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Endlicher E, Schnoy E, Troppmann M, Rogler G, Messmann H, Klebl F, Gelbmann C, Kullmann F. Irinotecan Plus Gemcitabine and Fluorouracil in Advanced Biliary Tract Cancer: A Retrospective Study. Digestion 2017; 93:229-33. [PMID: 27089254 DOI: 10.1159/000445187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/03/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Since 2010, combination therapy with gemcitabine and cisplatin is the standard treatment for patients with biliary tract cancer (BTC) based on the ABC-02 trial. However, treatment after first-line progression is less clearly defined. We therefore retrospectively analyzed the efficacy of a 3-drug chemotherapy regimen in patients with advanced BTC. METHODS Patients with advanced BTC treated with palliative chemotherapy between April 2000 and October 2005 at Regensburg University Hospital were reviewed retrospectively. We analyzed the efficacy and safety of an institutional standard 3-drug regimen consisting of irinotecan, gemcitabine and 5-FU (IGF). One cycle, lasting 21 days, included applications on days 1 and 8 consisting of 75 mg/m2 irinotecan i.v. for 90 min, 1,000 mg/m2 gemcitabine i.v. for 30 min and 2,000 mg/m2 fluorouracil (5-FU) for 24 h. RESULTS A total of 12 histologically confirmed cases with gallbladder cancer and intrahepatic BTC were reviewed. Fifty percent of the patients (6/12) had been pretreated with other chemotherapies. Median progression-free survival was 9.4 months (1.5-21.5) and median overall survival was 17.2 months (2.5-24.3). Only neutropenia (8%) was observed as an NCI-CTC grade 3 toxicity. Anemia and leucopenia grades 1 and 2 were the most common side effects. CONCLUSIONS The combination of IGF shows a promising survival benefit with manageable toxicity in patients with advanced BTC. Therefore, this regimen seems to be a feasible second-line treatment option for patients with rapid progression under first-line therapy with gemcitabine and cisplatin and with a good performance status.
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Affiliation(s)
- Esther Endlicher
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
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Thomas S, Schelker R, Klobuch S, Zaiss S, Troppmann M, Rehli M, Haferlach T, Herr W, Reichle A. Biomodulatory therapy induces complete molecular remission in chemorefractory acute myeloid leukemia. Haematologica 2014; 100:e4-6. [PMID: 25261094 DOI: 10.3324/haematol.2014.115055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Simone Thomas
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
| | - Roland Schelker
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
| | - Sebastian Klobuch
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
| | - Sascha Zaiss
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
| | - Martina Troppmann
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
| | - Michael Rehli
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
| | | | - Wolfgang Herr
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg
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Troppmann M, Büttner R, Boewer M, Salzberger B. Smoldering myeloma presenting as progressive multifocal leukoencephalopathy: a case report. J Med Case Rep 2012; 6:177. [PMID: 22747665 PMCID: PMC3438020 DOI: 10.1186/1752-1947-6-177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Received: 12/23/2011] [Accepted: 04/25/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy is an opportunistic infection occurring in patients with severe cellular immunodeficiency. This case highlights the role of cellular immunodeficiency in the reactivation of John Cunningham virus in a case of an early stage plasmacytoma. CASE PRESENTATION A 76-year-old Caucasian woman presented with progressive left-sided hemiparesis, accompanied by hypoesthesia, hypoalgesia and neuropsychological symptoms. Magnetic resonance imaging demonstrated new hyperattenuating lesions in the right thalamus and left-sided subcortically. A polymerase chain reaction test revealed 4500 copies of John Cunningham virus-deoxyribonucleic acid/ml in cerebrospinal fluid. Human immunodeficiency virus infection was ruled out. A bone marrow biopsy showed an early stage immunoglobulin G-kappa plasmacytoma. Cidofovir (5mg/kg) weekly for three weeks was started. A significant improvement of her neuropsychological symptoms was achieved, but motor system and sensory symptoms did not change. CONCLUSIONS This case shows a rapid course of progressive multifocal leukoencephalopathy with severe residual deficits. In the diagnostic workup of all patients with atypical neurologic symptoms or immunodeficiency, progressive multifocal leukoencephalopathy should be included as a differential diagnosis.
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Affiliation(s)
- Martina Troppmann
- Department of Internal Medicine I, University of Regensburg, Regensburg, Germany.
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Kullmann F, Hartmann A, Stöhr R, Messmann H, Dollinger MM, Trojan J, Fuchs M, Hollerbach S, Harder J, Troppmann M, Kutscheidt A, Endlicher E. KRAS mutation in metastatic pancreatic ductal adenocarcinoma: results of a multicenter phase II study evaluating efficacy of cetuximab plus gemcitabine/oxaliplatin (GEMOXCET) in first-line therapy. Oncology 2011; 81:3-8. [PMID: 21894049 DOI: 10.1159/000330194] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 05/02/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Genetic alterations within the epidermal growth factor receptor (EGFR) pathway, including KRAS mutations, have been demonstrated to be associated with response to EGFR inhibitors like cetuximab in colorectal cancers. Mutations in the KRAS gene have been found in 70-90% of pancreatic cancers. Unfortunately, the addition of cetuximab to chemotherapy did not increase response or survival in patients with advanced pancreatic cancer in phase II and phase III studies. The aim of this study was to evaluate the relationship between KRAS mutations and response or survival in patients with metastatic pancreatic cancer treated with cetuximab plus chemotherapy. METHODS Within a multicenter phase II trial, 64 patients with metastatic pancreatic cancer were treated with cetuximab in combination with gemcitabine and oxaliplatin until disease progression. Analyses of the EGFR pathway, including KRAS mutations, could be performed in 25 patients. Analyses were carried out following microdissection of the tumor. RESULTS Fourteen (56%) of the 25 patients examined harbored a point mutation in codon 12 of the KRAS gene. No differences between the groups were noted in median progression-free survival (104 days in KRAS wild-type patients vs. 118 days in patients with KRAS mutations). Overall survival was longer in wild-type patients compared to patients with KRAS mutations (263 vs. 162 days), but the difference did not reach statistical significance. A further analysis of our clinical phase II trial showed that the presence of a rash was significantly correlated with overall survival. CONCLUSIONS KRAS mutation in codon 12 may be associated with reduced survival compared to KRAS wild type. The role of KRAS mutations for cetuximab therapy in pancreatic cancer warrants further investigation in larger trials to exclude an epiphenomenon. Furthermore, the development of a rash is indicative of clinical benefit.
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Affiliation(s)
- F Kullmann
- University of Regensburg, Regensburg, Germany.
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Poschenrieder F, Troppmann M, Lippert E, Hamer OW, Endlicher E. Dickdarmwandverdickung im CT: Endoskopische Abklärung erforderlich? ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279472] [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: 10/18/2022]
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Troppmann M, Lippert E, Hamer OW, Kirchner G, Endlicher E. Darmwandverdickung im CT – ist eine endoskopische Untersuchung erforderlich? Z Gastroenterol 2010. [DOI: 10.1055/s-0030-1267663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Troppmann M, Endlicher E. [Adherence to guidelines in the management of Barrett's Esophagus in the UK]. Z Gastroenterol 2009; 47:694-696. [PMID: 19606414 DOI: 10.1055/s-0028-1109499] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- M Troppmann
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg, 93042 Regensburg.
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Endlicher E, Troppmann M, Kullmann A, Golder S, Herold T, Herfarth H, Grossmann J, Schlottmann K, Kullmann F. Irinotecan plus gemcitabine and 5-fluorouracil in advanced pancreatic cancer: a phase II study. Oncology 2008; 72:279-84. [PMID: 18187949 DOI: 10.1159/000113039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 07/19/2007] [Indexed: 11/19/2022]
Abstract
AIMS The aim of the present study was to evaluate the 6-month survival rate of patients with inoperable or metastatic pancreatic cancer treated with irinotecan and gemcitabine plus 5-fluorouracil. Secondary efficacy end points included response rate, time to progression (TTP), overall survival (OS) and toxicity. PATIENTS AND METHODS 30 patients with histologically proven pancreatic carcinoma and at least one bidimensionally measurable lesion were enrolled. Of the patients, 83% had metastatic and 17% locally advanced disease. One cycle, lasting 21 days, comprised treatment on days 1 and 8 consisting of 75 mg/m(2) irinotecan i.v. for 90 min, 1,000 mg/m(2) gemcitabine i.v. for 30 min and 2,000 mg/m(2) fluorouracil (5-FU) for 24 h. A total of six cycles was planned for each patient. RESULTS 28 patients competed at least one treatment cycle and were therefore assessable for efficacy, and 75% of them achieved the primary end point of the study (survival after 6 months). One-year survival was 25%. Stabilization (partial response and stable disease) was observed in 35.7% (10/28) and partial remission in 7.1% (2/28). The objective response rate was 7.1% (2/28) after completion of the six cycles. Median TTP was 3.4 months (1.2-11.5), and median OS was 8.3 months (2.1-36.2). Regarding severe hematological toxicities, only neutropenia was observed (grade 3 20.7%, 6/29, and grade 4 3.5%, 1/29). In spite of anti-emetic supportive care, nausea affected most of the patients: 79.3% (23/29). Grade 3 vomiting was observed in 4 of the 29 patients (13.8%) and grade 4 in 1 patient (3.5%). Only 1 patient experienced diarrhea grade 3 (3.5%) and 1 patient (3.5%) suffered from a grade 3 peroneal nerve enervation. CONCLUSIONS A combination of irinotecan, gemcitabine and 5-FU is feasible and shows considerable efficacy in patients with inoperable or metastatic pancreatic cancer. Due to its low toxicity, this combination might be an interesting cytotoxic regimen in addition to targeted therapies.
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Affiliation(s)
- E Endlicher
- Department of Internal Medicine I, University of Regensburg, Regensburg, Germany
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Gruber O, Kallenbach A, Kaufmann M, Lackner K, Mertens V, Neuhauser J, Ryter F, Zohm H, Bessenrodt-Weberpals M, Büchl K, Fiedler S, Field A, Fuchs C, Garcia-Rosales C, Haas G, Herrmann A, Herrmann W, Hirsch S, Köppendörfer W, Lang P, Lieder G, Mast K, Pitcher CS, Schittenhelm M, Stober J, Suttrop W, Troppmann M, Weinlich M, Albrecht M, Alexander M, Asmussen K, Ballico M, Behler K, Behringer K, Bosch HS, Brambilla M, Carlson A, Coster D, Cupido L, DeBlank HJ, Deschka S, Dorn C, Drube R, Dux R, Eberhagen A, Engelhardt W, Fahrbach H, Feist H, Fieg D, Gehre O, Gernhardt J, Ignacz P, Jüttner B, Junker W, Kass T, Kiemer K, Kollotzek H, Kornherr M, Krieger K, Kurzan B, Lang R, Laux M. Observation of continuous divertor detachment in H-mode discharges in ASDEX upgrade. Phys Rev Lett 1995; 74:4217-4220. [PMID: 10058445 DOI: 10.1103/physrevlett.74.4217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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