical practice. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Welslau M, Marschner N, Wolff T, Otremba B, Topaly J, Bittencourt da Silva L. SANDOZ RITUXIMAB FOR TREATMENT OF DIFFUSE LARGE B-CELL LYMPHOMA: INTERIM SAFETY RESULTS OF THE NON-INTERVENTIONAL, OBSERVATIONAL, MULTICENTER, OPEN-LABEL REFLECT STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.120_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Welslau
- Onkologie Aschaffenburg; Aschaffenburg Germany
| | | | - T. Wolff
- Onkologie Lerchenfeld; Hamburg Germany
| | - B. Otremba
- Onkologische Praxis Oldenburg/Delmenhorst; Oldenburg Germany
| | - J. Topaly
- MVZ Klinikum Osnabrück GmbH; Osnabrück Germany
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Grabowski JP, Sehouli J, Hilpert F, Welslau M, Schinköthe T, Seitz J, El-Balat A, Grischke EM, Glowik R, Marmé F. Olaparib in German routine clinical practice – Updated interim results of the non-interventional study C-PATROL. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- JP Grabowski
- Charité Medical University Berlin, Department of Gynecology and Center for Oncological Surgery and European Competence Center for Ovarian Cancer, Berlin, Deutschland
| | - J Sehouli
- Charité Medical University Berlin, Department of Gynecology and Center for Oncological Surgery and European Competence Center for Ovarian Cancer, Berlin, Deutschland
| | - F Hilpert
- Oncology Centre at Jerusalem Hospital Hamburg, Hamburg, Deutschland
| | - M Welslau
- Medical office for hemato-oncology, Aschaffenburg, Deutschland
| | | | - J Seitz
- University Hospital Heidelberg, Department of Obstetrics & Gynecology, Heidelberg, Deutschland
| | - A El-Balat
- Goethe University Frankfurt, Department of Obstetrics and Gynecology, Frankfurt, Deutschland
| | - EM Grischke
- University Hospital of Tübingen, Center for Women's Health, Tübingen, Deutschland
| | | | - F Marmé
- University Hospital Heidelberg, Department of Obstetrics & Gynecology, Heidelberg, Deutschland
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Sehouli J, Hilpert F, Welslau M, Schinköthe T, Glowik R, Marmé F. Olaparib in German routine clinical practice: Updated interim results of the non-interventional study c-patrol. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bedke J, Welslau M, Boegemann M, Schostak M, Hering-Schubert C, Petzoldt A, Wolf T, Schleicher J, Doehn C, Grüllich C, Grünwald V, Steiner T, Ehness R, Klein D, Medinger T, Goebell P. Interim results from PAZOREAL: A non-interventional study to assess effectiveness and safety of pazopanib and everolimus in the changing mRCC treatment landscape. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wonhöfer M, Welslau M, Würstlein R, Harbeck N, Schinköthe T. eHealth Strategy for Elderly Patients (eStEP). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hecht M, Hahn D, Beutner D, Reichert D, Göhler T, Wurm R, Welslau M, Renziehausen L, Balermpas P, Bergmann T, Aßmann M, Belka C, Orlowski K, Finzsch M, Illerhaus G, Fietkau R. Cetuximab in combination with platinum-based chemotherapy or radiotherapy in recurent and/or metastatic SCCHN in a non-selected patient cohort (interim analysis of the phase IV SOCCER trial). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw376.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Goebell P, Doehn C, Grüllich C, Grünwald V, Steiner T, Ehness R, Welslau M. The PAZOREAL non-interventional study to assess efficacy and safety of pazopanib and everolimus in the changing metastatic renal cell carcinoma (mRCC) treatment landscape. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Diéras V, Miles D, Verma S, Pegram M, Welslau M, Baselga J, Krop I, Blackwell K, Kang B, Xu J, Green M, Gianni L. Abstract P4-14-01: Trastuzumab emtansine improves overall survival versus capecitabine plus lapatinib in patients with previously treated HER2-positive advanced breast cancer: Final results from the phase 3 EMILIA study. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-14-01] [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]
Abstract
Abstract
Introduction
T-DM1 is indicated for the treatment of advanced HER2-positive MBC in patients who previously received trastuzumab and a taxane (separately or in combination) based on data from the phase 3 EMILIA study (BO21977/TDM4370g; NCT00829166). In the primary PFS and second interim OS analyses, respectively, T-DM1 significantly improved PFS (median 9.6 vs 6.4 months; HR=0.65; 95% CI, 0.55–0.77; p<0.0001) and OS (median 30.9 vs 25.1 months; HR=0.68; 95% CI, 0.55–0.85; p<0.0006) compared with capecitabine (X) plus lapatinib (L). T-DM1 treatment was associated with fewer grade ≥3 AEs (41% vs 57%) vs XL. Here we present the final OS analysis from EMILIA.
Methods
EMILIA was a randomized, open-label study of patients with centrally confirmed HER2-positive (IHC3+ and/or FISH amplification ratio ≥2.0), unresectable, locally advanced or MBC, previously treated with trastuzumab and a taxane. Patients were randomized 1:1 to T-DM1 (3.6 mg/kg IV every 3 weeks) or X (1000 mg/m2 PO twice daily, days 1–14 every 3 weeks) plus L (1250 mg PO daily). The final OS analysis was to be conducted following 632 events, and these results are descriptive only. Since the OS efficacy boundary (HR<0.71, p=0.0025) was crossed in the second interim analysis, a protocol amendment allowed crossover from XL to T-DM1.
Results
From Feb 2009 to Oct 2011, 991 patients were randomized to T-DM1 (n=495) or XL (n=496). Patient disposition by the data cutoff (31 Dec 2014) is shown in Table 1. OS was longer with T-DM1 vs XL (median OS 29.9 vs 25.9 months; HR=0.75; 95% CI, 0.64–0.88; p=0.0003). In a sensitivity analysis, which censored crossover patients at the time of switching from XL to T-DM1, the HR was 0.69 (95% CI, 0.59–0.82; p<0.0001). The overall safety profile was similar to previous analyses (Table 2). More grade ≥3 thrombocytopenia occurred with T-DM1 vs XL (14.3% vs 0.4%). Cardiac dysfunction occurred in 2.7% of T-DM1 patients vs 3.5% of XL patients.
Table 1. Patient disposition. T-DM1 (n=495)XL (n=496)Median treatment duration, months7.6X: 5.3 L: 5.5Median duration of follow-up, months47.841.9Discontinued study, n (%)364 (74)404 (82)Crossover, n (%) Per protocolaNot applicable136 (27)Non-protocol therapybX: 252 (54)X: 53 (11) L: 224 (48)L: 74 (15)aMedian duration of follow-up among per-protocol crossover patients was 24.1 months.bBy investigator choice after study treatment discontinuation; X or L could be given in combination with each other or other agents after progression.
Table 2. Safety summary in patients who received ≥1 dose of study treatment.n (%)T-DM1 (n=490)XL (n=488)Grade ≥3 AEs233 (47.6)291 (59.6)Serious AEs91 (18.6)99 (20.3)AEs leading to dose reduction91 (18.6)X: 205 (42.0) L: 98 (20.1)
Conclusions
This final analysis of EMILIA shows an OS benefit of T-DM1 compared with XL. While median drug exposure was longer with T-DM1 than XL, T-DM1 was associated with fewer grade ≥3 AEs and AEs leading to dose reduction compared with XL. These final OS results confirm that T-DM1 treatment improved survival, even in the presence of treatment crossover, and reaffirm T-DM1 as the standard of care in patients with previously treated HER2-positive MBC.
Citation Format: Diéras V, Miles D, Verma S, Pegram M, Welslau M, Baselga J, Krop I, Blackwell K, Kang B, Xu J, Green M, Gianni L. Trastuzumab emtansine improves overall survival versus capecitabine plus lapatinib in patients with previously treated HER2-positive advanced breast cancer: Final results from the phase 3 EMILIA study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-01.
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Affiliation(s)
- V Diéras
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - D Miles
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - S Verma
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - M Pegram
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - M Welslau
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - J Baselga
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - I Krop
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - K Blackwell
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - B Kang
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - J Xu
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - M Green
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
| | - L Gianni
- Institut Curie, Paris, France; Mount Vernon Cancer Center, Northwood, United Kingdom; Sunnybrook Odette Cancer Center, Toronto, ON, Canada; Stanford Cancer Institute, Palo Alto, CA; Medical Office Hematology, Aschaffenburg, Bavaria, Germany; Memorial Sloan Kettering Cancer Center, NY, NY; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Genentech, Inc, South San Francisco, CA; San Raffaele Hospital, Milan, Italy
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Krop IE, Lin NU, Blackwell K, Guardino E, Huober J, Lu M, Miles D, Samant M, Welslau M, Diéras V. Trastuzumab emtansine (T-DM1) versus lapatinib plus capecitabine in patients with HER2-positive metastatic breast cancer and central nervous system metastases: a retrospective, exploratory analysis in EMILIA. Ann Oncol 2015; 26:113-119. [PMID: 25355722 PMCID: PMC4679405 DOI: 10.1093/annonc/mdu486] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [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: 08/15/2014] [Revised: 09/24/2014] [Accepted: 09/30/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND We characterized the incidence of central nervous system (CNS) metastases after treatment with trastuzumab emtansine (T-DM1) versus capecitabine-lapatinib (XL), and treatment efficacy among patients with pre-existing CNS metastases in the phase III EMILIA study. PATIENTS AND METHODS In EMILIA, patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer previously treated with trastuzumab and a taxane were randomized to T-DM1 or XL until disease progression. Patients with treated, asymptomatic CNS metastases at baseline and patients developing postbaseline CNS metastases were identified retrospectively by independent review; exploratory analyses were carried out. RESULTS Among 991 randomized patients (T-DM1 = 495; XL = 496), 95 (T-DM1 = 45; XL = 50) had CNS metastases at baseline. CNS progression occurred in 9 of 450 (2.0%) and 3 of 446 (0.7%) patients without CNS metastases at baseline in the T-DM1 and XL arms, respectively, and in 10 of 45 (22.2%) and 8 of 50 (16.0%) patients with CNS metastases at baseline. Among patients with CNS metastases at baseline, a significant improvement in overall survival (OS) was observed in the T-DM1 arm compared with the XL arm [hazard ratio (HR) = 0.38; P = 0.008; median, 26.8 versus 12.9 months]. Progression-free survival by independent review was similar in the two treatment arms (HR = 1.00; P = 1.000; median, 5.9 versus 5.7 months). Multivariate analyses demonstrated similar results. Grade ≥3 adverse events were reported in 48.8% and 63.3% of patients with CNS metastases at baseline administered T-DM1 and XL, respectively; no new safety signals were observed. CONCLUSION In this retrospective, exploratory analysis, the rate of CNS progression in patients with HER2-positive advanced breast cancer was similar for T-DM1 and for XL, and higher overall in patients with CNS metastases at baseline compared with those without CNS metastases at baseline. In patients with treated, asymptomatic CNS metastases at baseline, T-DM1 was associated with significantly improved OS compared with XL.
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Affiliation(s)
- I E Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston.
| | - N U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - K Blackwell
- Department of Medicine, Duke University Medical Center, Durham
| | - E Guardino
- Product Development, Oncology, Genentech, Inc., South San Francisco, USA
| | - J Huober
- Department of Medical Oncology and Breast Centre, Cantonal Hospital, St Gallen, Switzerland
| | - M Lu
- Product Development, Oncology, Genentech, Inc., South San Francisco, USA
| | - D Miles
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - M Samant
- Biostatistics, Genentech, Inc., South San Francisco, USA
| | - M Welslau
- Hematology, Medical Office, Aschaffenburg, Germany
| | - V Diéras
- Department of Medical Oncology, Institut Curie, Paris, France
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Herth I, Dietrich S, Benner A, Hegenbart U, Rieger M, Stadtherr P, Bondong A, Tran TH, Weide R, Hensel M, Knauf W, Franz-Werner J, Welslau M, Procaccianti M, Görner M, Meissner J, Luft T, Schönland S, Witzens-Harig M, Zenz T, Ho AD, Dreger P. The impact of allogeneic stem cell transplantation on the natural course of poor-risk chronic lymphocytic leukemia as defined by the EBMT consensus criteria: a retrospective donor versus no donor comparison. Ann Oncol 2014; 25:200-6. [PMID: 24356631 DOI: 10.1093/annonc/mdt511] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 12/20/2022] Open
Abstract
BACKGROUND In a single-center retrospective donor versus no-donor comparison, we investigated if allogeneic stem cell transplantation (alloSCT) can improve the dismal course of poor-risk chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS All patients with CLL who were referred for evaluation of alloSCT within a 7-year time frame and had a donor search indication according to the EBMT criteria or because of Richter's transformation were included. Patients for whom a matched donor could be found within 3 months (matches) were compared with patients without such a donor (controls). Primary end point was overall survival measured from the 3-month landmark after search initiation. RESULTS Of 105 patients with donor search, 97 (matches 83; controls 14) were assessable at the 3-month landmark. Matches and controls were comparable for age, gender, time from diagnosis, number of previous regimens, and remission status. Disregarding if alloSCT was actually carried out or not, survival from the 3-month landmark was significantly better in matches versus controls [hazard ratio 0.38, 95% confidence interval (CI) 0.17-0.85; P = 0.014]. The survival benefit of matches remained significant on multivariate analysis. CONCLUSION This study provides first comparative evidence that alloSCT may have the potential to improve the natural course of poor-risk CLL as defined by the EBMT criteria.
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Affiliation(s)
- I Herth
- Department Medicine V, University of Heidelberg, Heidelberg
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Jackisch C, Welslau M, Schoenegg W, Selbach J, Harich HD, Schröder J, Schmidt M, Göhler T, Eustermann H, Ringel R, Hinke A. Impact of trastuzumab treatment beyond disease progression for advanced/metastatic breast cancer on survival - results from a prospective, observational study in Germany. Breast 2014; 23:603-8. [PMID: 25012046 DOI: 10.1016/j.breast.2014.06.003] [Citation(s) in RCA: 13] [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: 08/13/2013] [Revised: 04/11/2014] [Accepted: 06/05/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Evidence suggests that continued trastuzumab therapy beyond progression (TBP) may provide additional survival benefit. Within the framework of an observational prospective study of patients with advanced/metastatic breast cancer receiving trastuzumab in routine clinical practice, we had the opportunity to examine the effect of TBP in a large population. PATIENTS AND METHODS Among a total of 1843 trastuzumab-treated patients, a sub-cohort of 418 fulfilled the selection criteria for the TBP analysis: 261 continued trastuzumab and 157 discontinued. Logrank tests and Cox models were used to compare survival and identify prognostic factors. RESULTS Survival from progression was significantly longer in those patients continuing trastuzumab treatment beyond disease progression (TBP: median 22.1 months; no TBP: median 14.9 months; HR = 0.64; P = 0.00021). In addition to TBP, a positive endocrine receptor status, a longer relapse-free interval, no visceral metastasis, no concomitant chemotherapy during first-line treatment, and first-line response were independently significant prognostic variables for longer survival on multivariate analysis. CONCLUSION The hitherto limited evidence for TBP benefit from randomized studies was confirmed. While a number of strong disease-related predictors for survival after first progression could be identified, the positive effect of trastuzumab continuation retained statistical significance in a multivariate model.
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Affiliation(s)
| | | | | | | | | | | | - M Schmidt
- Johannes Gutenberg University, Mainz, Germany
| | - T Göhler
- Onkozentrum Dresden/Freiberg, Germany
| | | | | | - A Hinke
- WiSP Research Institute, Langenfeld, Germany
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Krop I, Lin N, Blackwell K, Guardino E, Huober J, Lu M, Miles D, Samant M, Welslau M, Diéras V. Abstract P4-12-27: Efficacy and safety of trastuzumab emtansine (T-DM1) vs lapatinib plus capecitabine (XL) in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) and central nervous system (CNS) metastases: Results from a retrospective exploratory analysis of EMILIA. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-12-27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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]
Abstract
Abstract
Introduction
T-DM1 is an antibody–drug conjugate that was recently approved by the FDA for patients with HER2-positive MBC who have received prior treatment with trastuzumab and a taxane. In the phase 3 EMILIA trial, T-DM1 significantly prolonged progression-free survival (PFS) and overall survival (OS) compared with XL in patients with previously treated HER2-positive MBC (Verma 2012). Because the CNS is a common site of progression in HER2-positive MBC, it is of interest to characterize the incidence of CNS metastases in patients treated with TDM1 vs XL and the efficacy of T-DM1 in patients with pre-existing CNS metastases.
Methods
EMILIA is a multicenter, randomized, open-label trial in which patients with HER2-positive, unresectable, locally advanced or MBC previously treated with trastuzumab and a taxane were randomized (1:1) to T-DM1 (3.6 mg/kg every 21 days) or XL (X: 1000 mg/m2 bid on days 1–14 of each 21-day cycle; L: 1250 mg/day on days 1–21). Treatment continued until disease progression or unacceptable toxicity. All patients underwent brain magnetic resonance imaging or computed tomography at screening, and follow-up scans were performed as clinically indicated. Those with untreated or symptomatic brain metastases and those who required therapy for symptom control ≤2 months before randomization were excluded from the trial. Patients with CNS metastases at baseline or who developed CNS metastases on study were retrospectively identified using independent review committee data, and exploratory analyses were performed on data from these patients.
Results
Of the 896 patients without CNS metastases at baseline (T-DM1 = 450; XL = 446), 9 (1.8%) and 3 (0.6%), respectively, developed CNS progression on study. Of the 95 patients with CNS metastases at baseline (T-DM1 = 45; XL = 50), 10 (2.0%) and 8 (1.6%), respectively, developed CNS progression on study. Median PFS in patients with CNS metastases at baseline was 5.9 months in the T-DM1 arm and 5.7 months in the XL arm (HR = 1.000; 95% CI: 0.542–1.844; P = 0.9998). Median OS was 26.8 months and 12.9 months in the T-DM1 and XL arms, respectively (HR = 0.382; CI: 0.184–0.795; P = 0.0081). Multivariate analysis adjusting for baseline risk factors produced similar results. Safety profiles of T-DM1 and XL in patients with CNS metastases at baseline (T-DM1 = 43; XL = 49) were consistent with those for the overall study population. Grade ≥3 adverse events (AEs) were reported in 17 (39.5%) patients in the T-DM1 arm and 29 (59.2%) patients in the XL arm. Serious AEs were reported in 5 (11.6%) and 11 (22.4%) patients in the T-DM1 and XL arms, respectively. No new safety signals were identified.
Conclusions
In this retrospective exploratory analysis of data from EMILIA, the rate of CNS progression in patients with or without baseline CNS metastases was low in both treatment arms. In the subset of patients with brain metastases at baseline, similar to the intent-to-treat population, T-DM1 was associated with significantly improved OS compared with XL. Prospective phase 3 trials are necessary to confirm these results.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-12-27.
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Affiliation(s)
- I Krop
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - N Lin
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - K Blackwell
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - E Guardino
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - J Huober
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - M Lu
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - D Miles
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - M Samant
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - M Welslau
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
| | - V Diéras
- Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center; Genentech, Inc.; Breast Center, St. Gallen; Mount Vernon Cancer Center; Medical Office Hematology; Institut Curie
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Heidenreich A, Rawal SK, Szkarlat K, Bogdanova N, Dirix L, Stenzl A, Welslau M, Wang G, Dawkins F, de Boer CJ, Schrijvers D. A randomized, double-blind, multicenter, phase 2 study of a human monoclonal antibody to human αν integrins (intetumumab) in combination with docetaxel and prednisone for the first-line treatment of patients with metastatic castration-resistant prostate cancer. Ann Oncol 2013; 24:329-336. [PMID: 23104724 DOI: 10.1093/annonc/mds505] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 10/07/2023] Open
Abstract
BACKGROUND Intetumumab is a fully human mAb with antiangiogenic, antitumor properties which has shown potential therapeutic effect in castration-resistant prostate cancer (CRPC) patients. PATIENTS AND METHODS In a phase 2, randomized, double-blind, multicenter study, men with metastatic CRPC without prior systemic nonhormonal therapy were randomly assigned to 75-mg/m(2) docetaxel (Taxotere) and 5-mg prednisone plus placebo (N = 65) or 10-mg/kg intetumumab (N = 66) q3w. Placebo patients with progressive disease (PD) could cross over to 10-mg/kg intetumumab alone or with docetaxel. The primary end-point was progression-free survival (PFS). The secondary end-points included tumor response (complete response + partial response, CR + PR), prostate-specific antigen (PSA) response, and overall survival (OS). RESULTS All efficacy end-points favored placebo over intetumumab, including PFS (median 11.0 versus 7.6 months, P = 0.014), tumor response (20% versus 16%, P = 0.795), PSA response (68% versus 47%, P = 0.018), OS (median 20.6 versus 17.2 months, P = 0.163). Common all-grade adverse events (AEs) with placebo and intetumumab were alopecia (43% versus 26%); diarrhea, leukopenia (both 34% versus 27%); neutropenia (35% versus 23%). Grade ≥ 3 leukopenia (28% versus 17%) and neutropenia (26% versus 18%) occurred more often with placebo than with intetumumab. Intetumumab serum concentrations increased with repeated dosing and did not reach steady-state. Greater decreases in N-telopeptide of type I collagen (NTx), C-telopeptide (CTx) and CTCs occurred with intetumumab than with placebo. CONCLUSION The addition of intetumumab to docetaxel resulted in shorter PFS without additional toxicity among CRPC patients.
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Affiliation(s)
- A Heidenreich
- Department of Urology, University Hospital of Cologne, Cologne.
| | - S K Rawal
- Department of Uro-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - K Szkarlat
- Urological Ward, Koscierzyna Hospital, Koscierzyna, Poland
| | - N Bogdanova
- P. A. Hertzen Oncology Research Institute, Moscow, Russia
| | - L Dirix
- Department of Cancer Research, GZA Hospitals St. Augustine Campus, Wilrijk, Belgium
| | - A Stenzl
- Department of Urology, Eberhard-Karls University, Tübingen
| | - M Welslau
- Hematology/Oncology, Studienzentrum, Aschaffenburg, Germany
| | - G Wang
- Biostatistics, Janssen Research & Development, Spring House
| | - F Dawkins
- Hematology & Oncology General, Janssen Research & Development, Raritan, USA
| | - C J de Boer
- Oncology, Janssen Biologics Europe, Leiden, The Netherlands
| | - D Schrijvers
- Medical Oncology, Hospital Network Antwerp (ZNA)-Middelheim, Antwerp, Belgium
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Zamora P, Riese C, Welslau M. Patientenkompetenz in der oralen Krebstherapie bei niedergelassenen Hämatologen und Onkologen – Eine Untersuchung zur Erfassung des Managements in der oralen antineoplastischen Therapie (Phase A) und zur Evaluation eines Schulungsmoduls zur Optimierung der Patientenunterstützung (Phase B). Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Welslau M, Diéras V, Sohn J, Hurvitz S, Lalla D, Fang L, Guardino E, Miles D. Patient-Reported Outcomes (PROS) From EMILIA, a Phase 3 Study of Trastuzumab Emtansine (T-DM1) vs Capecitabine and Lapatinib (XL) In HER2-Positive Locally Advanced or MBC. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32890-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Verma S, Miles D, Gianni L, Krop I, Welslau M, Baselga J, Pegram M, Oh D, Diéras V, Guardino E, Fang L, Lu M, Olsen S, Blackwell K. Results from Emilia, A Phase 3 Study of Trastuzumab Emtansine (T-DM1) vs Capecitabine (X) and Lapatinib (L) in Her2-Positive Locally Advanced or Metastatic Breast Cancer (MBC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34362-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Verma S, Dieras V, Gianni L, Miles D, Welslau M, Pegram MD, Baselga J, Guardino E, Fang L, Linehan CM, Blackwell KL. EMILIA: A phase III, randomized, multicenter study of trastuzumab-DM1 (T-DM1) compared with lapatinib (L) plus capecitabine (X) in patients with HER2-positive locally advanced or metastatic breast cancer (MBC) and previously treated with a trastuzumab-based regimen. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rummel MJ, Atta J, Welslau M, Kofahl-Krause D, von Gruenhagen U, Schalk K, Boeck HP, Banat AG, Knauf W, Niederle N. Bendamustine and rituximab (BR) are effective in the treatment of relapsed or refractory indolent and mantle-cell lymphomas: Long-term follow-up of a phase II study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8034 Bendamustine combines a purine-like benzimidazol and bifunctionally alkylating nitrogen mustard group. The aim of this multicenter- study was to evaluate the progression-free survival (PFS), response rate and toxicity of BR in patients with mantle-cell or low-grade lymphomas in 1st to 3rd relapse or refractory to previous treatment. A median of 4 courses per patient were administered to 63 pts. Bendamustine was given at a dose of 90 mg/m2 on day 1 and 2 combined with 375 mg/m2 Rituximab on day 1 for a max. of 4 cycles every 4 weeks. Histologies: 24 follicular, 16 mantle cell, 17 lymphoplasmacytoid, 6 marginal zone lymphoma. 57 of 63 pts responded to BR corresponding to an overall response rate of 90% with a CR-rate of 60%. In mantle cell lymphomas BR showed a considerable activity achieving a response rate of 75% with a CR-rate of 50%. In an updated analysis the median time of PFS was 30 months and the median duration of overall survival has not yet been reached. With a median follow-up period of 3 years two secondary neoplasms have been observed (bronchial carcinoma). No MDS was observed to date. These results demonstrate that the combination of Bendamustine and Rituximab is a highly active regimen in the treatment of low-grade lymphomas and mantle cell lymphomas. Based upon these encouraging results the Studiengruppe indolente Lymphome (StiL) initiated two Phase III trials that compare BR to established chemo-immunotherapy regimens: BR vs R-CHOP in untreated pts, and BR vs Fludarabine- R in relapsed pts. These studies should provide considerable guidance for the appropriate role of Bendamustine in the treatment of low-grade and mantle cell lymphomas. No significant financial relationships to disclose.
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Affiliation(s)
- M. J. Rummel
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - J. Atta
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - M. Welslau
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - D. Kofahl-Krause
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - U. von Gruenhagen
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - K. Schalk
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - H. P. Boeck
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - A. G. Banat
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - W. Knauf
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - N. Niederle
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
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Rummel MJ, Al-Bartran S, Welslau M, Kofahl-Krause D, Duerk H, Hoelzer D, Mitrou PS. Bendamustine and rituximab act synergistically in vitro and are effective in the treatment of relapsed or refractory indolent and mantle cell lymphomas. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- M. J. Rummel
- Univ Clinic, Frankfurt, Germany; Nordwest Krankenhaus, Frankfurt, Germany; Onk. Schwerpunktpraxis, Aschaffenburg, Germany; MHH, Hannover, Germany; St. Marien Hosp, Hamm, Germany
| | - S. Al-Bartran
- Univ Clinic, Frankfurt, Germany; Nordwest Krankenhaus, Frankfurt, Germany; Onk. Schwerpunktpraxis, Aschaffenburg, Germany; MHH, Hannover, Germany; St. Marien Hosp, Hamm, Germany
| | - M. Welslau
- Univ Clinic, Frankfurt, Germany; Nordwest Krankenhaus, Frankfurt, Germany; Onk. Schwerpunktpraxis, Aschaffenburg, Germany; MHH, Hannover, Germany; St. Marien Hosp, Hamm, Germany
| | - D. Kofahl-Krause
- Univ Clinic, Frankfurt, Germany; Nordwest Krankenhaus, Frankfurt, Germany; Onk. Schwerpunktpraxis, Aschaffenburg, Germany; MHH, Hannover, Germany; St. Marien Hosp, Hamm, Germany
| | - H. Duerk
- Univ Clinic, Frankfurt, Germany; Nordwest Krankenhaus, Frankfurt, Germany; Onk. Schwerpunktpraxis, Aschaffenburg, Germany; MHH, Hannover, Germany; St. Marien Hosp, Hamm, Germany
| | - D. Hoelzer
- Univ Clinic, Frankfurt, Germany; Nordwest Krankenhaus, Frankfurt, Germany; Onk. Schwerpunktpraxis, Aschaffenburg, Germany; MHH, Hannover, Germany; St. Marien Hosp, Hamm, Germany
| | - P. S. Mitrou
- Univ Clinic, Frankfurt, Germany; Nordwest Krankenhaus, Frankfurt, Germany; Onk. Schwerpunktpraxis, Aschaffenburg, Germany; MHH, Hannover, Germany; St. Marien Hosp, Hamm, Germany
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Kollmannsberger C, Rick O, Klaproth H, Kubin T, Sayer HG, Hentrich M, Welslau M, Mayer F, Kuczyk M, Spott C, Kanz L, Bokemeyer C. Irinotecan in patients with relapsed or cisplatin-refractory germ cell cancer: a phase II study of the German Testicular Cancer Study Group. Br J Cancer 2002; 87:729-32. [PMID: 12232755 PMCID: PMC2364262 DOI: 10.1038/sj.bjc.66000524] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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: 02/21/2002] [Revised: 04/15/2002] [Accepted: 07/14/2002] [Indexed: 02/07/2023] Open
Abstract
Despite generally high cure rates in patients with metastatic germ cell cancer, patients with progressive disease on first-line cisplatin-based chemotherapy or with relapsed disease following high-dose salvage therapy exhibit a very poor prognosis. Irinotecan has shown antitumour activity in human testicular tumour xenografts in nude mice. We have performed a phase II study examining the single agent activity of irinotecan in patients with metastatic relapsed or cisplatin-refractory germ cell cancer. Refractory disease was defined as progression or relapse within 4 weeks after cisplatin-based chemotherapy or relapse after salvage high-dose chemotherapy with autologous stem cell support. Irinotecan was administered at a dose of 300 (-350) mg m(-2) every 3 weeks. Response was evaluated every 4 weeks. Fifteen patients have been enrolled. Median age was 35 (19-53) years. Primary tumour localisation was gonadal/mediastinal in 12/3 patients. Patients had been pretreated with a median of six (4-12) cisplatin-containing cycles and 13 out of 15 patients had previously failed high-dose chemotherapy with blood stem cell support. Median number of irinotecan applications was two (1-3). Fourteen patients are assessable for response and all for toxicity. In one patient, no adequate response evaluation was performed. Toxicity was generally acceptable and consisted mainly of haematological side effects with common toxicity criteria 3 degrees anaemia (two patients), common toxicity criteria 3 degrees leukocytopenia (one patient) and common toxicity criteria 3 degrees thrombocytopenia (three patients). Common toxicity criteria 3/4 degrees non-haematological toxicity occurred in five patients (33%): 1 x diarrhoea, 2 x alopecia, 1 x fever and in one patient worsening of pre-existing peripheral polyneuropathy from 1 degrees to 4 degrees. No response was observed to irinotecan therapy. Currently, 13 patients have died of the disease and two patients are alive with the disease. The patients included in our study exhibit similar prognostic characteristics as patients treated in previous trials evaluating new drugs in this setting. Irinotecan at a dose of 300-350 mg m(-2) every 3 weeks appears to have no antitumour activity in patients with cisplatin-refractory germ cell cancer and, thus, further investigation in this disease is not justified.
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Affiliation(s)
- C Kollmannsberger
- Department of Haematology/Oncology, University of Tuebingen Medical Center, Germany
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Pflüger KH, Grüber A, Welslau M, Köppler H, Havemann K. Transferrin derivatives with growth factor activities in acute myeloblastic leukemia: an autocrine/paracrine pathway. Haematol Blood Transfus 1990; 33:87-94. [PMID: 2323677 DOI: 10.1007/978-3-642-74643-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- K H Pflüger
- Department of Internal Medicine, Philipps-University of Marburg, FRG
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