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Peixoto D, Callia JPB, Bittencourt MS, Generoso G, Anastácio VM, Alves-Jr JL, Silva TLD, Belizário JC, Araújo BLM, Ho W, Diz MDPE, Hoff PM, Abdala E, Ibrahim KY. Clinical presentation and in-hospital prognosis of lung cancer patients presenting with suspected and confirmed COVID-19. Braz J Med Biol Res 2022; 55:e12140. [PMID: 36102415 PMCID: PMC9467285 DOI: 10.1590/1414-431x2022e12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 01/08/2023] Open
Abstract
We sought to compare the clinical presentation and prognosis of patients with lung cancer and confirmed COVID-19 infection to those with negative RT-PCR SARS-CoV-2 results. We included patients with confirmed lung cancer and suspected COVID-19 who presented to the emergency department. The primary outcome was in-hospital mortality and secondary outcomes included admission to intensive care unit (ICU) or mechanical ventilation. We analyzed the characteristics according to RT-PCR results and primary outcome. We constructed a logistic regression for each RT-PCR result group to find potential predictors of the primary outcome. Among 110 individuals with confirmed lung cancer (65±9 years, 51% male), 38 patients had positive RT-PCR and 72 patients had negative RT-PCR. There was no difference between groups for any clinical characteristic or comorbidities though individuals with confirmed COVID-19 had higher functionality in the ECOG scale. Leucocytes and lymphocytes were lower in individuals with positive tests. The primary outcome occurred in 58 (53%) individuals, 37 (34%) were admitted to the ICU, and 29 (26%) required mechanical ventilation. Although mortality was similar between the two groups, individuals with confirmed COVID-19 were significantly more likely to be admitted to the ICU or receive mechanical ventilation. Only lower lymphocytes and higher CRP were significantly associated with higher mortality. The clinical presentation of COVID-19 in lung cancer is not sufficient to identify higher or lower probability groups among symptomatic individuals, the overall mortality is high irrespective of RT-PCR results, and lymphopenia on admission was associated with the diagnosis and prognosis for COVID-19.
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Affiliation(s)
- D Peixoto
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J P B Callia
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Bittencourt
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - G Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V M Anastácio
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J L Alves-Jr
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - T L da Silva
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J C Belizário
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - B L M Araújo
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - W Ho
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M D P E Diz
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P M Hoff
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E Abdala
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - K Y Ibrahim
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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2
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Freire MP, de Oliveira Garcia D, Garcia CP, Campagnari Bueno MF, Camargo CH, Kono Magri ASG, Francisco GR, Reghini R, Vieira MF, Ibrahim KY, Rossi F, Hajjar L, Levin AS, Hoff PM, Pierrotti LC, Abdala E. Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia. Clin Microbiol Infect 2015; 22:352-358. [PMID: 26711434 DOI: 10.1016/j.cmi.2015.12.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.
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Affiliation(s)
- M P Freire
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | | | - C P Garcia
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - C H Camargo
- Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil
| | - A S G Kono Magri
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G R Francisco
- Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil
| | - R Reghini
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M F Vieira
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - K Y Ibrahim
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - F Rossi
- Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - L Hajjar
- Intensive Care Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - A S Levin
- Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - P M Hoff
- Department of Oncology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - L C Pierrotti
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - E Abdala
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
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3
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Petry V, Gagliato DM, Leal AIC, Arai RJ, Longo E, Andrade F, Ricci MD, Piato JR, Barroso-Sousa R, Hoff PM, Mano MS. Metronomic chemotherapy in the neoadjuvant setting: results of two parallel feasibility trials (TraQme and TAME) in patients with HER2+ and HER2- locally advanced breast cancer. ACTA ACUST UNITED AC 2015; 48:479-85. [PMID: 25760024 PMCID: PMC4445673 DOI: 10.1590/1414-431x20144354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/05/2014] [Indexed: 11/23/2022]
Abstract
Neoadjuvant chemotherapy has practical and theoretical advantages over adjuvant
chemotherapy strategy in breast cancer (BC) management. Moreover, metronomic delivery
has a more favorable toxicity profile. The present study examined the feasibility of
neoadjuvant metronomic chemotherapy in two cohorts [HER2+ (TraQme) and HER2− (TAME)]
of locally advanced BC. Twenty patients were prospectively enrolled (TraQme, n=9;
TAME, n=11). Both cohorts received weekly paclitaxel at 100 mg/m2 during 8
weeks followed by weekly doxorubicin at 24 mg/m2 for 9 weeks in
combination with oral cyclophosphamide at 100 mg/day (fixed dose). The HER2+ cohort
received weekly trastuzumab. The study was interrupted because of safety issues.
Thirty-six percent of patients in the TAME cohort and all patients from the TraQme
cohort had stage III BC. Of note, 33% from the TraQme cohort and 66% from the TAME
cohort displayed hormone receptor positivity in tumor tissue. The pathological
complete response rates were 55% and 18% among patients enrolled in the TraQme and
TAME cohorts, respectively. Patients in the TraQme cohort had more advanced BC stages
at diagnosis, higher-grade pathological classification, and more tumors lacking
hormone receptor expression, compared to the TAME cohort. The toxicity profile was
also different. Two patients in the TraQme cohort developed pneumonitis, and in the
TAME cohort we observed more hematological toxicity and hand-foot syndrome. The
neoadjuvant metronomic chemotherapy regimen evaluated in this trial was highly
effective in achieving a tumor response, especially in the HER2+ cohort. Pneumonitis
was a serious, unexpected adverse event observed in this group. Further larger and
randomized trials are warranted to evaluate the association between metronomic
chemotherapy and trastuzumab treatment.
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Affiliation(s)
- V Petry
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - D M Gagliato
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A I C Leal
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R J Arai
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E Longo
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - F Andrade
- Núcleo de Mastologia, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - M D Ricci
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J R Piato
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R Barroso-Sousa
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P M Hoff
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Mano
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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4
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Freire MP, Pierrotti LC, Filho HHC, Ibrahim KY, Magri ASGK, Bonazzi PR, Hajar L, Diz MPE, Pereira J, Hoff PM, Abdala E. Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients. Eur J Clin Microbiol Infect Dis 2014; 34:277-86. [DOI: 10.1007/s10096-014-2233-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
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Abstract
Background Invasive lobular carcinoma (ILC) is the second most common histological type of invasive breast carcinoma, preceded only by infiltrating ductal carcinoma, which has clinical, biological and molecular distinctions. These distinctions imply a different metastatic behavior between the histology of these 2 types of breast cancer. Case Presentation We report the case of a 51-year-old woman with breast cancer with ILC histology, diagnosed at an early stage. In the course of her disease, recurrences in the gastric mucosa and endobronchial area occurred. The treatment she received is described herein. Conclusion This is a case of ILC with unusual metastases. The absence of E-cadherin is related to the carcinogenesis of ILC and probably to these patterns of metastasis as well.
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Affiliation(s)
- G S Fernandes
- Oncology Center, Hospital Sírio-Libanês, Unidade Brasília, Brasília, Brazil
| | - T S Corrêa
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - E P B Carvalho
- Oncology Center, Hospital Sírio-Libanês, Unidade Brasília, Brasília, Brazil
| | - A Katz
- Oncology Center, Hospital Sírio-Libanês, Unidade Brasília, Brasília, Brazil
| | - P M Hoff
- Oncology Center, Hospital Sírio-Libanês, Unidade Brasília, Brasília, Brazil ; Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Abstract
BACKGROUND Non-inferiority clinical trials (NIFCTs) aim to demonstrate that the experimental therapy has advantages over the standard of care, with acceptable loss of efficacy. We evaluated the purposes underlying the selection of a non-inferiority design in oncology and the size of their non-inferiority margins (NIFm's). PATIENTS AND METHODS All NIFCTs of cancer-directed therapies and supportive care agents published in a 10-year period were eligible. Two investigators extracted the data and independently classified the trials by their purpose to choose a non-inferiority design. RESULTS Seventy-five were included: 43% received funds from industry, overall survival was the most common primary end point and 73% reported positive results. The most frequent purposes underlying the selection of a non-inferiority design were to test more conveniently administered schedules and/or less toxic treatments. In 13 (17%) trials, a clear purpose was not identified. Among the trials that reported a pre-specified NIFm, the median value was 12.5% (range 4%-25%) for trials with binary primary end points and Hazard Ratio of 1.25 (range 1.10-1.50) for trials that used time-to-event primary outcomes. CONCLUSION Cancer NIFCT harbor serious methodological and ethical issues. Many use large NIFm and nearly one-fifth did not state a clear purpose for selecting a non-inferiority design.
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Affiliation(s)
- R P Riechelmann
- Discipline of Radiology and Oncology, Universidade de Sao Paulo, Instituto do Câncer de Estado de São Paulo, Sao Paulo, Brazil.
| | - A Alex
- Discipline of Radiology and Oncology, Universidade de Sao Paulo, Instituto do Câncer de Estado de São Paulo, Sao Paulo, Brazil
| | - L Cruz
- Discipline of Radiology and Oncology, Universidade de Sao Paulo, Instituto do Câncer de Estado de São Paulo, Sao Paulo, Brazil
| | - G M Bariani
- Discipline of Radiology and Oncology, Universidade de Sao Paulo, Instituto do Câncer de Estado de São Paulo, Sao Paulo, Brazil
| | - P M Hoff
- Discipline of Radiology and Oncology, Universidade de Sao Paulo, Instituto do Câncer de Estado de São Paulo, Sao Paulo, Brazil
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7
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Jürgensmeier JM, Schmoll HJ, Robertson JD, Brooks L, Taboada M, Morgan SR, Wilson D, Hoff PM. Prognostic and predictive value of VEGF, sVEGFR-2 and CEA in mCRC studies comparing cediranib, bevacizumab and chemotherapy. Br J Cancer 2013; 108:1316-23. [PMID: 23449351 PMCID: PMC3619270 DOI: 10.1038/bjc.2013.79] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prognostic/predictive value of potential vascular endothelial growth factor (VEGF) signalling biomarkers was evaluated retrospectively using samples from two randomized Phase III studies (HORIZON II and III) investigating cediranib in metastatic colorectal cancer (mCRC). METHODS Baseline levels of VEGF, soluble VEGF receptor-2 (sVEGFR-2) and carcinoembryonic antigen (CEA) were measured in plasma/serum samples collected from patients participating in HORIZON II (n=860; FOLFOX/XELOX plus cediranib 20 mg (n=502) or placebo (n=358)) and HORIZON III (n=1422; mFOLFOX6 plus cediranib 20 mg (n=709) or bevacizumab (n=713)). Median biomarker baseline levels determined cutoff values for the patient subgroups. RESULTS Baseline data were available for 88-97% of patients/study (>2000 patients). In both the studies, high baseline VEGF and CEA were associated with worse outcomes for progression-free survival (PFS) and overall survival (OS) independent of treatment (HORIZON II OS: VEGF, hazard ratio (HR)=1.35 (95% confidence interval (CI): 1.12-1.63); CEA, HR=1.63 (1.36-1.96); HORIZON III OS: VEGF, HR=1.32 (1.12-1.54); CEA, HR=1.50 (1.29-1.76)). sVEGFR-2 was not prognostic for PFS/OS. Baseline VEGF and CEA were not predictive for PFS/OS outcome to cediranib treatment; low sVEGFR-2 was associated with a trend towards improved cediranib effect in HORIZON II. CONCLUSION Baseline VEGF and CEA levels were treatment-independent prognostic biomarkers for PFS and OS in both the studies.
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Affiliation(s)
- J M Jürgensmeier
- Translational Sciences, Oncology, AstraZeneca, Alderley Park, Macclesfield SK10 4TG, UK.
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Abstract
Oxaliplatin is a third generation platinum compound that inhibits DNA synthesis, mainly through intrastrandal cross-links in DNA. Most of the experience with the clinical use of this drug is derived from colorectal cancer but it is also used in other tumor types such as ovary, breast, liver and non-Hodgkin's lymphoma. Thrombocytopenia is a frequent toxicity seen during oxaliplatin treatment, occurring at any grade in up to 70% of patients and leading to delays or even discontinuation of the chemotherapy. Although myelossupression is recognized as the main cause of oxaliplatin-related thrombocytopenia, new mechanisms for this side-effect have emerged, including splenic sequestration of platelets related to oxaliplatin-induced liver damage and immune thrombocytopenia. These new pathophysiology pathways have different clinical presentations and evolution and may need specific therapeutic maneuvers. This article attempts to review this topic and provides useful clinical information for the management of oxaliplatin-related thrombocytopenia.
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Affiliation(s)
- D L Jardim
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo.
| | - C A Rodrigues
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo; Department of Clinical and Experimental Hematology, Universidade Federal do Estado de Sao Paulo, Sao Paulo
| | - Y A S Novis
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo
| | - V G Rocha
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo; Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - P M Hoff
- Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo; Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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George B, Estrella J, Machado KK, Ferrarotto R, Hoff PM, Rashid A, Kopetz S. High-grade neuroendocrine carcinomas (HGNECs) of the colon and rectum: A single-institution retrospective analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14040] [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: 11/20/2022] Open
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Jürgensmeier JM, Hoff PM, Pike L, Robertson JD, Morgan S, McWalter G, Wilson D, Smith JC. Use of KRAS mutation status to predict clinical outcomes in patients with metastatic colorectal cancer (mCRC) treated with the VEGF signaling inhibitor cediranib. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3613] [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: 11/20/2022] Open
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Schmoll H, Hoff PM, Robertson JD, Pike L, Morgan S, Wilson D, Jürgensmeier JM. Association of baseline CEA, VEGF, and soluble VEGF receptor-2 with treatment outcomes in two randomized phase III trials of cediranib in metastatic colorectal cancer (mCRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3590] [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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Fielding A, Hoff PM, Pike L, Wilson D, Robertson JD. Exploration of the effect of treatment to progression with the VEGF signaling inhibitor cediranib (CED) plus chemotherapy (CT) on the results of the HORIZON (HZ) II trial in first-line metastatic colorectal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14052] [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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13
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Testa L, Barbosa CC, Chaves AC, Hoff PM, Riechelmann RP. Health-related quality-of-life (HRQoL) reporting by randomized cancer trials (RCT): Pitfalls for interpretation. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6102] [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: 11/20/2022] Open
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14
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Saad ED, Marta GN, Del Nero LG, Marta GN, Mangabeira A, Critchi G, da Silva JLF, Hoff PM. Cancer patient (CP), health care professional (HCP), and layperson priorities between survival time (ST) and quality of life (QOL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19524] [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: 11/20/2022] Open
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Andre T, Van Cutsem E, Schmoll H, Tabernero J, Clarke S, Moore MJ, Cunningham D, Cartwright TH, Hecht JR, Rivera F, Im S, Bodoky G, Salazar R, Maindrault-Goebel F, Shmueli E, Bajetta E, Makrutzki M, Shang A, De Gramont A, Hoff PM. A multinational, randomized phase III study of bevacizumab (Bev) with FOLFOX4 or XELOX versus FOLFOX4 alone as adjuvant treatment for colon cancer (CC): Subgroup analyses from the AVANT trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wilson D, Hoff PM, Schmoll H, Robertson JD, Stone A. Application of adaptive study designs: Phase II and III results from the cediranib (CED) HORIZON (HZ) II and III studies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3633] [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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Ferrarotto R, Machado KK, Mak MP, Vieira VA, Takahashi TK, Saragiotto DF, Kopetz S, Overman MJ, Hoff PM. A multicenter, multinational retrospective analysis of mitomycin C (MMC) in refractory metastatic colorectal cancer (mCRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3577] [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: 11/20/2022] Open
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Hajjar LA, Galas F, Almeida J, Nagaoka D, Duarte FA, Nakamura RE, Simoes C, Kalil-Filho R, Hoff PM, Auler JOC. Outcomes of 3,400 patients with cancer admitted to intensive care unit: a Brazilian prospective study. Crit Care 2011. [PMCID: PMC3124155 DOI: 10.1186/cc10153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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De Gramont A, Van Cutsem E, Tabernero J, Moore MJ, Cunningham D, Rivera F, Im S, Makrutzki M, Shang A, Hoff PM. AVANT: Results from a randomized, three-arm multinational phase III study to investigate bevacizumab with either XELOX or FOLFOX4 versus FOLFOX4 alone as adjuvant treatment for colon cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.362] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [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
362 Background: Bevacizumab (BEV), a humanized anti-VEGF monoclonal antibody, has demonstrated clinical efficacy in combination with 5-FU-based regimens in patients with metastatic colorectal cancer. The therapeutic impact of concurrent BEV with either FOLFOX4 or XELOX chemotherapy in the adjuvant setting was evaluated in this international, controlled phase III trial. Methods: Eligible patients had high-risk stage II or stage III colon cancer and had undergone surgical resection. Patients were randomly assigned to one of three treatment groups and stratified by geographic region and tumor stage: Arm A: FOLFOX4 on weeks 1–24; Arm B: FOLFOX4 + BEV on weeks 1–24, then BEV alone on weeks 25–48; Arm C: XELOX + BEV on weeks 1–24, then BEV alone on weeks 25–48. The primary endpoint was disease-free survival (DFS) for patients with stage III colon cancer; secondary endpoints included overall survival (OS), and safety. DFS/OS follow-up assessments were performed every 6 months after randomization for 4 years, then annually until recurrence or death. Results: 3,451 (2,867 stage III) patients were enrolled between December 2004 and June 2007; median age was 58–59 years. Median duration of follow-up was 48 months (range 0–66 months). BEV did not prolong DFS or OS when added to either FOLFOX4 or XELOX in patients with stage III colon cancer based on the final efficacy analysis conducted in September 2010. Efficacy results favored the chemotherapy-alone control arm. Numerically more relapses and deaths occurred in both the BEV arms compared to control. The observed adverse events were consistent with those previously reported in pivotal trials of BEV across tumor types for approved indications. Conclusions: The primary endpoint of the AVANT study was not met. BEV does not prolong DFS when added to either FOLFOX4 or XELOX in patients with stage III colon cancer. The safety profile of BEV was consistent with prior study results. [Table: see text]
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Affiliation(s)
- A. De Gramont
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - E. Van Cutsem
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - J. Tabernero
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - M. J. Moore
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - D. Cunningham
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - F. Rivera
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - S. Im
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - M. Makrutzki
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - A. Shang
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
| | - P. M. Hoff
- Hôpital Saint-Antoine, Paris, France; University Hospital Gasthuisberg, Leuven, Belgium; Vall d'Hebron University Hospital, Barcelona, Spain; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom; Hospital Marques de Valdecilla, Santander, Spain; Seoul National University Hospital, Seoul, South Korea; F. Hoffmann-La Roche, Basel, Switzerland; Centro de Oncologia/Hospital Sirio Libanes, Sao Paulo, Brazil
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Kalil Filho R, Hajjar LA, Bacal F, Hoff PM, Diz MDP, Galas FRBG. I Diretriz Brasileira de Cardio-Oncologia da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2011. [DOI: 10.1590/s0066-782x2011000700001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Hajjar LA, Mauad T, Galas FRBG, Kumar A, da Silva LFF, Dolhnikoff M, Trielli T, Almeida JP, Borsato MRL, Abdalla E, Pierrot L, Kalil Filho R, Auler JOC, Saldiva PHN, Hoff PM. Severe novel influenza A (H1N1) infection in cancer patients. Ann Oncol 2010; 21:2333-2341. [PMID: 20511340 PMCID: PMC2990816 DOI: 10.1093/annonc/mdq254] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The natural history and consequences of severe H1N1 influenza infection among cancer patients are not yet fully characterized. We describe eight cases of H1N1 infection in cancer patients admitted to the intensive care unit of a referral cancer center. Patients and methods: Clinical data from all patients admitted with acute respiratory failure due to novel viral H1N1 infection were reviewed. Lung tissue was submitted for viral and bacteriological analyses by real-time RT-PCR, and autopsy was conducted on all patients who died. Results: Eight patients were admitted, with ages ranging from 55 to 65 years old. There were five patients with solid organ tumors (62.5%) and three with hematological malignancies (37.5%). Five patients required mechanical ventilation and all died. Four patients had bacterial bronchopneumonia. All deaths occurred due to multiple organ failure. A milder form of lung disease was present in the three cases who survived. Lung tissue analysis was performed in all patients and showed diffuse alveolar damage in most patients. Other lung findings were necrotizing bronchiolitis or extensive hemorrhage. Conclusions: H1N1 viral infection in patients with cancer can cause severe illness, resulting in acute respiratory distress syndrome and death. More data are needed to identify predictors of unfavorable evolution in these patients.
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Affiliation(s)
- L A Hajjar
- Department of Anesthesia and Intensive Care
| | - T Mauad
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - A Kumar
- Department of Section of Critical Care Medicine, University of Manitoba, Manitoba, Canada
| | - L F F da Silva
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | - M Dolhnikoff
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | - T Trielli
- Department of Anesthesia and Intensive Care
| | | | - M R L Borsato
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | | | | | | | | | - P H N Saldiva
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | - P M Hoff
- Department of Oncology, Universidade de São Paulo, São Paulo, Brazil.
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Leal AI, Barra WF, Saragiotto DF, Saad ED, Hoff PM. Publication bias in randomized controlled trials (RCTs) of colorectal cancer presented at ASCO Annual Meetings. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Schmerling R, Maluf FC, Hoff PM, Costa F, Buzaid AC. Trabectedin in advanced, pretreated soft tissue sarcoma: The Hospital Sírio-Libanês experience in a compassionate use program. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e20511] [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: 11/20/2022] Open
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24
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Calabrich A, Azevedo FC, Saad ED, Maluf FC, Buzaid AC, Marques RJ, Schmerling R, Costa F, Hoff PM, Katz A. The feasibility and real-life effectiveness of the combination of chemotherapy (CT) and bevacizumab (Bev) in the treatment of high-grade gliomas (HGG) in a private community oncology center. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12552] [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: 11/20/2022] Open
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25
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Saad ED, Katz A, Pusztai L, Hoff PM, Buyse ME. Do experts agree on how to assess disease progression (DP) and progression-free survival (PFS) in phase III trials? A survey with experts in breast cancer research. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1084] [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: 11/20/2022] Open
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26
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Estevez-Diz MD, Maistro S, Escobar KA, Pasini FS, Snitcovsky IM, Brentani M, Hoff PM, Federico MH. Prevalence of germline BRCA1 and BRCA2 deleterious and of unknown clinical significance (UCS) mutations in positive hormone receptor female breast cancer patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12006] [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: 11/20/2022] Open
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27
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Machado KK, Nebuloni DR, Estevez-Diz MD, Castro G, Hoff PM. Nonepithelial ovarian cancer: Outcomes after aggressive treatment with surgery and platinum-based chemotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15548] [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: 11/20/2022] Open
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28
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Hoff PM, Kopetz S, Thomas MB, Langleben A, Rinaldi D, Anthony L, Wolff RA, Lassere Y, Abbruzzese JL. A phase II study of UFT with leucovorin administered as a twice daily schedule in the treatment of patients with metastatic colorectal cancer. Br J Cancer 2008; 99:722-6. [PMID: 18728662 PMCID: PMC2528148 DOI: 10.1038/sj.bjc.6604541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prolonged infusions have been shown to be safer and potentially more effective than bolus regimens of 5-fluorouracil (5-FU) as treatment for metastatic colorectal cancer (mCRC). However, infusional 5-FU requires central venous access and costly infusion pumps. Oral fluoropyrimidines enable longer exposures to 5-FU with increased convenience. Tegafur–uracil (UFT) with leucovorin (LV) given thrice daily has improved safety plus comparable survival and response rates to bolus 5-FU/LV. We conducted a phase II clinical study in 98 patients with mCRC to evaluate if UFT with LV given twice daily provided comparable time to progression (TTP), efficacy and tolerability to that reported for thrice daily in two phase III clinical studies. Secondary objectives included overall response rate (ORR) and overall survival (OS). Median TTP was 3.8 months, when compared with 3.5 months for thrice daily. The ORR (11%) and median OS (12.8 months) with twice daily administration were similar to that of thrice daily administration (12% and 12.4 months). The incidence of grade 3/4 treatment-related diarrhoea was 30% on the twice daily and 21% on the thrice daily schedule. These results suggest that twice daily administration has similar efficacy and tolerability to thrice daily administration and is an acceptable alternative for patients who would benefit from UFT with LV therapy.
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Affiliation(s)
- P M Hoff
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Souza CE, Castro G, Saragiotto DF, Nadalin W, Kiss DR, Nahas C, Siqueira SA, Hoff PM. Comparison of tolerability and efficacy of concurrent chemoradiation (CRT) for anal squamous cell carcinoma (SCC) in HIV-positive (HIV+) and -negative (HIV-) patients (pts). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4606] [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: 11/20/2022] Open
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30
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Politano S, Pathak P, Hoff PM, Charnsangavej C, Overman MJ, Loyer E, Vauthey J, Wallace MJ, Wolff RA, Kopetz S. The use of 5-fluorouracil and oxaliplatin (FOLFOX) for colorectal cancer is associated with the development of splenomegaly and thrombocytopenia. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4102] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
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31
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Pinheiro CA, Masson AS, Borghesi G, Prisco F, Rotea W, Hoff PM, Saad ED. Characterizing cancer research in Brazil through bibliometric analysis of abstracts from the ASCO meetings 2001–2005. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17561] [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: 11/20/2022] Open
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32
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Diz MD, Carelli G, Hoff PM. Identifying best support care patients in an outpatient medical oncology unity: difficulties presented by training medical oncologists. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20613] [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: 11/20/2022] Open
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33
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Kopetz S, Glover KY, Eng C, Wolff RA, Chang DZ, Adinin RB, Morris J, Abbruzzese JL, Hoff PM. Phase II study of infusional 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab as first-line treatment for metastatic colorectal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4089] [Citation(s) in RCA: 2] [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
4089 Background: When compared to bolus 5-fluorouracil (F), leucovorin (L), and irinotecan (I) regimens such as IFL, the infusional F, L, I regimen (FOLFIRI) resulted in a improved toxicity profile with a response rate (RR) of 35% and median progression free survival (PFS) of 6.7 months. When combined with bevacizumab (B) as first-line treatment, IFL demonstrated improved activity with a RR of 45% and a median PFS of 10.6 months. Combining FOLFIRI and B may further improve the efficacy. Methods: We designed a single-arm, phase II trial of FOLFIRI+B with B (5mg/kg), I (180mg/m2), bolus of F (400mg/m2) and L (400mg/m2) with a 46-hour infusion of F (2400mg/m2) every 2 weeks. The primary endpoint was PFS. Chemotherapy naïve mCRC patients (pts) with a performance status of 0–2 received B alone on Day -14, starting FOLFIRI+B on Day 1. Proteomic and radiographic correlative studies were completed and will be reported separately. Results: N=41 pts, median age 56 y/o (range 26–78), M:F = 16:25, 5 pts with prior adjuvant therapy, were enrolled from 1/2005 to 1/2007. A total of 502 cycles have been administered (median = 12). The median PFS is 12.6 months. Response rate by intention-to-treat analysis was 62% (24 pts), with 33% stable disease (13 pts). Responses occurred after a median of 4 months of therapy. Fifteen pts remain on treatment; 26 pts are off study: 7 for progressive disease, 2 withdrew consent, 7 for toxicity and 2 for surgery unrelated to cancer. Eight pts were removed from the study for metastasectomies. Grade 3 or 4 toxicities included 17 occurrences of grade = 3 neutropenia, including 1 grade 4 febrile neutropenia, 4 grade 4 pulmonary emboli, 2 grade 3 hand-foot syndrome, and 1 grade 3 diarrhea. One pt included in the analysis developed a possible microperforation, manifested by peritonitis, after B alone and never received FOLFIRI. Conclusion: FOLFIRI+B is well-tolerated and efficacious, with an impressive PFS that compares favorably to historical controls. This regimen is an excellent choice as a first-line treatment for mCRC. No significant financial relationships to disclose.
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Affiliation(s)
- S. Kopetz
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - K. Y. Glover
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - C. Eng
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - R. A. Wolff
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - D. Z. Chang
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - R. B. Adinin
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - J. Morris
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - J. L. Abbruzzese
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
| | - P. M. Hoff
- MD Anderson Cancer Ctr, Houston, TX; Hospital Sirio Libanes, Sao Paulo, Brazil
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Palhares AC, Costa FP, Belfer AJ, Bacchi CE, Jokh SH, Hoff PM, Buzaid AC, Maluf FC, Marques RJ, Dzik C, Lopes LF. Lack of concordance between I-111 pentreotide (PEN) status and immuno-histochemistry (IHC) status for somatostatin receptors type 1, 2, and 3 in neuroendocrine tumors (NET). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15060 Background: The use of somatostatin analogues (ST) in the treatment of NET is recommended for functional and non- function slow progressing tumors that present with positive PEN. The goal of the study was to determine if expression of ST receptors type 2, 3 and 1 in NET tumors by IHC predict the PEN status and response to ST. Methods: Retrospective analysis of paraffin blocs from primary or metastatic sites and PEN imaging from 39 patients with a diagnosis of NET confirmed by independent pathology review. IHC analysis was performed in a central laboratory using antibody ST receptor type 1 from Neomarkers and type 2 and 3 from Affinity Bio Reagents. Status for each receptor type was reported as positive or negative, diffuse or focal and by % of positive cells. All slides were reviewed by the same pathologist. PEN images were submitted to an independent radiology review and reported as positive or negative and the signal intensity was graded from 1 to 4. Investigators were blinded to receptor and PEN status. This concordance analysis study was designed with a power to detect at least 60% correlation between receptor and PEN status with type I error of 5% and a type II error of 20%. Results: There was no correlation between receptor and PEN status ( Table ). Furthermore, there was no significant correlation between PEN and receptor types 3 and 1 in receptor type 2 negative patients (p=0,54, p=0,14, respectively). There was no correlation between receptor type status and PEN positive intensity. No independent or multivariate characteristics by IHC can correlate to PEN status in this cohort. Conclusions: Commonly used antibodies for IHC detection of receptors type 2, 3 and 1 used in this study failed to correlate with PEN. These results do not support the use of IHC as a substitute for PEN with respect to prediction of ST activity in NET. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- A. C. Palhares
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - F. P. Costa
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - A. J. Belfer
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - C. E. Bacchi
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - S. H. Jokh
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - P. M. Hoff
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - A. C. Buzaid
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - F. C. Maluf
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - R. J. Marques
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - C. Dzik
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
| | - L. F. Lopes
- Sirio Libanes Hospital, São Paulo, Brazil; Unidade Radiológica Paulista, São Paulo, Brazil; Consultoria Patologia, São Paulo, Brazil
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Wolff RA, Hoff PM, Mita A, Fukushima M, Blais JC, Abbruzzese JL, Xiong HQ. A phase I trial of TAS-102 administered on a three times a day schedule in patients with solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.2053] [Citation(s) in RCA: 2] [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
2053 Background: TAS-102 consists of trifluorothymidine (FTD) and an inhibitor of thymidine phosphorylase (TP). FTD, like 5-fluorouracil, is an inhibitor of thymidylate synthase. However, when orally administered, FTD is rapidly degraded to an inactive form, primarily by TP. Co-administration of FTD with an inhibitor of TP elevates FTD concentrations. Since tumor xenograft models demonstrated greater anti-tumor activity with divided daily dosing of TAS-102, and a phase I trial of once-daily TAS-102 showed a short FTD half-life, this trial was designed to explore a three times a day dosing schedule. Methods: Patients with advanced solid tumors having received prior therapy, with adequate organ function, and performance status Zubrod 0–2, were eligible. TAS-102 was administered orally three times a day for 5 days a week for two weeks, followed by two weeks off. Courses were repeated every 4 weeks. Results: A total of 15 patients (8 female, age 37–72 years) were enrolled into the study; three at 60 mg/m2/day, 6 each at 70 mg/m2/day and 80 mg/m2/day. Nine patients had colorectal cancer, 2 carcinoma of unknown primary, 2 pancreatic cancer, one each medullary thyroid cancer and cholangiocarcinoma. Toxicity was assessed throughout all courses of therapy. Grade 3 and 4 hematological toxicities were the most common, including 3 episodes of grade 3 neutropenia at 60 mg/m2/day, 5 at 70 mg/m2/day, 5 at 80 mg/m2/day with only 1 instance of grade 3 thrombocytopenia at 80 mg/m2/day. Non-hematological grade 3 toxicities included nausea/vomiting (1 at 70 mg/m2/day), colitis, gout, and hematuria (1 each at 70 mg/m2/day), and fatigue (1 at 70 mg/m2/day and 2 at 80 mg/m2/day) Two episodes of dose-limiting toxicity were observed at 80 mg/m2/day: grade 3 fatigue and grade 4 neutropenia. Although there were no objective responses, nine patients (60%) maintained stable disease with a median duration of disease stabilization of 4.3 months (range, 1.9 to 8.6 months). Conclusions: TAS-102 is well tolerated with manageable hematologic toxicity and few non-hematological toxicities. The most common grade 3 or 4 toxicity was neutropenia. The suggested phase II dose of TAS-102 is 70 mg/m2/day when administered orally three times a day for 5 days a week for two weeks followed by two weeks off every 4 weeks. [Table: see text]
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Affiliation(s)
- R. A. Wolff
- M. D. Anderson Cancer Center, Houston, TX; Taiho Pharmaceutical, Tokyo, Japan
| | - P. M. Hoff
- M. D. Anderson Cancer Center, Houston, TX; Taiho Pharmaceutical, Tokyo, Japan
| | - A. Mita
- M. D. Anderson Cancer Center, Houston, TX; Taiho Pharmaceutical, Tokyo, Japan
| | - M. Fukushima
- M. D. Anderson Cancer Center, Houston, TX; Taiho Pharmaceutical, Tokyo, Japan
| | - J. C. Blais
- M. D. Anderson Cancer Center, Houston, TX; Taiho Pharmaceutical, Tokyo, Japan
| | - J. L. Abbruzzese
- M. D. Anderson Cancer Center, Houston, TX; Taiho Pharmaceutical, Tokyo, Japan
| | - H. Q. Xiong
- M. D. Anderson Cancer Center, Houston, TX; Taiho Pharmaceutical, Tokyo, Japan
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Whitehead RP, McCoy S, Wollner IS, Wong L, Harker WG, Hoff PM, Gold PJ, Billingsley KG, Blanke CD. Phase II trial of depsipeptide (NSC-630176) in colorectal cancer patients who have received either one or two prior chemotherapy regimens for metastatic or locally advanced, unresectable disease: A Southwest Oncology Group study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3598 The treatment for metastatic colorectal cancer has markedly improved but the disease is still not curable, and additional active agents need to be found. Depsipeptide is a histone deacetylase inhibitor that has shown activity against human solid tumor cell lines and promising results in murine model systems. This phase II trial was undertaken to determine its activity in patients with advanced colorectal cancer. Eligibility requirements included measurable disease, either metastatic or locally advanced and not surgically resectable, Zubrod performance status of 0–1, and adequate renal, hepatic, hematologic and cardiac function. Prior surgery or radiation therapy was allowed and patients were required to have received either one or two prior chemotherapy regimens for advanced disease. A two-stage design was used designed to detect a difference in the null hypothesis of 5% response vs. an alternative 20% response, with 20 eligible patients to be accrued initially followed by an additional 20 patients if one or more confirmed responses were observed. The study closed after the first stage, with 28 patients registered. Three patients are ineligible, two who did not meet requirements for serum magnesium level, and one whose baseline labs were performed more than 14 days prior to registration. One eligible patient never received treatment and is not analyzable for any endpoint. For the 24 eligible and analyzable patients, median age was 58.6 years (range 31–84) with 14 males. Performance status was 0 in 16 patients and 1 in 8. Ten patients received 1 prior chemotherapy regimen and 14 received 2 prior regimens. There were no grade 4 or higher toxicities. The most common grade 2 or 3 toxicities were anorexia, fatigue, nausea, and dehydration. No objective responses were observed. Four patients had stable disease, 15 showed increasing disease, 3 had symptomatic deterioration, and 2 had assessment inadequate. The current Kaplan-Meier estimate of 6 month overall survival is 69% (95% CI 50%-88%) with a median survival of 8.4 months. Depsipeptide does not show significant anti-tumor activity in previously treated patients with advanced colorectal cancer. No significant financial relationships to disclose.
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Affiliation(s)
- R. P. Whitehead
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - S. McCoy
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - I. S. Wollner
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - L. Wong
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - W. G. Harker
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - P. M. Hoff
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - P. J. Gold
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - K. G. Billingsley
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
| | - C. D. Blanke
- University of Texas Medical Branch, Galveston, TX; Southwest Oncology Group Statistical Center, Seattle, WA; Henry Ford Hospital, Detroit, MI; Scott and White CCOP, Temple, TX; Utah Cancer Specialists, Salt Lake City, UT; M. D. Anderson Cancer Center, Houston, TX; Swedish Cancer Institute, Seattle, WA; Oregon Health & Science University Cancer Inst, Portland, OR
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Hoff PM, Hoff AO, Phan AT, Sherman SI, Yao J, White N, Phan L, Abbruzzese JL, Gagel RF. Phase I/II trial of capecitabine (C), dacarbazine (D) and imatinib (I) (CDI) for patients (pts) metastatic medullary thyroid carcinomas (MTC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13048 Background: MTC is a rare tumor that responds poorly to conventional chemotherapy. 5-FU and D are frequently used, with an expected response rate of around 15%. MTC is often associated with multiple endocrine neoplasia type 2, an autosomal dominant syndrome caused by a mutation in the RET proto-oncogene which encodes RET, a tyrosine kinase receptor. I is a tyrosine kinase inhibitor with activity against c-Kit, PDGF and possibly RET, and we postulated that its addition to chemotherapy would increase its efficacy against this disease. Methods: We designed a phase I/II trial combining escalating doses of oral C, IV D and oral I. Pts with any advanced solid tumors were eligible for the phase I part of the trial. Results: 13 pts were entered and 12 were eligible (7 MTC, 2 adrenocortical, 1 islet-cell, 1 insular thyroid and 1 small cell). 4 pts did not complete one cycle (1 pt withdrew after 5 days and 2 pts progressed in less than 10 days and were replaced for toxicity analysis, 1 had a DLT and is included). 3 patients were entered in dose level 1, without DLT. 2 out of 6 pts developed DLT at the second dose level (1 G 3 fatigue and 1 G3 hypokalemia). Three additional pts are being entered on dose level 1. The first one had PD after 7 days and is being replaced. For the 11 pts who were evaluable, best response was 3 SD (range 3 to 9 + months) and 8 PD. Conclusions: The combination of CDI is feasible but has resulted in an unexpected pattern of toxicity in this patient population, with fatigue and hypokalemia as the DLT. No significant diarrhea or hand-foot syndrome was seen. Only G1 and 2 fluid retention and neutropenia have been encountered. Only minor reduction in tumor size has been seen among these heavily pretreated pts. Once the phase I is complete, the trial will continue in a phase II setting for untreated MTC pts. [Table: see text] [Table: see text]
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Affiliation(s)
- P. M. Hoff
- M. D. Anderson Cancer Center, Houston, TX
| | - A. O. Hoff
- M. D. Anderson Cancer Center, Houston, TX
| | - A. T. Phan
- M. D. Anderson Cancer Center, Houston, TX
| | | | - J. Yao
- M. D. Anderson Cancer Center, Houston, TX
| | - N. White
- M. D. Anderson Cancer Center, Houston, TX
| | - L. Phan
- M. D. Anderson Cancer Center, Houston, TX
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Varadhachary GR, Blais JC, Raber MN, Lenzi R, Hoff PM, Abbruzzese JL. Phase II study to evaluate the efficacy and toxicity of oxaliplatin in combination with gemcitabine (GEMOX) in cancer of unknown primary (CUP). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - R. Lenzi
- MD Anderson Cancer Ctr, Houston, TX
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Eng C, Crane CH, Rosner GL, Rodriguez-Bigas MA, Skibber JM, Bogaard KR, Delclos ME, Lassere YM, Hoff PM, Abbruzzese JL. A phase II study of capecitabine plus oxaliplatin and radiation therpy, XELOX-XRT, in squamous cell carcinoma (SCCA) of the anal canal: A preliminary analysis. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4271] [Citation(s) in RCA: 2] [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)
- C. Eng
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - C. H. Crane
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - G. L. Rosner
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | | | - J. M. Skibber
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - K. R. Bogaard
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - M. E. Delclos
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - Y. M. Lassere
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
| | - P. M. Hoff
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX
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Glover KY, Thomas MB, Brown TD, Hoff PM, Iwasaki M, Abbruzzese JL. A phase II study of oxaliplatin and capecitabine (XELOX) in patients with unresectable cholangiocarcinoma, including carcinoma of the gallbladder and biliary tract. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
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Das P, Skibber JM, Rodriguez-Bigas MA, Feig B, Hoff PM, Eng C, Janjan NA, Krishnan S, Ellis LM, Crane CH. Clinical and pathologic predictors of locoregional recurrence (LR), distant metastasis (DM) and overall survival (OS) in patients treated with chemoradiation and mesorectal excision for locally advanced rectal cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. Das
- U T M. D. Anderson Cancer Ctr, Houston, TX
| | | | | | - B. Feig
- U T M. D. Anderson Cancer Ctr, Houston, TX
| | - P. M. Hoff
- U T M. D. Anderson Cancer Ctr, Houston, TX
| | - C. Eng
- U T M. D. Anderson Cancer Ctr, Houston, TX
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Rhee JM, Lee FC, Saif MW, Ardalan B, Wolff R, Eng C, Bogaard KR, Cheverton P, Kimura M, Danna M, Hoff PM. Phase II trial of DJ-927 as a second-line treatment for colorectal cancer demonstrates objective responses. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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)
- J. M. Rhee
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - F. C. Lee
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - M. W. Saif
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - B. Ardalan
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - R. Wolff
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - C. Eng
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - K. R. Bogaard
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - P. Cheverton
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - M. Kimura
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - M. Danna
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
| | - P. M. Hoff
- UT M. D. Anderson Cancer Ctr, Houston, TX; Univ of New Mexico, Alburquerque, NM; Univ of Alabama, Birmingham, AL; Univ of Miami, Miami, FL; Daiichi Medcl Research, Inc, Park Ridge, NJ
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Yao JC, Ng C, Hoff PM, Phan AT, Hess K, Chen H, Wang X, Abbruzzese JL, Ajani JA. Improved progression free survival (PFS), and rapid, sustained decrease in tumor perfusion among patients with advanced carcinoid treated with bevacizumab. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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)
- J. C. Yao
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - C. Ng
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - P. M. Hoff
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - A. T. Phan
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - K. Hess
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - H. Chen
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - X. Wang
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - J. L. Abbruzzese
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - J. A. Ajani
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
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Thomas MB, Dutta A, Brown T, Charnsangavej C, Rashid A, Hoff PM, Dancey J, Abbruzzese JL. A phase II open-label study of OSI-774 (NSC 718781) in unresectable hepatocellular carcinoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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)
- M. B. Thomas
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - A. Dutta
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - T. Brown
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - C. Charnsangavej
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - A. Rashid
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - P. M. Hoff
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - J. Dancey
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - J. L. Abbruzzese
- Univ of Texas M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
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Mares JE, Worah S, Mathew SV, Charnsangavej C, Chen H, Ajani JA, Hoff PM, Phan AT, Yao JC. Increased rates of hypertension (HTN) among patients with advanced carcinoid treated with bevacizumab. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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)
- J. E. Mares
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - S. Worah
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - S. V. Mathew
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - C. Charnsangavej
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - H. Chen
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - J. A. Ajani
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - P. M. Hoff
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - A. T. Phan
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
| | - J. C. Yao
- UT M. D. Anderson Cancer Ctr, Houston, TX; National Cancer Institute, Bethesda, MD
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Shirao K, Hoff PM, Ohtsu A, Loehrer PJ, Hyodo I, Wadler S, Wadleigh RG, O'Dwyer PJ, Muro K, Yamada Y, Boku N, Nagashima F, Abbruzzese JL. Comparison of the efficacy, toxicity, and pharmacokinetics of a uracil/tegafur (UFT) plus oral leucovorin (LV) regimen between Japanese and American patients with advanced colorectal cancer: joint United States and Japan study of UFT/LV. J Clin Oncol 2004; 22:3466-74. [PMID: 15277535 DOI: 10.1200/jco.2004.05.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the efficacy, toxicities, and pharmacokinetics of an oral regimen consisting of uracil/tegafur (UFT) and leucovorin (LV) between Japanese patients and patients in the United States with previously untreated metastatic colorectal cancer. PATIENTS AND METHODS Forty-four Japanese patients and 45 patients in the United States were enrolled in concurrent nonrandomized phase II trials. UFT 300 mg/m2/d and leucovorin 75 mg/d were administered orally for 28 days followed by a 7-day rest period. The total daily dose of each drug was divided into three equal doses. Treatment was repeated every 5 weeks until disease progression. Blood samples for the pharmacokinetic study were obtained after the initial dose on day 1 of the first course. RESULTS The response rate for the Japanese patients and the patients in the United States was 36.4% (95% CI, 22.4% to 52.2%) and 34.1% (95% CI, 20.5% to 49.9%), respectively. The only major toxicity was diarrhea, and other toxicities were mild in both populations. The incidence of grade 3 or higher diarrhea in the Japanese and Americans was 9% and 22%, respectively. Although the area under the curve and maximum concentration of fluorouracil were found to be slightly higher in the Japanese patients than the patients in the United States, and area under the curve-adjusted body surface area appeared to be comparable between the two groups. CONCLUSION The efficacy and pharmacokinetic parameters of UFT and LV are comparable in Japanese and American patients; however, a difference in toxicity profile, specifically diarrhea, was noted. This oral regimen of UFT and LV is considered to have similar activity against metastatic colorectal cancer and to have acceptable toxicity in patients in both countries.
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Affiliation(s)
- K Shirao
- Division of Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo, Japan.
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Van Cutsem E, Hoff PM, Harper P, Bukowski RM, Cunningham D, Dufour P, Graeven U, Lokich J, Madajewicz S, Maroun JA, Marshall JL, Mitchell EP, Perez-Manga G, Rougier P, Schmiegel W, Schoelmerich J, Sobrero A, Schilsky RL. Oral capecitabine vs intravenous 5-fluorouracil and leucovorin: integrated efficacy data and novel analyses from two large, randomised, phase III trials. Br J Cancer 2004; 90:1190-7. [PMID: 15026800 PMCID: PMC2409640 DOI: 10.1038/sj.bjc.6601676] [Citation(s) in RCA: 276] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study evaluates the efficacy of capecitabine using data from a large, well-characterised population of patients with metastatic colorectal cancer (mCRC) treated in two identically designed phase III studies. A total of 1207 patients with previously untreated mCRC were randomised to either oral capecitabine (1250 mg m−2 twice daily, days 1−14 every 21 days; n=603) or intravenous (i.v.) bolus 5-fluorouracil/leucovorin (5-FU/LV; Mayo Clinic regimen; n=604). Capecitabine demonstrated a statistically significant superior response rate compared with 5-FU/LV (26 vs 17%; P<0.0002). Subgroup analysis demonstrated that capecitabine consistently resulted in superior response rates (P<0.05), even in patient subgroups with poor prognostic indicators. The median time to response and duration of response were similar and time to progression (TTP) was equivalent in the two arms (hazard ratio (HR) 0.997, 95% confidence interval (CI) 0.885–1.123, P=0.95; median 4.6 vs 4.7 months with capecitabine and 5-FU/LV, respectively). Multivariate Cox regression analysis identified younger age, liver metastases, multiple metastases and poor Karnofsky Performance Status as independent prognostic indicators for poor TTP. Overall survival was equivalent in the two arms (HR 0.95, 95% CI 0.84–1.06, P=0.48; median 12.9 vs 12.8 months, respectively). Capecitabine results in superior response rate, equivalent TTP and overall survival, an improved safety profile and improved convenience compared with i.v. 5-FU/LV as first-line treatment for MCRC. For patients in whom fluoropyrimidine monotherapy is indicated, capecitabine should be strongly considered. Following encouraging results from phase I and II trials, randomised trials are evaluating capecitabine in combination with irinotecan, oxaliplatin and radiotherapy. Capecitabine is a suitable replacement for i.v. 5-FU as the backbone of colorectal cancer therapy.
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Affiliation(s)
- E Van Cutsem
- University Hospital Gasthuisberg, Leuven, Belgium.
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Van Cutsem E, Hoff PM, Blum JL, Abt M, Osterwalder B. Incidence of cardiotoxicity with the oral fluoropyrimidine capecitabine is typical of that reported with 5-fluorouracil. Ann Oncol 2002; 13:484-5. [PMID: 11996484 DOI: 10.1093/annonc/mdf108] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Abstract
Chemotherapy for advanced colorectal cancer is based on i.v. 5-fluorouracil (5-FU). Numerous attempts have been made to increase the therapeutic benefit of 5-FU through schedule modification and biomodulation, but only modest improvements have been achieved. Capecitabine is an oral fluoropyrimidine that was developed in response to the clinical need for new therapeutic options offering improved efficacy, tolerability, and convenience for patients. Capecitabine was rationally designed to mimic continuous infusion 5-FU. It is rapidly and almost completely absorbed through the gastrointestinal wall and is converted to 5-FU via a three-step enzymatic cascade. 5-FU is generated preferentially in tumor by exploiting the higher activity of thymidine phosphorylase in tumor tissue compared with normal tissue. Results of a randomized, phase II trial led to the selection of a regimen of capecitabine for further clinical development (1,250 mg/m(2) twice daily for 14 days followed by a 7-day rest period). Subsequently, two large, randomized, phase III trials were conducted to compare capecitabine with i.v. bolus 5-FU/leucovorin ([LV]; Mayo Clinic regimen) in patients with metastatic colorectal cancer. A prospective, integrated analysis of data from the studies showed that capecitabine offers superior activity and an improved safety profile compared with 5-FU/LV. This article summarizes these developments in the treatment of colorectal cancer and assesses the feasibility of replacing i.v. 5-FU-based therapy with oral capecitabine. In addition, retrospective analyses assessing the impact of the dose modification scheme on the efficacy and tolerability of capecitabine are presented, and dose recommendations in special populations are reviewed.
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Affiliation(s)
- P M Hoff
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Albert Einstein Hospital, São Paulo, Brazil.
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Affiliation(s)
- E Van Cutsem
- University Hospital Gasthuisberg, Leuven, Belgium.
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