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Mir O, Honoré C, Chamseddine AN, Faron M, Haddag-Miliani L, Bayle A, Le Cesne A. Outcomes of Oral Vinorelbine in Progressive Desmoid Fibromatosis-Response. Clin Cancer Res 2021; 27:2120. [PMID: 33795374 DOI: 10.1158/1078-0432.ccr-21-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy Cancer Institute, Villejuif, France.
| | - Charles Honoré
- Department of Surgery, Gustave Roussy Cancer Institute, Villejuif, France
| | - Ali N Chamseddine
- Department of International Patients Care, Gustave Roussy Cancer Institute, Villejuif, France
| | - Matthieu Faron
- Department of Surgery, Gustave Roussy Cancer Institute, Villejuif, France
| | - Leila Haddag-Miliani
- Department of Medical Imaging, Gustave Roussy Cancer Institute, Villejuif, France
| | - Arnaud Bayle
- Department of Ambulatory Cancer Care, Gustave Roussy Cancer Institute, Villejuif, France
| | - Axel Le Cesne
- Department of International Patients Care, Gustave Roussy Cancer Institute, Villejuif, France
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Mir O, Honoré C, Chamseddine AN, Dômont J, Dumont SN, Cavalcanti A, Faron M, Rimareix F, Haddag-Miliani L, Le Péchoux C, Levy A, Court C, Briand S, Fadel E, Mercier O, Bayle A, Brunet A, Ngo C, Rouleau E, Adam J, Le Cesne A. Long-term Outcomes of Oral Vinorelbine in Advanced, Progressive Desmoid Fibromatosis and Influence of CTNNB1 Mutational Status. Clin Cancer Res 2020; 26:6277-6283. [PMID: 32873570 DOI: 10.1158/1078-0432.ccr-20-1847] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/15/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Desmoid-type fibromatosis (DF) are locally aggressive neoplasms, with a need for effective systemic treatment in case of progression to avoid the short- and long-term complications of local treatments. EXPERIMENTAL DESIGN We retrospectively analyzed the outcomes of adult patients with DF treated with oral vinorelbine (90 mg once weekly) at Gustave Roussy Cancer Institute (Villejuif, Paris, France). Only patients with documented progressive disease according to RECIST v1.1 for more than 3 months (±2 weeks) before treatment initiation were included. RESULTS From 2009 to 2019, 90 out of 438 patients with DF were eligible for this analysis. Vinorelbine was given alone in 56 patients (62%), or concomitantly with endocrine therapy in 34 patients, for a median duration of 6.7 months. A partial response was observed in 29% and stable disease in another 57%. With a median follow-up of 52.4 months, the median time to treatment failure (TTF) was not reached. Progression-free rates at 6 and 12 months were 88.7% and 77.5%, respectively. Concomitant endocrine therapy was associated with longer TTF in women [HR, 2.16; 95% confidence interval (CI), 1.06-4.37; P = 0.03). Among 64 patients with documented CTNNB1 mutational status, p.S45F or p.S45P mutations were associated with longer TTF compared with p.T41A or wild-type tumors (HR, 2.78; 95% CI, 1.23-6.27; P = 0.04). Toxicity profile was favorable, without grade 3-4 toxicity, except for one grade 3 neutropenia. CONCLUSIONS Oral vinorelbine is an effective, affordable, and well-tolerated regimen in patients with advanced, progressive DF. Prolonged activity was observed in patients with tumors harboring CTNNB1 p.S45F or p.S45P mutations.
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Affiliation(s)
- Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy Cancer Institute, Villejuif, Paris, France.
| | - Charles Honoré
- Department of Surgery, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Ali N Chamseddine
- Department of International Patients Care, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Julien Dômont
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Sarah N Dumont
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Andrea Cavalcanti
- Department of Surgery, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Matthieu Faron
- Department of Surgery, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Françoise Rimareix
- Department of Surgery, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Leila Haddag-Miliani
- Department of Medical Imaging, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Charles Court
- Department of Orthopedic Surgery, Kremlin-Bicêtre Teaching Hospital, Université Paris Saclay, Le Kremlin-Bicêtre, Paris, France
| | - Sylvain Briand
- Department of Orthopedic Surgery, Kremlin-Bicêtre Teaching Hospital, Université Paris Saclay, Le Kremlin-Bicêtre, Paris, France
| | - Elie Fadel
- Department of Thoracic Surgery, Marie Lannelongue Teaching Hospital, Université Paris Saclay, Le Plessis-Robinson, Paris, France
| | - Olaf Mercier
- Department of Thoracic Surgery, Marie Lannelongue Teaching Hospital, Université Paris Saclay, Le Plessis-Robinson, Paris, France
| | - Arnaud Bayle
- Department of Ambulatory Cancer Care, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Anaïs Brunet
- Department of Biology and Pathology, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Carine Ngo
- Department of Biology and Pathology, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Etienne Rouleau
- Department of Biology and Pathology, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Julien Adam
- Department of Biology and Pathology, Gustave Roussy Cancer Institute, Villejuif, Paris, France
| | - Axel Le Cesne
- Department of International Patients Care, Gustave Roussy Cancer Institute, Villejuif, Paris, France
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Fricker J. Initiatives to Improve Safety of Oral Anticancer Agents Delivered by Community Pharmacists. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10310935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
With the recent growth in oral anticancer agents (OAA), pharmacists working in the community have recognised the urgent need to develop safe and effective systems to administer and manage these drugs. For community pharmacists, education regarding OAA can be challenging, with a number of international surveys showing that many believe they have received inadequate education regarding OAA and feel uncomfortable educating their patients about these drugs. Patients prescribed OAA have also reported feeling unsupported, and this lack of support could lead to both under and overadherence to OAA, with an impact on efficacy and adverse events. Poor adherence can result in disease progression, treatment complications, reduced functional ability, and premature death.
The current review, written by international authors from Europe, North America, and East Asia, set out to identify worldwide initiatives to support community pharmacists working with patients taking OAA. The authors identified one project, the Oral Anticancer Therapy – Safe and Effective initiative, that was developed in Germany in 2011 to aid community pharmacists in their interactions with patients prescribed OAA. The initiative, which has been rolled out across Germany, includes the creation of training programme content that can be delivered at regional meetings and monographs, which can be downloaded to educate both community pharmacists and their patients about individual OAA. As part of the Empowering Patients to Improve Health Care for Oral Chemotherapy (EPIC) programme, the European Society of Oncology Pharmacy (ESOP) has extended the German initiative to Slovenia and Estonia, with plans to launch the scheme in additional European countries in the autumn of 2018. Ultimately, it is hoped that better support of cancer patients in the community will improve adherence to OAA.
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The role of diet on the clinical pharmacology of oral antineoplastic agents. Eur J Clin Pharmacol 2011; 68:115-22. [PMID: 21796375 DOI: 10.1007/s00228-011-1102-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 07/12/2011] [Indexed: 01/27/2023]
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Schott S, Schneeweiss A, Reinhardt J, Bruckner T, Domschke C, Sohn C, Eichbaum MH. Acceptance of oral chemotherapy in breast cancer patients - a survey study. BMC Cancer 2011; 11:129. [PMID: 21486437 PMCID: PMC3080835 DOI: 10.1186/1471-2407-11-129] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 04/12/2011] [Indexed: 12/02/2022] Open
Abstract
Background Oral (p.o.) chemotherapy treatments gained increasing importance in the palliative treatment of metastatic breast cancer (MBC). Aim of this survey was to evaluate the acceptance of p.o. treatment and patients' individual attitudes towards it. Methods A specific 14 item-questionnaire was designed. Patients suffering from breast cancer receiving a newly launched p.o. or i.v. chemotherapy treatment were prospectively evaluated during 4 months of time. 224 questionnaires using descriptive statistics, chi-square test, Spearman correlation were evaluated. Results Patients' median age was 54 years, 164 received i.v., 60 p.o therapy. 89% with p.o. and 67% with i.v. regimens would choose p.o. over i.v. therapy, if equal efficacy is guaranteed. Significant differences were especially found in terms of personal benefit (55% i.v., 92% p.o.), reduced feeling of being ill due to p.o. treatment (26% i.v., 65% p.o.), better coping with disease due to p.o. therapy (36% i.v., 68% p.o.). Side effects were significantly less often reported under p.o. treatment (19% p.o. vs. 53% i.v.) Conclusion P.o. chemotherapy shows a high acceptance in MBC patients under palliative therapy. Compliance can be achieved in particular through a differentiated indication, patient education and competent support along a p.o. treatment.
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Affiliation(s)
- Sarah Schott
- University Hospital Heidelberg, Department of Gynecology and Obstetrics, The National Center for Tumor Diseases, Voßstraße 9, D-69115 Heidelberg, Germany.
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Anticancer oral therapy: emerging related issues. Cancer Treat Rev 2010; 36:595-605. [PMID: 20570443 DOI: 10.1016/j.ctrv.2010.04.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/10/2010] [Accepted: 04/25/2010] [Indexed: 11/23/2022]
Abstract
The use of oral anticancer drugs has shown a steady increase. Most patients prefer anticancer oral therapy to intravenous treatment primarily for the convenience of a home-based therapy, although they require that the efficacy of oral therapy must be equivalent and toxicity not superior than those expected with the intravenous treatment. A better patient compliance, drug tolerability, convenience and possible better efficacy for oral therapy as compared to intravenous emerge as the major reasons to use oral anticancer agents among oncologists. Inter- and intra-individual pharmacokinetic variations in the bioavailability of oral anticancer drugs may be more relevant than for intravenous agents. Compliance is particularly important for oral therapy because it determines the dose-intensity of the treatment and ultimately treatment efficacy and toxicity. Patient stands as the most important determinant of compliance. Possible measures for an active and safe administration of oral therapy include a careful preliminary medical evaluation and selection of patients based on possible barriers to an adequate compliance, pharmacologic issues, patient-focused education, an improvement of the accessibility to healthcare service, as well as the development of home-care nursing symptom-focused interventions. Current evidences show similar quality of life profile between oral and intravenous treatments, although anticancer oral therapy seems to be more convenient in terms of administration and reduced time lost for work or other activities. Regarding cost-effectiveness, current evidences are in favor of oral therapy, mainly due to reduced need of visits and/or day in hospital for the administration of the drug and/or the management of adverse events.
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Findlay M, von Minckwitz G, Wardley A. Effective oral chemotherapy for breast cancer: pillars of strength. Ann Oncol 2007; 19:212-22. [PMID: 18006898 DOI: 10.1093/annonc/mdm285] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Traditionally, anticancer therapy has been dominated by intravenous drug therapy. However, oral agents provide an attractive approach to chemotherapy and use of oral treatments is increasing. We discuss the benefits and challenges of oral chemotherapy from the perspectives of patients, healthcare providers and healthcare funders. Important issues include patient preference, efficacy, compliance, bioavailability, reimbursement, use in special patient populations, financial and staff time savings and flexibility of dosing. We review data for traditional oral agents (e.g. cyclophosphamide, methotrexate), newer oral chemotherapies (e.g. capecitabine), oral formulations of traditionally intravenous agents (e.g. vinorelbine, idarubicin) and new biologic agents under evaluation in breast cancer (e.g. tyrosine kinase inhibitors). Lastly, we review studies of all-oral combination regimens. The wealth of data available and the increasing use of oral agents in breast cancer suggest that many of the concerns and perceptions about oral therapy, including efficacy and bioavailability, have been overcome, and that oral therapy will play a major role in breast cancer management in the future in both the metastatic and adjuvant settings.
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Affiliation(s)
- M Findlay
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
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Johansen M, Kuttesch J, Bleyer WA, Krailo M, Ames M, Madden T. Phase I Evaluation of Oral and Intravenous Vinorelbine in Pediatric Cancer Patients: A Report from the Children's Oncology Group. Clin Cancer Res 2006; 12:516-22. [PMID: 16428494 DOI: 10.1158/1078-0432.ccr-05-1541] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Vinorelbine (Navelbine) is an orally absorbable Vinca with broad antitumor activity. It differs from other Vinca in that it is structurally modified on the catharanthine nucleus and has differential actions on tubulin that render it less neurotoxic than other compounds in this class. We conducted a phase I study of vinorelbine given the activity of Vinca alkaloids in many pediatric tumors. EXPERIMENTAL DESIGN We evaluated the safety and pharmacokinetics of oral and i.v. vinorelbine administered weekly x 6 in children (age, 2-17 years) with different tumors. Patients with disease involvement in the bone marrow were eligible but were stratified and dose-escalated separately. Oral vinorelbine (week 1) was administered as liquid-filled gelatin capsules at thrice the i.v. dose. Intravenous vinorelbine doses of 24 to 37.5 mg/m(2) were administered on weeks 2 to 6. RESULTS The dose-limiting toxicity in patients without marrow involvement was reversible neutropenia. Common nonhematologic toxicities included < or = grade 2 nausea/vomiting and increased hepatic transaminases. A higher mean i.v. Cl(TB) was observed (1.75 +/- 1.0 L/h/kg) compared with adult reports, with a mean t(1/2B) of 16.5 +/- 9.7 hours. Mean oral bioavailability was 28.5 +/- 22.5%. The apparent oral clearance (12.1 +/- 13.0 L/h/kg) and volume of distribution (69.4 +/- 30.6 L/kg) were substantially higher than in adults given similar oral doses. CONCLUSIONS The maximum tolerated dose in children without bone marrow involvement was 30 mg/m(2), similar to that reported in adults, with myelosuppression being the dose-limiting toxicity. Higher plasma clearance resulted in lower area under the plasma concentration-time curves at a given dose compared with that reported in adults.
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Affiliation(s)
- Mary Johansen
- Division of Pharmacy, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Abstract
Pharmacokinetic interactions between food and orally administered drugs involve changes mainly in the absorption and metabolism of a drug, and may have clinical implications. Such interactions, in particular, may be of major clinical significance for cancer chemotherapy since the majority of anticancer agents are toxic, have a low therapeutic index and are administered long term, most often in combination with other cytotoxic agents. The purpose of this review is to compare the pharmacokinetic profiles of various anticancer drugs, including chemopreventive agents that have been examined previously in fasted and fed conditions, and to discuss the underlying basis/mechanisms of food effect in light of a drug's physicochemical and pharmacokinetic properties. Clinical pharmacokinetic parameters such as maximum concentration, area under the concentration-time curve, time to maximum concentration and half-life for each drug are compared in fasted and fed states, and specific dietary recommendations are summarised accordingly. In addition, the effects of food on the metabolite kinetics and pharmacodynamic responses, and the potential role of food effect in the modulation of oral biovariability and multidrug resistance have been extensively discussed. Overall, this comprehensive pharmacokinetic analysis indicates that a broad spectrum of food effects is seen among anticancer agents because of diverse factors regulating each drug's oral bioavailability and its interactions with food. The consideration of such effects is important, as it could lead to more rational pharmacological monitoring and possibly improve the oral chemotherapy of cancer in children, adults and the elderly.
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Affiliation(s)
- Brahma N Singh
- Department of Pharmacy and Administrative Sciences, College of Pharmacy and Allied Health Professions, St John's University, Jamaica, New York 10591, USA.
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Abstract
Anticancer treatment has recently shifted to include a broad range of antineoplastic therapies. Old agents are continuously being re-evaluated, and new mechanisms of treatment are rapidly being explored and developed. At the same time, the patient's perceived quality of life, adverse effects of therapy, time demands, and healthcare costs have become paramount in the treatment process. Lung cancer is the most common cause of cancer death in the USA, and because many of the patients are older or debilitated, these issues become all the more important. The oral administration of anticancer therapy offers both quality-of-life and healthcare cost advantages. Oral forms of 3 new cytotoxic agents and 2 novel oral therapies are discussed. Vinorelbine, a vinca alkaloid, has well documented activity in non-small cell lung cancer. Myelosuppression is dose limiting; neurotoxicity is rare. Satraplatin (JM-216), an oral platinum derivative, shows activity in lung cancer with a favourable adverse effect profile, with no neurotoxicity or nephrotoxicity. The oral topoisomerase I inhibitor topotecan may be ideal for obtaining long term low plasma drug concentrations, which appears to maximise efficacy. LGD-1069 is a retinoid X receptor agonist that modulates cell proliferation, and BAY-129566, a matrix metalloproteinase inhibitor, appears to interrupt both the processes of angiogenesis and metastasis. LGD-1069 and BAY-129566 are nontraditional anticancer agents which may be used in conjunction with chemotherapy, other modalities, or in prevention. These 5 agents will be discussed with particular reference to recent developments in the treatment of lung cancer.
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Affiliation(s)
- E M Bengtson
- Dartmouth Medical School, Hanover, New Hampshire, USA
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Terwogt JM, Schellens JH, Huinink WW, Beijnen JH. Clinical pharmacology of anticancer agents in relation to formulations and administration routes. Cancer Treat Rev 1999; 25:83-101. [PMID: 10395834 DOI: 10.1053/ctrv.1998.0107] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the past years, alternative administration routes and pharmaceutical formulations of anticancer agents have been investigated in order to improve conventional chemotherapy treatment. The impact of these adjustments on the pharmacokinetics and pharmacodynamics is discussed. A review of the literature shows many examples of alternative administration forms of anticancer agents with improved pharmacokinetics. Local administration routes have been investigated in order to reduce the systemic toxicity and to enhance the local efficacy of conventional chemotherapy. Oral administration of anticancer agents is preferred by patients for its convenience and its potential for outpatient treatment. In addition, oral administration facilitates a prolonged exposure to the cytotoxic agent. However, poor bioavailability and substantial interpatient variability are noted as limitations for oral chemotherapy. Increased tumour selectivity can also be achieved by the use of specific pharmaceutical formulations, such as liposomes and macromolecular drug conjugates. The composition of these formulations often determine the pharmacokinetic behaviour of the formulated drug. In conclusion, several alternative administration forms of anticancer agents have been designed in the past years, with the potential for improvement of conventional chemotherapy, however, more extensive clinical evaluation of these novel strategies is warranted to prove their real clinical value.
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Affiliation(s)
- J M Terwogt
- Department of Medical Oncology, The Netherlands Cancer Institute4 / Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
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