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Hochmair MJ, Unk M, Spasic J, Cerić T, Konsoulova A, Dediu M, Bogos K, Hegmane A, Oselin K, Stojiljkovic M, Roblek T, Jakopovic M. Unmet needs in EGFR exon 20 insertion mutations in Central and Eastern Europe: reimbursement, diagnostic procedures, and treatment availability. BMC Proc 2024; 18:2. [PMID: 38233854 PMCID: PMC10795200 DOI: 10.1186/s12919-023-00287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Lung cancer remains the leading cause of cancer-related deaths in Europe, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of cases. NSCLC is a heterogeneous disease encompassing various oncogenic alterations. Among them, EGFR exon 20 insertion mutations, constituting 0.3-2.2% of NSCLC cases, rank as the third most common EGFR alteration after exon 19 deletions and the L858R point mutation in exon 21, also known as "typical" EGFR alterations. Recent advancements in understanding the molecular pathogenesis of NSCLC have led to significant breakthroughs in targeted therapies, revolutionizing treatment options for patients with specific genetic alterations.This article presents the outcomes of a Virtual Meeting conducted on the online platform (provided Within3©) from September 19 to October 30, 2022. The meeting focused on addressing the challenges in the diagnosis and treatment of NSCLC patients with EGFR exon 20 insertion mutations. The participants consisted of healthcare professionals from ten Central and Eastern European countries who shared their experiences and opinions on various aspects, including epidemiology, treatment options, and diagnostic approaches employed in their respective healthcare institutions. The discussions were facilitated through open-ended and multiple-choice questions.The primary objective of this article is to provide an overview of the identified challenges associated with the diagnosis and treatment of this heterogeneous disease, based on the assessments of the meeting participants. Among the major emerging challenges discussed, the reimbursement issues concerning next-generation sequencing (NGS), a recommended method in NSCLC molecular diagnosis, and the availability of approved targeted treatments to enhance patient outcomes were of paramount importance. Furthermore, fostering community awareness of lung cancer and promoting harmonized lung cancer care were identified as areas deserving greater attention. Notably, the rapidly evolving treatment landscape, particularly with NGS for NSCLC patients with genomic alterations like EGFR, ALK, RET, MET, NTRK, and ROS1, necessitates prioritizing the development of new drugs, even for the relatively smaller subgroup with exon 20 insertion mutations.
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Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Mojca Unk
- Institute of Oncology Ljubljana, Zaloška Cesta 2, Ljubljana, Slovenia
| | - Jelena Spasic
- Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, Serbia
| | - Timur Cerić
- University Clinical Center Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
| | - Assia Konsoulova
- National Oncology Hospital, "Plovdivsko Pole" 6, Sofia, 1756, Bulgaria
| | - Mircea Dediu
- Sanador Oncology Center Bucharest, Strada Sevastopol 5, Bucharest, Romania
| | - Krisztina Bogos
- National Koranyi Institute for Pulmonology, Korányi Frigyes út 1, Budapest, Hungary
| | - Alinta Hegmane
- Riga East University Hospital, Oncology Center of Latvia, Hipokrāta iela 4, Rīga, Latvia
| | - Kersti Oselin
- North Estonia Medical Centre, J. Sütiste tee 19, Tallinn, Estonia
| | | | - Tina Roblek
- Takeda Pharmaceuticals d.o.o., Bleiweisova cesta 30, Ljubljana, Slovenia
| | - Marko Jakopovic
- Zagreb Medical School, University Clinical Hospital Center Zagreb, Jordanovac 104, Zagreb, Croatia.
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Buium C, Negru S, Ionescu DN, Dediu M. The Unmet Diagnostic and Treatment Needs in Large Cell Neuroendocrine Carcinoma of the Lung. Curr Oncol 2023; 30:7218-7228. [PMID: 37623004 PMCID: PMC10453448 DOI: 10.3390/curroncol30080523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Large cell neuroendocrine carcinoma of the lung (LCNEC) is currently classified as a rare lung cancer subtype, but given the high incidence of lung cancer, the overall number of cases is considerable. The pathologic diagnosis of LCNEC is mainly based on the microscopic appearance of the tumor cells, the mitotic rate, the amount of intra-tumoral necrosis, and the presence of positive neuroendocrine markers identified by immunohistochemistry. Recently, a subdivision into two main categories was proposed based on mutation signatures involving the RB1, TP53, KRAS, and STK11/LKB1 genes, into SCLC-like (small cell lung cancer-like) and NSCLC-like (non-small cell lung cancer-like) LCNEC. In terms of treatment, surgery is still the best option for resectable, stage I-IIIA cases. Chemotherapy and radiotherapy have conflicting evidence. Etoposide/platinum remains the standard chemotherapy regimen. However, based on the newly proposed LCNEC subtypes, some retrospective series report better outcomes using a pathology-driven chemotherapy approach. Encouraging outcomes have also been reported for immunotherapy and targeted therapy, but the real impact of these strategies is still being determined in the absence of adequate prospective clinical trials. The current paper scrutinized the epidemiology, reviewed the reliability of pathologic diagnosis, discussed the need for molecular subtyping, and reviewed the heterogeneity of treatment algorithms in LCNEC.
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Affiliation(s)
- Catalin Buium
- Department of Medical Oncology, Asociatia Oncohelp, 300239 Timisoara, Romania;
| | - Serban Negru
- Department of Medical Oncology, Asociatia Oncohelp, 300239 Timisoara, Romania;
- Department of Oncology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania
| | - Diana N. Ionescu
- Department of Pathology, BC Cancer, The University of British Columbia, Vancouver, BC V6B5M5, Canada;
| | - Mircea Dediu
- Department of Medical Oncology, Sanador Clinical Hospital, 010991 Bucharest, Romania;
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Zielinski CC, Cufer T, Seruga B, Jassem J, Dediu M, Thallinger C. Perspectives for Cancer Care and Research in Central and Eastern Europe. Oncol Res Treat 2023; 46:80-88. [PMID: 36463856 PMCID: PMC10015746 DOI: 10.1159/000528487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/24/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Discrepancies between the outcomes of cancer patients between Western European and Central and Eastern European (CEE) countries have often been observed. Despite the enormous economic and civilizational progress made in these countries after the abolishment of the communist regime, structural problems persist. SUMMARY The present article reviews the domains of medical oncology education, human resources in oncology, cancer care, and clinical research in CEE in order to comprehensively assess the current situation and needs, describe important initiatives, and also propose ways to improving cancer outcomes in the region. Activities are under way to address these issues in national action plans to divert funding into oncology-related education, research, the purchase of equipment, and the attainment of modern hospital organization and structures. KEY MESSAGE Over the past more than 30 years, CEE countries have made enormous economic and societal progress. Nevertheless, challenges especially in the health care sector persist.
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Affiliation(s)
- Christoph C Zielinski
- Wiener Privatklinik, Central European Academy Cancer Center, Vienna, Austria.,Central European Cooperative Oncology Group, Vienna, Austria
| | - Tanja Cufer
- Medical Faculty, University of Ljubljana, Slovenia, Ljubljana, Slovenia
| | - Bostjan Seruga
- Medical Oncology Department, SANADOR Oncology Center, Bucharest, Romania
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Mircea Dediu
- Division of Medical Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Christiane Thallinger
- Central European Cooperative Oncology Group, Vienna, Austria.,Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Ciuca I, Pop L, Dediu M, Popin D. WS19.04 Lung ultrasound in cystic fibrosis bronchiectasis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00264-8] [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: 11/27/2022]
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Dediu M, Janzic U, Marinca M, Pluzanski A, Turnsek N, Lupu R, Teodorescu G, Donev IS. 1244P Real-world EGFR and T790M testing patterns in patients from Central Eastern Europe with advanced non-small cell lung cancer: Results from a large retrospective study (REFLECT). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1849] [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] Open
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Dediu M, Ciuca I, Tudorache V, Pop L. P130 Chronic inflammation biomarkers and lung function in cystic fibrosis patients. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01156-5] [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: 10/21/2022]
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Dediu M, Zielinski C. Reply to the Correspondence by Untch et al. "Concerning Dediu M, Zielinski C: A Proposal to Redefine Pathologic Complete Remission as Endpoint following Neoadjuvant Chemotherapy in Early Breast Cancer" [Breast Care 2019; DOI 10.1159/000500624]. Breast Care (Basel) 2020; 15:314-316. [PMID: 32774227 DOI: 10.1159/000502508] [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] [Received: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Christoph Zielinski
- Vienna Cancer Center, Vienna Hospital Association and Medical University Vienna, Vienna, Austria
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Dediu M, Zielinski C. A Proposal to Redefine Pathologic Complete Remission as Endpoint following Neoadjuvant Chemotherapy in Early Breast Cancer. Breast Care (Basel) 2020; 15:67-71. [PMID: 32231500 PMCID: PMC7098275 DOI: 10.1159/000500620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/20/2018] [Indexed: 12/24/2022] Open
Abstract
Many analyses of the efficacy of neoadjuvant treatment (NAT) for early breast cancer including a meta-analysis derived from 10 randomized trials came to the conclusion that patients who would achieve pathologic complete response (pCR) following NAT would experience significant improvement in disease-free and overall survival (OS). Thus, pCR was proposed as a surrogate endpoint for OS, with pCR representing a robust prognostic marker for survival at an individual level. In the current analysis, we argue that OS following NAT-induced pCR might have reflected the initial prognosis of patients mainly defined - among other factors - by the initial pathological lymph node status while being largely independent on the type of administrated treatment, thus pleading against the pCR surrogacy hypothesis. We therefore propose to redefine pCR as a surrogate endpoint of NAT trials by the involvement of additional biologic parameters.
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Affiliation(s)
| | - Christoph Zielinski
- Comprehensive Cancer Center, General Hospital, Medical University Vienna, Vienna, Austria
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Popa IT, Dediu M, Florescu V. CHALLENGES IN THE DIAGNOSIS AND SURGICAL MANAGEMENT OF AN UNCINATE PROCESS ADENOCARCINOMA IN A PREVIOUSLY HEALTHY YOUNG ADULT. JSS 2018. [DOI: 10.33695/jss.v5i3.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite the increasing numbers of young adults being diagnosed with aggressive forms ofpancreatic cancer, there is still insufficient data regarding the evolution patterns for early stagepredictors. However, a correct and timely diagnosis is of major importance in the management andthe outcome for pancreatic cancer patients.We are reporting the case of a 39 year old male whopresented to the emergency department on the Easter holiday evening with visible signs of jaundice,no abdominal pain and no history of disease. The patient was admitted due to inconclusiveparaclinical test results, the significantly elevated value of conjugated bilirubin being the onlysignaled abnormality. During the following two weeks, a number of basic and advanced imaginginvestigations were carried out due to insufficient information offered by the clinical andparaclinical investigations. During admission, EUS ( endoscopic ultrasonography) identifies animprecisely delimited hypoechoic mass, confirmed by MRCP (Magnetic Resonance Cholangio-Pancreatography) as an uncinate process nodule. The patient is informed about the pancreaticcancer diagnosis treatment options and prognosis. Surgical management of the uncinate processmass is decided and a Cephalic Pancreaticoduodenectomy (Traverso-Longmire) is performed withpara-aortic and para-caval lymphadenectomy. The patient is discharged 17 days postoperatively,without complications; due to the histopathological diagnosis of poorly differentiated pancreaticduct adenocarcinoma, the multidisciplinary oncological meeting set the indication for combinedchemotherapy and radiotherapy. Diagnosing pancreatic cancer in young adults without specificsymptoms or a prior condition is a challenging task, more so with the limited resources and meansof investigation in an emergency hospital. In conlusion, EUS had the highest sensibility whileMRCP had the highest specificity after normal endoscopy and inconclusive abdominalultrasonography and CT scan. Another predictor of probability for an uncinate process tumor isassociated with the high-low variations of direct bilirubin levels during antispasticity medication.
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Ciuca I, Dediu M, Vlad D, Popa Z, Pop L. P123 Lung Clearance Index and vitamin D. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30419-3] [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: 10/14/2022]
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Ciuca I, Dediu M, Tamas L, Pop L. WS06.4 Lung ultrasound score and the relation with lung clearance index. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30152-8] [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: 11/25/2022]
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Kiesewetter B, Dediu M, Bartsch R. ESMO 2017-my personal highlights. Memo 2018; 11:77-79. [PMID: 29606982 PMCID: PMC5862913 DOI: 10.1007/s12254-018-0385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
This article is not intended to be a comprehensive review of all highlights presented at the recent ESMO Annual Meeting, but rather a summary from a personal point of view in three very different fields of oncology. Breast cancer and lung cancer are traditionally in the focus of interest, and again, relevant new data were presented. The third part of this overview is focused on novel treatment strategies in malignant lymphoma, a field that is also quickly evolving and traditionally underrepresented at meetings dealing with solid cancers.
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Affiliation(s)
- Barbara Kiesewetter
- Department of Medicine I, Clinical Division of Oncology, Medical University Vienna, Vienna, Austria
| | - Mircea Dediu
- SANADOR Hospital Bucharest, Str. Sevastopol, Nr. 9, Sector 1, 010991 Bucharest, Romania
| | - Rupert Bartsch
- Department of Medicine I, Clinical Division of Oncology, Medical University Vienna, Vienna, Austria
- German Breast Group, Martin-Behaim-Straße 12, Neu Isenburg, Germany
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Dediu M, Gerger A, Zojer N, Bartsch R. My personal highlights of ESMO 2016. Memo 2017; 10:46-47. [PMID: 28367254 PMCID: PMC5357251 DOI: 10.1007/s12254-017-0314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 06/07/2023]
Abstract
Results of several clinically relevant studies were presented at the 2016 Annual Meeting of the European Society of Medical Oncology (ESMO). This article summerizes the personal highlights of three medical oncologists in their respective areas of expertise.
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Affiliation(s)
- M. Dediu
- Department of Oncology, Sanador Hospital, Bucharest, Romania
| | - A. Gerger
- Department of Medicine, Division of Oncology, Medical University of Graz, Graz, Austria
| | - N. Zojer
- Department of Haematology and Medical Oncology, Wilhelminenspital Vienna, Vienna, Austria
| | - R. Bartsch
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090 Austria
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Dediu M, Bratu F, Amarandei M, Fejer E. Docetaxel in the treatment of castrate resistant advanced prostate cancer: a paradigm in change. J BUON 2016; 21:1379-1382. [PMID: 28039695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Until last year, the international guidelines recommended the use of docetaxel in advanced prostate cancer (PC) at the time of progression following androgen deprivation therapy (ADT). Nevertheless, two randomized phase III trials, CHAARTED and STAMPEDE, delivered level I evidence showing that upfront introduction of docetaxel, during the androgen sensitive course of disease, is able to significantly improve the patients' overall survival. As such, this strategy was rapidly included in the current guideline recommendations, with slightly different indications in the ESMO as compared to the NCCN version. Side effects of chemotherapy along with the possible higher benefit in high vs low-volume metastatic disease should be taken into consideration when choosing this alternative. The present paper makes a review of the current data supporting the new indication of docetaxel, and provides detailed information in order to assist the clinician in deciding the best treatment for patients with advanced PC.
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Affiliation(s)
- Mircea Dediu
- Sanador Hospital Bucharest, Department of Medical Oncology, Bucharest, Romania
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Yonesaka K, Hirotani K, Von Pawel J, Dediu M, Chen S, Copigneaux C, Nakagawa K. Soluble heregulin, HER3 ligand, to predict the efficacy of anti-HER3 antibody patritumab combination with erlotinib in randomized phase II study, HERALD, for non-small cell lung cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9071] [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)
| | | | | | - Mircea Dediu
- Institute of Oncology Bucharest, Bucharest, Romania
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Reck M, Socinski MA, Luft A, Szczęsna A, Dediu M, Ramlau R, Losonczy G, Molinier O, Schumann C, Gralla RJ, Bonomi P, Brown J, Soldatenkova V, Chouaki N, Obasaju C, Peterson P, Thatcher N. The Effect of Necitumumab in Combination with Gemcitabine plus Cisplatin on Tolerability and on Quality of Life: Results from the Phase 3 SQUIRE Trial. J Thorac Oncol 2016; 11:808-18. [PMID: 26980471 DOI: 10.1016/j.jtho.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/26/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Necitumumab, a second-generation, recombinant human immunoglobulin G1 epidermal growth factor receptor antibody in the phase 3 SQUIRE trial (NCT00981058), increased survival benefit for patients randomized to receive necitumumab plus gemcitabine-cisplatin compared with those who received gemcitabine-cisplatin. Here we characterize health-related quality of life (HRQoL) and tolerability results. METHODS A total of 1093 patients with stage IV squamous non-small cell lung cancer were randomized 1:1 to receive necitumumab (800 mg absolute dose intravenously [IV]) plus gemcitabine-cisplatin (gemcitabine = 1250 mg/m(2) IV on days 1 and 8; cisplatin = 75 mg/m(2) IV on day 1) or gemcitabine-cisplatin alone (every 21 days) for up to six cycles. Patients receiving necitumumab plus gemcitabine-cisplatin without disease progression continued necitumumab until progression. HRQoL was measured by Eastern Cooperative Oncology Group performance status, the Lung Cancer Symptom Scale (LCSS), and the European Quality of Life Five-Dimensions questionnaire. Efficacy and LCSS outcomes were analyzed using the baseline maximum severity score of the LCSS. Tolerability was measured in terms of exposure to the study treatment and adverse events. Hospitalization rates were collected. RESULTS Most patients in both study arms similarly maintained Eastern Cooperative Oncology Group performance status and comparable LCSS and European Quality of Life Five-Dimensions questionnaire assessments. Patients with a higher baseline LCSS had a greater survival benefit on the necitumumab arm. Chemotherapy exposure was similar in both treatment arms; 51% of patients on the necitumumab plus gemcitabine-cisplatin arm continued on single-agent necitumumab. The most frequent grade 4 adverse events were neutropenia (6.1% versus 7.9%) and thrombocytopenia (3.2% versus 4.3%) in the necitumumab plus gemcitabine-cisplatin versus gemcitabine-cisplatin arms, respectively. Hospitalizations were slightly higher with necitumumab plus gemcitabine-cisplatin (36.4%) than with gemcitabine-cisplatin (34.0%). CONCLUSIONS The addition of necitumumab to gemcitabine-cisplatin was well tolerated, did not negatively affect HRQoL or toxicity, and particularly benefited patients with more severe baseline symptoms or lower HRQoL.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf, Germany.
| | - Mark A Socinski
- Lung Cancer Section, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | | | - Mircea Dediu
- Institute of Oncology "Alexandru Trestioreanu," Bucharest, Romania
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznań, Poland
| | - György Losonczy
- Semmelweis University Department of Pulmonology, Budapest, Hungary
| | | | - Christian Schumann
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany; Clinic for Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Kempten-Oberallgaeu Hospitals, Kempten, Germany
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Thatcher N, Hirsch FR, Luft AV, Szczesna A, Ciuleanu TE, Dediu M, Ramlau R, Galiulin RK, Bálint B, Losonczy G, Kazarnowicz A, Park K, Schumann C, Reck M, Depenbrock H, Nanda S, Kruljac-Letunic A, Kurek R, Paz-Ares L, Socinski MA. Necitumumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin alone as first-line therapy in patients with stage IV squamous non-small-cell lung cancer (SQUIRE): an open-label, randomised, controlled phase 3 trial. Lancet Oncol 2015; 16:763-74. [PMID: 26045340 DOI: 10.1016/s1470-2045(15)00021-2] [Citation(s) in RCA: 341] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Necitumumab is a second-generation, recombinant, human immunoglobulin G1 EGFR antibody. In this study, we aimed to compare treatment with necitumumab plus gemcitabine and cisplatin versus gemcitabine and cisplatin alone in patients with previously untreated stage IV squamous non-small-cell lung cancer. METHODS We did this open-label, randomised phase 3 study at 184 investigative sites in 26 countries. Patients aged 18 years or older with histologically or cytologically confirmed stage IV squamous non-small-cell lung cancer, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 and adequate organ function and who had not received previous chemotherapy for their disease were eligible for inclusion. Enrolled patients were randomly assigned centrally 1:1 to a maximum of six 3-week cycles of gemcitabine and cisplastin chemotherapy with or without necitumumab according to a block randomisation scheme (block size of four) by a telephone-based interactive voice response system or interactive web response system. Chemotherapy was gemcitabine 1250 mg/m(2) administered intravenously over 30 min on days 1 and 8 of a 3-week cycle and cisplatin 75 mg/m(2) administered intravenously over 120 min on day 1 of a 3-week cycle. Necitumumab 800 mg, administered intravenously over a minimum of 50 min on days 1 and 8, was continued after the end of chemotherapy until disease progression or intolerable toxic side-effects occurred. Randomisation was stratified by ECOG performance status and geographical region. Neither physicians nor patients were masked to group assignment because of the expected occurrence of acne-like rash--a class effect of EGFR antibodies--that would have unmasked most patients and investigators to treatment. The primary endpoint was overall survival, analysed by intention to treat. We report the final clinical analysis. This study is registered with ClinicalTrials.gov, number NCT00981058. FINDINGS Between Jan 7, 2010, and Feb 22, 2012, we enrolled 1093 patients and randomly assigned them to receive necitumumab plus gemcitabine and cisplatin (n=545) or gemcitabine and cisplatin (n=548). Overall survival was significantly longer in the necitumumab plus gemcitabine and cisplatin group than in the gemcitabine and cisplatin alone group (median 11·5 months [95% CI 10·4-12·6]) vs 9·9 months [8·9-11·1]; stratified hazard ratio 0·84 [95% CI 0·74-0·96; p=0·01]). In the necitumumab plus gemcitabine and cisplatin group, the number of patients with at least one grade 3 or worse adverse event was higher (388 [72%] of 538 patients) than in the gemcitabine and cisplatin group (333 [62%] of 541), as was the incidence of serious adverse events (257 [48%] of 538 patients vs 203 [38%] of 541). More patients in the necitumumab plus gemcitabine and cisplatin group had grade 3-4 hypomagnesaemia (47 [9%] of 538 patients in the necitumumab plus gemcitabine and cisplatin group vs six [1%] of 541 in the gemcitabine and cisplatin group) and grade 3 rash (20 [4%] vs one [<1%]). Including events related to disease progression, adverse events with an outcome of death were reported for 66 (12%) of 538 patients in the necitumumab plus gemcitabine and cisplatin group and 57 (11%) of 541 patients in the gemcitabine and cisplatin group; these were deemed to be related to study drugs in 15 (3%) and ten (2%) patients, respectively. Overall, we found that the safety profile of necitumumab plus gemcitabine and cisplatin was acceptable and in line with expectations. INTERPRETATION Our findings show that the addition of necitumumab to gemcitabine and cisplatin chemotherapy improves overall survival in patients with advanced squamous non-small-cell lung cancer and represents a new first-line treatment option for this disease. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | - Fred R Hirsch
- University of Colorado Cancer Center, Aurora, CO, USA
| | | | | | - Tudor E Ciuleanu
- Institutul Oncologic Prof Dr Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | | | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznań, Poland
| | | | - Beatrix Bálint
- Csongrád County Hospital of Chest Diseases, Deszk, Hungary
| | - György Losonczy
- Semmelweis University Department of Pulmonology, Budapest, Hungary
| | | | | | - Christian Schumann
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany; Clinic for Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Kempten-Oberallgaeu Hospitals, Kempten, Germany
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | | | | | | | - Luis Paz-Ares
- Instituto de Biomedicina de Sevilla - IBIS (Hospital Virgen del Rocío, Universidad de Sevilla & CSIC), Seville, Spain
| | - Mark A Socinski
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Paz-Ares L, Mezger J, Ciuleanu TE, Fischer JR, von Pawel J, Provencio M, Kazarnowicz A, Losonczy G, de Castro G, Szczesna A, Crino L, Reck M, Ramlau R, Ulsperger E, Schumann C, Miziara JEA, Lessa ÁE, Dediu M, Bálint B, Depenbrock H, Soldatenkova V, Kurek R, Hirsch FR, Thatcher N, Socinski MA. Necitumumab plus pemetrexed and cisplatin as first-line therapy in patients with stage IV non-squamous non-small-cell lung cancer (INSPIRE): an open-label, randomised, controlled phase 3 study. Lancet Oncol 2015; 16:328-37. [PMID: 25701171 DOI: 10.1016/s1470-2045(15)70046-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [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: 01/25/2023]
Abstract
BACKGROUND Necitumumab is a second-generation recombinant human immunoglobulin G1 EGFR monoclonal antibody that competitively inhibits ligand binding. We aimed to compare necitumumab plus pemetrexed and cisplatin with pemetrexed and cisplatin alone in patients with previously untreated, stage IV, non-squamous non-small-cell lung cancer (NSCLC). METHODS We did this randomised, open-label, controlled phase 3 study at 103 sites in 20 countries. Patients aged 18 years or older, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 and adequate organ function, were randomly assigned 1:1 to treatment with a block randomisation scheme (block size of four) via a telephone-based interactive voice-response system or interactive web-response system. Patients received either cisplatin 75 mg/m(2) and pemetrexed 500 mg/m(2) on day 1 of a 3-week cycle for a maximum of six cycles alone, or with necitumumab 800 mg on days 1 and 8. Necitumumab was continued after the end of chemotherapy until disease progression or unacceptable toxic effects. Randomisation was stratified by smoking history, ECOG performance status, disease histology, and geographical region. Patients and study investigators were not masked to group assignment. The primary endpoint was overall survival. Efficacy analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00982111. FINDINGS Between Nov 11, 2009, and Feb 2, 2011, we randomly assigned 633 patients to receive either necitumumab plus pemetrexed and cisplatin (n=315) or pemetrexed and cisplatin alone (n=318). Enrolment was stopped on Feb 2, 2011, after a recommendation from the independent data monitoring committee. There was no significant difference in overall survival between treatment groups, with a median overall survival of 11·3 months (95% CI 9·5-13·4) in the necitumumab plus pemetrexed and cisplatin group versus 11·5 months (10·1-13·1) in the pemetrexed and cisplatin group (hazard ratio 1·01 [95% CI 0·84-1·21]; p=0·96). The incidence of grade 3 or worse adverse events, including deaths, was higher in the necitumumab plus pemetrexed and cisplatin group than in the pemetrexed and cisplatin group; in particular, deaths regarded as related to study drug were reported in 15 (5%) of 304 patients in the necitumumab group versus nine (3%) of 312 patients in the pemetrexed and cisplatin group. Serious adverse events were likewise more frequent in the necitumumab plus pemetrexed and cisplatin group than in the pemetrexed and cisplatin group (155 [51%] of 304 vs 127 [41%] of 312 patients). Patients in the necitumumab plus pemetrexed and cisplatin group had more grade 3-4 rash (45 [15%] of 304 vs one [<1%] of 312 patients in the pemetrexed and cisplatin alone group), hypomagnesaemia (23 [8%] vs seven [2%] patients), and grade 3 or higher venous thromboembolic events (23 [8%] vs 11 [4%] patients) than did those in the pemetrexed and cisplatin alone group. INTERPRETATION Our findings show no evidence to suggest that the addition of necitumumab to pemetrexed and cisplatin increases survival of previously untreated patients with stage IV non-squamous NSCLC. Unless future studies identify potentially useful predictive biomarkers, necitumumab is unlikely to provide benefit in this patient population when combined with pemetrexed and cisplatin. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Luis Paz-Ares
- Instituto de Biomedicina de Sevilla-IBIS (Hospital Virgen del Rocío/Universidad de Sevilla/CSIC), Sevilla, Spain; Hospital Universitario Doce de Octubre and CNIO Lung Cancer Unit, Madrid, Spain.
| | | | - Tudor E Ciuleanu
- Institute of Oncology and University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | | | | | - Andrzej Kazarnowicz
- Samodzielny Publiczny Zespól Gruźlicy i Chorób Pluc w Olsztynie, Olsztyn, Poland
| | | | | | | | - Lucio Crino
- Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Wielkopolskie Centrum Pulmonologii i Torakochirurgii, Poznan, Poland
| | | | - Christian Schumann
- Department of Internal Medicine II, University Clinic Ulm, Ulm, Germany; Klinik für Pneumologie, Thoraxonkologie, Schlaf-und Beatmungsmedizin, Kempten-Oberallgäu, Germany
| | | | - Álvaro E Lessa
- Hospital Santa Izabel-Santa Casa de Misericordia da Bahia, Nazare, Nazare, Brazil
| | - Mircea Dediu
- Institute of Oncology Bucharest, Bucharest, Romania
| | - Beatrix Bálint
- Csongrád Megye Mellkasi Betegségek Szakkórháza, Deszk, Hungary
| | | | | | | | - Fred R Hirsch
- University of Colorado, Division of Medical Oncology, Aurora, CO, USA
| | - Nick Thatcher
- The Christie Hospital, National Health Services Trust, Manchester, UK
| | - Mark A Socinski
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Pawel JV, Tseng J, Dediu M, Schumann C, Moritz B, Mendell J, Jin X, Feng W, Copigneaux C, Beckman RA. Phase 2 HERALD study of patritumab (P) with erlotinib (E) in advanced NSCLC subjects (SBJs). Pneumologie 2015. [DOI: 10.1055/s-0035-1544763] [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: 10/24/2022]
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Reck M, Socinski M, Luft A, Szczesna A, Dediu M, Ramlau R, Losonczy G, Molinier O, Schumann C, Brown J, Soldatenkova V, Chouaki N, Thatcher N. Quality-Of-Life (Qol), Tolerability, and Supportive Care Results: Necitumumab Phase 3 Squire Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Scagliotti GV, Gridelli C, de Marinis F, Thomas M, Dediu M, Pujol JL, Manegold C, San Antonio B, Peterson PM, John W, Chouaki N, Visseren-Grul C, Paz-Ares LG. Efficacy and safety of maintenance pemetrexed in patients with advanced nonsquamous non-small cell lung cancer following pemetrexed plus cisplatin induction treatment: A cross-trial comparison of two phase III trials. Lung Cancer 2014; 85:408-14. [PMID: 25088661 DOI: 10.1016/j.lungcan.2014.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 04/15/2014] [Revised: 07/01/2014] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Two phase III trials of advanced NSCLC patients were compared to examine relative efficacy and safety of differing treatment regimens. The JMDB trial investigated first-line pemetrexed-cisplatin (pemetrexed 500mg/m(2) plus cisplatin 75mg/m(2) every 21 days; maximum: 6 cycles). The PARAMOUNT phase III trial compared maintenance pemetrexed versus placebo after patients with nonsquamous NSCLC completed 4 cycles of first-line pemetrexed-cisplatin without disease progression. METHODS Overall survival (OS) and progression-free survival (PFS), analyzed by Kaplan-Meier and Cox methods, and toxicity rates were compared between the PARAMOUNT arms and a selected homogeneous population from JMDB: 346 patients with disease and prior treatment characteristics matching the PARAMOUNT population. RESULTS Outcomes for the PARAMOUNT placebo arm were similar to the JMDB homogeneous group (median PFS: 5.6 versus 6.2 months, p=0.117, HR=1.16; median OS: 14.0 versus 14.2 months, p=0.979, HR=1.00). The PARAMOUNT maintenance pemetrexed group had statistically superior efficacy compared with the JMDB homogeneous group (median PFS: 7.5 versus 6.2 months, p<0.00001, HR=0.66; median OS: 16.9 versus 14.2 months, p=0.003, HR=0.75). Patients who received pemetrexed maintenance (median 4 cycles, range 1-44) following 4 cycles of pemetrexed-cisplatin exhibited a higher incidence of drug-related serious adverse events compared with JMDB patients (median 6 cycles of pemetrexed-cisplatin) (10.6% versus 2.9%); grade 3/4 fatigue and renal toxicity were also higher in the pemetrexed arm of PARAMOUNT. CONCLUSIONS The across-trial comparison of a relevant JMDB study population with the two arms of the PARAMOUNT study supported the efficacy of the pemetrexed continuation maintenance strategy and suggested the results are not influenced by limiting the pemetrexed-cisplatin induction treatment to four cycles. Although longer exposure to pemetrexed-cisplatin or maintenance pemetrexed increased some toxicities, the overall incidence remained low, underscoring the relative safety of these treatment regimens.
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Affiliation(s)
- G V Scagliotti
- University of Torino at S. Luigi Hospital, Orbassano, Torino, Italy
| | - C Gridelli
- S. Giuseppe Moscati Hospital, Avellino, Italy
| | - F de Marinis
- European Institute of Oncology, Thoracic Oncology Division, Milan, Italy
| | - M Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - M Dediu
- Institute of Oncology Bucharest, Bucharest, Romania
| | - J-L Pujol
- Montpellier Academic Hospital, Montpellier, France
| | - C Manegold
- Heidelberg University Medical Center, Mannheim, Germany
| | | | | | - W John
- Eli Lilly and Company, Indianapolis, IN, USA
| | - N Chouaki
- Eli Lilly and Company, Suresnes, Hauts de Seine, France
| | | | - L G Paz-Ares
- Instituto de Biomedicina de Sevilla (University Hospital Virgen del Rocío, CSIC and Seville University), Seville, Spain.
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Pujol JL, Paz-Ares L, de Marinis F, Dediu M, Thomas M, Bidoli P, Corral J, San Antonio B, Chouaki N, John W, Zimmermann A, Visseren-Grul C, Gridelli C. Long-term and low-grade safety results of a phase III study (PARAMOUNT): maintenance pemetrexed plus best supportive care versus placebo plus best supportive care immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. Clin Lung Cancer 2014; 15:418-25. [PMID: 25104617 DOI: 10.1016/j.cllc.2014.06.007] [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] [Received: 05/14/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In the PARAMOUNT ("A Phase 3, Double-Blind, Placebo-Controlled Study of Maintenance Pemetrexed plus Best Supportive Care vs. Best Supportive Care Immediately Following Induction Treatment with Pemetrexed Plus Cisplatin for Advanced Non-Squamous Non-Small-Cell Lung Cancer") trial, patients with advanced nonsquamous non-small-cell lung cancer (NS-NSCLC) benefited from pemetrexed maintenance therapy after induction therapy with pemetrexed and cisplatin by extending survival, delaying disease progression, and maintaining quality of life (QoL). However, low-grade 1 or 2 toxicities during long-term maintenance treatment may become burdensome and impact QoL. MATERIALS AND METHODS Patients in this double-blind study (n = 539), who had completed 4 induction cycles (pemetrexed with cisplatin) without progressive disease (PD) and had an ECOG performance status of 0/1, were randomized 2:1 to pemetrexed maintenance (500 mg/m(2), day 1) plus best supportive care (BSC) or placebo plus BSC until PD. Adverse events (by maximum Common Terminology Criteria for Adverse Events [CTCAE] grade) and QoL (EuroQol 5-dimensional [EQ-5D] scale) were assessed. RESULTS A median of 4 maintenance cycles was administered (range, pemetrexed 1-44; mean ± SD 7.9 ± 8.3; placebo 1-38; mean ± SD 5.0 ± 5.2), with 28% of pemetrexed and 12% of placebo patients receiving ≥ 10 maintenance cycles. The pemetrexed dose intensity was 94%. More patients receiving pemetrexed (12%) than placebo discontinued because of possible drug-related CTCAEs (4%; P = .005). Overall, pemetrexed was associated with significantly more (P < .05) low-grade events (grade 1/2 nausea, grade 2 anemia, edema, and neutropenia) than placebo. Overall, the incidence of low-grade fatigue, anemia, and neutropenia decreased with long-term pemetrexed exposure; however, renal events increased across treatment arms. EQ-5D analyses demonstrated no treatment-by-time interaction or overall treatment differences between the 2 arms. CONCLUSION PARAMOUNT demonstrated a low incidence of low-grade toxicities with long-term pemetrexed exposure without compromising QoL in patients with NS-NSCLC.
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Affiliation(s)
| | - Luis Paz-Ares
- Instituto de Biomedicina de Sevilla - IBIS (Hospital Universitario Virgen del Rocío, Universidad de Sevilla and Consejo Superior de Investigaciones Científicas), Seville, Spain
| | - Filippo de Marinis
- San Camillo, High Specialization Hospital, Rome, Italy; Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Mircea Dediu
- Institute of Oncology Bucharest, Bucharest, Romania
| | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Jesus Corral
- Instituto de Biomedicina de Sevilla - IBIS (Hospital Universitario Virgen del Rocío, Universidad de Sevilla and Consejo Superior de Investigaciones Científicas), Seville, Spain
| | | | | | | | | | | | - Cesare Gridelli
- Division of Medical Oncology, S. G. Moscati Hospital, Avellino, Italy
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Abstract
SUMMARY Pemetrexed, a multitargeted antifolate agent, is currently used in the treatment of non-small-cell lung cancer. Strong evidence has shown a treatment-by-histology interaction, with pemetrexed acting significantly better in the nonsquamous cell subtype. Therefore, all pemetrexed indications are restricted to this histology. Associated initially with somewhat high toxicity, the use of vitamin supplementation and corticoid premedication turned pemetrexed into one of the most convenient chemotherapy agents. At present pemetrexed is recommended as one of the preferred platinum partners in first line and as a single agent in the second-line setting for nonsquamous histology. The particular efficacy/toxicity profile has confirmed pemetrexed as the only chemotherapy agent approved for both continuation and switch maintenance therapy.
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Affiliation(s)
- Mircea Dediu
- Medical Oncology Department, Institute of Oncology 'Alexandru Trestioreanu' Bucharest, Sos Fundeni 252, 022328, Bucharest, Romania
| | - Aurelia Alexandru
- Medical Oncology Department, Institute of Oncology 'Alexandru Trestioreanu' Bucharest, Sos Fundeni 252, 022328, Bucharest, Romania
| | - Florentina Bratu
- Medical Oncology Department, Institute of Oncology 'Alexandru Trestioreanu' Bucharest, Sos Fundeni 252, 022328, Bucharest, Romania
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Thatcher N, Hirsch FR, Szczesna A, Ciuleanu TE, Szafranski W, Dediu M, Ramlau R, Galiulin R, Bálint B, Losonczy G, Kazarnowicz A, Park K, Schumann C, Reck M, Paz-Ares L, Depenbrock H, Nanda S, Kruljac-Letunic A, Socinski MA. A randomized, multicenter, open-label, phase III study of gemcitabine-cisplatin (GC) chemotherapy plus necitumumab (IMC-11F8/LY3012211) versus GC alone in the first-line treatment of patients (pts) with stage IV squamous non-small cell lung cancer (sq-NSCLC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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)
- Nick Thatcher
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | - Mircea Dediu
- Institute of Oncology “Alexandru Trestioreanu”, Bucharest, Romania
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznañ, Poland
| | | | - Beatrix Bálint
- Csongrad County Hospital of Chest Diseases, Deszk, Hungary
| | - Gyorgy Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Keunchil Park
- Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Martin Reck
- Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Luis Paz-Ares
- University Hospital Virgen del Rocío, Seville, Spain
| | | | | | | | - Mark A. Socinski
- Lung Cancer Section, Division of Hematology/Oncology UPMC, Pittsburgh, PA
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Von Pawel J, Tseng J, Dediu M, Schumann C, Moritz B, Mendell-Harary J, Jin X, Feng W, Copigneaux C, Beckman RA. Phase 2 HERALD study of patritumab (P) with erlotinib (E) in advanced NSCLC subjects (SBJs). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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)
| | | | - Mircea Dediu
- Institute of Oncology Bucharest, Bucharest, Romania
| | | | - Berta Moritz
- CESAR Central European Society for Anticancer Drug Research - EWIV, Vienna, Austria
| | | | | | - Wenqin Feng
- Daiichi Sankyo Pharma Development, Edison, NJ
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von Pawel J, Harvey JH, Spigel DR, Dediu M, Reck M, Cebotaru CL, Humphreys RC, Gribbin MJ, Fox NL, Camidge DR. Phase II trial of mapatumumab, a fully human agonist monoclonal antibody to tumor necrosis factor-related apoptosis-inducing ligand receptor 1 (TRAIL-R1), in combination with paclitaxel and carboplatin in patients with advanced non-small-cell lung cancer. Clin Lung Cancer 2013; 15:188-196.e2. [PMID: 24560012 DOI: 10.1016/j.cllc.2013.12.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/16/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This phase II study examined the efficacy of mapatumumab in combination with paclitaxel and carboplatin in patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with stage IIIB or stage IV advanced primary NSCLC were randomly assigned (1:1:1) to receive up to 6 courses of standard-dose paclitaxel and carboplatin or a combination of paclitaxel, carboplatin, and mapatumumab (10 mg/kg or 30 mg/kg). Primary efficacy end points were overall response rate and median progression-free survival (PFS). Secondary efficacy end points included disease control rate, overall survival (OS), time to response, and duration of response. Exploratory studies included evaluation of historical biopsy materials for TRAIL-R1 expression by immunohistochemical analysis and serum levels of M30, a marker of apoptosis, before and after the first 2 doses of mapatumumab. Safety parameters, including adverse events (AEs), laboratory tests, and immunogenicity, were assessed. RESULTS The majority of patients had stage IV disease (79%) and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 (58%); baseline characteristics were similar across treatment arms. No improvements in response or disease control rates, PFS, or OS were gained from the addition of mapatumumab. Adverse events in the mapatumumab arms were generally consistent with toxicities seen in the carboplatin and paclitaxel control arm. Levels of M30 were highly variable, and consistent patterns were not seen across treatment arms. CONCLUSION This study showed no clinical benefit from adding mapatumumab to carboplatin and paclitaxel in unselected patients with NSCLC. The combination was generally well tolerated. The possibility of subgroups sensitive to mapatumumab is discussed.
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Affiliation(s)
- Joachim von Pawel
- Department of Oncology, Asklepios-Fachkliniken München-Gauting, Munich, Germany.
| | | | - David R Spigel
- Tennessee Oncology, Sarah Cannon Research Institute, Nashville, TN
| | - Mircea Dediu
- Department of Medical Oncology, Institute of Oncology "Prof. Dr. Alexandru Trestioreanu", Bucharest, Romania
| | - Martin Reck
- Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany
| | - Cristina L Cebotaru
- Department of Radiotherapy I-Medical Oncology, Prof Dr Ion Chircuta Institute of Oncology, Cluj, Romania
| | | | | | | | - D Ross Camidge
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO
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Atasoy A, Bogdanovic G, Aladashvili A, Cvijetic Z, Dediu M, Cicmil-Saric N, Nersesyan A, Athanasiou A, Serdar Turhal N. An international survey of practice patterns and difficulties in cancer pain management in Southeastern Europe: a Turkish & Balkan Oncology Group common initiative. J BUON 2013; 18:1082-1087. [PMID: 24344043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE While pain is highly prevalent in cancer patients and its management is universally challenging, it is more commonly undertreated in the developing world. Southeastern European countries have limited resources and manpower to allocate for delivery of effective care for cancer-related pain. The purpose of this study was to explore the practice methods and the barriers to effective pain management in Southeastern Europe. METHODS We conducted a Web-based survey using a specially designed questionnaire among physicians practicing in member countries of the Balkan Union of Oncology (BUON). RESULTS A representative from each of the member countries of BUON (including Armenia and Georgia) and close to 100 physicians from 8 countries responded. The majority (89%) of respondents were medical oncologists and had been practising for 10 years on average. For pain assessment, only 35.4% of the physicians used a formal pain scale. Of the respondents 34.1% were not able to reach the optimal doses of narcotic medications while managing cancer pain, mostly due to concerns about toxicity, such as constipation and nausea. Most physicians listed their inability to consult sub-specialists to seek assistance for improving pain management cases as one of the major difficulties in day-to- day clinical practice, along with lack of time. CONCLUSIONS The limitations faced by our respondents seem to be related mostly to the shortcomings of the respective health care systems, along with the need for more experience and knowledge about the titration of pain medications and dealing with toxicities.
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Affiliation(s)
- Ajlan Atasoy
- Medical Oncology Department, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
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Paz-Ares LG, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. PARAMOUNT: Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. J Clin Oncol 2013; 31:2895-902. [PMID: 23835707 DOI: 10.1200/jco.2012.47.1102] [Citation(s) in RCA: 445] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE In the phase III PARAMOUNT trial, pemetrexed continuation maintenance therapy reduced the risk of disease progression versus placebo (hazard ratio [HR], 0.62; 95% CI, 0.49 to 0.79; P < .001). Here we report final overall survival (OS) and updated safety data. PATIENTS AND METHODS In all, 939 patients with advanced nonsquamous non-small-cell lung cancer (NSCLC) received four cycles of pemetrexed-cisplatin induction therapy; then, 539 patients with no disease progression and Eastern Cooperative Oncology Group performance status 0 or 1 were randomly assigned (2:1) to maintenance pemetrexed (500 mg/m(2) on day 1 of 21-day cycles; n = 359) or placebo (n = 180). Log-rank test compared OS between arms as measured from random assignment (α = .0498). RESULTS The mean number of maintenance cycles was 7.9 (range, one to 44) for pemetrexed and 5.0 (range, one to 38) for placebo. After 397 deaths (pemetrexed, 71%; placebo, 78%) and a median follow-up of 24.3 months for alive patients (95% CI, 23.2 to 25.1 months), pemetrexed therapy resulted in a statistically significant 22% reduction in the risk of death (HR, 0.78; 95% CI, 0.64 to 0.96; P = .0195; median OS: pemetrexed, 13.9 months; placebo, 11.0 months). Survival on pemetrexed was consistently improved for all patient subgroups, including induction response: complete/partial responders (n = 234) OS HR, 0.81; 95% CI, 0.59 to 1.11 and stable disease (n = 285) OS HR, 0.76; 95% CI, 0.57 to 1.01). Postdiscontinuation therapy use was similar: pemetrexed, 64%; placebo, 72%. No new safety findings emerged. Drug-related grade 3 to 4 anemia, fatigue, and neutropenia were significantly higher in pemetrexed-treated patients. CONCLUSION Pemetrexed continuation maintenance therapy is well-tolerated and offers superior OS compared with placebo, further demonstrating that it is an efficacious treatment strategy for patients with advanced nonsquamous NSCLC and good performance status who did not progress during pemetrexed-cisplatin induction therapy.
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Affiliation(s)
- Luis G Paz-Ares
- Servicio de Oncología Médica, University Hospital Virgen del Rocío, Seville, Spain.
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Pujol JL, Molinier O, El-Kouri C, Favier L, Godbert B, Gatineau M, Hilgers W, Uwer L, Paz-Ares L, Demarinis F, Dediu M, Thomas M, Bidoli P, Sahoo T., Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann A, Visseren-Grul C., Gridelli C. PARAMOUNT : résultats finaux de survie globale de la phase 3 comparant un traitement de maintenance par Pem + BSC vs placebo (plb) + BSC après un ttt d’induction par Pem-Cisplatine (Cis) dans les CBNPC non épidermoïdes (NE) avancés. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.057] [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: 11/16/2022]
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Obasaju C, Paz-Ares L, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo T, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann A, Visseren-Grul C, Gridelli C. Maintenance Pemetrexed (PEM) Plus Best Supportive Care (BSC) Versus Placebo Plus BSC after PEM Plus Cisplatin for Advanced Nonsquamous NSCLC. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31933-5] [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] Open
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Pujol J, Paz-Ares L, Dediu M, Thomas M, Bidoli P, Corral J, Chouaki N, Visseren-Grul C, Zimmermann A, Gridelli C. Updated Safety and Quality of Life (QOL) Results of Paramount Study: Maintenance Pemetrexed (PEM) Plus Best Supportive Care (BSC) vs Placebo (PBO) Plus Bsc Immediately Following Induction Treatment with Pem Plus Cisplatin (CP) for Advanced Nonsquamous Non-Small Cell Lung Cancer (NS-NSCLC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33870-9] [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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Scagliotti GV, Vynnychenko I, Park K, Ichinose Y, Kubota K, Blackhall F, Pirker R, Galiulin R, Ciuleanu TE, Sydorenko O, Dediu M, Papai-Szekely Z, Banaclocha NM, McCoy S, Yao B, Hei YJ, Galimi F, Spigel DR. International, randomized, placebo-controlled, double-blind phase III study of motesanib plus carboplatin/paclitaxel in patients with advanced nonsquamous non-small-cell lung cancer: MONET1. J Clin Oncol 2012; 30:2829-36. [PMID: 22753922 DOI: 10.1200/jco.2011.41.4987] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE We evaluated whether motesanib (a selective oral inhibitor of vascular endothelial growth factor receptors 1, 2, and 3; platelet-derived growth factor receptor; and Kit) combined with carboplatin/paclitaxel improved overall survival (OS) versus chemotherapy alone in patients with nonsquamous non-small-cell lung cancer (NSCLC) and in the subset of patients with adenocarcinoma. PATIENTS AND METHODS Patients with stage IIIB/IV or recurrent nonsquamous NSCLC (no prior systemic therapy for advanced disease) were randomly assigned 1:1 to carboplatin (area under the curve, 6 mg/ml · min) and paclitaxel (200 mg/m(2)) intravenously for up to six 3-week cycles plus either motesanib 125 mg (arm A) or placebo (arm B) once daily orally. OS was the primary end point. Secondary end points included progression-free survival (PFS), objective response rate (ORR), adverse events (AEs), and association between placental growth factor (PLGF) change and OS. RESULTS A total of 1,090 patients with nonsquamous NSCLC were randomly assigned (arms A/B, n = 541 of 549); of those, 890 had adenocarcinoma (n = 448 of 442). Median OS in arms A and B was 13.0 and 11.0 months, respectively (hazard ratio [HR], 0.90; 95% CI, 0.78 to 1.04; P = .14); median OS for the adenocarcinoma subset was 13.5 and 11.0 months, respectively (HR, 0.88; 95% CI, 0.75 to 1.03; P = .11). In descriptive analyses (arms A v B), median PFS was 5.6 months versus 5.4 months (P = < .001); ORR was 40% versus 26% (P < .001). There was no association between PLGF change and OS in arm A. The incidence of grade ≥ 3 AEs (arms A and B, 73% and 59%, respectively) and grade 5 AEs (14% and 9%, respectively) was higher with motesanib treatment. CONCLUSION Motesanib plus carboplatin/paclitaxel did not significantly improve OS over carboplatin/paclitaxel alone in patients with advanced nonsquamous NSCLC or in the adenocarcinoma subset.
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Paz-Ares L, De Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral Jaime J, Melemed S, John WJ, Chouaki N, Zimmermann A, Visseren-Grul C, Gridelli C. PARAMOUNT: Final overall survival (OS) results of the phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo (plb) plus BSC immediately following induction treatment with pem plus cisplatin (cis) for advanced nonsquamous (NS) non-small cell lung cancer (NSCLC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.18_suppl.lba7507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7507 Background: The PARAMOUNT trial showed that pem continuation maintenance therapy significantly reduced the risk of disease progression over plb (HR=0.62; 95% CI: 0.49-0.79; p <0.0001) in patients (pts) with advanced NS NSCLC who had not progressed during pem-cis induction. Here we present the final OS data. Methods: In a double-blind, plb-controlled study, alpha-controlled for OS, 939 pts received induction (4 cycles of pem 500 mg/m2 and cis 75 mg/m2 on d1 of 21d cycles), and 539 pts who had not progressed and had an ECOG performance status (PS) of 0/1 were randomized (2:1) to maintenance pem (500 mg/m2, on day 1 of 21-day cycles) plus BSC or plb plus BSC until disease progression. All received B12, folic acid, and dexamethasone. After 397 deaths, a log-rank test compared OS between arms using anominal α level of 0.0498. Results: Pt characteristics were balanced between arms: median age 61 years; 58% men; 32% PS 0; 95% Caucasian; 86% adenocarcinoma; 45% complete/partial response (CR/PR) to induction. Pem resulted in a statistically significant 22% reduction in risk of death (HR=0.78). The HR was the same when measured from the beginning of induction. Survival improvement was similar for pts with an induction outcome of CR/PR versus stable disease. Conclusions: Pem continuation maintenance therapy offers superior OS compared with plb. These final results confirm that pem-cis induction followed by continuation pem further benefits pts compared with induction therapy alone, offering a change in the treatment paradigm for advanced NS NSCLC. [Table: see text]
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Affiliation(s)
- Luis Paz-Ares
- University Hospital - Virgen del Rocio, Seville, Spain
| | | | - Mircea Dediu
- Medical Oncology Department, Institute of Oncology, Bucharest, Romania
| | - Michael Thomas
- Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Eckart Laack
- Ambulantes Krebszentrum Hamburg, Hamburg, Germany
| | - Martin Reck
- Hospital Großhansdorf, Großhansdorf, Germany
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Paz-Ares L, De Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral Jaime J, Melemed S, John WJ, Chouaki N, Zimmermann A, Visseren-Grul C, Gridelli C. PARAMOUNT: Final overall survival (OS) results of the phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo (plb) plus BSC immediately following induction treatment with pem plus cisplatin (cis) for advanced nonsquamous (NS) non-small cell lung cancer (NSCLC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.lba7507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7507 The full, final text of this abstract will be available at abstract.asco.org at 12:01 AM (EDT) on Monday, June 4, 2012, and in the Annual Meeting Proceedings online supplement to the June 20, 2012, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.
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Affiliation(s)
- Luis Paz-Ares
- University Hospital - Virgen del Rocio, Seville, Spain
| | | | - Mircea Dediu
- Medical Oncology Department, Institute of Oncology, Bucharest, Romania
| | - Michael Thomas
- Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Eckart Laack
- Ambulantes Krebszentrum Hamburg, Hamburg, Germany
| | - Martin Reck
- Hospital Großhansdorf, Großhansdorf, Germany
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Dediu M, Ion O, Ion R, Alexandru A, Median D, Gal C, Horvat T, Motas C, Motas N. Impact of adjuvant chemotherapy in stage IB non-small-cell lung cancer: an analysis of 112 consecutively treated patients. J BUON 2012; 17:317-322. [PMID: 22740212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The impact of adjuvant chemotherapy (CT) in the management of radically resected stage IB non-small cell lung cancer (NSCLC) is highly debated. The aim of this study was to evaluate the outcome of this category of patients treated at our institution. METHODS We retrospectively analysed the survival data of patients with pathologic stage IB NSCLC, who received at least 1 cycle of adjuvant CT. CT was planned to be platinum based and to be delivered for 6 cycles. RESULTS One hundred and twelve consecutively treated patients were evaluated. PATIENT CHARACTERISTICS median age 60 years, median tumor diameter 4 cm, 87% underwent lobectomy and 13% pneumonectomy, 58% had visceral pleural involvement (VPI). After a median follow up of 46 months, the estimated 5-year disease-free (DFS) and overall survival (OS) rates were 68% and 77%, respectively. The mean number of CT cycles was 5.2 (range 3-6), with 82% of patients receiving ≥ 5 cycles. The median cisplatin dose intensity (DI) was 22 mg/m(2)/week, and the relative DI was 85%. Median total cisplatin (CDDP) dose/patient was 416 mg/m(2). A total of 31 (27.6%) relapses were recorded, of which 81% were distant. Multivariate analysis showed no significant interaction between overall survival and the following variables: gender, type of surgery, histology, tumor volume, VPI. CONCLUSION Our results compare favorably with the historical data evaluating the outcome of stage IB patients treated by surgery alone in a customary medical setting. Overall, our data support the use of adjuvant CT in stage IB NSCLC patients.
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Affiliation(s)
- M Dediu
- Department of Medical Oncology, Institute of Oncology, Bucharest, Romania.
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Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 2012. [PMID: 22341744 DOI: 10.1016/s1470-2045(12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Patients with advanced non-squamous non-small-cell lung cancer (NSCLC) benefit from pemetrexed maintenance therapy after induction therapy with a platinum-containing, non-pemetrexed doublet. The PARAMOUNT trial investigated whether continuation maintenance with pemetrexed improved progression-free survival after induction therapy with pemetrexed plus cisplatin. METHODS In this double-blind, multicentre, phase 3, randomised placebo-controlled trial, patients with advanced non-squamous NSCLC aged 18 years or older, with no previous systemic chemotherapy for lung cancer, with at least one measurable lesion, and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 participated. Before randomisation, patients entered an induction phase which consisted of four cycles of induction pemetrexed (500 mg/m(2)) plus cisplatin (75 mg/m(2)) on day 1 of a 21-day cycle. Patients who did not progress after completion of four cycles of induction and who had an ECOG performance status of 0 or 1 were stratified according to disease stage (IIIB or IV), ECOG performance status (0 or 1), and induction response (complete or partial response, or stable disease), and randomly assigned (2:1 ratio) to receive maintenance therapy with either pemetrexed (500 mg/m(2) every 21 days) plus best supportive care or placebo plus best supportive care until disease progression. Randomisation was done with the Pocock and Simon minimisation method. Patients and investigators were masked to treatment assignment. The primary endpoint was progression-free survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT00789373. FINDINGS Of the 1022 patients enrolled, 939 participated in the induction phase. Of these, 539 patients were randomly assigned to receive continuation maintenance with pemetrexed plus best supportive care (n=359) or with placebo plus best supportive care (n=180). Among the 359 patients randomised to continuation maintenance with pemetrexed, there was a significant reduction in the risk of disease progression over the placebo group (HR 0·62, 95% CI 0·49-0·79; p<0·0001). The median progression-free survival, measured from randomisation, was 4·1 months (95% CI 3·2-4·6) for pemetrexed and 2·8 months (2·6-3·1) for placebo. Possibly treatment-related laboratory grade 3-4 adverse events were more common in the pemetrexed group (33 [9%] of 359 patients) than in the placebo group (one [<1%] of 180 patients; p<0·0001), as were non-laboratory grade 3-5 adverse events (32 [9%] of 359 patients in the pemetrexed group; eight [4%] of 180 patients in the placebo group; p=0·080); one possibly treatment-related death was reported in each group. The most common adverse events of grade 3-4 in the pemetrexed group were anaemia (16 [4%] of 359 patients), neutropenia (13 [4%]), and fatigue (15 [4%]). In the placebo group, these adverse events were less common: anaemia (one [<1%] of 180 patients), neutropenia (none), and fatigue (one <1%]). The most frequent serious adverse events were anaemia (eight [2%] of 359 patients in the pemetrexed group vs none in the placebo group) and febrile neutropenia (five [1%] vs none). Discontinuations due to drug-related adverse events occurred in 19 (5%) patients in the pemetrexed group and six (3%) patients in the placebo group. INTERPRETATION Continuation maintenance with pemetrexed is an effective and well tolerated treatment option for patients with advanced non-squamous NSCLC with good performance status who have not progressed after induction therapy with pemetrexed plus cisplatin. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Luis Paz-Ares
- Instituto de Biomedicina de Sevilla, University Hospital Virgen del Rocío, Seville, Spain.
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Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 2012; 13:247-55. [PMID: 22341744 DOI: 10.1016/s1470-2045(12)70063-3] [Citation(s) in RCA: 429] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with advanced non-squamous non-small-cell lung cancer (NSCLC) benefit from pemetrexed maintenance therapy after induction therapy with a platinum-containing, non-pemetrexed doublet. The PARAMOUNT trial investigated whether continuation maintenance with pemetrexed improved progression-free survival after induction therapy with pemetrexed plus cisplatin. METHODS In this double-blind, multicentre, phase 3, randomised placebo-controlled trial, patients with advanced non-squamous NSCLC aged 18 years or older, with no previous systemic chemotherapy for lung cancer, with at least one measurable lesion, and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 participated. Before randomisation, patients entered an induction phase which consisted of four cycles of induction pemetrexed (500 mg/m(2)) plus cisplatin (75 mg/m(2)) on day 1 of a 21-day cycle. Patients who did not progress after completion of four cycles of induction and who had an ECOG performance status of 0 or 1 were stratified according to disease stage (IIIB or IV), ECOG performance status (0 or 1), and induction response (complete or partial response, or stable disease), and randomly assigned (2:1 ratio) to receive maintenance therapy with either pemetrexed (500 mg/m(2) every 21 days) plus best supportive care or placebo plus best supportive care until disease progression. Randomisation was done with the Pocock and Simon minimisation method. Patients and investigators were masked to treatment assignment. The primary endpoint was progression-free survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT00789373. FINDINGS Of the 1022 patients enrolled, 939 participated in the induction phase. Of these, 539 patients were randomly assigned to receive continuation maintenance with pemetrexed plus best supportive care (n=359) or with placebo plus best supportive care (n=180). Among the 359 patients randomised to continuation maintenance with pemetrexed, there was a significant reduction in the risk of disease progression over the placebo group (HR 0·62, 95% CI 0·49-0·79; p<0·0001). The median progression-free survival, measured from randomisation, was 4·1 months (95% CI 3·2-4·6) for pemetrexed and 2·8 months (2·6-3·1) for placebo. Possibly treatment-related laboratory grade 3-4 adverse events were more common in the pemetrexed group (33 [9%] of 359 patients) than in the placebo group (one [<1%] of 180 patients; p<0·0001), as were non-laboratory grade 3-5 adverse events (32 [9%] of 359 patients in the pemetrexed group; eight [4%] of 180 patients in the placebo group; p=0·080); one possibly treatment-related death was reported in each group. The most common adverse events of grade 3-4 in the pemetrexed group were anaemia (16 [4%] of 359 patients), neutropenia (13 [4%]), and fatigue (15 [4%]). In the placebo group, these adverse events were less common: anaemia (one [<1%] of 180 patients), neutropenia (none), and fatigue (one <1%]). The most frequent serious adverse events were anaemia (eight [2%] of 359 patients in the pemetrexed group vs none in the placebo group) and febrile neutropenia (five [1%] vs none). Discontinuations due to drug-related adverse events occurred in 19 (5%) patients in the pemetrexed group and six (3%) patients in the placebo group. INTERPRETATION Continuation maintenance with pemetrexed is an effective and well tolerated treatment option for patients with advanced non-squamous NSCLC with good performance status who have not progressed after induction therapy with pemetrexed plus cisplatin. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Luis Paz-Ares
- Instituto de Biomedicina de Sevilla, University Hospital Virgen del Rocío, Seville, Spain.
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Pujol JL, Paz-Ares L, Demarinis F, Dediu M, Thomas M, Molinier O, Bidoli P, Sahoo TP, Laack E, Reck M, El Kouri C, Favier L, Corral J, Martinet Y, Melemed S, John W, Zimmermann A, Chouaki N, Gridelli C. PARAMOUNT : phase 3 comparant un traitement (ttt) de maintenance par Pemetrexed (Pem) plus soins de support (BSC) versus placebo plus BSC après un ttt d’induction par Pem-Cisplatine (Cispt) dans les CBNPC non épidermoïdes avancés. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.050] [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: 10/14/2022]
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Dediu M. Controversies in the management of advanced non-small cell lung cancer: maintenance therapy. J BUON 2011; 16:431-433. [PMID: 22006744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The majority of patients with non-small cell lung (NSCLC) present with advanced, metastatic disease at the time of diagnosis. The current state of the art for the management of this condition is first- and second-line chemotherapy (CT), along with appropriate supporting care measures, which are supposed to alleviate symptoms and to improve survival. During the last years, maintenance therapy (MT) was included in the therapeutic algorithm for these patients. MT could be defined as continuation of an active treatment until disease progression in patients who demonstrated a non-progressing status following induction chemotherapy. Despite the results of several randomized trials showing a significant benefit by using this approach, the strategy is far from being universally accepted. The internationally recognized guidelines provide different recommendation when it comes to this topic, while some major drawbacks in the design of the positive clinical trials may have distorted the relevance of the communicated data. This paper aimed to review the most contentious aspects which should be considered while contemplating the use of MT in the daily clinical practice.
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Affiliation(s)
- M Dediu
- Department of Medical Oncology, Institute of Oncology Bucharest, Bucharest, Romania.
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Scagliotti G, Vynnychenko I, Ichinose Y, Park K, Kubota K, Blackhall FH, Pirker R, Galiulin R, Ciuleanu T, Sydorenko O, Dediu M, Papai-Szekely Z, Martinez Banaclocha N, McCoy S, Yao B, Hei YJ, Spigel DR. An international, randomized, placebo-controlled, double-blind phase III study (MONET1) of motesanib plus carboplatin/paclitaxel (C/P) in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba7512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7512 Background: This study evaluated whether motesanib (a selective oral inhibitor of VEGFR 1, 2 and 3; PDGFR and Kit) plus C/P improved overall survival (OS) compared with placebo + C/P in patients (pts) with nonsquamous NSCLC and in a subset of pts with adenocarcinoma. Methods: Pts had stage IIIB/IV or recurrent nonsquamous NSCLC and no prior systemic therapy for advanced NSCLC. The study initially enrolled all histologies but was amended to exclude pts with squamous NSCLC owing to a high rate of hemoptysis. Pts were randomized 1:1 to receive up to six 3-wk cycles of C (AUC 6 mg/mL·min) and P (200 mg/m2) with either motesanib 125 mg QD (Arm A) or placebo QD (Arm B) orally continuously. The primary endpoint was OS; secondary endpoints included progression-free survival (PFS), adverse events (AEs), objective response rate (ORR) and association between placental growth factor (PLGF) change and OS. OS was evaluated using a stratified Cox model and 2-sided log-rank test (α=0.03 for nonsquamous pts and α=0.02 for adenocarcinoma pts). Results: 1090 pts with nonsquamous NSCLC were randomized (Arm A/B, n=541/549); 890 had adenocarcinoma (n=448/442). 61% were men; median age was 60 years (range 21–87); 83% had stage IV disease. At the time of analysis, 753 pts had died (608 pts with adenocarcinoma). Median follow-up was 10.6 mo. OS was not significantly improved in Arm A compared with Arm B (Table). In Arm A, PLGF analysis did not show an association with OS. The incidence of grade ≥3 AEs in Arms A/B was 73/59%. Grade ≥3 AEs occurring more frequently in Arm A than B included neutropenia (22/15%), diarrhea (9/1%), hypertension (7/1%) and cholecystitis (3/0%). The incidence of grade 5 AEs was 14/9% in Arms A/B. Conclusions: In pts with advanced nonsquamous NSCLC, treatment with motesanib + C/P did not significantly improve OS compared with C/P alone. [Table: see text]
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Affiliation(s)
- G. Scagliotti
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - I. Vynnychenko
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Y. Ichinose
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - K. Park
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - K. Kubota
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - F. H. Blackhall
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - R. Pirker
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - R. Galiulin
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - T. Ciuleanu
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - O. Sydorenko
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - M. Dediu
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Z. Papai-Szekely
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - N. Martinez Banaclocha
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - S. McCoy
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - B. Yao
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Y. J. Hei
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - D. R. Spigel
- Department of Clinical and Biological Sciences, University of Turin, S. Luigi Hospital, Turin, Italy; Sumy Regional Oncology Centre, Sumy, Ukraine; National Kyushu Cancer Center, Fukuoka, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; National Cancer Center, Tokyo, Japan; Department of Medical Oncology, The Christie National Health Services Foundation Trust, Manchester, United Kingdom; Department of Medicine I, Medical University Vienna, Vienna, Austria
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Paz-Ares LG, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed SA, John WJ, Chouaki N, Zimmerman A, Visseren Grul CM, Gridelli C. PARAMOUNT: Phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo plus BSC immediately following induction treatment with pem plus cisplatin for advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.cra7510] [Citation(s) in RCA: 11] [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: 11/20/2022] Open
Abstract
CRA7510 Background: The PARAMOUNT trial investigated whether pem continuation maintenance therapy improves progression-free survival (PFS) after pem-cisplatin induction therapy in patients (pts) with advanced nonsquamous NSCLC. Methods: In this double-blind, placebo-controlled trial, 939 pts participated in the induction phase, specified as four cycles of induction pem (500 mg/m2) and cisplatin (75 mg/m2) on day 1 of a 21-day cycle. Pts who had not progressed during pem-cisplatin induction and had an Eastern Cooperative Oncology Group performance status (PS) of 0/1 (n=539; 57.4%) were randomized (2:1, stratified for disease stage, PS, and induction response) to maintenance pem (500 mg/m2 on day 1 of a 21-day cycle) plus BSC (n=359) or placebo plus BSC (n=180) until disease progression. All pts received vitamin B12, folic acid, and dexamethasone. The primary endpoint was PFS (target: HR=0.65, two-sided alpha=0.05; 90% power with minimum of 238 events). Results: Pt characteristics were balanced between arms: median age=61 years; 58% male; 95% Caucasian; 32% PS 0; 91% stage IV; 87% adenocarcinoma; and 45% induction complete/partial response. Pem continuation maintenance resulted in a 36% reduction in the risk of progression (HR=0.64, 95% CI: 0.51-0.81; P=0.00025). The median independently reviewed PFS (472 pts, 297 events), measured from randomization, was 3.9 months (95% CI: 3.0-4.2) on the pem arm, and 2.6 months (95% CI: 2.2-2.9) on the placebo arm. The disease control rate (% pts with response/stable disease) was 71.8% on the pem arm, and 59.6% on the placebo arm (P=0.009). The drug-related serious adverse event (AE) rate was 8.9% on the pem arm, and 9.2% of pts had grade 3/4 laboratory Common Toxicity Criteria AEs. On the placebo arm, the rates were 2.8% and 0.6%, respectively. Discontinuations due to AEs were 5.3% on the pem arm, 3.3% on the placebo arm. Conclusions: PARAMOUNT met its primary endpoint and showed that pem continuation maintenance following pem-cisplatin induction is an effective and well tolerated treatment for pts with advanced nonsquamous NSCLC.
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Affiliation(s)
- L. G. Paz-Ares
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - F. De Marinis
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Dediu
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Thomas
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - J. Pujol
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - P. Bidoli
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - O. Molinier
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - T. P. Sahoo
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - E. Laack
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Reck
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - J. Corral
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - S. A. Melemed
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - W. J. John
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - N. Chouaki
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - A. Zimmerman
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - C. M. Visseren Grul
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - C. Gridelli
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
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Scagliotti G, Vynnychenko I, Ichinose Y, Park K, Kubota K, Blackhall FH, Pirker R, Galiulin R, Ciuleanu T, Sydorenko O, Dediu M, Papai-Szekely Z, Martinez Banaclocha N, McCoy S, Yao B, Hei YJ, Spigel DR. An international, randomized, placebo-controlled, double-blind phase III study (MONET1) of motesanib plus carboplatin/paclitaxel (C/P) in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba7512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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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Paz-Ares LG, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed SA, John WJ, Chouaki N, Zimmerman A, Visseren Grul CM, Gridelli C. PARAMOUNT: Phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo plus BSC immediately following induction treatment with pem plus cisplatin for advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.cra7510] [Citation(s) in RCA: 2] [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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Pawel JV, Harvey J, Spigel D, Dediu M, Reck M, Cebotaru C, Kumm E, Gallant G, Fox N, Camidge D. A randomized phase IItrial of mapatumumab, a TRAIL R1 agonist monoclonal antibody, in combination with carboplatin and paclitaxel in patients with advanced NSCLC. Pneumologie 2011. [DOI: 10.1055/s-0031-1272244] [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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Goodwin R, Ding K, Seymour L, LeMaître A, Arnold A, Shepherd F, Dediu M, Ciuleanu T, Fenton D, Zukin M, Walde D, Laberge F, Vincent M, Ellis P, Laurie S. Treatment-emergent hypertension and outcomes in patients with advanced non-small-cell lung cancer receiving chemotherapy with or without the vascular endothelial growth factor receptor inhibitor cediranib: NCIC Clinical Trials Group Study BR24. Ann Oncol 2010; 21:2220-2226. [DOI: 10.1093/annonc/mdq221] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Von Pawel J, Harvey JH, Spigel DR, Dediu M, Reck M, Cebotaru CL, Kumm E, Gallant G, Fox N, Camidge DR. A randomized phase II trial of mapatumumab, a TRAIL-R1 agonist monoclonal antibody, in combination with carboplatin and paclitaxel in patients with advanced NSCLC. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.18_suppl.lba7501] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7501 Background: Mapatumumab, a fully human agonist monoclonal antibody, targets and activates the death receptor TRAIL-R1. We conducted this randomized, controlled phase II trial to evaluate mapatumumab in combination with carboplatin and paclitaxel as first-line therapy in advanced non-small call lung cancer (NSCLC). Methods: Patients were required to have histologically or cytologically confirmed Stage IIIB or IV advanced primary NSCLC with measurable disease by RECIST. Patients were randomly assigned to Arm A, paclitaxel 200 mg/m2 + carboplatin AUC 6.0 (PC); Arm B, PC + mapatumumab 10 mg/kg; or Arm C, PC + mapatumumab 30 mg/kg. Cycles were repeated every 21 days; patients completed up to 6 cycles in the absence of evidence of disease progression or unacceptable toxicity. Patients in Arms B and C could receive additional cycles of mapatumumab in the absence of disease progression. The co-primary endpoints were response rate (RR; complete response + partial response) and progression-free survival (PFS). Images were read by independent radiologists blinded to treatment group assignment, as well as locally. Results: 111 patients were enrolled at 22 sites in 4 countries. Addition of mapatumumab to PC did not improve RR or PFS. RR and PFS, based on the independent read, and overall survival results are summarized below. The results based on local reading also showed no benefit from the addition of mapatumumab to PC. Adverse events were generally balanced across treatment groups; there was no evidence that mapatumumab exacerbated toxicities associated with PC. Conclusions: The results do not support further evaluation of mapatumumab in combination with PC in patients with advanced NSCLC. Additional trials of mapatumumab in other indications are ongoing. [Table: see text] [Table: see text]
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Affiliation(s)
- J. Von Pawel
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - J. H. Harvey
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - D. R. Spigel
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - M. Dediu
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - M. Reck
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - C. L. Cebotaru
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - E. Kumm
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - G. Gallant
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - N. Fox
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
| | - D. R. Camidge
- Asklepios Klinikum Gauting, Munich, Germany; Birmingham Hematology and Oncology Associates, Birmingham, AL; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Institute of Oncology Bucharest, Bucharest, Romania; Hospital Grosshansdorf, Grosshansdorf, Germany; Oncology Institute I. Chiricuta, Cluj, Romania; Human Genome Sciences, Rockville, MD; University of Colorado Denver, Aurora, CO
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Goss GD, Arnold A, Shepherd FA, Dediu M, Ciuleanu TE, Fenton D, Zukin M, Walde D, Laberge F, Vincent MD, Ellis PM, Laurie SA, Ding K, Frymire E, Gauthier I, Leighl NB, Ho C, Noble J, Lee CW, Seymour L. Randomized, double-blind trial of carboplatin and paclitaxel with either daily oral cediranib or placebo in advanced non-small-cell lung cancer: NCIC clinical trials group BR24 study. J Clin Oncol 2009; 28:49-55. [PMID: 19917841 DOI: 10.1200/jco.2009.22.9427] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This phase II/III double-blind study assessed efficacy and safety of cediranib with standard chemotherapy as initial therapy for advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Paclitaxel (200 mg/m(2)) and carboplatin (area under the serum concentration-time curve 6) were given every 3 weeks, with daily oral cediranib or placebo at 30 mg (first 45 patients received 45 mg). Progression-free survival (PFS) was the primary outcome of the phase II interim analysis; phase III would proceed if the hazard ratio (HR) for PFS < or = 0.77 and toxicity were acceptable. Results A total of 296 patients were enrolled, 251 to the 30-mg cohort. The phase II interim analysis demonstrated a significantly higher response rate (RR) for cediranib than for placebo, HR of 0.77 for PFS, no excess hemoptysis, and a similar number of deaths in each arm. The study was halted to review imbalances in assigned causes of death. In the primary phase II analysis (30-mg cohort), the adjusted HR for PFS was 0.77 (95% CI, 0.56 to 1.08) with a higher RR for cediranib than for placebo (38% v 16%; P < .0001). Cediranib patients had more hypertension, hypothyroidism, hand-foot syndrome, and GI toxicity. Hypoalbuminemia, age > or = 65 years, and female sex predicted increased toxicity. Survival update (N = 296) 10 months after study unblinding favored cediranib over placebo (median of 10.5 months v 10.1 months; HR, 0.78; 95% CI, 0.57 to 1.06; P = .11). Causes of death in the cediranib 30-mg cohort were NSCLC (81%), protocol toxicity +/- NSCLC (13%), and other (6%); for the placebo group, they were 98%, 0%, and 2%, respectively. CONCLUSION The addition of cediranib to carboplatin/paclitaxel results in improved response and PFS, but does not appear tolerable at a 30-mg dose. Consequently, the National Cancer Institute of Canada Clinical Trials Group and the Australasian Lung Cancer Trials Group initiated a randomized, double-blind, placebo-controlled trial of cediranib 20 mg with carboplatin and paclitaxel in advanced NSCLC.
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Affiliation(s)
- Glenwood D Goss
- FCP(SA), FRCPC, The Ottawa Hospital Cancer Centre, 501 Smyth Rd, Ottawa ON K1H 8L6, Canada.
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Dediu M, Ion O, Ion R, Gal C, Median D, Gongu M. Controversies around the use of monoclonal antibodies in the treatment of advanced non-small cell lung cancer. J BUON 2009; 14 Suppl 1:S159-S164. [PMID: 19785059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
First line combination chemotherapy (CT) using platinum-based doublets is established as a standard of care for advanced non-small cell lung cancer (NSCLC). Nevertheless, no significant advances have been recorded during the last years in this field. Therefore, there is a wide consensus among physicians that a plateau has already been reached with this strategy. Targeted therapy using tyrosine-kinase inhibitors (TKIs) and monoclonal antibodies emerged as a new field of development in the NSCLC therapeutics. Recently, the results of the phase III trials testing antibodies against vascular endothelial growth factor-VEGF (bevacizumab) and epidermal growth factor receptor-EGFR (cetuximab) challenged the paradigm of the platinum doublets as a gold standard in advanced NSCLC. Their appearance was enthusiastically commended both by patients and the oncological community. However, all medical oncologists have the responsibility to carefully analyze the real benefits of these new agents, to balance the advantages against the implicit risks of therapy and to make the decision having in mind the best interest of their patients. Last but not least, the associated health economic burden should also be considered. This paper addresses some issues related to the use of cetuximab and bevacizumab in advanced NSCLC. The main controversial aspects regarding patient selection, the real benefit of therapy, the molecular and clinical predictors, and the impact of other independent variables are carefully examined and presented. Due to many unsolved questions, no definite conclusions can be supported. The final decision about the optimal use of these agents is left to the clinical judgment of each treating physician.
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Affiliation(s)
- M Dediu
- Department of Medical Oncology, Institute of Oncology Alexandru Trestioreanu, Bucharest, Romania.
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Socinski MA, Smit EF, Lorigan P, Konduri K, Reck M, Szczesna A, Blakely J, Serwatowski P, Karaseva NA, Ciuleanu T, Jassem J, Dediu M, Hong S, Visseren-Grul C, Hanauske AR, Obasaju CK, Guba SC, Thatcher N. Phase III study of pemetrexed plus carboplatin compared with etoposide plus carboplatin in chemotherapy-naive patients with extensive-stage small-cell lung cancer. J Clin Oncol 2009; 27:4787-92. [PMID: 19720897 DOI: 10.1200/jco.2009.23.1548] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Following a phase II trial in which pemetrexed-platinum demonstrated similar activity to that of historical etoposide-platinum controls, a phase III study was conducted to compare pemetrexed-carboplatin with etoposide-carboplatin for the treatment of extensive-stage small-cell lung cancer (ES-SCLC). PATIENTS AND METHODS Chemotherapy-naive patients with ES-SCLC and an Eastern Cooperative Oncology Group performance status of zero to 2 were randomly assigned to receive pemetrexed-carboplatin (pemetrexed 500 mg/m(2) on day 1; carboplatin at area under the serum concentration-time curve [AUC] 5 on day 1) or etoposide-carboplatin (etoposide 100 mg/m(2) on days 1 through 3; carboplatin AUC 5 on day 1) every 3 weeks for up to six cycles. The primary objective of the study was noninferiority of pemetrexed-carboplatin overall survival with a 15% margin. RESULTS Accrual was terminated with 908 of 1,820 patients enrolled after results of a planned interim analysis. In the final analysis, pemetrexed-carboplatin was inferior to etoposide-carboplatin for overall survival (median, 8.1 v 10.6 months; hazard ratio [HR],1.56; 95% CI, 1.27 to 1.92; log-rank P < .01) and progression-free survival (median, 3.8 v 5.4 months; HR, 1.85; 95% CI, 1.58 to 2.17; log-rank P < .01). Objective response rates were also significantly lower for pemetrexed-carboplatin (31% v 52%; P < .001). Pemetrexed-carboplatin had lower grade 3 to 4 neutropenia, febrile neutropenia, and leukopenia than etoposide-carboplatin; grade 3 to 4 thrombocytopenia was comparable between arms and anemia was higher in the pemetrexed-carboplatin arm. CONCLUSION Pemetrexed-carboplatin is inferior for the treatment of ES-SCLC. Planned translational research and pharmacogenomic analyses of tumor and blood samples may help explain the study results and provide insight into new treatment strategies.
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Affiliation(s)
- Mark A Socinski
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA.
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Dediu M, Median D, Alexandru A, Vremes G, Gal C, Gongu M. Adjuvant therapy with aromatase inhibitors in postmenopausal, estrogen receptor- positive breast cancer patients: upfront or sequential? J BUON 2009; 14:375-379. [PMID: 19810126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
For decades tamoxifen (TAM) has been the mainstay hormonal treatment for estrogen receptor positive (ER+) breast cancer patients. Nevertheless, during the last years, for postmenopausal women particularly, the third generation aromatase inhibitors (AI) became the preferred alternative. The results of the randomized trials showed that AI were superior to TAM in terms of efficacy, and were accompanied by a different but fairly convenient side effects profile. Subsequently, all updated guidelines recommend the use of AI in the adjuvant setting for this category of patients, either upfront, following 2-3 years of TAM or as extended adjuvant therapy, after 5 years of TAM. However, no consensus has been reached regarding the best strategy to be used, and the expert opinion is divided, based on the available evidence. The controversial aspect of whether AI should be used upfront or following 2-3 years of TAM is further detailed in this manuscript, and some useful recommendations are provided in order to facilitate the decision-making process during the current clinical practice.
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Affiliation(s)
- M Dediu
- Department of Medical Oncology, Institute of Oncology "Alexandru Trestioreanu", Bucharest, Romania.
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