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Hecht JR, Trarbach T, Hainsworth JD, Major P, Jäger E, Wolff RA, Lloyd-Salvant K, Bodoky G, Pendergrass K, Berg W, Chen BL, Jalava T, Meinhardt G, Laurent D, Lebwohl D, Kerr D. Randomized, placebo-controlled, phase III study of first-line oxaliplatin-based chemotherapy plus PTK787/ZK 222584, an oral vascular endothelial growth factor receptor inhibitor, in patients with metastatic colorectal adenocarcinoma. J Clin Oncol 2011; 29:1997-2003. [PMID: 21464406 DOI: 10.1200/jco.2010.29.4496] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE PTK787/ZK 222584 (PTK/ZK; vatalanib), an orally active, multitargeted angiogenesis inhibitor, has shown tolerability and promising activity in early-phase studies, which led to a phase III trial in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4). PATIENTS AND METHODS Patients (N = 1,168) with previously untreated metastatic colorectal cancer were randomly assigned 1:1 to receive FOLFOX4 plus PTK/ZK or placebo (ClinicalTrials.gov identifier: NCT00056459). Stratification factors included WHO performance status (0 v 1 or 2) and serum lactate dehydrogenase (LDH; ≤ v > 1.5× the upper limit of normal). The primary end point was progression-free survival (PFS). Secondary end points included overall survival (OS) and overall response rate (ORR). RESULTS PFS, OS, and ORR were not statistically improved with PTK/ZK (P > .05). Median PFS by central review was 7.7 months with PTK/ZK versus 7.6 months with placebo (hazard ratio [HR], 0.88; 95% CI, 0.74 to 1.03; P = .118); median OS was 21.4 months with PTK/ZK versus 20.5 months with placebo (HR, 1.08; 95% CI, 0.94 to 1.24; P = .260). In an exploratory post hoc analysis of PFS in patients (n = 158 per arm) with high serum LDH, a potential marker of hypoxia, PFS was longer with PTK/ZK versus placebo (7.7 v 5.8 months, respectively; HR, 0.67; 95% CI, 0.49 to 0.91; P = .009). CONCLUSION Although the efficacy objectives of this study were not met, a subgroup of patients who may potentially benefit from small-molecule vascular endothelial growth factor receptor inhibitor therapy has been identified and further research is warranted.
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Affiliation(s)
- J Randolph Hecht
- David Geffen School of Medicine at University of California, Los Angeles, Santa Monica, CA 90404, USA.
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Eatock MM, Szanto J, Tebbutt NC, Bampton CL, Strickland AH, Valladares Ayerbes M, Nanayakkara N, Sun Y, Adewoye AH, Bodoky G. Randomized, double-blind, placebo-controlled phase II study of AMG 386 in combination with cisplatin and capecitabine (CX) in patients (pts) with metastatic gastroesophageal adenocarcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.66] [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
66 Background: AMG 386, a first-in-class investigational peptide-Fc fusion protein (peptibody), blocks angiogenesis via inhibiting the interaction between angiopoietins-1 and -2 and the Tie2 receptor. We evaluated the efficacy and tolerability of AMG 386 or placebo plus CX in the first-line treatment of metastatic gastroesophageal adenocarcinoma. Methods: Pts with confirmed metastatic adenocarcinoma of the stomach, gastroesophageal junction or distal esophagus were randomized 1:1:1 to receive CX (cisplatin, 80 mg/m2 IV Q3W; capecitabine, 1,000 mg/m2 orally BID for 14 days Q3W) plus AMG 386 10 mg/kg (Arm A), 3 mg/kg (Arm B), or placebo (Arm C) IV QW. The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR; in pts with measurable disease), adverse events (AEs), and pharmacokinetics (PK). Results: 171 pts were randomized (Arm A/B/C, n = 56/59/56). Efficacy results are summarized in the table. The incidence of grade ≥ 3 AEs in Arms A/B/C was 80/84/75%. Serious AEs occurred in 73/60/47% and serious AEs grade ≥ 3 in 66/60/43% of pts. AEs in Arms A/B/C included abdominal pain (30/40/17%; grade ≥ 3, 18/3/4%), peripheral edema (13/29/6%; grade ≥ 3, 0/2/0%), venous thromboembolic events (20/22/19%; grade ≥ 3, 20/19/17%), and pulmonary embolism (9/3/15%; grade ≥ 3, 9/2/13%). Median AMG 386 Cmax and Cmin values at steady state after CX coadministration were dose-proportional. Coadministration with CX did not markedly affect AMG 386 exposure. Conclusions: In this study, AMG 386 plus CX did not significantly improve PFS or ORR over placebo plus CX in this patient population. The toxicity of the combination of AMG 386 plus CX, compared with placebo, was greater but manageable. No unexpected AEs occurred. [Table: see text] [Table: see text]
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Affiliation(s)
- M. M. Eatock
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - J. Szanto
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - N. C. Tebbutt
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - C. L. Bampton
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - A. H. Strickland
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - M. Valladares Ayerbes
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - N. Nanayakkara
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - Y. Sun
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - A. H. Adewoye
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - G. Bodoky
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
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Yoshida K, Ikeda K, Yoshisue K, Rodriguez W, Bodoky G, Moiseyenko V, Lichinitser M, Saito K, Benedetti FM, Ajani JA. Population pharmacokinetic (PPK) analysis for 5-FU, tegafur (FT), gimeracil (CDHP), and oteracil potassium (Oxo) in the eight clinical studies of S-1 in Western patients with advanced solid tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.53] [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
53 Background: This analysis was performed to establish the PPK model of S-1, and to identify the intrinsic or extrinsic factors that influence S-1 exposure in the Western patients with advanced solid tumor. Methods: PK data obtained in seven phase I and one phase III (FLAGS) studies were combined for PPK analysis. The total number of patients was 315, and the number of data points for FT, CDHP, 5-FU and Oxo were 2,860, 2,625, 2,492, and 2,484, respectively. The two-compartment model was used for FT, CDHP and Oxo, whereas for 5-FU, inhibitory effect of CDHP on 5-FU clearance was incorporated into a two-compartment model to describe its non-linear PK. The final models were validated by visual predictive check and bootstrapping. Results: The individual fit and the stability of four models were acceptable. The predicted daily AUCs (at steady state) were calculated to evaluate the effect of covariates. The daily AUC of 5-FU strongly correlated with oral clearance (CL/F) of CDHP, but not with that of FT. The ethnic difference in exposure to 5-FU was not apparent despite the significantly lower CL/F of FT observed in the Asian patients. Co-administration with food delayed the absorption of S-1 but exhibited no or limited effect on the AUC of FT, CDHP and 5-FU, whereas the bioavailability of Oxo decreased to approximately 30%. Renal function primarily influenced CDHP exposure and, in turn, 5-FU. The model simulation suggested that the S-1 dosages of 30, 25 and 20 mg/m2 BID could achieve similar daily AUC of 5-FU in the Western patients with normal renal function (CLcr>80 mL/min), mild (50-80 mL/min) and moderate (30-50 mL/min) renal impairment, respectively. Other factors such as age, gender, liver function, serum albumin, PS, gastric cancer, gastrectomy, combination with cisplatin and liver metastasis, had little or minimal impact on the daily AUC of 5-FU. Conclusions: This analysis suggests that the daily AUC of 5-FU after S-1 administration is primarily affected by the CDHP levels, and hence renal function remains the primary factor for 5-FU PK in patients. Other factors as well as CL/F of FT had little impact on 5-FU. [Table: see text]
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Affiliation(s)
- K. Yoshida
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - K. Ikeda
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - K. Yoshisue
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - W. Rodriguez
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - G. Bodoky
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - V. Moiseyenko
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - M. Lichinitser
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - K. Saito
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - F. M. Benedetti
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. A. Ajani
- Taiho Pharmaceutical, Tokushima, Japan; Clinica Ricardo Palma and INEN, Lima, Peru; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz-Rendelointezet, Budapest, Hungary; N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Taiho Pharmaceutical, Tokyo, Japan; Taiho Pharmaceutical, Princeton, NJ; University of Texas M. D. Anderson Cancer Center, Houston, TX
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Abstract
The authors review the most important clinical aspects of carcinoid tumors. Carcinoid tumors originating in neuroendocrine cells are rare, usually slowly-growing neoplasms, however, they may present as aggressive and rapidly progressing tumors. Epidemiologic data indicates that their prevalence is gradually increasing, which may be explained, at least in part, by the development and wider use of advanced diagnostic methods. A considerable proportion of patients with neuroendocrine tumors are symptom-free, whereas others may have carcinoid syndrome or symptoms of other endocrine syndromes. Early diagnosis may be established by the measurement of biochemical markers (serum chromogranin A, urinary 5-hydroxyindoleacetic acid) and advanced localization methods. A considerable number of patients are diagnosed at the late stages of the disease; in these cases surgical cure is not possible but surgical and/or interventional radiologic procedures which reduce tumoral mass should be still considered. The most effective drugs for symptomatic treatment of carcinoid tumors are somatostatin analogues; in addition to their beneficial effect on clinical symptoms they may stabilize tumor growth for many years and, less frequently, may produce tumor regression. The use of chemotherapeutic agents is considered in patients with aggressive, rapidly growing and advanced tumors; initial findings with temozolomide and thalidomide in clinical trials raise the possibility that these chemotherapeutic agents may prove to be new therapeutic options. Radioisotope-labeled peptide receptor therapy with 131 I-MIBG, 90 Y-DOTA-TOC or 177 Lu-DOTA-TOC may offer a highly effective option for patients with progressive and advanced stage of neuroendocrine tumors. Initial observations obtained in clinical trials with some tyrosine kinase inhibitors, antibodies against tyrosine kinases, and with inhibitors of mammalian target of rapamycin (mTOR) support the possibility that at least some of these new agents may have a role in future treatment options in patients with advanced neuroendocrine tumors.
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Affiliation(s)
- István Pregun
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest.
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Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, Humblet Y, Bodoky G, Cunningham D, Jassem J, Rivera F, Kocákova I, Ruff P, Błasińska-Morawiec M, Šmakal M, Canon JL, Rother M, Oliner KS, Wolf M, Gansert J. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol 2010; 28:4697-705. [PMID: 20921465 DOI: 10.1200/jco.2009.27.4860] [Citation(s) in RCA: 1336] [Impact Index Per Article: 95.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Panitumumab, a fully human anti-epidermal growth factor receptor (EGFR) monoclonal antibody that improves progression-free survival (PFS), is approved as monotherapy for patients with chemotherapy-refractory metastatic colorectal cancer (mCRC). The Panitumumab Randomized Trial in Combination With Chemotherapy for Metastatic Colorectal Cancer to Determine Efficacy (PRIME) was designed to evaluate the efficacy and safety of panitumumab plus infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as initial treatment for mCRC. PATIENTS AND METHODS In this multicenter, phase III trial, patients with no prior chemotherapy for mCRC, Eastern Cooperative Oncology Group performance status of 0 to 2, and available tissue for biomarker testing were randomly assigned 1:1 to receive panitumumab-FOLFOX4 versus FOLFOX4. The primary end point was PFS; overall survival (OS) was a secondary end point. Results were prospectively analyzed on an intent-to-treat basis by tumor KRAS status. RESULTS KRAS results were available for 93% of the 1,183 patients randomly assigned. In the wild-type (WT) KRAS stratum, panitumumab-FOLFOX4 significantly improved PFS compared with FOLFOX4 (median PFS, 9.6 v 8.0 months, respectively; hazard ratio [HR], 0.80; 95% CI, 0.66 to 0.97; P = .02). A nonsignificant increase in OS was also observed for panitumumab-FOLFOX4 versus FOLFOX4 (median OS, 23.9 v 19.7 months, respectively; HR, 0.83; 95% CI, 0.67 to 1.02; P = .072). In the mutant KRAS stratum, PFS was significantly reduced in the panitumumab-FOLFOX4 arm versus the FOLFOX4 arm (HR, 1.29; 95% CI, 1.04 to 1.62; P = .02), and median OS was 15.5 months versus 19.3 months, respectively (HR, 1.24; 95% CI, 0.98 to 1.57; P = .068). Adverse event rates were generally comparable across arms with the exception of toxicities known to be associated with anti-EGFR therapy. CONCLUSION This study demonstrated that panitumumab-FOLFOX4 was well tolerated and significantly improved PFS in patients with WT KRAS tumors and underscores the importance of KRAS testing for patients with mCRC.
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Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, Humblet Y, Bodoky G, Cunningham D, Jassem J, Rivera F, Kocákova I, Ruff P, Błasińska-Morawiec M, Šmakal M, Canon JL, Rother M, Oliner KS, Wolf M, Gansert J. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol 2010. [PMID: 20921462 DOI: 10.1200/jco.2009.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Panitumumab, a fully human anti-epidermal growth factor receptor (EGFR) monoclonal antibody that improves progression-free survival (PFS), is approved as monotherapy for patients with chemotherapy-refractory metastatic colorectal cancer (mCRC). The Panitumumab Randomized Trial in Combination With Chemotherapy for Metastatic Colorectal Cancer to Determine Efficacy (PRIME) was designed to evaluate the efficacy and safety of panitumumab plus infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as initial treatment for mCRC. PATIENTS AND METHODS In this multicenter, phase III trial, patients with no prior chemotherapy for mCRC, Eastern Cooperative Oncology Group performance status of 0 to 2, and available tissue for biomarker testing were randomly assigned 1:1 to receive panitumumab-FOLFOX4 versus FOLFOX4. The primary end point was PFS; overall survival (OS) was a secondary end point. Results were prospectively analyzed on an intent-to-treat basis by tumor KRAS status. RESULTS KRAS results were available for 93% of the 1,183 patients randomly assigned. In the wild-type (WT) KRAS stratum, panitumumab-FOLFOX4 significantly improved PFS compared with FOLFOX4 (median PFS, 9.6 v 8.0 months, respectively; hazard ratio [HR], 0.80; 95% CI, 0.66 to 0.97; P = .02). A nonsignificant increase in OS was also observed for panitumumab-FOLFOX4 versus FOLFOX4 (median OS, 23.9 v 19.7 months, respectively; HR, 0.83; 95% CI, 0.67 to 1.02; P = .072). In the mutant KRAS stratum, PFS was significantly reduced in the panitumumab-FOLFOX4 arm versus the FOLFOX4 arm (HR, 1.29; 95% CI, 1.04 to 1.62; P = .02), and median OS was 15.5 months versus 19.3 months, respectively (HR, 1.24; 95% CI, 0.98 to 1.57; P = .068). Adverse event rates were generally comparable across arms with the exception of toxicities known to be associated with anti-EGFR therapy. CONCLUSION This study demonstrated that panitumumab-FOLFOX4 was well tolerated and significantly improved PFS in patients with WT KRAS tumors and underscores the importance of KRAS testing for patients with mCRC.
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Bernhard J, Dietrich D, Glimelius B, Hess V, Bodoky G, Scheithauer W, Herrmann R. Estimating prognosis and palliation based on tumour marker CA 19-9 and quality of life indicators in patients with advanced pancreatic cancer receiving chemotherapy. Br J Cancer 2010; 103:1318-24. [PMID: 20877359 PMCID: PMC2990612 DOI: 10.1038/sj.bjc.6605929] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: To investigate the prognostic value of quality of life (QOL) relative to tumour marker carbohydrate antigen (CA) 19-9, and the role of CA 19-9 in estimating palliation in patients with advanced pancreatic cancer receiving chemotherapy. Methods: CA 19-9 serum concentration was measured at baseline and every 3 weeks in a phase III trial (SAKK 44/00–CECOG/PAN.1.3.001). Patients scored QOL indicators at baseline, and before each administration of chemotherapy (weekly or bi-weekly) for 24 weeks or until progression. Prognostic factors were investigated by Cox models, QOL during chemotherapy by mixed-effect models. Results: Patient-rated pain (P<0.02) and tiredness (P<0.03) were independent predictors for survival, although less prognostic than CA 19-9 (P<0.001). Baseline CA 19-9 did not predict QOL during chemotherapy, except for a marginal effect on pain (P<0.05). Mean changes in physical domains across the whole observation period were marginally correlated with the maximum CA 19-9 decrease. Patients in a better health status reported the most improvement in QOL within 20 days before maximum CA 19-9 decrease. They indicated substantially less pain and better physical well-being, already, early on during chemotherapy with a maximum CA 19-9 decrease of ⩾50% vs <50%. Conclusion: In advanced pancreatic cancer, pain and tiredness are independent prognostic factors for survival, although less prognostic than CA 19-9. Quality of life improves before best CA 19-9 response but the maximum CA 19-9 decrease has no impact on subsequent QOL. To estimate palliation by chemotherapy, patient's perception needs to be taken into account.
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Affiliation(s)
- J Bernhard
- SAKK Coordinating Center, Bern, Switzerland.
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Koeberle D, Montemurro M, Samaras P, Majno P, Simcock M, Limacher A, Lerch S, Kovàcs K, Inauen R, Hess V, Saletti P, Borner M, Roth A, Bodoky G. Continuous Sunitinib treatment in patients with advanced hepatocellular carcinoma: a Swiss Group for Clinical Cancer Research (SAKK) and Swiss Association for the Study of the Liver (SASL) multicenter phase II trial (SAKK 77/06). Oncologist 2010; 15:285-92. [PMID: 20203173 DOI: 10.1634/theoncologist.2009-0316] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenic activity. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS Key eligibility criteria included unresectable or metastatic HCC, no prior systemic anticancer treatment, measurable disease, and Child-Pugh class A or mild Child-Pugh class B liver dysfunction. Patients received 37.5 mg SU daily until progression or unacceptable toxicity. The primary endpoint was progression-free survival at 12 weeks (PFS12). RESULTS Forty-five patients were enrolled. The median age was 63 years; 89% had Child-Pugh class A disease and 47% had distant metastases. PFS12 was rated successful in 15 patients (33%; 95% confidence interval, 20%-47%). Over the whole trial period, one complete response and a 40% rate of stable disease as the best response were achieved. The median PFS duration, disease stabilization duration, time to progression, and overall survival time were 1.5, 2.9, 1.5, and 9.3 months, respectively. Grade 3 and 4 adverse events were infrequent. None of the 33 deaths were considered drug related. CONCLUSION Continuous SU treatment with 37.5 mg daily is feasible and has moderate activity in patients with advanced HCC and mild to moderately impaired liver dysfunction. Under this trial design (>13 PFS12 successes), the therapy is considered promising. This is the first trial describing the clinical effects of continuous dosing of SU in HCC patients on a schedule that is used in an ongoing, randomized, phase III trial in comparison with the current treatment standard, sorafenib (ClinicalTrials.gov identifier, NCT00699374).
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Affiliation(s)
- Dieter Koeberle
- Department of Internal Medicine, Division Oncology/Hematology, Kantonsspital St. Gallen, CH-9007 St. Gallen, Switzerland.
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109
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Roth AD, Tejpar S, Delorenzi M, Yan P, Fiocca R, Klingbiel D, Dietrich D, Biesmans B, Bodoky G, Barone C, Aranda E, Nordlinger B, Cisar L, Labianca R, Cunningham D, Van Cutsem E, Bosman F. Prognostic role of KRAS and BRAF in stage II and III resected colon cancer: results of the translational study on the PETACC-3, EORTC 40993, SAKK 60-00 trial. J Clin Oncol 2009; 28:466-74. [PMID: 20008640 DOI: 10.1200/jco.2009.23.3452] [Citation(s) in RCA: 880] [Impact Index Per Article: 58.7] [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 Mutations within the KRAS proto-oncogene have predictive value but are of uncertain prognostic value in the treatment of advanced colorectal cancer. We took advantage of PETACC-3, an adjuvant trial with 3,278 patients with stage II to III colon cancer, to evaluate the prognostic value of KRAS and BRAF tumor mutation status in this setting. PATIENTS AND METHODS Formalin-fixed paraffin-embedded tissue blocks (n = 1,564) were prospectively collected and DNA was extracted from tissue sections from 1,404 cases. Planned analysis of KRAS exon 2 and BRAF exon 15 mutations was performed by allele-specific real-time polymerase chain reaction. Survival analyses were based on univariate and multivariate proportional hazard regression models. RESULTS KRAS and BRAF tumor mutation rates were 37.0% and 7.9%, respectively, and were not significantly different according to tumor stage. In a multivariate analysis containing stage, tumor site, nodal status, sex, age, grade, and microsatellite instability (MSI) status, KRAS mutation was associated with grade (P = .0016), while BRAF mutation was significantly associated with female sex (P = .017), and highly significantly associated with right-sided tumors, older age, high grade, and MSI-high tumors (all P < 10(-4)). In univariate and multivariate analysis, KRAS mutations did not have a major prognostic value regarding relapse-free survival (RFS) or overall survival (OS). BRAF mutation was not prognostic for RFS, but was for OS, particularly in patients with MSI-low (MSI-L) and stable (MSI-S) tumors (hazard ratio, 2.2; 95% CI, 1.4 to 3.4; P = .0003). CONCLUSION In stage II-III colon cancer, the KRAS mutation status does not have major prognostic value. BRAF is prognostic for OS in MS-L/S tumors.
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Affiliation(s)
- Arnaud D Roth
- Oncosurgery, Geneva UniversityHospital, Geneva, Switzerland.
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Löhr J, Bodoky G, Fölsch U, Märten A, Lilla C, Meyer I, Osinsky D, Szanto J, Lutz M. 6588 A phase II trial of cationic liposomal paclitaxel in combination with gemcitabine in patients with advanced pancreatic cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71309-6] [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: 11/28/2022] Open
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111
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Koeberle D, Montemurro M, Samaras P, Simcock M, Limacher A, Hess V, Inauen R, Borner M, Roth A, Bodoky G. 6515 Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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112
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Koeberle D, Montemurro M, Samaras P, Majno P, Simcock M, Kovacs K, Inauen R, Hess V, Saletti P, Bodoky G. Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4591] [Citation(s) in RCA: 7] [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
4591 Background: Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenetic activity. Evidence for clinical activity in HCC was reported in 2 phase II trials [Zhu et al and Faivre et al, ASCO 2007] using either a 37.5 or a 50 mg daily dose in a 4 weeks on, 2 weeks off regimen. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients (pts) with HCC. Methods: Key eligibility criteria included unresectable or metastatic HCC, no prior systemic anticancer treatment, measurable disease and Child-Pugh A or B liver dysfunction. Pts received 37.5 mg SU daily until progression or unacceptable toxicity. The primary endpoint was progression free survival at 12 weeks (PFS12) defined as ‘success’ if the patient was alive and without tumor progression assessed by 12 weeks (± 7 days) after registration. A PFS12 of ≤ 20% was considered uninteresting and promising if ≥ 40%. Using the Simon-two minimax stage design with 90% power and 5% significance the sample size was 45 pts. Secondary endpoints included safety assessments, measurement of serum cobalamin levels and tumor density. Results: From September 2007 to August 2008 45 pts, mostly male (87%), were enrolled in 10 centers. Median age was 63 years, 89% had Child-Pugh A and 47% had distant metastases. Median largest lesion diameter was 84 mm (range: 18 - 280) and 18% had prior TACE. Reasons for stopping therapy were: PD 60%, symptomatic deterioration 16%, toxicity 11%, death 2% (due to tumor), and other reasons 4%; 7% remain on therapy. PFS12 was rated as success in 15 pts (33%) (95% CI: 20%, 49%) and failure in 27 (60%); 3 were not evaluable (due to refusal). Over the whole trial period 1 CR and 40% SD as best response were achieved. Median PFS, duration of disease stabilization, TTP and OS were 2.8, 3.2, 2.8 and 9.3 months, respectively. Grade 3 and 4 adverse events were infrequent and all deaths due to the tumor. Conclusions: Continuous SU treatment with 37.5 mg/d daily is feasible and demonstrates moderate activity in pts with advanced HCC and mild to moderately impaired liver dysfunction. Under this trial design the therapy is considered promising (> 13 PFS12 successes). No significant financial relationships to disclose.
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Affiliation(s)
- D. Koeberle
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Montemurro
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Samaras
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Majno
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Simcock
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - K. Kovacs
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - R. Inauen
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - V. Hess
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Saletti
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - G. Bodoky
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
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Loehr M, Bodoky G, Fölsch U, Märten A, Karrasch M, Lilla C, Meyer I, Osinsky D, Szanto J, Lutz M. Cationic liposomal paclitaxel in combination with gemcitabine in patients with advanced pancreatic cancer: A phase II trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4526 Background: EndoTAG-1 is a novel cationic liposomal formulation of paclitaxel being developed for the treatment of solid malignancies. It acts by targeting activated negatively charged endothelial cells of tumor blood vessels. We present safety and efficacy data of a randomized, controlled phase II trial in pancreatic cancer (PC). Methods: 200 patients with advanced PC were randomized to 1st line treatment with weekly gemcitabine (GEM: 1000 mg/m2) and twice weekly infusions of EndoTAG-1 (E) at 3 different dose levels (Elow: 11 mg/m2, Emed: 22 mg/m2, Ehigh: 44 mg/m2) or GEM monotherapy. Patients were treated for 7 weeks and followed up for overall survival (OS) for at least 1 year. After finishing study treatment, any anti-tumor therapy was allowed. A subgroup of patients had the option to receive repeated cycles of combination therapy in case of at least stable disease according to RECIST until disease progression. Results: Median OS was substantially higher in the GEM+Emed and GEM+ Ehigh groups than the GEM monotherapy group. Adjusted hazard ratios for OS were 0.72 (95% CI 0.46–1.13) and 0.67 (0.43–1.07). In patients receiving >1 treatment cycle, median OS was 11.5 months (GEM+Ehigh); in the GEM+Emed group 75% of patients were alive at 1 year. Treatment with EndoTAG-1 and gemcitabine was generally well tolerated. A trend for increasing adverse event frequency with EndoTAG-1 dose was observed for infusion-related reactions associated with chills and pyrexia, and thrombocytopenia. The overall frequency of serious adverse events in the GEM+E groups was low, the most frequent SAE being pyrexia in 4 (8%) patients in the GEM+Ehigh group. There was no indication for significant organ toxicity associated with EndoTAG-1, even in patients receiving multiple treatment cycles. Conclusions: This phase II trial indicates a considerable survival benefit for patients with advanced PC receiving EndoTAG-1 in combination with gemcitabine and a favourable safety profile warranting further development of EndoTAG-1 in this indication. [Table: see text]
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Affiliation(s)
- M. Loehr
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - G. Bodoky
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - U. Fölsch
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - A. Märten
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - M. Karrasch
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - C. Lilla
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - I. Meyer
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - D. Osinsky
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - J. Szanto
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
| | - M. Lutz
- Karolinska Institute, Stockholm, Sweden; Szent Laszlo Hospital, Budapest, Hungary; University Hospital Schleswig-Holstein, Kiel, Germany; University Hospital Heidelberg, Heidelberg, Germany; MediGene AG, Martinsried, Germany; Institute of Oncology AMS of Ukraine, Kiev, Ukraine; Medical University of Debrecen, Debrecen, Hungary; Caritasklinik St. Theresa, Saarbrücken, Germany
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Kohne C, Stroiakovski D, Chang-chien C, Lim R, Pintér T, Bodoky G, Stroh C, Celik I, Rougier P, Van Cutsem E. Predictive biomarkers to improve treatment of metastatic colorectal cancer (mCRC): Outcomes with cetuximab plus FOLFIRI in the CRYSTAL trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4068] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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
4068 Background: KRAS oncogene mutation status is predictive of efficacy of cetuximab alone or combined with chemotherapy (CT) in mCRC. Previous data from the phase III CRYSTAL trial showed that adding cetuximab to FOLFIRI in first-line mCRC significantly improved the overall response rate (ORR) and progression-free survival (PFS) in pts with KRAS wild-type (wt) tumors. The serine-threonine kinase BRAF is a direct downstream effector of KRAS. Here, we report the influence of KRAS and BRAF status on mature overall survival (OS) data. Methods: DNA was extracted from archived tumor material where available from randomized pts. KRAS and BRAF mutation status (wt or mutant [mt]) was determined by quantitative PCR. Treatment arms were compared using two-sided log-rank tests (5% significance level) for PFS and OS, and the CMH test for best ORR. Results: The KRAS-evaluable cohort (n=540; 64.4% KRAS wt) was similar to the overall ITT group. In KRAS wt pts, adding cetuximab to FOLFIRI significantly increased the odds for tumor response nearly 2-fold, reduced the risk of progression by 32% and extended median OS from 21.0 months (mo) to 24.9 mo (details in Table ). KRAS mt pts did not benefit from cetuximab. Data on the impact of BRAF mutations on cetuximab activity will be presented at the meeting. In the FOLFIRI and cetuximab + FOLFIRI arms, 31.2% and 36.1% of pts, respectively, received no further line of therapy, while 25.4% and 6.2%, respectively, received EGFR antibody therapy. Conclusions: The benefits of adding cetuximab to CT were greater in KRAS wt pts than ITT pts for all clinically relevant endpoints. KRAS is a key biomarker for selecting a targeted therapy combined with standard CT in first-line mCRC. [Table: see text] [Table: see text]
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Affiliation(s)
- C. Kohne
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - D. Stroiakovski
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - C. Chang-chien
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - R. Lim
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - T. Pintér
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - G. Bodoky
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - C. Stroh
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - I. Celik
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - P. Rougier
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - E. Van Cutsem
- Klinikum Oldenburg, Oldenburg, Germany; Moscow City Oncology Hospital N62, Moscow, Russian Federation; Chang-Gung Memorial Hospital, Taipei, Taiwan; National University Hospital, Singapore; Petz Aladár Megyei Oktató Kórház Onkoradiológiai, Györ, Hungary; St László Hospital, Budapest, Hungary; Merck KGaA, Darmstadt, Germany; CHU Ambroise Pare, Universite de Versailles, Boulogne, France; University Hospital Gasthuisberg/Leuven, Leuven, Belgium
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Ajani JA, Rodriquez W, Bodoky G, Moiseyenko V, Lichinitser M, Gorbunova V, Vynnychenko I, Garin A, Lang I, Falcon S. Multicenter phase III comparison of cisplatin/S-1 (CS) with cisplatin/5-FU (CF) as first-line therapy in patients with advanced gastric cancer (FLAGS): Secondary and subset analyses. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [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
4511 Background: The primary analysis of FLAGS (ASCO-GI-2009) showed that CS and CF had similar overall survival (OS) but CS had a significantly superior safety profile. Methods: 1,053 (1,029 treated; CS=521/CF=508) patients with untreated, advanced gastric/gastroesophageal adenocarcinoma were randomized to either S-1 (25 mg/m2 bid, d 1–21)/cisplatin (75 mg/m2 d 1) q 28 d or 5-FU (1,000 mg/m2/d 5-d infusion)/cisplatin (100 mg/m2 d 1) q 28 d. OS analyses for non-inferiority (NI), by pre-specified stratifications, and by the largest histologic subset (diffuse type histology) were performed. Results: OS for NI: OS from CS compared to CF had a HR=0.92 (two-sided 95% CI, 0.80–1.05). HR=1.05 being much lower than HR=1.22 derived from the literature. Using a stringent HR non-inferiority margin of 1.10, CS remains statistically significantly non-inferior (p=0.0068) to CF. The 74% preserved control effect by CS is well above the suggested 50% by Rothmann et al. (Statist-Med2003;22:239–264). OS by stratifications: Of 12 stratification sub-categories, CS produced OS HR=<1.0 in 9 and HR=>1.0 in 3. Subset analysis: OS analysis for diffuse type histology (n=590) showed that CS (median survival=9.0 months) resulted in a superior OS (Log rank p=0.0413; HR, 0.83 [95% CI, 0.70 to 0.99]) than CF (median survival=7.1 months). Conclusions: CS is statistically non-inferior to CF while proving much safer for the patients. CS resulted in a HR=<1.0 in the majority of pre-specified stratifications and CS produced statistically superior OS for patients with diffuse type histology (needs prospective studies). CS is an optimum substitute for CF. Supported by Taiho Pharma, USA. No significant financial relationships to disclose.
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Affiliation(s)
- J. A. Ajani
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - W. Rodriquez
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - G. Bodoky
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - V. Moiseyenko
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - M. Lichinitser
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - V. Gorbunova
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - I. Vynnychenko
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - A. Garin
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - I. Lang
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - S. Falcon
- M. D. Anderson Cancer Center, Houston, TX; Instituto de Oncologia y Radioterapia, Lima, Peru; Onkologiai Osztaly, Budapest, Hungary; N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Russian Cancer Research Center, Moscow, Russian Federation; Sumy Regional Oncology Centre, Sumy, Ukraine; Orszagos Onkologiai Intezet, Budapest, Hungary; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
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Van Cutsem E, Labianca R, Bodoky G, Barone C, Aranda E, Nordlinger B, Topham C, Tabernero J, André T, Sobrero AF, Mini E, Greil R, Di Costanzo F, Collette L, Cisar L, Zhang X, Khayat D, Bokemeyer C, Roth AD, Cunningham D. Randomized phase III trial comparing biweekly infusional fluorouracil/leucovorin alone or with irinotecan in the adjuvant treatment of stage III colon cancer: PETACC-3. J Clin Oncol 2009; 27:3117-25. [PMID: 19451425 DOI: 10.1200/jco.2008.21.6663] [Citation(s) in RCA: 316] [Impact Index Per Article: 21.1] [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 The primary objective of this randomized, multicenter, phase III trial was to investigate whether the addition of irinotecan to the de Gramont infusional fluorouracil (FU)/leucovorin (LV) adjuvant regimen (LV5FU2) would improve disease-free survival (DFS) in patients with stage III colon cancer. PATIENTS AND METHODS After curatively intentioned surgery, patients with stage II and III colon cancer were randomly allocated surgery to receive LV5FU2 (LV 200 mg/m(2) as a 2-hour infusion, followed by FU; as a 400 mg/m(2) bolus and then a 600 mg/m(2) continuous infusion over 22 hours, days 1 and 2, every 2 weeks for 12 cycles: de Gramont regimen) with or without irinotecan (180 mg/m(2) as a 30- to 90-minute infusion, day 1, every 2 weeks). In total, 260 (7.9%) of 3,278 patients received an alternative high-dose infusional FU/LV regimen (Arbeitsgemeinschaft Internische Onkologie regimen) with or without irinotecan. Results The principal efficacy analysis was based on 2,094 treated patients with stage III disease, randomly allocated in the LV5FU2 strata. After a median follow-up of 66.3 months, the 5-year DFS rate was 56.7% with irinotecan/LV5FU2 and 54.3% with LV5FU2 alone (primary end point: log-rank P = .106). Combining irinotecan with LV5FU2 did not significantly improve overall survival in this patient group compared with LV5FU2 alone (5-year rate 73.6% v 71.3%, respectively; log-rank P = .094). The addition of irinotecan to LV5FU2 was associated with an increased incidence of grade 3 to 4 GI events and neutropenia. CONCLUSION Irinotecan added to LV5FU2 as adjuvant therapy did not confer a statistically significant improvement in DFS or overall survival in patients with stage III colon cancer compared with LV5FU2 alone.
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Affiliation(s)
- Eric Van Cutsem
- Digestive Oncology Unit, University Hospital Gasthuisberg/Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Van Cutsem E, Köhne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, D'Haens G, Pintér T, Lim R, Bodoky G, Roh JK, Folprecht G, Ruff P, Stroh C, Tejpar S, Schlichting M, Nippgen J, Rougier P. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med 2009; 360:1408-17. [PMID: 19339720 DOI: 10.1056/nejmoa0805019] [Citation(s) in RCA: 3021] [Impact Index Per Article: 201.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We investigated the efficacy of cetuximab plus irinotecan, fluorouracil, and leucovorin (FOLFIRI) as first-line treatment for metastatic colorectal cancer and sought associations between the mutation status of the KRAS gene in tumors and clinical response to cetuximab. METHODS We randomly assigned patients with epidermal growth factor receptor-positive colorectal cancer with unresectable metastases to receive FOLFIRI either alone or in combination with cetuximab. The primary end point was progression-free survival. RESULTS A total of 599 patients received cetuximab plus FOLFIRI, and 599 received FOLFIRI alone. The hazard ratio for progression-free survival in the cetuximab-FOLFIRI group as compared with the FOLFIRI group was 0.85 (95% confidence interval [CI], 0.72 to 0.99; P=0.048). There was no significant difference in the overall survival between the two treatment groups (hazard ratio, 0.93; 95% CI, 0.81 to 1.07; P=0.31). There was a significant interaction between treatment group and KRAS mutation status for tumor response (P=0.03) but not for progression-free survival (P=0.07) or overall survival (P=0.44). The hazard ratio for progression-free survival among patients with wild-type-KRAS tumors was 0.68 (95% CI, 0.50 to 0.94), in favor of the cetuximab-FOLFIRI group. The following grade 3 or 4 adverse events were more frequent with cetuximab plus FOLFIRI than with FOLFIRI alone: skin reactions (which were grade 3 only) (in 19.7% vs. 0.2% of patients, P<0.001), infusion-related reactions (in 2.5% vs. 0%, P<0.001), and diarrhea (in 15.7% vs. 10.5%, P=0.008). CONCLUSIONS First-line treatment with cetuximab plus FOLFIRI, as compared with FOLFIRI alone, reduced the risk of progression of metastatic colorectal cancer. The benefit of cetuximab was limited to patients with KRAS wild-type tumors. (ClinicalTrials.gov number, NCT00154102.)
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Affiliation(s)
- Eric Van Cutsem
- University Hospital Gasthuisberg, Digestive Oncology Unit, Herestraat 49, 3000 Leuven, Belgium.
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Bernhard J, Dietrich D, Scheithauer W, Gerber D, Bodoky G, Ruhstaller T, Glimelius B, Bajetta E, Schüller J, Saletti P, Bauer J, Figer A, Pestalozzi BC, Köhne CH, Mingrone W, Stemmer SM, Tàmas K, Kornek GV, Koeberle D, Herrmann R. Clinical benefit and quality of life in patients with advanced pancreatic cancer receiving gemcitabine plus capecitabine versus gemcitabine alone: a randomized multicenter phase III clinical trial--SAKK 44/00-CECOG/PAN.1.3.001. J Clin Oncol 2008; 26:3695-701. [PMID: 18669454 DOI: 10.1200/jco.2007.15.6240] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [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 To compare clinical benefit response (CBR) and quality of life (QOL) in patients receiving gemcitabine (Gem) plus capecitabine (Cap) versus single-agent Gem for advanced/metastatic pancreatic cancer. PATIENTS AND METHODS Patients were randomly assigned to receive GemCap (oral Cap 650 mg/m(2) twice daily on days 1 through 14 plus Gem 1,000 mg/m(2) in a 30-minute infusion on days 1 and 8 every 3 weeks) or Gem (1,000 mg/m(2) in a 30-minute infusion weekly for 7 weeks, followed by a 1-week break, and then weekly for 3 weeks every 4 weeks) for 24 weeks or until progression. CBR criteria and QOL indicators were assessed over this period. CBR was defined as improvement from baseline for >or= 4 consecutive weeks in pain (pain intensity or analgesic consumption) and Karnofsky performance status, stability in one but improvement in the other, or stability in pain and performance status but improvement in weight. RESULTS Of 319 patients, 19% treated with GemCap and 20% treated with Gem experienced a CBR, with a median duration of 9.5 and 6.5 weeks, respectively (P < .02); 54% of patients treated with GemCap and 60% treated with Gem had no CBR (remaining patients were not assessable). There was no treatment difference in QOL (n = 311). QOL indicators were improving under chemotherapy (P < .05). These changes differed by the time to failure, with a worsening 1 to 2 months before treatment failure (all P < .05). CONCLUSION There is no indication of a difference in CBR or QOL between GemCap and Gem. Regardless of their initial condition, some patients experience an improvement in QOL on chemotherapy, followed by a worsening before treatment failure.
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Affiliation(s)
- Jürg Bernhard
- Swiss Group for Clinical Cancer Research Coordinating Center, Bern, Switzerland.
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Löhr M, Haas S, Bechstein W, Karrasch M, Mescheder A, Meyer I, Bodoky G, Pap A, Jäger D, Fölsch UR. First-line treatment of inoperable pancreatic adenocarcinoma with lipid complexed paclitaxel nanoparticles plus gemcitabine compared with gemcitabine monotherapy. A prospective RCT - phase II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4618] [Citation(s) in RCA: 5] [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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121
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Roth AD, Yan P, Dietrich D, Fiocca R, Bodoky G, Labianca R, Cunningham D, Van Cutsem E, Bosman F, Tejpar S. Is UGT1A1*28 homozygosity the strongest predictor for severe hematotoxicity in patients treated with 5-fluorouracil (5-FU)-irinotecan (IRI)? Results of the PETACC 3 - EORTC 40993 -SAKK 60/00 trial comparing IRI/5-FU/folinic acid (FA) to 5-FU/FA in stage II- III colon cancer (COC) patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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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Hess V, Glimelius B, Grawe P, Dietrich D, Bodoky G, Ruhstaller T, Bajetta E, Saletti P, Figer A, Scheithauer W, Herrmann R. CA 19-9 tumour-marker response to chemotherapy in patients with advanced pancreatic cancer enrolled in a randomised controlled trial. Lancet Oncol 2008; 9:132-8. [PMID: 18249033 DOI: 10.1016/s1470-2045(08)70001-9] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies in patients undergoing chemotherapy for advanced pancreatic carcinoma have linked a decrease in the concentration of the tumour marker carbohydrate antigen (CA) 19-9 to lengthened survival. The aim of this study was to test the hypotheses that an early decrease in baseline serum CA 19-9 concentration (on day 42, after two cycles of chemotherapy) by at least 50% is associated with lengthened survival, and that a decrease in CA 19-9 concentration of at least 50% from the baseline concentration to the lowest value measured at any time during treatment (nadir) is of prognostic significance, enabling its use as a surrogate endpoint for survival. METHODS CA 19-9 serum concentration was measured at baseline and every 3 weeks thereafter in patients with histologically proven advanced pancreatic carcinoma enrolled in a randomised trial of gemcitabine versus gemcitabine plus capecitabine. Patients were excluded if baseline serum CA 19-9 concentration was below the upper limit of normal (ULN) in the laboratory or if this measurement was missing. Comparisons of survival between patients with and without a CA 19-9 response were corrected for the guarantee-time bias by the landmark method. The trial on which this study is based is registered on the clinical trials site of the US National Cancer Institute website http://www.clinicaltrials.gov/ct/show/NCT00030732. FINDINGS 247 of 319 randomised patients were assessable for analysis of baseline serum CA 19-9 concentration, and, of these, 175 patients were assessable for tumour-marker response to treatment. Median overall survival for patients with a baseline CA 19-9 concentration equal to or above the median value (ie, 59xULN) was 5.8 months (95% CI 5.1-7.0), which was significantly shorter than that for patients with baseline concentrations below the median value (10.3 months [95% CI 8.6-12.8], p<0.0001). An early decrease in CA 19-9 concentration of at least 50% after two cycles of chemotherapy was not associated with a longer overall survival compared with patients who did not have a decrease of at least 50% (median 10.1 months [9.2-12.7] vs 8.6 months [6.9-11.2], p=0.53; hazard ratio for death 1.11 [0.81-1.52]). Furthermore, a decrease in CA 19-9 concentration of at least 50% reached at the CA 19-9 nadir concentration was not associated with a longer overall survival compared with those patients who did not have a decrease of at least 50% (median 7.8 months [6.5.10.1] vs 6.7 months [5.5-9.8], p=0.74; 0.95 [0.69-1.31]) after adjusting for the guarantee-time bias. INTERPRETATION Pretreatment serum CA 19-9 concentration is an independent prognostic factor for survival, but a decrease in concentration during chemotherapy is not significantly associated with lengthened survival compared with those who did not have a corresponding decrease. Our data suggest that CA 19-9 response during chemotherapy is not a valid surrogate endpoint for survival in clinical trials.
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Affiliation(s)
- Viviane Hess
- Division of Medical Oncology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
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Langmuir V, Ciuleanu T, Pavlovsky A, Bodoky G, Garin A, Kroll S, Colowick A, Tidmarsh G. 3505 ORAL Glufosfamide (GLU) in metastatic pancreatic adenocarcinoma previously treated with gemcitabine: Results of a Phase III trial. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71008-x] [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: 11/30/2022] Open
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van Cutsem E, Bodoky G, Kyung Roh J, Folprecht G, Park Y, van Laethem J, Raoul J, Ciardiello F, Lebrun P, Rougier P. 3001 ORAL CRYSTAL, a randomized phase III trial of cetuximab plus FOLFIRI vs. FOLFIRI in first-line metastatic colorectal cancer (mCRC). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70929-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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125
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Hecht J, Trarbach T, Jaeger E, Hainsworth J, Wolff R, Lloyd K, Bodoky G, Borner M, Laurent D, Jacques C. 3010 ORAL Final overall survival (OS) results of CONFIRM 1 (CF1), a randomized, double-blind, placebo-controlled phase III trial in patients with metastatic adenocarcinoma of the colon or rectum (mCRC) receiving first line chemotherapy with oxaliplatin/5-fluorouracil/Leucovorin (FOLFOX 4) and PTK787/ZK 222584 (PTK/ZK) or placebo (PBO). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70938-2] [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: 10/22/2022] Open
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126
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Roth A, Tejpar S, Yan P, Fiocca R, Hsu Schmitz S, Bodoky G, Labianca R, Cunningham D, van Cutsem E, Bosman F. 3013 ORAL Tissue biomarkers in colon cancer (COC): Early results of the translational study on a phase III trial comparing infused irinotecan/ 5-fluorouracil (5-FU)/folinic acid (FA) to 5-FU/FA in stage II–III COC patients (PETACC 3–EORTC 40993–SAKK 60/00). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70941-2] [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: 10/22/2022] Open
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Bodoky G. [Role of angiogenesis inhibitors in the treatment of colorectal cancer]. Magy Onkol 2007; 51:139-144. [PMID: 17660870] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 06/25/2007] [Indexed: 05/25/2023]
Abstract
In our time, molecular targeted therapy plays a key role in the modern therapy of solid tumors. Of these modalities, in colorectal cancer monoclonal antibodies are introduced in routine use. In our article we provide an overview of the mechanism of action, place in treatment and efficacy of bevacizumab, an angiogenic inhibitor.
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Affiliation(s)
- György Bodoky
- Fovárosi Szent László és Szent István Kórház, Onkológiai Osztály, Budapest.
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128
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Roth AD, Tejpar S, Yan P, Fiocca R, Dietrich D, Bodoky G, Labianca R, Cunningham D, Van Cutsem E, Bosman F. Tissue biomarkers (BIOM) in colon cancer (COC): The translational study on the randomized phase III trial comparing infused irinotecan/5-fluorouracil (5-FU)/folinic acid (FA) to 5-FU/FA in stage II-III COC patients (pts). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4022] [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
4022 Background and Aims: PETACC 3 is a large adjuvant trial with 3,005 COC pts. The value of BIOM in COC in adjuvant setting is still a matter of debate because of lack of large data sets. We took advantage of PETACC 3 to assess P53, SMAD4, thymidylate synthetase (TS), telomerase (HTERT) expressions, UGT1A1 genotype, KRAS and BRAF mutations, microsatellite instability (MSI), 18q and 8p LOH with regard to their prognostic and predictive value and their individual interactions on a very large homogeneous cohort of COC pts. In addition we investigated the association between UGT1A1 genotype and occurrence of diarrhoea and Gd 4 neutropenia. Methods: 1,564 formalin fixed paraffin embedded (FFPE) tissue blocks of PETACC 3 pts were prospectively collected and 5–20μ sections cut. DNA from normal (Nor) and tumoral (Tu) tissue was extracted after section microdissection. P53, SMAD4, TS and HTERT were assessed by immunohistochemistry (IHC); MSI was typed with 10 markers, KRAS exon 2 and BRAF exon 15 mutations by allele specific real time PCR on Tu DNA; 18q and 8p LOH by typing multiple SNPs by pyrosequencing on Nor/Tu DNA; UGT1A1 genotypes by PCR and fragment sizing on Nor DNA. Prognostic/predictive value of each BIOM is analysed by Cox regression for disease free survival and by logistic regression for specific toxicity. Associations between any 2 categorized BIOM and between each BIOM and each known prognostic variable are tested by chi-square tests. Results: DNA of 1405 pts was extracted and successfully analyzed in 97.1% for KRAS, 98.6% for BRAF, 94% for 18q LOH, 93.6% for MSI, 86% for UGT1A1, 8p LOH is still ongoing. Of 1530 pts slides IHC analysis was successful in 94.5% for P53, 94.2% for SMAD4, 82.9% for TS, 53.9% for HTERT. The clinical database was made available in Nov 06 and statistical analysis started on Dec 11th 2006. Conclusion: This is the largest multicenter centrally coordinated tissue BIOM study performed in COC to date. The high success rate of analysis shows that large prospective BIOM studies can be performed on routine FFPE material. Final results on the prognostic/predictive value of each molecular BIOM will be available at the meeting. No significant financial relationships to disclose.
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Affiliation(s)
- A. D. Roth
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - S. Tejpar
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - P. Yan
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - R. Fiocca
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - D. Dietrich
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - G. Bodoky
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - R. Labianca
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - D. Cunningham
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - E. Van Cutsem
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
| | - F. Bosman
- Geneva University Hospital, Geneva, Switzerland; University Hospital Gasthuisberg, Leuven, Belgium; Lausanne University, Lausanne, Switzerland; University of Genova, Genova, Italy; Swiss Group for Clinical Cancer Research, Bern, Switzerland; St Laszlo Hospital, Budapest, Hungary; Ospedali Riuniti, Bergamo, Italy; The Royal Marsden Hospital, Sutton, United Kingdom
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Herrmann R, Bodoky G, Ruhstaller T, Glimelius B, Bajetta E, Schüller J, Saletti P, Bauer J, Figer A, Pestalozzi B, Köhne CH, Mingrone W, Stemmer SM, Tàmas K, Kornek GV, Koeberle D, Cina S, Bernhard J, Dietrich D, Scheithauer W. Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol 2007; 25:2212-7. [PMID: 17538165 DOI: 10.1200/jco.2006.09.0886] [Citation(s) in RCA: 422] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This phase III trial compared the efficacy and safety of gemcitabine (Gem) plus capecitabine (GemCap) versus single-agent Gem in advanced/metastatic pancreatic cancer. PATIENTS AND METHODS Patients were randomly assigned to receive GemCap (oral capecitabine 650 mg/m2 twice daily on days 1 to 14 plus Gem 1,000 mg/m2 by 30-minute infusion on days 1 and 8 every 3 weeks) or Gem (1,000 mg/m2 by 30-minute infusion weekly for 7 weeks, followed by a 1-week break, and then weekly for 3 weeks every 4 weeks). Patients were stratified according to center, Karnofsky performance score (KPS), presence of pain, and disease extent. RESULTS A total of 319 patients were enrolled between June 2001 and June 2004. Median overall survival (OS) time, the primary end point, was 8.4 and 7.2 months in the GemCap and Gem arms, respectively (P = .234). Post hoc analysis in patients with good KPS (score of 90 to 100) showed a significant prolongation of median OS time in the GemCap arm compared with the Gem arm (10.1 v 7.4 months, respectively; P = .014). The overall frequency of grade 3 or 4 adverse events was similar in each arm. Neutropenia was the most frequent grade 3 or 4 adverse event in both arms. CONCLUSION GemCap failed to improve OS at a statistically significant level compared with standard Gem treatment. The safety of GemCap and Gem was similar. In the subgroup of patients with good performance status, median OS was improved significantly. GemCap is a practical regimen that may be considered as an alternative to single-agent Gem for the treatment of advanced/metastatic pancreatic cancer patients with a good performance status.
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Affiliation(s)
- Richard Herrmann
- Division of Oncology, Department of Internal Medicine, University Hospital of Basel, Basel, Switzerland.
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Pulay T, Baki M, Bodoky G, Dank M, Cseh J, Csejtei A, Csömör S, Erfán J, Esik O, Faluhelyi Z, Izsó J, Hernádi Z, Kammerer K, Magyar T, Mayer A, Megyery E, Moskovits K, Pécsi L, Pikó B, Pintér T, Ruzsa A, Szánthó A, Szántó I, Szántó J, Szucs M, Tálos Z, Thurzó L, Kásler M. [The results of ovarian cancer therapy in the Hungarian Centers in 2002-2003]. Orv Hetil 2006; 147:2493-500. [PMID: 17294573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED Authors presented data of treatment results and course of disease in 487 ovarian cancer patients treated by primary surgery and paclitaxel-carboplatin combination chemotherapy between July 1, 2002 and December 31, 2003. PATIENTS Most of our patients (87.8%) belonged to the age-group between 40-70 years. Distribution of their histological diagnosis was as 69.6% serous, 10.7% mucinous, 5.1% endometrial and 4.7% undifferentiated carcinoma. The grade distribution was found as 8.4% grade 1, 40.9% grade 2 and 35.9% grade 3. RESULTS The primary surgery was evaluated as optimal in 41.7%, suboptimal in 37.3% and exploration was performed in 21.1%. Most patients started chemotherapy 20 days after surgery and 74.2% of them got six courses. During the evaluation period 61 intervallum laparotomies were performed, and resulted on 55.7% optimal debulking. Complete remission was found in 58.9%, and partial remission in 14.7% of patients. This treatment resulted on a complete remission in 40.9% at the follow-up of 12 months.
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131
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Cassidy J, Bjarnason GA, Hickish T, Topham C, Provencio M, Bodoky G, Landherr L, Koralewski P, Lopez-Vivanco G, Said G. Randomized double blind (DB) placebo (Plcb) controlled phase III study assessing the efficacy of xaliproden (X) in reducing the cumulative peripheral sensory neuropathy (PSN) induced by the oxaliplatin (Ox) and 5-FU/LV combination (FOLFOX4) in first-line treatment of patients (pts) with metastatic colorectal cancer (MCRC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3507] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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
3507 Background: X, an orally administered non-peptide neurotrophic agent developed by sanofi-aventis, was shown in vitro to minimize neuritic damage induced by Ox (co-culture of Schwann cells and dorsal roots ganglia explant). The probability of occurrence of Grade (Gr) 3–4 PSN at a cumulative dose of Ox of 1000 mg/m2, was consistently reported to be of 18–20%. Methods: First line MCRC pts were randomized to receive, in a DB fashion, FOLFOX4 and either Plcb or X 1mg daily. X was administered from the 1st day of chemotherapy till 15 days post last Ox cycle. Co-primary objectives were reduction in the risk of occurrence of Gr 3–4 PSN relative to cumulative dose of Ox (Kaplan-Meier method) and non-inferiority in response rate (RR). Secondary endpoints included evaluation of sensory action potential (SAP) and safety. Results: From July 2002 to May 2004, 649 pts were randomized (324 Plcb, 325 X). Pts characteristics were well balanced across arms, median number of Ox cycles was 12 in both arms, median relative dose intensity (%) was 83.8 (Plcb) and 85.2 (X). A significant risk reduction of 39% in the probability of Grade 3–4 PSN in favor of X was reported (hazard ratio [95% CI] = 0.61 [0.40; 0.93], p= 0.0203). Overall RR [95 % CI] was: Plcb 42.6% [37.1; 48.2] and X 44.9% [39.4; 50.6]. As prospectively defined in the protocol, the lower bound of the CI of the RR ratio above 0.8 confirms noninferiority in RR (1.055 [0.88; 1.26]). In both arms the mean % of change in SAP worsens as a function of PSN severity. 17.3 (Plcb) and 13.5% (X) of the pts discontinued Ox because of PSN. Severe toxicities (% Gr 3–4), reported with a ≥2% difference between arms, were (plcb vs X): diarrhea 10.9 vs 13.0, pulmonary embolism 0.9 vs 3.1, fatigue 3.7 vs 1.5, neutropenia 43.0 vs 37.8. Conclusion: X was shown to be efficient in reducing the risk of Grade 3–4 oxaliplatin-induced PSN without impacting FOLFOX4 antitumor activity. No significant financial relationships to disclose.
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Affiliation(s)
- J. Cassidy
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - G. A. Bjarnason
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - T. Hickish
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - C. Topham
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - M. Provencio
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - G. Bodoky
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - L. Landherr
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - P. Koralewski
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - G. Lopez-Vivanco
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - G. Said
- Beatson Oncology Center, Glasgow, United Kingdom; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Poole and Bournemouth Hospitals, Poole and Bournemouth, United Kingdom; Royal Surrey County Hospital, Guildford, United Kingdom; Clinica Puerta de Hierro, Madrid, Spain; St Laszlo Hospital, Budapest, Hungary; Uzsoki Street Hospital, Budapest, Hungary; Rydygier Memorial Hospital, Krakow, Poland; Hospital de Cruces, Barakaldo, Spain; Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de van der Schueren MAE, von Meyenfeldt M, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr 2006; 25:245-59. [PMID: 16697500 DOI: 10.1016/j.clnu.2006.01.020] [Citation(s) in RCA: 386] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 02/06/2023]
Abstract
Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in cancer patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards, are based on all relevant publications since 1985 and were discussed and accepted in a consensus conference. Undernutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is markedly reduced for more than 7-10 days. Standard formulae are recommended for EN. Nutritional needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status. EN is indicated preoperatively for 5-7 days in cancer patients undergoing major abdominal surgery. During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose) chemotherapy.
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Affiliation(s)
- J Arends
- Department of Medical Oncology, Tumor Biology Center, Albert-Ludwigs-Universität, Freiburg, Germany.
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Canon JL, Vansteenkiste J, Bodoky G, Mateos MV, Bastit L, Ferreira I, Rossi G, Amado RG. Randomized, double-blind, active-controlled trial of every-3-week darbepoetin alfa for the treatment of chemotherapy-induced anemia. J Natl Cancer Inst 2006; 98:273-84. [PMID: 16478746 DOI: 10.1093/jnci/djj053] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the United States, darbepoetin alfa (Aranesp) is often used to treat patients with chemotherapy-induced anemia using weekly or every-2-week administration schedules. In Europe, darbepoetin alfa is used either weekly or in every-3-week dosing. The every-3-week schedule can be synchronized with many chemotherapy regimens, resulting in fewer visits and reducing burden to patients, but the safety and efficacy of this regimen have not been clear. METHODS A randomized, double-blind, double-dummy, active-controlled phase 3 trial was performed in 110 European centers. Eligible patients (age > or = 18 years) were anemic (hemoglobin level < 11 g/dL), had a nonmyeloid malignancy, and were to receive at least 12 weeks of chemotherapy. Patients were randomly assigned 1:1 to darbepoetin alfa treatment every 3 weeks (500-microg dose) or weekly (2.25-microg/kg) for 15 weeks. We compared red blood cell transfusion incidence among the two arms from week 5 to the end of the treatment phase using a noninferiority study design. Noninferiority was determined if the upper limit of the 95% confidence interval (CI) for the difference in blood transfusions between groups, calculated using Kaplan-Meier methods, did not exceed 12.5%, a margin based on previous placebo-controlled studies. RESULTS A total of 705 patients were randomly assigned, and 672 remained in the study at week 5. Fewer patients in the every-3-week arm than in the weekly arm received blood transfusions from week 5 to the end of the treatment phase (unadjusted Kaplan-Meier estimates = 23% versus 30%, difference = -6.8%; 95% CI = -13.6 to 0.1). Percentages of patients achieving the target hemoglobin level (> or = 11 g/dL, consistent with evidence-based practice guidelines) were 84% (every 3 weeks) and 77% (weekly). The frequency of cardiovascular/thromboembolic adverse events was 8% in both groups, and safety was comparable. CONCLUSIONS Patients with chemotherapy-induced anemia can safely and effectively be treated with 500 microg of darbepoetin alfa every 3 weeks.
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Affiliation(s)
- Jean-Luc Canon
- Centre Hospitalier Notre Dame et Reine Fabiola, Charleroi, Belgium.
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van Cutsem E, Labianca R, Hossfeld D, Bodoky G, Roth A, Aranda E, Nordlinger B, Assadourian S, Wang K, Cunningham D. Randomized phase III trial comparing infused irinotecan/5-fluorouracil (5-FU)/folinic acid (IF) versus 5-FU/FA (F) in stage III colon cancer patients (pts). (PETACC 3). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba8] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [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)
- E. van Cutsem
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - R. Labianca
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - D. Hossfeld
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - G. Bodoky
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - A. Roth
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - E. Aranda
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - B. Nordlinger
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - S. Assadourian
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - K. Wang
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
| | - D. Cunningham
- Univ Hosp Gasthuisberg/Leuven, Leuven, Belgium; Ospedali Riuniti, Bergamo, Italy; Univ of Hamburg, Hamburg, Germany; Szt. Laszlo Hosp, Budapest, Hungary; Hosp Univ de Geneve, Geneva, Switzerland; Hosp Universiterio’ Reina Sofia, Cordoba, Spain; Hosp Ambroise Pare, Boulogne, France; Sanofi-Aventis, Antony, France; Pfizer Inc, New York, NY; The Royal Marsden Hosp, Sutton, United Kingdom
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Canon JL, Vansteenkiste J, Bodoky G, Mateos MV, Bastit L, Ferreira I, Rossi G. Final results of a randomized, double-blind, active-controlled trial of darbepoetin alfa administered once every 3 weeks (Q3W) for the treatment of anemia in patients receiving multicycle chemotherapy. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba8284] [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.-L. Canon
- Hôpital De Jour D’onco-Hématologie, Charleroi, Belgium; Univ Hosp Gasthuisberg, Leuven, Belgium; Szt. László Hosp, Budapest, Hungary; Univ of Salamanca Hosp Clinic, Salamanca, Spain; Ctr Fréderic Joliot, Rouen, France; Amgen Inc., Thousand Oaks, CA
| | - J. Vansteenkiste
- Hôpital De Jour D’onco-Hématologie, Charleroi, Belgium; Univ Hosp Gasthuisberg, Leuven, Belgium; Szt. László Hosp, Budapest, Hungary; Univ of Salamanca Hosp Clinic, Salamanca, Spain; Ctr Fréderic Joliot, Rouen, France; Amgen Inc., Thousand Oaks, CA
| | - G. Bodoky
- Hôpital De Jour D’onco-Hématologie, Charleroi, Belgium; Univ Hosp Gasthuisberg, Leuven, Belgium; Szt. László Hosp, Budapest, Hungary; Univ of Salamanca Hosp Clinic, Salamanca, Spain; Ctr Fréderic Joliot, Rouen, France; Amgen Inc., Thousand Oaks, CA
| | - M. V. Mateos
- Hôpital De Jour D’onco-Hématologie, Charleroi, Belgium; Univ Hosp Gasthuisberg, Leuven, Belgium; Szt. László Hosp, Budapest, Hungary; Univ of Salamanca Hosp Clinic, Salamanca, Spain; Ctr Fréderic Joliot, Rouen, France; Amgen Inc., Thousand Oaks, CA
| | - L. Bastit
- Hôpital De Jour D’onco-Hématologie, Charleroi, Belgium; Univ Hosp Gasthuisberg, Leuven, Belgium; Szt. László Hosp, Budapest, Hungary; Univ of Salamanca Hosp Clinic, Salamanca, Spain; Ctr Fréderic Joliot, Rouen, France; Amgen Inc., Thousand Oaks, CA
| | - I. Ferreira
- Hôpital De Jour D’onco-Hématologie, Charleroi, Belgium; Univ Hosp Gasthuisberg, Leuven, Belgium; Szt. László Hosp, Budapest, Hungary; Univ of Salamanca Hosp Clinic, Salamanca, Spain; Ctr Fréderic Joliot, Rouen, France; Amgen Inc., Thousand Oaks, CA
| | - G. Rossi
- Hôpital De Jour D’onco-Hématologie, Charleroi, Belgium; Univ Hosp Gasthuisberg, Leuven, Belgium; Szt. László Hosp, Budapest, Hungary; Univ of Salamanca Hosp Clinic, Salamanca, Spain; Ctr Fréderic Joliot, Rouen, France; Amgen Inc., Thousand Oaks, CA
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Hecht JR, Trarbach T, Jaeger E, Hainsworth J, Wolff R, Lloyd K, Bodoky G, Borner M, Laurent D, Jacques C. A randomized, double-blind, placebo-controlled, phase III study in patients (Pts) with metastatic adenocarcinoma of the colon or rectum receiving first-line chemotherapy with oxaliplatin/5-fluorouracil/leucovorin and PTK787/ZK 222584 or placebo (CONFIRM-1). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba3] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [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)
- J. R. Hecht
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - T. Trarbach
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - E. Jaeger
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - J. Hainsworth
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - R. Wolff
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - K. Lloyd
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - G. Bodoky
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - M. Borner
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - D. Laurent
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
| | - C. Jacques
- UCLA Sch of Medcn, Los Angeles, CA; Univ of Essen, Essen, Germany; Krankenhaus Nordwest, Frankfurt, Germany; Sarah Cannon Cancer Ctr, Nashville, TN; MD Anderson Cancer Ctr, Houston, TX; Virginia Cancer Institute, Richmond, VA; Szent Laszlo Hosp, Budapest, Hungary; Inst for Medcl Oncology, Bern, Switzerland; Schering AG, Berlin, Germany; Novartis, East Hanover, NJ
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137
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Herrmann R, Bodoky G, Ruhstaller T, Glimelius B, Saletti P, Bajetta E, Schueller J, Bernhard J, Dietrich D, Scheithauer W. Gemcitabine (G) plus capecitabine (C) versus G alone in locally advanced or metastatic pancreatic cancer. A randomized phase III study of the Swiss Group for Clinical Cancer Research (SAKK) and the Central European Cooperative Oncology Group (CECOG). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba4010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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. Herrmann
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - G. Bodoky
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - T. Ruhstaller
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - B. Glimelius
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - P. Saletti
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - E. Bajetta
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - J. Schueller
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - J. Bernhard
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - D. Dietrich
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - W. Scheithauer
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
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138
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Pulay T, Baki M, Bodoky G, Dank M, Cseh J, Csejtei A, Csömör S, Erfán J, Esik O, Faluhelyi Z, Izsó J, Hernádi Z, Kammerer K, Krommer K, Magyar T, Mayer A, Megyery E, Moskovits K, Pécsi L, Pikó B, Pintér T, Ruzsa A, Szánthó A, Szántó I, Szántó J, Szucs M, Tálos Z, Thurzó L, Kásler M. [Status report on the chemotherapy of ovarian cancer at special cancer centers in Hungary (2002-2003)]. Magy Onkol 2005; 48:275-280. [PMID: 15655571] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 11/30/2004] [Indexed: 05/24/2023]
Abstract
Data on the first-line treatment of ovarian cancer in special centers of Hungary 2002 and 2003 are presented, involving 283 and 416 patients, respectively. Patients' age, clinical stage and histological type of the tumor were highly similar to literature data, while grades were different. Surgical effectiveness in case of IIIc staged tumors with >1 cm residual mass was 37%. The ratio of interval laparotomy was about 15%. Overall response rates of the first-line treatment of ovarian cancer was 82%, while the rate of complete remissions was 60%. The authors provide detailed analysis of factors that can improve the chemotherapy of ovarian cancer in Hungary.
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Affiliation(s)
- Tamás Pulay
- Országos Onkológiai Intézet, Budapest 1122, Hungary.
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139
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Abstract
BACKGROUND As colorectal malignancies are relatively well treatable and show acceptable survival rates, the quality of life indicators are very important in this group of patients. PATIENTS AND METHODS 372 patients with rectal cancer were included on a voluntary basis in this prospective study. The patient material consisted of two groups, those who underwent sphincter saving operation (64.51 %), and those who underwent Miles operation (35.49 %). The patients answered a colorectal cancer specific questionnaire on quality of life (CRC_QoL) 1 year after surgery. A CRC_QoL was prepared to analyze the correlation between the characteristics of the colorectal cancer and its treatment versus the physical and psychological state, somatic sensations and social connections of the patients. Our QoL questionnaire consists of 62 questions. Internal consistency of each factor was assessed by calculating Cronbach alpha values and was found satisfactory. For the test-retest reliability analysis the questionnaires were re-assessed. Correlation analysis showed that the answers were consistent (p < 0.01 in all cases). Discriminative validity analysis of the factors showed a significant difference in all cases. In self made score system higher numbers mean (9) worse, the smaller mean (0) better quality of life. The scale can also be seen as a percent distribution, where - in turn - the best quality is 100. The CRC_QoL questionnaire, scoring system, and score-to-percent transformation were done in this study. The results were evaluated by question and by patient group too. RESULTS Our indicator did not show poor QoL for ostomates. Physical function was quite good in both groups: non-ostomates 87.69 +/- 20.85, ostomates: 96.46 +/- 8.25, p = 0.05 respectively. The cumulated converted percentile value for general state was significantly better (p = 0.03) for the ostomates (86.18 +/- 13.43) compared to non-ostomates (69.80 +/- 31.37). The cumulative gastrointestinal problem score did not reveal any significant difference (non-ostomates: 90.19 +/- 12.50, ostomates: 95.62 +/- 9.04, p = 0.11). Non-ostomates and ostomates did not differ regarding the cumulative score of stool-related questions: 83.75 +/- 20.53 versus 89.85 +/- 10.01 respectively, p = 0.14. The score for the peristomal problems was as high as 90.00 +/- 16.12. There was no difference in the cumulative gender specific indicators for both sexes, which showed the value 72.50 +/- 44.35 at non-ostomates and 63.64 +/- 50.45 at ostomates (p = 0.31). None of the patients regarded the chemotherapy problem as a factor diminishing the quality of their life. After calculating the total of all above mentioned functional parameters the score for non-ostomates results 82.50 +/- 19.83, and that of ostomates results 88.60 +/- 8.48, what is about the same, p = 0.12. The cumulative score of the two groups concerning emotional indicators did not really differ (non ostomates 78.69 +/- 24.19, ostomates 84.95 +/- 12.08, p = 0.11). The total cumulative scores among the groups did not show significant difference (non-ostomates 81.67 +/- 31.48, ostomates 87.12 +/- 16.40, p = 0.27). The global QoL was high in both groups with no significant difference among non-ostomates and ostomates (82.00 +/- 24.86 versus 88.60 +/- 8.48, respectively, p = 0.12). CONCLUSION The quality of life of all patients was poorer than it was prior to the onset of the disease, but most of them could return to their prior way of living with not too many compromises. This process can be well monitored with our score system.
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Affiliation(s)
- R Harisi
- 1st Depaertment of Surgery, Faculty of Medicine, Semmelweiss University, Budapest, Hungary
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140
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Cheverton P, Friess H, Andras C, Salek T, Geddes C, Bodoky G, Valle J, Humblet Y. Phase III results of exatecan (DX-8951f) versus gemcitabine (Gem) in chemotherapy-naïve patients with advanced pancreatic cancer (APC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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. Cheverton
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
| | - H. Friess
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
| | - C. Andras
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
| | - T. Salek
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
| | - C. Geddes
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
| | - G. Bodoky
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
| | - J. Valle
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
| | - Y. Humblet
- Daiichi Pharmaceuticals UK Ltd, London, United Kingdom; University of Heidelberg, Heidelberg, Germany; Debrecen University Medical Centre, Debrecen, Hungary; National Cancer Institute, Bratislava, Slovakia; Groote Schuur Hospital, Cape Town, South Africa; St Laszlo Hospital, Budapest, Hungary; Christie Hospital, Manchester, United Kingdom; St Luc University Hospital, Brussels, Belgium
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141
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Péter Z, Bodoky G, Szabó Z, Sonfalvi E, Varga Z, Szilvási I. Ileocolic Anastomotic Ulcer after Surgery in Adulthood: Case Report and Review of the Literature. Z Gastroenterol 2004; 42:605-8. [PMID: 15248109 DOI: 10.1055/s-2004-813231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Anastomotic ulcer is a rare complication after ileocolic resection, especially in adults without evidence of inflammatory bowel disease or tumor recurrence. We report the case of a 63-year-old male patient who presented 6 years after ileocolic resection, and also review the data of six similar cases described in the literature. The markedly reduced bile acid absorption found in our case raises the possibility of an etiological role of bile acids in the development of ileocolic anastomotic ulcers.
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Affiliation(s)
- Z Péter
- Department of Gastroenterology and Hepatology, Szent László Hospital, Budapest, Hungary.
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142
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Eckhardt S, Pápai Z, Bodoky G, Horti J, Tamás K, Nagy T, Orosz Z, Sápi Z, Gödény M, Jakab K, Esik O, Trón L, Besznyák I. [Effect of imatinib treatment of gastrointestinal stromal tumors]. Orv Hetil 2003; 144:2207-12. [PMID: 14686005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
INTRODUCTION Advanced malignant gastrointestinal stromal tumours are practically resistant to further radio- or chemotherapy. These tumours are characterized by the presence of C-KIT (a transmembrane tyrosin kinase) mutation which can be specified by CD117 expression. Imatinib (2-fenilaminopirimidine) is a selective inhibitor of the mutated C-KIT. AIM The purpose of our study was to determine the potential antitumour effect of imatinib in patients with gastrointestinal stroma tumour patients. MATERIALS AND METHODS An open, non-randomized trial was performed involving 38 patients each of which had received/metastatic disease associated with CD117 positivity. Consecutively daily doses of 400-600 mg imatinib was administered orally to the patients. The evaluation was carried out on 37 patients in a form of an interim analysis. RESULTS After a 3-18 months observation period 1 complete, 19 partial remissions and 10 static diseases could be registered (78%), in association of only grade 1-2 toxicity. CONCLUSIONS The imatinib treatment improved the quality of life of the patients with gastrointestinal stroma tumour and their life expectancy became considerably prolonged. Further follow-up of the patients as well as design of a prospective, randomized trial on a larger patient material is urgently needed.
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Affiliation(s)
- Sándor Eckhardt
- Országos Onkológiai Intézet, B Belgyógyászati Osztály, Budapest.
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143
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Bodoky G. [Experience with the treatment of advanced pancreatic cancer in Hungary]. Magy Onkol 2003; 47:194-197. [PMID: 12975669] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2003] [Accepted: 04/18/2003] [Indexed: 05/24/2023]
Abstract
In the first phase of this study 34 patients with advanced pancreatic cancer have been treated either with gemcitabine/cisplatin or gemcitabine/5-fluorouracil (5FU)/leucovorin combination. (Gemzar: 900 mg/m2, Cisplatin: 20 mg/m2, 5-FU: 750 mg/m2). Treatments were continued till tumor progression. There was no difference observed between the two protocols in the clinical response rates (PR=65%). On the other hand, a significant difference was found between the two protocols regarding the side effects. In the case of gemcitabine/5-FU neutropenia, thrombocytopenia and anaemia (as well as nausea and vomiting) were much less frequent compared to gemcitabine/cisplatin combination. Based on these data the efficacy of gemcitabine/5-FU combination was evaluated in 99 stage III, T1-4, N1 and stage IV, T1-4, N0-1, M1 pancreatic cancer patients throughout 364 treatment cycles. OR was achieved in 10% while stable disease in 52% of the cases. The average survival period was 8.33 months while the time to progression was 5.75 months. Based on these data we recommend gemcitabine/5-FU/leucovorin combination for the treatment of advanced pancreatic cancer.
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Affiliation(s)
- György Bodoky
- Fôvárosi Szent László Kórház, Budapest 1097, Hungary
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144
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Pápai Z, Bodoky G, Szántó J, Poller I, Rahóty P, Eckhardt S, Láng I, Szendroi M. The efficacy of a combination of etoposide, ifosfamide, and cisplatin in the treatment of patients with soft tissue sarcoma. Cancer 2000; 89:177-80. [PMID: 10897015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Successful chemotherapy for patients with soft tissue sarcoma (STS) has been limited by a lack of active drugs. The most effective single agents are doxorubicin, dacarbazine, and, more recently, ifosfamide. Previously the most widely used combination has been CYVADIC (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). In one randomized trial, ifosfamide was superior to cyclophosphamide; two nonrandomized studies also reported favorable results. Etoposide monotherapy was successful in 8%; the effectiveness of cisplatin was 5-23%. In view of these findings, the authors treated STS patients with an etoposide, cisplatin, and ifosfamide (VIP) combination. METHODS The eligibility criteria included histologically confirmed, inoperable, metastatic or locally recurrent STS; a World Health Organization (WHO) performance status of 0-2; a maximum age of 75 years; and progressive, measurable disease. A total of 104 patients were treated from January 1990 to June 1997. The median age of the patients was 42.4 years. The patients were treated with a combination of etoposide (100mg/m(2) for 5 days), ifosfamide (2000 mg/m(2) for 2 days), and cisplatin (20mg/m(2) for 5 days) once a month via a peripheral vein. The treatment response and the toxicity were assessed according to WHO criteria. RESULTS Of 104 evaluable patients, 47 responded. The overall response rate was 46% (complete response: 10%; partial response: 36%). In 43 patients the disease remained stable (41%). Remission duration was 4.6 months. Toxicity was moderate. The main adverse events were alopecia (100%), nausea and vomiting (73%), and leukopenia (29%). CONCLUSIONS This new combination is promising for the treatment of patients with advanced STS.
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Affiliation(s)
- Z Pápai
- Department of Chemotherapy, National Institute of Oncology, Budapest, Hungary
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145
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Petri M, Székely G, Tóth GT, Bodoky G, Harsányi L, Topa L. [Difficulties of artificial nutrition in short bowel syndrome]. Orv Hetil 1999; 140:541-3. [PMID: 10323069] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The authors expound the case of a 47 years old woman who was operated on 25 months ago for bowels necrosis caused from occlusion of arteria mesenterica superior. The operation was composed of a partial jejunale resection, total ileum resection and a right side hemicolectomy, the residual part of the intestine (jejunum) is 70-80 cm. Eleven months after the operation her status has got worse with 10-12 watery faeceses, abdominal pain and body weight losing (15 kg in 2 months). In the beginning a complete central parenteral and enteral nutrition was necessary. The authors expound the complications connected with the nutrition and the successful rehabilitation of the patient as well. They built her nutrition gradually completed with oral given nutriment. The nutritional status of the patient now is adequate and she is able to do the housekeeping.
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Affiliation(s)
- M Petri
- F+városi Onkormányzat Visegrádi Rehabilitációs Szakkórház, Visegrád Gastroenterologia, Budapest
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146
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Affiliation(s)
- L Harsányi
- 1st Surgical Department, Semmelweis Medical School, St. László Teaching Hospital, Budapest, Hungary.
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147
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Pajkos G, Bodoky G, Pádi E, Izsó J, Szántó J. [Low-dose leucovorin and interferon-alpha as modulators of 5-fluorouracil for adjuvant chemotherapy of colorectal cancer]. Orv Hetil 1998; 139:1571-5. [PMID: 9676118] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
It has recently been published the results of a prospective, comparative study for adjuvant chemotherapy of 164 colorectal cancer patients. Pathological stages were Dukes B 79, C 85 of the cases. The site of primary tumour was colon 108, rectum 56 of the patients. The treatment protocols were as follows: 425 mg/m2 5-fluorouracil plus 20 mg/m2 leucovorin on days 1-5 at 28 days cycles six times (LV group). The IFN group received the same chemotherapy completed with weekly 3 x 3 MIU interferon alpha. Both treatment groups were well balanced. The mean follow up time was 38.1 months. There were 91 patients of relapse and 65 deaths this time. The time to progression was 15 months in the LV group and 12.7 months in the IFN group (p < 0.05). The mean survival time was 24 months in the LV group compared to 22.3 of the IFN group. The frequency and sites of relapses did not differ statistically between the both groups. The preoperative CEA-level was elevated in 42 cases. The mean survival time was 26.4 months in the cases having normal CEA-level compared to 16.1 months of the cases with high-level (p < 0.001). The side-effects were transient and mild, while in the group treated with interferon were more instances of fever, fatigue, flu-like syndrome, psychic disorders, depression and agitation. The administration of interferon had to be interrupted in 4 cases. The results of interim analysis suggest choosing the so-called Mayo protocol for the standard adjuvant treatment of colorectal cancer.
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Affiliation(s)
- G Pajkos
- II. Belgyógyászat-Onkológia, BM Központi Kórház és Intézményei, Budapest
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148
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Paku S, Bodoky G, Kupcsulik P, Tímár J. Blood supply of metastatic hepatic tumors: suggestions for improved delivery of chemotherapeutic agents. J Natl Cancer Inst 1998; 90:936-7. [PMID: 9637145 DOI: 10.1093/jnci/90.12.936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bodoky G, Yang ZJ, Meguid MM, Laviano A, Szeverenyi N. Effects of fasting, intermittent feeding, or continuous parenteral nutrition on rat liver and brain energy metabolism as assessed by 31P-NMR. Physiol Behav 1995; 58:521-7. [PMID: 8587960 DOI: 10.1016/0031-9384(95)00078-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We wanted to determine what happens to brain PCr and ATP relative to that in liver during a series of dietary manipulation consisting of a severe fast, during eating (when nutrients are intermittently supplied), and during and after PN-100, when an excess amount of nutrients are continuously supplied, using 31P-NMR spectroscopy, in rats randomized to a Fast or Fed group in which energy was provided either as chow or as PN-100. Liver ATP concentration, and brain and liver 31P-nuclear magnetic resonance (NMR) spectras were measured serially. Brain energy metabolism was not different between groups and among days. In contrast, Fasted group showed increased liver ATP/Pi ratio and decreased ATP concentration and ATP/phosphomonoester ratio, there being no difference between Fed and PN-100 groups. Data suggest that brain energy metabolism is maintained regardless of whether energy is supplied intermittently or continuously, and during a negative caloric intake period, brain energy metabolism is quantitatively preserved, suggesting that ATP production by liver is subservient to brain ATP state.
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Affiliation(s)
- G Bodoky
- Department of Surgery, SUNY Health Science Center, Syracuse 13210, USA
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Abstract
Whether spontaneous food intake (SFI) is controlled by infused nutrient type or its caloric content, irrespective of nutrient type, was investigated. Rats were infused for 4 days with isocaloric solutions of different nutrient type but sharing the same intermediary metabolic oxidative pathway, providing 25% of daily caloric needs. One parenteral solution was a glucose, fat and amino acid mix (TPN-25%); the other provided ketone bodies (TRI-3.5%). Effects of parenteral infusions on SFI and metabolic concomitants were compared and contrasted to that in a group of orally fed rats. Both infusions reduced SFT by 50%. Rats receiving TRI-3.5% had lower blood glucose and insulin concentrations, but increased hepatic glycogen content compared to TPN-25% or orally fed rats. No differences in hepatic triglycerides occurred between the three groups. However, serum free fatty acids were significantly lower in TRI-3.5% and in TPN-25% groups vs. fed rats. Data indicate food intake suppression is mediated by caloric content rather than nutrient type, suggesting that a mediator of SFI regulation could be at the citric acid cycle level.
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Affiliation(s)
- G Bodoky
- Department of Surgery, University Hospital, SUNY Health Science Center, Syracuse, NY 13210, USA
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