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Yip PL, Fung WHB, Lee FAS, Lee CF, Wong NSM, Lee SF. Effectiveness and safety of capecitabine, irinotecan and panitumumab in advanced colorectal cancer. Front Oncol 2023; 13:1138357. [PMID: 37091154 PMCID: PMC10116611 DOI: 10.3389/fonc.2023.1138357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Capecitabine, irinotecan, and panitumumab (CAPIRI-P) is a controversial regimen for metastatic colorectal cancer, with concerns regarding the efficacy and toxicity. However, its toxicity profile has been improved with dose reduction, and concerns regarding efficacy have been extrapolated from other trials. This retrospective study reports the real-world effectiveness and safety of modified CAPIRI-P (mCAPIRI-P). Material and methods Advanced colorectal cancer patients receiving mCAPIPI-P in the first-line setting between July 2019 and December 2021 were analyzed. The progression-free survival on treatment (PFSOT) and overall survival (OS) were estimated using the Kaplan-Meier method, and the association with clinical and disease factors was analyzed using the Cox regression model. Serial changes in carcinoembryonic antigen (CEA) level and treatment toxicity were also evaluated. Results A total of 106 patients were included, of whom 97 (92%) and 31 (29%) had left-sided primary and unresectable liver-only disease, respectively. The median PFSOT and OS were 15.4 (95% CI 12.5-18.3) and 25.5 (95% CI 17.6-33.4) months, respectively. Sixteen (51.6%) and 10 (32.3%) liver-only disease patients underwent secondary liver treatment and R0 resection, respectively. In multivariable Cox regression, CEA responders (PFSOT: HR 0.53) and CEA normalization (PFSOT: HR 0.27; OS: HR 0.28) were independent favorable prognostic factors for PFSOT and OS. Grade ≥3 toxicity rate was 43%, mainly related to uncomplicated hematological toxicities. Conclusion The real-world data show that mCAPIRI-P is safe and effective as the first-line treatment regimen for RAS wild-type advanced colorectal cancer and warrants further study.
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Affiliation(s)
- Pui Lam Yip
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Wai Him Brian Fung
- Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Francis Ann Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Chak Fei Lee
- Department of Pharmacy, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Natalie Sean Man Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
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2
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Zekri J, Baghdadi MA, Ibrahim RB, Meliti A, Sobahy TM. Biweekly cetuximab in combination with capecitabine and oxaliplatin (XELOX) or irinotecan (XELIRI) in the first-line and second-line treatment of patients with RAS wild-type metastatic colorectal cancer. Ecancermedicalscience 2022; 16:1490. [PMID: 36819803 PMCID: PMC9934971 DOI: 10.3332/ecancer.2022.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Oral capecitabine in combination with intravenous oxaliplatin (XELOX) or irinotecan (XELIRI) are acceptable substitutions to fully intravenous regimens. Biweekly (as opposed to weekly) cetuximab is more convenient when combined with biweekly chemotherapy. Here, we report the tolerability and efficacy of biweekly cetuximab in combination with biweekly XELOX or XELIRI in patients with RAS wild-type metastatic colorectal cancer (RAS-WT mCRC). Methods Clinical data of consecutive patients with mCRC who received biweekly cetuximab (500 mg/m2) in combination with XELOX or XELIRI between January 2009 and May 2019 in the first- or second-line settings was extracted. Dosage of XEL (Capecitabine/XELODA) was 1,000 mg/m2 twice daily for 9 days, plus on day 1 oxaliplatin 85 mg/m2 or irinotecan 180 mg/m2. Treatment dose reduction and delay for ≥7 days was analysed as surrogates for toxicity. Extended RAS testing was performed in the context of this study for patients who received treatment based on limited KRAS-WT genotype. Results Sixty one patients with RAS-WT mCRC fulfilled the eligibility criteria. XELOX was administered to 26 (42.6%) and XELIRI to 35 (57.4%) of patients. For all patients in the first-line setting, the objective response rate (ORR), median progression free survival (PFS) and median overall survival (OS) were 54%, 8 months and 25 months, respectively. The corresponding outcomes for the subgroup of patients who received first-line XELOX were 68%, 10 months and not reached, respectively. For all patients in the second-line setting, the ORR, PFS and OS were 50%, 7 months and 20 months, respectively. Chemotherapy components dose reduction and delays were observed in 18 (29.5%) and 25 (41%) patients, respectively. The corresponding frequencies for cetuximab were 3 (5%) and 31 (50.8%). Conclusion Biweekly cetuximab in combination with XELOX or XELIRI is tolerable and effective. The addition of cetuximab to capecitabine and oxaliplatin is associated with favourable outcome.
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Affiliation(s)
- Jamal Zekri
- College of Medicine, Al-Faisal University, Riyadh 11533, Saudi Arabia,King Faisal Specialist Hospital & Research Centre (Jeddah), Jeddah 21499, Saudi Arabia
| | - Mohammed Abbas Baghdadi
- Research Centre, King Faisal Specialist Hospital & Research Centre (Jeddah), Jeddah 21499, Saudi Arabia
| | - Refaei Belal Ibrahim
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Al Azhar University, Cairo 11884, Egypt
| | - Abdelrazak Meliti
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah 21499, Saudi Arabia
| | - Turki M Sobahy
- Research Centre, King Faisal Specialist Hospital & Research Centre (Jeddah), Jeddah 21499, Saudi Arabia
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3
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Hoang T, Sohn DK, Kim BC, Cha Y, Kim J. Efficacy and Safety of Systemic Treatments Among Colorectal Cancer Patients: A Network Meta-Analysis of Randomized Controlled Trials. Front Oncol 2022; 11:756214. [PMID: 35223449 PMCID: PMC8864322 DOI: 10.3389/fonc.2021.756214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/31/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Systemic treatments, namely, either monotherapy or combination therapy, are commonly administered to patients with advanced or metastatic colorectal cancer (CRC). This study aimed to provide the complete efficacy and safety profiles and ranking of systemic therapies for the treatment of unresectable advanced or metastatic CRC. METHODS We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception until June 30, 2021, and also the bibliographies of relevant studies. Randomized controlled trials comparing two or more treatments, namely, at least capecitabine, 5-fluorouracil, leucovorin, irinotecan, bevacizumab, cetuximab, oxaliplatin, or panitumumab were investigated. A network meta-analysis using the Bayesian approach was performed to compare the efficacy and safety of treatments. The surface under the cumulative ranking curve (SUCRA) was calculated for the probability of each treatment as the most effective. The overall response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), adverse events (AEs) grade ≥3, and serious adverse events (SAEs) were evaluated. RESULTS One hundred two publications with 36,147 participants were assigned to 39 different treatments. Among 11 treatments with full information on six outcomes, FOLFIRI/FOLFOX/FOLFOXIRI + bevacizumab significantly improved both the ORR and DCR, compared to FOLFIRI. Although FOLFOX and FOLFIRI/FOLFOX + cetuximab significantly prolonged both OS and PFS, treatments were comparable in terms of AEs grade ≥3 and SAEs. The top highest SUCRA values were observed in the FOLFOXIRI + panitumumab group for ORR (96%) and DCR (99%), FOLFIRI + bevacizumab + panitumumab group for OS (62%) and PFS (54%), and FOLFOXIRI + bevacizumab group for AEs grade ≥3 (59%) and SAEs (59%) outcomes. CONCLUSIONS These findings suggest an available range of systemic treatment therapies with different efficacy and safety profiles with patients. Further investigations of the side effects and mutation status are required to confirm our findings. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42019127772.
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Affiliation(s)
- Tung Hoang
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Yongjun Cha
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jeongseon Kim
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea
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Alig AHS, Heinemann V, Geissler M, Fischer von Weikersthal L, Decker T, Heinrich K, Held S, Weiss L, Fischer LE, Moosmann N, Stahler A, Jelas I, Kurreck A, von Einem JC, Reinacher-Schick AC, Tannapfel A, Giessen-Jung C, Stintzing S, Modest DP. Exact Primary Tumor Location in mCRC: Prognostic Value and Predictive Impact on Anti-EGFR mAb Efficacy. Cancers (Basel) 2022; 14:cancers14030526. [PMID: 35158793 PMCID: PMC8833757 DOI: 10.3390/cancers14030526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Sidedness of primary tumor is a well-established prognostic marker and is predictive for anti-EGFR efficacy in RAS/BRAF wild-type metastatic colorectal cancer (mCRC) patients. As molecular markers change rather continuously throughout the colon, we ask whether the exact primary tumor location (PTL) is a better prognostic marker than sidedness and predictive for anti-EGFR efficacy in RAS/BRAF wild-type mCRC. We retrospectively analyzed five studies containing various therapy protocols concerning primary tumor location, dividing the colorectal frame into six segments. In our cohort, PTL has a prognostic impact on disease spread and overall survival. Only distal segments benefitted when receiving anti-EGFR containing therapy regarding overall survival. Intermediate segments were indifferent and caecal primaries had a detrimental effect receiving anti-EGFR based therapy. Being a retrospective analysis and challenging the standard of basing anti-EGFR treatment on sidedness in RAS/BRAF wild-type mCRC, future studies are necessary to confirm and further investigate our hypothesis-generating results. Abstract Primary tumor sidedness (left vs. right) has prognostic and predictive impact on anti-EGFR agent efficacy and thus management of metastatic colorectal cancer (mCRC). This analysis evaluates the relevance of primary tumor location (PTL) in RAS/BRAF wild-type mCRC patients, when dividing the colorectal frame into six segments. This pooled analysis, performed on a single-patient basis of five randomized first-line therapy trials, evaluates the impact of exact PTL classification on baseline characteristics, prognosis and prediction of anti-EGFR antibody efficacy by chi-square and log-rank tests, the Kaplan–Meier method, Cox and logistic regressions. The PTL was significantly associated with metastatic spread: liver (p = 0.001), lung (p = 0.047), peritoneal (p < 0.001) and lymph nodes (p = 0.048). A multivariate analysis indicated an impact on anti-EGFR agent efficacy in terms of overall survival depending on the exact primary tumor location: from detrimental in caecal (HR 2.63), rather neutral effects in the ascending colon (HR 1.24), right flexure/transverse colon (HR 0.99) and left flexure/descending colon (HR 0.91) to clear benefit in sigmoid (HR 0.71) and rectal (HR 0.58) primaries. Exact primary tumor location affects anti-EGFR antibody efficacy in a rather continuous than a dichotomous fashion in RAS/BRAF wild-type mCRC patients. This perspective might help to support clinical decisions when anti-EGFR antibodies are considered.
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Affiliation(s)
- Annabel H. S. Alig
- Department of Hematology, Oncology, and Tumorimmunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, 10117 Berlin, Germany; (A.H.S.A.); (A.S.); (I.J.); (A.K.); (J.C.v.E.); (S.S.)
| | - Volker Heinemann
- Department of Medical Oncology & Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig Maximilians Universität (LMU), 81377 Munich, Germany; (V.H.); (K.H.); (L.W.); (L.E.F.); (C.G.-J.)
- German Cancer Consortium (DKTK), DKFZ, 69120 Heidelberg, Germany
| | | | | | | | - Kathrin Heinrich
- Department of Medical Oncology & Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig Maximilians Universität (LMU), 81377 Munich, Germany; (V.H.); (K.H.); (L.W.); (L.E.F.); (C.G.-J.)
| | | | - Lena Weiss
- Department of Medical Oncology & Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig Maximilians Universität (LMU), 81377 Munich, Germany; (V.H.); (K.H.); (L.W.); (L.E.F.); (C.G.-J.)
| | - Laura E. Fischer
- Department of Medical Oncology & Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig Maximilians Universität (LMU), 81377 Munich, Germany; (V.H.); (K.H.); (L.W.); (L.E.F.); (C.G.-J.)
| | - Nicolas Moosmann
- Krankenhaus Barmherzige Brüder Regensburg, 93049 Regensburg, Germany;
| | - Arndt Stahler
- Department of Hematology, Oncology, and Tumorimmunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, 10117 Berlin, Germany; (A.H.S.A.); (A.S.); (I.J.); (A.K.); (J.C.v.E.); (S.S.)
| | - Ivan Jelas
- Department of Hematology, Oncology, and Tumorimmunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, 10117 Berlin, Germany; (A.H.S.A.); (A.S.); (I.J.); (A.K.); (J.C.v.E.); (S.S.)
| | - Annika Kurreck
- Department of Hematology, Oncology, and Tumorimmunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, 10117 Berlin, Germany; (A.H.S.A.); (A.S.); (I.J.); (A.K.); (J.C.v.E.); (S.S.)
| | - Jobst C. von Einem
- Department of Hematology, Oncology, and Tumorimmunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, 10117 Berlin, Germany; (A.H.S.A.); (A.S.); (I.J.); (A.K.); (J.C.v.E.); (S.S.)
| | | | - Andrea Tannapfel
- Pathologisches Institut der Ruhr Universität Bochum, 44789 Bochum, Germany;
| | - Clemens Giessen-Jung
- Department of Medical Oncology & Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig Maximilians Universität (LMU), 81377 Munich, Germany; (V.H.); (K.H.); (L.W.); (L.E.F.); (C.G.-J.)
| | - Sebastian Stintzing
- Department of Hematology, Oncology, and Tumorimmunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, 10117 Berlin, Germany; (A.H.S.A.); (A.S.); (I.J.); (A.K.); (J.C.v.E.); (S.S.)
| | - Dominik P. Modest
- Department of Hematology, Oncology, and Tumorimmunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, 10117 Berlin, Germany; (A.H.S.A.); (A.S.); (I.J.); (A.K.); (J.C.v.E.); (S.S.)
- Correspondence: ; Tel.: +49-30-450-665237
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5
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Cohen R, Liu H, Fiskum J, Adams R, Chibaudel B, Maughan TS, Van Cutsem E, Venook A, Douillard JY, Heinemann V, Ja Punt C, Falcone A, Bokemeyer C, Kaplan R, Lenz HJ, Koopman M, Yoshino T, Zalcberg J, Grothey A, de Gramont A, Shi Q, André T. BRAF V600E Mutation in First-Line Metastatic Colorectal Cancer: An Analysis of Individual Patient Data From the ARCAD Database. J Natl Cancer Inst 2021; 113:1386-1395. [PMID: 33734401 DOI: 10.1093/jnci/djab042] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/06/2021] [Accepted: 03/15/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND First-line therapeutic strategies for patients with BRAFV600E-mutated (BRAFmt) metastatic colorectal cancer (mCRC) mainly rely on subgroup analyses from randomized controlled trials (RCTs). We aimed to assess the prognostic and predictive impact of BRAFmt on the efficacy of targeted therapies with first-line chemotherapy. METHODS Individual patient data from first-line RCTs with BRAF and KRAS status data in the ARCAD database were pooled. Progression-free survival and overall survival (OS) were assessed using Kaplan-Meier and Cox models. Outcomes were compared between treatment groups that were concurrently randomly assigned whenever possible. RESULTS A total of 6391 patients from 10 RCTs were included: 573 BRAFmt (9.0%), 2059 KRASmt (32.2%), and 3759 double wild type (58.8%). BRAFmt mCRC patients experienced statistically significantly poorer OS than those with KRASmt (adjusted hazard ratio [HRadj] = 1.46, 95% confidence interval [CI] = 1.30 to 1.64) and patients with double wild-type tumors (HRadj = 2.14, 95% CI = 1.94 to 2.36). Anti-EGFR agents did not improve progression-free survival or OS of BRAFmt mCRC patients, based on 4 RCTs testing chemotherapy with or without anti-epidermal growth factor receptor (anti-EGFR) (HRadj = 0.96, 95% CI = 0.71 to 1.30; and HRadj = 0.85, 95% CI = 0.66 to 1.14, respectively). CONCLUSIONS Our data suggest that the addition of anti-EGFR agents to chemotherapy is ineffective as first-line treatment for BRAFmt mCRC patients.
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Affiliation(s)
- Romain Cohen
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | - Heshan Liu
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Jack Fiskum
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Timothy S Maughan
- Cancer Research UK and the Medical Research Council Oxford Institute for Radiation Oncology, Oxford, UK
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and University of Leuven, Belgium
| | - Alan Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA, USA
| | | | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany
| | - Cornelis Ja Punt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | | | | | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Thierry André
- Department of Medical Oncology, Sorbonne University, Saint-Antoine Hospital, Paris, France
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Zhan Y, Zheng L, Liu J, Hu D, Wang J, Liu K, Guo J, Zhang T, Kong D. PLA2G4A promotes right-sided colorectal cancer progression by inducing CD39+γδ Treg polarization. JCI Insight 2021; 6:e148028. [PMID: 34283812 PMCID: PMC8409991 DOI: 10.1172/jci.insight.148028] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/01/2021] [Indexed: 12/17/2022] Open
Abstract
The γδ T cell is a promising candidate cell in tumor immunotherapy. However, γδ T cells polarize to CD39+γδ Tregs upon colorectal cancer (CRC) induction, and the underlying mechanism remains unclear. Here, we show that the frequency of CD39+γδ Tregs, which positively correlated with poor prognosis, was significantly higher in right-sided CRC (RSCRC) than in the left-sided CRC (LSCRC). Interestingly, CD39+γδ Tregs from RSCRC showed stronger immunosuppressive phenotype and function than LSCRC. Furthermore, the quantitative mass spectrometry data show that CD39+γδ Treg polarization was related to the abnormal activation of the Phospholipase a2-IVa/Arachidonic acid (PLA2G4A/AA) metabolic pathway in RSCRC. Using an in vitro coculture system and an orthotopic murine model of CRC, we show that the overexpression of Pla2g4a in CT26 cells induced CD39+γδ Tregs, inhibiting the antitumor immune response. Finally, we found that the overall survival of the PLA2G4Ahi group was significantly shortened compared with PLA2G4Alo RSCRC, while the survival of LSCRC showed the opposite. Collectively, RSCRC with abnormal PLA2G4A expression educates γδ T cells into CD39+γδ Tregs to promote tumor progression and metastasis. Our work highlights the interaction between cancer cells and immune cells by distinguishing the primary tumor site and deepens the understanding of the tumor microenvironment and immunosuppression.
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Affiliation(s)
- Yang Zhan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Lei Zheng
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jia Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Dongzhi Hu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Junfeng Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Kai Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jiansheng Guo
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Ti Zhang
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai,China
| | - Dalu Kong
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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7
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Yin J, Dawood S, Cohen R, Meyers J, Zalcberg J, Yoshino T, Seymour M, Maughan T, Saltz L, Van Cutsem E, Venook A, Schmoll HJ, Goldberg R, Hoff P, Hecht JR, Hurwitz H, Punt C, Diaz Rubio E, Koopman M, Cremolini C, Heinemann V, Tournigard C, Bokemeyer C, Fuchs C, Tebbutt N, Souglakos J, Doulliard JY, Kabbinavar F, Chibaudel B, de Gramont A, Shi Q, Grothey A, Adams R. Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis. Ther Adv Med Oncol 2021; 13:17588359211020547. [PMID: 34262614 PMCID: PMC8252342 DOI: 10.1177/17588359211020547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs). DESIGN Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions. RESULTS Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland (p = 0.0034 and p < 0.001, respectively), with median difference of 3-4 months. The survival deficits in the UK and Ireland cohorts were, at most, 15% at 1 year. No evidence of a regional disparity was observed for PFS. Among those treated without biological therapies, patients from the UK and Ireland had shorter OS than central Europe patients (p < 0.001). CONCLUSIONS Significant international disparities in the OS of cohorts of mCRC patients enrolled in RCTs were found. Survival of mCRC patients included in RCTs was consistently lower in the UK and Ireland regions than in central Europe, southern Europe, and the USA, potentially attributed to greater overall population representation, delayed diagnosis, and reduced availability of therapies.
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Affiliation(s)
- Jun Yin
- Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA
| | - Shaheenah Dawood
- Mediclinic City Hospital: North Wing, Dubai Health Care City, Dubai UAE
| | - Romain Cohen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeff Meyers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | | | - Tim Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Leonard Saltz
- Memory Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Alan Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA, USA
| | | | - Richard Goldberg
- Department of Oncology, West Virginia University, Morgantown, WV, USA
| | - Paulo Hoff
- Centro de Oncologia de Brasilia do Sirio Libanes: Unidade Lago Sul, Siro Libanes, Brazil
| | - J. Randolph Hecht
- Ronald Reagan UCLA Medical Center, UCLS Medical Center, Santa Monica, CA, USA
| | | | - Cornelis Punt
- Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Volker Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany
| | | | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Niall Tebbutt
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Center, Cardiff, UK
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8
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Selection of Oral Therapeutics in China for the Treatment of Colorectal Cancer. Curr Treat Options Oncol 2021; 22:55. [PMID: 34097129 DOI: 10.1007/s11864-021-00852-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT Intravenous administration of fluoropyrimidine-based chemotherapy has been the backbone of treatment in colorectal cancer (CRC) for decades. The availability of oral capecitabine has improved the tolerability and simplified combination schedules. In addition to capecitabine, several other oral drugs have proven efficacy, particularly in palliative treatment lines. Clinical guidelines describe several available third-line treatment options for metastatic CRC (mCRC), but few insights are provided to guide the selection and sequence. In this review, we describe the available evidence and most recent data concerning oral drugs with proven efficacy in CRC, including antiangiogenetic tyrosine kinase inhibitors (VEGFR TKIs), inhibitors blocking EGFR/Raf/MEK/ERK signaling pathway and modified fluoropyrimidine, and share recommendations and insights on selecting third-line oral therapies for mCRC in China. In general, third-line treatment options for mCRC are mainly regorafenib, fruquintinib, and chemo/targeted therapy reintroduction, while FTD/TPI was rarely used in China probably due to poor accessibility. Fruquintinib is preferred in patients with poor performance status (PS), elder age, and severe organ dysfunction, compared to regorafenib. New drugs of clinical trials were more recommended for the patients with BRAF mutant tumor, and those with good previous treatment efficacy tended to be recommended for chemo/targeted therapy reintroduction. The management of mCRC is evolving, and it must be emphasized that the consideration and recommendations presented here reflect current treatment practices in China and thus might change according to new clinical data as well as the availability of new oral drugs.
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9
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Kawai S, Takeshima N, Hayasaka Y, Notsu A, Yamazaki M, Kawabata T, Yamazaki K, Mori K, Yasui H. Comparison of irinotecan and oxaliplatin as the first-line therapies for metastatic colorectal cancer: a meta-analysis. BMC Cancer 2021; 21:116. [PMID: 33541293 PMCID: PMC7863255 DOI: 10.1186/s12885-021-07823-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
Background Irinotecan (IRI) and oxaliplatin (Ox) are standard therapeutic agents of the first-line treatments for metastatic colorectal cancer (mCRC). Previous meta-analyses of randomized controlled trials (RCTs) showed that treatment with Ox-based compared with IRI-based regimens was associated with better overall survival (OS). However, these reports did not include trials of molecular targeting agents and did not take methods for the administration of concomitant drugs, such as bolus or continuous infusion of 5-fluorouracil, into account. A systematic literature review was performed to compare the efficacy and toxicity profiles between IRI- and Ox-based regimens as the first-line treatments for mCRC. Methods This meta-analysis used data from the Cochrane Central Register of Controlled Trials, PubMed, and SCOPUS. The primary endpoint was OS, and the secondary endpoints were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs). Results Nineteen trials involving 4571 patients were included in the analysis. No statistically significant difference was observed between the two groups in terms of OS, PFS, and ORR. There was no significant heterogeneity. Regarding ≥ grade 3 AEs, IRI-based regimens were associated with a high incidence of leukopenia, febrile neutropenia, and diarrhea. Moreover, there was a high incidence of thrombocytopenia and peripheral sensory neuropathy in patients who received Ox-based regimens. In a subgroup analysis, IRI combined with bevacizumab was correlated with a better PFS (HR = 0.90, 95% CI = 0.82–0.98, P = 0.02), but not with OS (pooled HR = 0.91, 95% CI = 0.80–1.03, P = 0.15). Conclusion Although the safety profiles of IRI- and Ox-based regimens varied, their efficacy did not significantly differ. The combination of anti-VEGF antibody and IRI was associated with better PFS compared with anti-VEGF antibody and Ox. Both regimens could be used as the first-line treatments for mCRC with consideration of the patients’ condition or toxicity profiles.
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Affiliation(s)
- Sadayuki Kawai
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan. .,Department of Medical Oncology, Shizuoka General Hospital, 4-27-1 Kita ando, Aoi-ku, Shizuoka City, 420-8527, Japan.
| | - Nozomi Takeshima
- Department of Psychiatry, Kitabayashi Hospital, 7-58 Nakamura-cho, Nakamura-ku, Nagoya, Aichi, 453-0053, Japan
| | - Yu Hayasaka
- Department of Psychiatry, Tsukuba Psychosomatics Clinic, 5-12-4, Kenkyu-gakuen, Tsukuba, Ibaraki, 305-0817, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Mutsumi Yamazaki
- Information Management Office, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Takanori Kawabata
- Clinical Research Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
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10
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Vacchelli E, Galluzzi L, Fridman WH, Galon J, Sautès-Fridman C, Tartour E, Kroemer G. Trial watch: Chemotherapy with immunogenic cell death inducers. Oncoimmunology 2021; 1:179-188. [PMID: 22720239 PMCID: PMC3376992 DOI: 10.4161/onci.1.2.19026] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The long-established notion that apoptosis would be immunologically silent, and hence it would go unnoticed by the immune system, if not tolerogenic, and hence it would actively suppress immune responses, has recently been revisited. In some instances, indeed, cancer cells undergo apoptosis while emitting a spatiotemporally-defined combination of signals that renders them capable of eliciting a long-term protective antitumor immune response. Importantly, only a few anticancer agents can stimulate such an immunogenic cell death. These include cyclophosphamide, doxorubicin and oxaliplatin, which are currently approved by FDA for the treatment of multiple hematologic and solid malignancies, as well as mitoxantrone, which is being used in cancer therapy and against multiple sclerosis. In this Trial Watch, we will review and discuss the progress of recent (initiated after January 2008) clinical trials evaluating the off-label use of cyclophosphamide, doxorubicin, oxaliplatin and mitoxantrone.
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Affiliation(s)
- Erika Vacchelli
- U848; Villejuif, France; INSERM; Université Paris-Sud/Paris XI; Paris, France
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11
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Stahler A, Stintzing S, Modest DP, Ricard I, Giessen-Jung C, Kapaun C, Ivanova B, Kaiser F, Fischer von Weikersthal L, Moosmann N, Schalhorn A, Stauch M, Kiani A, Held S, Decker T, Moehler M, Neumann J, Kirchner T, Jung A, Heinemann V. Amphiregulin Expression Is a Predictive Biomarker for EGFR Inhibition in Metastatic Colorectal Cancer: Combined Analysis of Three Randomized Trials. Clin Cancer Res 2020; 26:6559-6567. [PMID: 32943459 DOI: 10.1158/1078-0432.ccr-20-2748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Amphiregulin (AREG) and epiregulin (EREG) are ligands of EGFR. Predictive information for anti-EGFR treatment in metastatic colorectal cancer (mCRC) was observed, but data for other agents is limited. EXPERIMENTAL DESIGN Ligand mRNA expression; RAS, BRAF, PIK3CA mutations; and EGFR expression were assessed by qRT-PCR, pyrosequencing, and IHC, respectively, in mCRC tumor tissue of patients participating in the randomized controlled trials FIRE-1, CIOX, and FIRE-3. Normalized mRNA expression was dichotomized using median and third quartile. Overall (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier method including univariate and multivariate Cox regression analyses. Penalized spline regression analysis tested interaction of mRNA expression and outcome. RESULTS Of 688 patients with available material, high AREG expression was detected in 343 (>median) and 172 (>3rd quartile) patients. High AREG expression was associated with significantly higher OS [26.2 vs. 21.5 months, HR = 0.80; 95% confidence interval (CI), 0.68-0.94; P = 0.007], PFS (10.0 vs. 8.1 months, HR = 0.74; 95% CI, 0.63-0.86; P = 0.001), and objective response rate (63.1% vs. 51.6%, P = 0.004) compared to low expression at both threshold values. This effect remained significant in multivariate Cox regression analysis (OS: P = 0.01, PFS: P = 0.002). High AREG mRNA expression interacted significantly with the efficacy of cetuximab compared with bevacizumab (OS: P = 0.02, PFS: P = 0.04) in RAS WT mCRC. CONCLUSIONS High AREG mRNA expression is a favorable prognostic biomarker for mCRC which interacted significantly with efficacy of anti-EGFR treatment.
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Affiliation(s)
- Arndt Stahler
- Department of Internal Medicine III and Comprehensive Cancer Centre Munich, University Hospital Grosshadern, Ludwig-Maximilian-Universitaet Muenchen, Munich, Germany.
| | - Sebastian Stintzing
- Medical Department, Division of Hematology, Oncology and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany.,DKTK, German Cancer Consortium, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Dominik P Modest
- DKTK, German Cancer Consortium, German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Medical Department, Division of Hematology, Oncology and Tumor Immunology (CVK), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Ingrid Ricard
- Department of Internal Medicine III and Comprehensive Cancer Centre Munich, University Hospital Grosshadern, Ludwig-Maximilian-Universitaet Muenchen, Munich, Germany
| | - Clemens Giessen-Jung
- Department of Internal Medicine III and Comprehensive Cancer Centre Munich, University Hospital Grosshadern, Ludwig-Maximilian-Universitaet Muenchen, Munich, Germany
| | - Christine Kapaun
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Boryana Ivanova
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | | | | | - Nicolas Moosmann
- Department for Hematology and Oncology, Klinikum Barmherzige Brüder, Regensburg, Germany
| | - Andreas Schalhorn
- Department of Internal Medicine III and Comprehensive Cancer Centre Munich, University Hospital Grosshadern, Ludwig-Maximilian-Universitaet Muenchen, Munich, Germany
| | | | - Alexander Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | | | | | - Markus Moehler
- I. Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany
| | - Jens Neumann
- DKTK, German Cancer Consortium, German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas Kirchner
- DKTK, German Cancer Consortium, German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Andreas Jung
- DKTK, German Cancer Consortium, German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Volker Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Centre Munich, University Hospital Grosshadern, Ludwig-Maximilian-Universitaet Muenchen, Munich, Germany.,DKTK, German Cancer Consortium, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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12
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Cohen R, Pudlarz T, Delattre JF, Colle R, André T. Molecular Targets for the Treatment of Metastatic Colorectal Cancer. Cancers (Basel) 2020; 12:E2350. [PMID: 32825275 PMCID: PMC7563268 DOI: 10.3390/cancers12092350] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Over the past years, colorectal cancer (CRC) was subtyped according to its molecular and genetic characteristics, allowing the development of therapeutic strategies, based on predictive biomarkers. Biomarkers such as microsatellite instability (MSI), RAS and BRAF mutations, HER2 amplification or NTRK fusions represent major tools for personalized therapeutic strategies. Moreover, the routine implementation of molecular predictive tests provides new perspectives and challenges for the therapeutic management of CRC patients, such as liquid biopsies and the reintroduction of anti-EGFR monoclonal antibodies. In this review, we summarize the current landscape of targeted therapies for metastatic CRC patients, with a focus on new developments for EGFR blockade and emerging biomarkers (MSI, HER2, NTRK).
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Affiliation(s)
- Romain Cohen
- Department of Medical Oncology, Hôpital Saint-Antoine, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75012 Paris, France; (T.P.); (J.-F.D.); (R.C.); (T.A.)
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13
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Wang L, Liu Y, Yin X, Fang W, Xiong J, Zhao B, Zhang M, Zou Y, Qiu H, Yuan X. Effect of Reduced-Dose Capecitabine Plus Cetuximab as Maintenance Therapy for RAS Wild-Type Metastatic Colorectal Cancer: A Phase 2 Clinical Trial. JAMA Netw Open 2020; 3:e2011036. [PMID: 32687588 PMCID: PMC7372324 DOI: 10.1001/jamanetworkopen.2020.11036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Fluorouracil-based chemotherapy combined with anti-epidermal growth factor receptor/vascular endothelial growth factor therapy is the standard first-line treatment for metastatic colorectal cancer followed by low-intensity maintenance therapy to balance the clinical efficacy and adverse effects (AEs). However, there have been concerns about the AEs of capecitabine plus cetuximab as a maintenance therapy in patients with RAS wild-type metastatic colorectal cancer. OBJECTIVE To evaluate the biological activity and safety of capecitabine plus cetuximab as a novel maintenance therapy for RAS wild-type metastatic colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This phase 2 prospective clinical trial was conducted from April 29, 2016, to April 29, 2019, at 5 centers in China. Patients diagnosed as having RAS wild-type metastatic colorectal cancer were recruited to receive fluorouracil-based cytotoxic agents combined with cetuximab followed by capecitabine plus cetuximab for maintenance therapy. Forty-seven patients with histologically confirmed metastatic colorectal cancer and genetic test results showing a wild-type RAS were enrolled in maintenance therapy. INTERVENTIONS Induction therapy for patients with RAS wild-type metastatic colorectal cancer was 8 to 12 cycles of fluorouracil-based chemotherapy combined with cetuximab. After stable disease status or better was achieved, reduced-dose capecitabine plus cetuximab was administered for maintenance therapy. MAIN OUTCOMES AND MEASURES The primary end point was progression-free survival during maintenance therapy. The secondary end points were total progression-free survival, overall survival, quality of life, safety, and toxic effects of treatment. RESULTS Forty-seven patients were enrolled in maintenance therapy, with a median age of 52 years (range, 25-81 years) and 32 (68%) of them being men. The median maintenance progression-free survival was 7.2 (95% CI, 5.8-8.6) months. The median progression-free survival was 12.7 (95% CI, 11.8-15.4) months. The median overall survival was 27.4 (95% CI, 21.4-35.5) months. Grade 3 to 4 AEs during induction therapy included neutropenia (4 patients [9%]), diarrhea (4 patients [9%]), nausea or vomiting (3 patients [6%]), rash acneiform (10 patients [21%]), and hand-foot syndrome (8 patients [17%]). Grade 3 to 4 AEs during maintenance therapy included diarrhea (2 patients [4%]), rash acneiform (8 patients [17%]), and hand-foot syndrome (5 patients [11%]). CONCLUSIONS AND RELEVANCE Reduced-dose capecitabine plus cetuximab after initial chemotherapy is a novel maintenance therapy for patients with RAS wild-type metastatic colorectal cancer that achieved good outcomes and tolerable nonserious AEs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02717923.
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Affiliation(s)
- Lu Wang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Liu
- Department of Medical Oncology of Zhengzhou University Affiliated Cancer Hospital, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Xianli Yin
- Gastroenterology and Urology Department, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Weijia Fang
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianping Xiong
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ben Zhao
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingsheng Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanmei Zou
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hong Qiu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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14
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Aljehani MA, Morgan JW, Guthrie LA, Jabo B, Ramadan M, Bahjri K, Lum SS, Selleck M, Reeves ME, Garberoglio C, Senthil M. Association of Primary Tumor Site With Mortality in Patients Receiving Bevacizumab and Cetuximab for Metastatic Colorectal Cancer. JAMA Surg 2019; 153:60-67. [PMID: 28975237 DOI: 10.1001/jamasurg.2017.3466] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Biologic therapy (BT) (eg, bevacizumab or cetuximab) is increasingly used to treat metastatic colorectal cancer (mCRC). Recent investigations have suggested that right- or left-sided primary tumor origin affects survival and response to BT. Objective To evaluate the association of tumor origin with mortality in a diverse population-based data set of patients receiving systemic chemotherapy (SC) and bevacizumab or cetuximab for mCRC. Design, Setting, and Participants This population-based nonconcurrent cohort study of statewide California Cancer Registry data included all patients aged 40 to 85 years diagnosed with mCRC and treated with SC only or SC plus bevacizumab or cetuximab from January 1, 2004, through December 31, 2014. Patients were stratified by tumor origin in the left vs right sides. Interventions Treatment with SC or SC plus bevacizumab or cetuximab. Main Outcomes and Measures Mortality hazards by tumor origin (right vs left sides) were assessed for patients receiving SC alone or SC plus bevacizumab or cetuximab. Subgroup analysis for patients with wild-type KRAS tumors was also performed. Results A total of 11 905 patients with mCRC (6713 men [56.4%] and 5192 women [43.6%]; mean [SD] age, 60.0 [10.9] years) were eligible for the study. Among these, 4632 patients received SC and BT. Compared with SC alone, SC plus bevacizumab reduced mortality among patients with right- and left-sided mCRC, whereas SC plus cetuximab reduced mortality only among patients with left-sided tumors and was associated with significantly higher mortality for right-sided tumors (hazard ratio [HR], 1.31; 95% CI, 1.14-1.51; P < .001). Among patients treated with SC plus BT, right-sided tumor origin was associated with higher mortality among patients receiving bevacizumab (HR, 1.31; 95% CI, 1.25-1.36; P < .001) and cetuximab (HR, 1.88; 95% CI, 1.68-2.12; P < .001) BT, compared with left-sided tumor origin. In patients with wild-type KRAS tumors (n = 668), cetuximab was associated with reduced mortality among only patients with left-sided mCRC compared with bevacizumab (HR, 0.75; 95% CI, 0.63-0.90; P = .002), whereas patients with right-sided mCRC had more than double the mortality compared with those with left-sided mCRC (HR, 2.44; 95% CI, 1.83-3.25, P < .001). Conclusions and Relevance Primary tumor site is associated with response to BT in mCRC. Right-sided primary tumor location is associated with higher mortality regardless of BT type. In patients with wild-type KRAS tumors, treatment with cetuximab benefited only those with left-sided mCRC and was associated with significantly poorer survival among those with right-sided mCRC. Our results underscore the importance of stratification by tumor site for current treatment guidelines and future clinical trials.
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Affiliation(s)
- Mayada A Aljehani
- Epidemiology Program, Loma Linda University School of Public Health, Loma Linda, California
| | - John W Morgan
- Epidemiology Program, Loma Linda University School of Public Health, Loma Linda, California
| | - Laurel A Guthrie
- Division of Surgical Oncology, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California
| | - Brice Jabo
- Epidemiology Program, Loma Linda University School of Public Health, Loma Linda, California
| | - Majed Ramadan
- Epidemiology Program, Loma Linda University School of Public Health, Loma Linda, California
| | - Khaled Bahjri
- Epidemiology Program, Loma Linda University School of Public Health, Loma Linda, California
| | - Sharon S Lum
- Division of Surgical Oncology, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California
| | - Matthew Selleck
- Division of Surgical Oncology, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California
| | - Mark E Reeves
- Division of Surgical Oncology, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California
| | - Carlos Garberoglio
- Division of Surgical Oncology, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California
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15
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Colloca GA, Venturino A, Guarneri D. Analysis of response-related endpoints in trials of first-line medical treatment of metastatic colorectal cancer. Int J Clin Oncol 2019; 24:1406-1411. [PMID: 31289956 DOI: 10.1007/s10147-019-01504-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tumor radiologic response after systemic chemotherapy has been used as endpoint of trials of patients with metastatic colorectal cancer (mCRC), which can report the best overall response rate (ORR) and the disease control rate (DCR) by RECIST criteria as well as the early tumor shrinkage (ETS). The present study perform a trial-level analysis to verify whether such response-related endpoints are predictive of overall survival (OS). METHODS After a systematic search, randomized clinical trials (RCTs) were selected each time they evaluated the three response endpoints and progression-free survival (PFS). Two arms per trial were selected, and the correlation between the difference in each endpoint and the difference in OS was calculated. The analysis then evaluated the effects of treatment on ∆ORR, or ∆DCR, ∆ETS, ∆PFS, and on ∆OS, using separate linear regressions for each of them, and the proportion of variability explained (R2trial) on OS for each of the four endpoints was calculated. RESULTS The systematic review of the literature led to the selection of 12 RCTs, 7 phase-3 and 5 phase-2. ETS reported a different performance in the entire sample compared to phase-3 trials (R2trial = 0.172 vs. 0.842), differently from DCR (R2trial = 0.541 vs. 0.816) and ORR (R2trial = 0.349 vs. 0.740). Surprisingly, PFS predicted OS with a weak correlation, which was not significant in the subgroup of phase-3 studies (R2trial = 0.455 vs. 0.466). CONCLUSION The results of the present trial-level analysis report a good performance of two response-related endpoints, DCR and ETS, and suggest that they could be differently used depending on the setting of disease and the type of medical treatment.
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Affiliation(s)
- Giuseppe A Colloca
- Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, 18038, Sanremo, Imperia, Italy.
| | - Antonella Venturino
- Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, 18038, Sanremo, Imperia, Italy
| | - Domenico Guarneri
- Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, 18038, Sanremo, Imperia, Italy
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16
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Early tumor shrinkage after first-line medical treatment of metastatic colorectal cancer: a meta-analysis. Int J Clin Oncol 2019; 24:231-240. [PMID: 30719690 DOI: 10.1007/s10147-019-01405-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Early tumor shrinkage (ETS) is a response-related endpoint of clinical trials of chemotherapy (CHT) of patients with metastatic colorectal cancer (mCRC). It identifies a dimensional reduction of tumor size by at least 20-30% after 6-8 weeks of CHT. METHODS A literature search of randomized trials of systemic treatment including CHT with or without antiangiogenics or anti-EGFR inhibitors in patients with mCRC has been conducted, and studies reporting the results of the relationship of ETS with overall survival (OS) and progression-free survival (PFS) were selected. RESULTS Twelve trials, including 3117 patients, have been included; all data were retrospective and only 72% of the enrolled patients have been evaluated for ETS. Two meta-analyses, each including 20 study cohorts from the selected 12 trials, reported a strong relationship of ETS with OS (HR 0.62; CIs 0.55-0.69) and of ETS with PFS (HR 0.66; CIs 0.60-0.73). However, both meta-analyses displayed a high level of heterogeneity. Among nine possible moderators, three variables (median age, surgery of metastases, and publication year) were able to explain at least a part of this heterogeneity. CONCLUSION ETS is a simple and interesting intermediate endpoint for clinical practice and future trials of medical treatments of patients with mCRC, but a large prospective analysis and validation are mandatory.
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Modest DP, Fischer von Weikersthal L, Decker T, Vehling-Kaiser U, Uhlig J, Schenk M, Freiberg-Richter J, Peuser B, Denzlinger C, Peveling genannt Reddemann C, Graeven U, Schuch G, Schwaner I, Stahler A, Jung A, Kirchner T, Held S, Stintzing S, Giessen-Jung C, Heinemann V. Sequential Versus Combination Therapy of Metastatic Colorectal Cancer Using Fluoropyrimidines, Irinotecan, and Bevacizumab: A Randomized, Controlled Study—XELAVIRI (AIO KRK0110). J Clin Oncol 2019; 37:22-32. [DOI: 10.1200/jco.18.00052] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose The XELAVIRI trial investigated the optimal treatment strategy for patients with untreated metastatic colorectal cancer. We tested the noninferiority of initial treatment with a fluoropyrimidine plus bevacizumab, followed by the addition of irinotecan at first progression (arm A) versus upfront use of fluoropyrimidine plus irinotecan plus bevacizumab (arm B) in a 1:1 randomized, controlled phase III trial. Methods The primary efficacy end point was time to failure of the strategy (TFS). Given a 90% CI, a power of 70%, and a one-sided α of .05, the margin for noninferiority was set at 0.8. In the case of demonstrated noninferiority of TFS, an analysis of symptomatic toxicities during TFS would define the superior strategy. Secondary end points included the effect of molecular subgroups on efficacy parameters. Results A total of 421 randomly assigned patients (arm A: n = 212; arm B: n = 209) formed the full analysis set. Median age was 71 and 69 years, respectively. Noninferiority of TFS was not shown (hazard ratio [HR], 0.86; 90% CI, 0.73 to 1.02). In detail, patients with RAS/BRAF wild-type tumors benefitted from combination chemotherapy (HR, 0.61; 90% CI, 0.46 to 0.82; P = .005), whereas patients with RAS mutant tumors (HR, 1.09; 90% CI, 0.81 to 1.46; P = .58) did not (Cox model for interaction of study arm and RAS status: P = .03). Comparable results were obtained for overall survival. Conclusion Noninferiority of sequential escalation therapy compared with initial combination chemotherapy could not be demonstrated for TFS. RAS status may be important to guide therapy as treatment of patients with upfront combination therapy was clearly superior in RAS/BRAF wild-type tumors, whereas sequential escalation chemotherapy seems to provide comparable results in patients with RAS mutant tumors.
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Affiliation(s)
- Dominik Paul Modest
- University Hospital Grosshadern, Munich, Germany
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Centre, Heidelberg, Germany
| | | | | | | | - Jens Uhlig
- Private Oncological Practice, Naunhof, Germany
| | - Michael Schenk
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | | | - Bettina Peuser
- Onkologische Praxis am Diakonissenhaus, Leipzig, Germany
| | | | | | | | - Gunter Schuch
- Hämatologisch-Onkologische Praxis Altona, Hamburg, Germany
| | - Ingo Schwaner
- Onkologische Schwerpunktpraxis Kurfürstendamm, Berlin, Germany
| | | | - Andreas Jung
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Centre, Heidelberg, Germany
- Ludwig Maximilians-Universität, Munich, Germany
| | - Thomas Kirchner
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Centre, Heidelberg, Germany
- Ludwig Maximilians-Universität, Munich, Germany
| | | | - Sebastian Stintzing
- University Hospital Grosshadern, Munich, Germany
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Centre, Heidelberg, Germany
| | | | - Volker Heinemann
- University Hospital Grosshadern, Munich, Germany
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Centre, Heidelberg, Germany
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18
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Bormann F, Stinzing S, Tierling S, Morkel M, Markelova MR, Walter J, Weichert W, Roßner F, Kuhn N, Perner J, Dietz J, Ispasanie S, Dietel M, Schäfer R, Heinemann V, Sers C. Epigenetic regulation of Amphiregulin and Epiregulin in colorectal cancer. Int J Cancer 2018; 144:569-581. [PMID: 30252132 DOI: 10.1002/ijc.31892] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/05/2018] [Accepted: 08/20/2018] [Indexed: 12/23/2022]
Abstract
Expression of the epidermal growth factor ligands amphiregulin (AREG) and epiregulin (EREG) is positively correlated with a response to EGFR-targeted therapies in colorectal cancer. Gene-body methylation sites, which show a strong inverse correlation with AREG and EREG gene expression, were identified in cell lines using targeted 454 FLX-bisulfite sequencing and SIRPH analyses for AREG/EREG promoters and intragenic CpGs. Upon treatment of colorectal cancer cells with 5-aza-2'-desoxycytidine, methylation decreases at specific intragenic CpGs accompanied by upregulation of AREG and EREG gene expression. The same AREG gene-body methylation was also found in human colorectal cancer samples and is independent of KRAS and NRAS mutations. Methylation is specifically decreased in the tumor epithelial compartment as compared to stromal tissue and normal epithelium. Investigation of a promoter/enhancer function of the AREG exon 2 region revealed a potential promoter function in reverse orientation. Retrospective comparison of the predictive power of AREG gene-body methylation versus AREG gene expression using samples from colorectal cancer patients treated with anti-EGFR inhibitors with complete clinical follow-up revealed that AREG expression is superior to AREG gene methylation. AREG and EREG genes undergo a complex regulation involving both intragenic methylation and promoter-dependent control.
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Affiliation(s)
- Felix Bormann
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany
| | - Sebastian Stinzing
- Department of Hematology and Medical Oncology, Klinikum der Universität München (LMU); German Cancer Consortium site Munich (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Sascha Tierling
- Department of Genetics/Epigenetics, FR8.3 Life Sciences, Saarland University, Saarbrücken
| | - Markus Morkel
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany.,DKTK, German Consortium for Translational Cancer Research, Partner Site Berlin and DKFZ, German Cancer Research Center, Heidelberg, Germany
| | | | - Jörn Walter
- Department of Genetics/Epigenetics, FR8.3 Life Sciences, Saarland University, Saarbrücken
| | - Wilko Weichert
- DKTK, German Consortium for Translational Cancer Research, Partner Site Berlin and DKFZ, German Cancer Research Center, Heidelberg, Germany.,Institute of Pathology, Technical University Munich, Germany and Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Florian Roßner
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany
| | - Natalia Kuhn
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany
| | - Juliane Perner
- Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Johanna Dietz
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany
| | - Sylvia Ispasanie
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany.,BSIO Berlin School of Integrative Oncology, University Medicine Charité, Berlin, Germany
| | - Manfred Dietel
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany.,DKTK, German Consortium for Translational Cancer Research, Partner Site Berlin and DKFZ, German Cancer Research Center, Heidelberg, Germany
| | - Reinhold Schäfer
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany.,DKTK, German Consortium for Translational Cancer Research, Partner Site Berlin and DKFZ, German Cancer Research Center, Heidelberg, Germany
| | - Volker Heinemann
- Department of Hematology and Medical Oncology, Klinikum der Universität München (LMU); German Cancer Consortium site Munich (DKTK); German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Christine Sers
- Charité Universitätsmedizin Berlin, Institute of Pathology, Laboratory of Molecular Tumor Pathology and Systems Biology, Berlin, Germany.,DKTK, German Consortium for Translational Cancer Research, Partner Site Berlin and DKFZ, German Cancer Research Center, Heidelberg, Germany
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19
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Papaxoinis G, Kotoula V, Giannoulatou E, Koliou GA, Karavasilis V, Lakis S, Koureas A, Bobos M, Chalaralambous E, Daskalaki E, Chatzopoulos K, Tsironis G, Pazarli E, Chrisafi S, Samantas E, Kaklamanos IG, Varthalitis I, Konstantara A, Syrigos KN, Pentheroudakis G, Pectasides D, Fountzilas G. Phase II study of panitumumab combined with capecitabine and oxaliplatin as first-line treatment in metastatic colorectal cancer patients: clinical results including extended tumor genotyping. Med Oncol 2018; 35:101. [PMID: 29855806 DOI: 10.1007/s12032-018-1160-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/27/2018] [Indexed: 12/12/2022]
Abstract
This clinical trial assessed the efficacy and toxicity of panitumumab combined with oxaliplatin and capecitabine as first-line treatment in KRAS exon 2 wild-type metastatic colorectal cancer (mCRC) patients. Patients with exon 2 KRAS wild-type mCRC received panitumumab 9 mg/Kg, oxaliplatin 130 mg/m2, and capecitabine 2000 mg/m2 repeated every 3 weeks. The primary endpoint was objective response rate (ORR, minimum 42 responses). We retrospectively assessed mutations in genes implicated in CRC with massively parallel sequencing; ERBB2 and EGFR amplification with fluorescence in situ hybridization, and tumor-infiltrating lymphocyte density. Among 78 patients enrolled, 45 (57.7%) completed 6 cycles. Most common grade 3-4 toxicities were skin rash (19.2%), diarrhea (18%), and neuropathy (6.4%). Among 5 (6.4%) potentially treatment-related deaths, 2 (2.6%) were characterized toxic. Objective response occurred in 43 (55.1%) of the patients (complete 6.4% and partial response 48.7%; stable 17.9% and progressive disease 7.7%), while 3.8% were non-evaluable and 15% discontinued their treatment early. Additional mutations in KRAS/NRAS/BRAF were found in 11/62 assessable (18%) tumors. After 51 months median follow-up, median progression-free (PFS) was 8.1 and overall survival 20.2 months, independently of KRAS/NRAS/BRAF or PI3K-pathway mutation status. Patients with TP53 mutations (n = 34; 55%), as well as those with left colon primary tumors (n = 66; 85%), had significantly better PFS, also confirmed in multivariate analysis. Although the clinical trial met its primary endpoint, according to the current standards, the efficacy and tolerability of the drug combination are considered insufficient. Extended genotyping yielded interesting results regarding the significance of TP53 mutations.ClinicalTrials.gov identifier: NCT01215539, Registration date: Sep 29, 2010.
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Affiliation(s)
- George Papaxoinis
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527, Athens, Greece.
| | - Vassiliki Kotoula
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia.,The University of New South Wales, Kensington, NSW, Australia
| | | | - Vasilios Karavasilis
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Lakis
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Koureas
- Department of Radiology, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elpida Chalaralambous
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emily Daskalaki
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Chatzopoulos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Tsironis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Elisavet Pazarli
- Department of Pathology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Chrisafi
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Epaminontas Samantas
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Ioannis G Kaklamanos
- Department of Surgery, School of Health Sciences, General Oncologic Hospital of Kifisia, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Konstantinos N Syrigos
- Oncology Unit GPP, Sotiria General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Modified XELIRI (capecitabine plus irinotecan) for metastatic colorectal cancer. Lancet Oncol 2018; 19:587-589. [DOI: 10.1016/s1470-2045(18)30194-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 01/09/2023]
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21
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Xu RH, Muro K, Morita S, Iwasa S, Han SW, Wang W, Kotaka M, Nakamura M, Ahn JB, Deng YH, Kato T, Cho SH, Ba Y, Matsuoka H, Lee KW, Zhang T, Yamada Y, Sakamoto J, Park YS, Kim TW. Modified XELIRI (capecitabine plus irinotecan) versus FOLFIRI (leucovorin, fluorouracil, and irinotecan), both either with or without bevacizumab, as second-line therapy for metastatic colorectal cancer (AXEPT): a multicentre, open-label, randomised, non-inferiority, phase 3 trial. Lancet Oncol 2018; 19:660-671. [PMID: 29555258 DOI: 10.1016/s1470-2045(18)30140-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies of a modified XELIRI (mXELIRI; capecitabine plus irinotecan) regimen suggest promising efficacy and tolerability profiles in the first-line and second-line settings. Therefore, we aimed to compare the efficacy and safety of the mXELIRI regimen with that of standard FOLFIRI (leucovorin, fluorouracil, and irinotecan), with or without bevacizumab in both regimens, as a second-line therapy for metastatic colorectal cancer. METHODS We did a multicentre, open-label, randomised, non-inferiority, phase 3 trial. We enrolled patients from 98 hospitals in Japan, China, and South Korea who were aged 20 years or older with histologically confirmed and unresectable colorectal adenocarcinoma, and who had withdrawn from first-line chemotherapy for metastatic colorectal cancer. We randomly assigned patients (1:1) to receive either mXELIRI with or without bevacizumab (irinotecan 200 mg/m2 intravenously on day 1 plus oral capecitabine 800 mg/m2 twice daily on days 1-14, repeated every 21 days, with or without bevacizumab 7·5 mg/kg intravenously on day 1) or FOLFIRI with or without bevacizumab (irinotecan 180 mg/m2 intravenously on day 1, leucovorin 200 mg/m2 intravenously on day 1, fluorouracil 400 mg/m2 intravenously on day 1, and a 46-h continuous intravenous infusion of fluorouracil [2400 mg/m2], repeated every 14 days, with or without the addition of bevacizumab 5 mg/kg intravenously on day 1) via a centralised electronic system. We used the minimisation method to stratify randomisation by country, Eastern Cooperative Oncology Group performance status, number of metastatic sites, previous oxaliplatin treatment, and concomitant bevacizumab treatment. Patients and clinicians were not masked to the allocated treatment. The primary endpoint was overall survival analysed on an intention-to-treat basis with a non-inferiority upper margin of 1·30 for the hazard ratio (HR). This study is registered with ClinicalTrials.gov, number NCT01996306, and is ongoing but no longer recruiting participants. FINDINGS Between Dec 2, 2013, and Aug 13, 2015, 650 patients were enrolled and randomly assigned to receive mXELIRI with or without bevacizumab (n=326) or FOLFIRI with or without bevacizumab (n=324). After a median follow-up of 15·8 months (IQR 8·7-24·9), a total of 490 patients had died (242 in the mXELIRI with or without bevacizumab group and 248 in the FOLFIRI with or without bevacizumab group) and the median overall survival was 16·8 months (95% CI 15·3-19·1) in the mXELIRI group and 15·4 months (13·0-17·7) in the FOLFIRI group (HR 0·85, 95% CI 0·71-1·02; pnon-inferiority<0·0001). In the per-protocol safety population, the most common grade 3-4 adverse event was neutropenia (affecting 52 [17%] of 310 patients in the mXELIRI group and 133 [43%] of 310 in the FOLFIRI group). Incidences of grade 3-4 diarrhoea were higher in the mXELIRI group (22 [7%]) than in the FOLFIRI group (ten [3%]). Serious adverse events were reported in 46 (15%) of 310 patients in the mXELIRI group and 63 (20%) of 310 in the FOLFIRI group. Two treatment-related deaths (one pneumonitis and one lung infection) were observed in the mXELIRI group and there was one treatment-related death (lung infection) in the FOLFIRI group. INTERPRETATION mXELIRI with or without bevacizumab is well tolerated and non-inferior to FOLFIRI with or without bevacizumab in terms of overall survival. mXELIRI could be an alternative to FOLFIRI as a standard second-line backbone treatment for metastatic colorectal cancer, at least for Asian patient populations. FUNDING Chugai Pharmaceutical and F Hoffmann-La Roche.
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Affiliation(s)
- Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Iwasa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Sae Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Wei Wang
- Department of Gastrointestinal Oncology, The First People's Hospital of Foshan, Foshan, China
| | | | - Masato Nakamura
- Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | - Joong Bae Ahn
- Department of Internal Medicine, Severance Hospital, Yonsei University, Seoul, South Korea
| | - Yan-Hong Deng
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Takeshi Kato
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Sang-Hee Cho
- Department of Hematology-Oncology, Chonnam National University Hospital, Hwasun, South Korea
| | - Yi Ba
- Department of Digestive Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Tao Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yasuhide Yamada
- Department of Medical Oncology, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Young Suk Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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van Rooijen KL, Shi Q, Goey KKH, Meyers J, Heinemann V, Diaz-Rubio E, Aranda E, Falcone A, Green E, de Gramont A, Sargent DJ, Punt CJA, Koopman M. Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: Individual patient data analysis of first-line randomised trials from the ARCAD database. Eur J Cancer 2018; 91:99-106. [PMID: 29353165 DOI: 10.1016/j.ejca.2017.12.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022]
Abstract
Indication for primary tumour resection (PTR) in asymptomatic metastatic colorectal cancer (mCRC) patients is unclear. Previous retrospective analyses suggest a survival benefit for patients who underwent PTR. The aim was to evaluate the prognostic value of PTR in patients with synchronous mCRC by analysis of recent large RCTs including systemic therapy with modern targeted agents. Individual patient data (IPD) of 3423 patients enrolled into 8 randomised controlled trials (RCTs) with first-line systemic therapy in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were analysed. The number of patients with unresected synchronous mCRC, resected synchronous mCRC and metachronous mCRC was 710 (21%), 1705 (50%) and 1008 (29%), respectively. Adjusting for age, gender, performance status (PS) and prior chemotherapy, the unresected group had a significantly worse median overall survival (16.4 m) compared with the synchronous resected (22.2 m; hazard ratio [HR] 1.60, 95% CI 1.43-1.78) and metachronous (22.4 m; HR 1.81, 95% CI 1.58-2.07) groups. Similarly, median progression-free survival was significantly worse for the unresected group compared with the synchronous resected (HR 1.31, 95% CI 1.19-1.44) and metachronous (HR 1.47, 95% CI 1.30-1.66) groups. In a multivariate analysis, the observed associations remained significant. This largest IPD analysis of mCRC trials to date demonstrates an improved survival in synchronous mCRC patients after PTR. These results may be subject to bias since reasons for (non)resection were not available. Until results of ongoing RCTs are available, both upfront PTR followed by systemic treatment and upfront systemic treatment are considered appropriate treatment strategies.
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Affiliation(s)
- K L van Rooijen
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Q Shi
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - K K H Goey
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J Meyers
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | - E Diaz-Rubio
- Cancer Translational Unit, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - E Aranda
- Department of Medical Oncology, UCO, Maimonides Institute of Biomedical Research (IMIBIC), CIBERONC, Instituto de Salud Carlos III, Córdoba, Spain
| | - A Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy
| | - E Green
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - A de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - D J Sargent
- Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
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23
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Qiu T, Chen W, Li P, Sun J, Gu Y, Chen X. Subsequent anti-VEGF therapy after first-line anti-EGFR therapy improved overall survival of patients with metastatic colorectal cancer. Onco Targets Ther 2018; 11:465-471. [PMID: 29403291 PMCID: PMC5784580 DOI: 10.2147/ott.s149110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Colorectal cancer is one of the leading causes of cancer deaths worldwide. Due to targeted therapy, overall survival (OS) of metastatic colorectal cancer (mCRC) patients has been significantly increased over the past decade. However, the best sequencing of the therapeutic agents to be used in RAS wild-type subgroup is still under research. To determine the efficacy of targeted therapy, we collected randomized controlled trials which included patients receiving anti-epidermal growth factor receptor (EGFR) monoclonal antibody as first-line therapy in RAS/KRAS wild-type mCRC. In our study, we found that OS was significantly improved by anti-vascular endothelial growth factor (VEGF) agent after first-line anti-EGFR therapy. Our results revealed that it is a sensible treatment strategy to try anti-VEGF agent after first-line combination therapy with anti-EGFR monoclonal antibody for RAS/KRAS wild-type mCRC.
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Affiliation(s)
- Tianzhu Qiu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wensen Chen
- Infection Management Office, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ping Li
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jing Sun
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yanhong Gu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaofeng Chen
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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24
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Guéguinou M, Harnois T, Crottes D, Uguen A, Deliot N, Gambade A, Chantôme A, Haelters JP, Jaffrès PA, Jourdan ML, Weber G, Soriani O, Bougnoux P, Mignen O, Bourmeyster N, Constantin B, Lecomte T, Vandier C, Potier-Cartereau M. SK3/TRPC1/Orai1 complex regulates SOCE-dependent colon cancer cell migration: a novel opportunity to modulate anti-EGFR mAb action by the alkyl-lipid Ohmline. Oncotarget 2017; 7:36168-36184. [PMID: 27102434 PMCID: PMC5094991 DOI: 10.18632/oncotarget.8786] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background Barely 10-20% of patients with metastatic colorectal cancer (mCRC) receive a clinical benefit from the use of anti-EGFR monoclonal antibodies (mAbs). We hypothesized that this could depends on their efficiency to reduce Store Operated Calcium Entry (SOCE) that are known to enhance cancer cells. Results In the present study, we demonstrate that SOCE promotes migration of colon cancer cell following the formation of a lipid raft ion channel complex composed of TRPC1/Orai1 and SK3 channels. Formation of this complex is stimulated by the phosphorylation of the reticular protein STIM1 by EGF and activation of the Akt pathway. Our data show that, in a positive feedback loop SOCE activates both Akt pathway and SK3 channel activity which lead to SOCE amplification. This amplification occurs through the activation of Rac1/Calpain mediated by Akt. We also show that Anti-EGFR mAbs can modulate SOCE and cancer cell migration through the Akt pathway. Interestingly, the alkyl-lipid Ohmline, which we previously showed to be an inhibitor of SK3 channel, can dissociated the lipid raft ion channel complex through decreased phosphorylation of Akt and modulation of mAbs action. Conclusions This study demonstrates that the inhibition of the SOCE-dependent colon cancer cell migration trough SK3/TRPC1/Orai1 channel complex by the alkyl-lipid Ohmline may be a novel strategy to modulate Anti-EGFR mAb action in mCRC.
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Affiliation(s)
- Maxime Guéguinou
- INSERM UMR 1069, Université de Tours, Tours, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Thomas Harnois
- Equipe ERL 7368, CNRS, Université de Poitiers, Poitiers, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - David Crottes
- Department of Physiology, University of California, San Francisco, San Francisco, CA, USA
| | - Arnaud Uguen
- INSERM-UMR 1078 Université de Brest, Brest, France.,CHRU Brest, Service d'Anatomie et Cytologie Pathologiques, Brest, France
| | - Nadine Deliot
- Equipe ERL 7368, CNRS, Université de Poitiers, Poitiers, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | | | - Aurélie Chantôme
- INSERM UMR 1069, Université de Tours, Tours, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Jean Pierre Haelters
- CNRS-UMR 6521-Université de Brest, Brest, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Paul Alain Jaffrès
- CNRS-UMR 6521-Université de Brest, Brest, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Marie Lise Jourdan
- INSERM UMR 1069, Université de Tours, Tours, France.,CHRU Tours, Tours, France
| | | | - Olivier Soriani
- CNRS UMR 7299, INSERM-UMR 1099, Université de Nice Sophia-Antipolis, Nice, France
| | - Philippe Bougnoux
- INSERM UMR 1069, Université de Tours, Tours, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France.,CHRU Tours, Tours, France
| | - Olivier Mignen
- INSERM-UMR 1078 Université de Brest, Brest, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Nicolas Bourmeyster
- Equipe ERL 7368, CNRS, Université de Poitiers, Poitiers, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Bruno Constantin
- Equipe ERL 7368, CNRS, Université de Poitiers, Poitiers, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Thierry Lecomte
- GICC-UMR 7292 Université de Tours, Tours, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France.,CHRU Tours, Tours, France
| | - Christophe Vandier
- INSERM UMR 1069, Université de Tours, Tours, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
| | - Marie Potier-Cartereau
- INSERM UMR 1069, Université de Tours, Tours, France.,Ion Channels Network and Cancer-Cancéropôle Grand Ouest (IC-CGO), France
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25
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Gouverneur A, Salvo F, Berdaï D, Moore N, Fourrier-Réglat A, Noize P. Inclusion of elderly or frail patients in randomized controlled trials of targeted therapies for the treatment of metastatic colorectal cancer: A systematic review. J Geriatr Oncol 2017; 9:15-23. [PMID: 28844343 DOI: 10.1016/j.jgo.2017.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/23/2017] [Accepted: 08/09/2017] [Indexed: 01/20/2023]
Abstract
Treatment of metastatic colorectal cancer (mCRC) has been modified since the launching of targeted therapies. Colorectal cancer (CRC) is common in elderly patients; their representation in randomized controlled trials (RCTs) is thus crucial. This study aimed to evaluate and quantify the inclusion of elderly/frail patients in RCTs of targeted therapies in mCRC. A systematic review using Medline, Scopus, Cochrane Database and ISI Web of Science was performed to identify all phase II/III RCTs of bevacizumab, cetuximab, panitumumab, regorafenib and aflibercept in mCRC until January 2015. Two reviewers independently performed studies selection, and data extraction. The protocol was registered in Prospero (CRD42015016163). Among 1,369, identified publications, 54 RCTs were selected. Nine RCTs (17%) excluded elderly patients; median age of the included population was <65years old in 50 RCTs (93%). Twenty RCTs (37%) excluded frail patients, and many RCTs excluded patients with uncontrolled hypertension or heart failure, patients treated with specific drugs (mainly anticoagulants), and patients with inadequate creatinine clearance. Elderly/frail patients are underrepresented in RCTs studying targeted therapies in mCRC, and those elderly patients included in RCTs do not reflect well the general elderly population with mCRC because of the exclusion criteria. RCTs results concerning targeted therapies can be inferred only to relatively healthy elderly subjects.
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Affiliation(s)
- Amandine Gouverneur
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie médicale, F-33000 Bordeaux, France.
| | - Francesco Salvo
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie médicale, F-33000 Bordeaux, France
| | - Driss Berdaï
- CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie médicale, F-33000 Bordeaux, France
| | - Nicholas Moore
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie médicale, F-33000 Bordeaux, France
| | - Annie Fourrier-Réglat
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie médicale, F-33000 Bordeaux, France
| | - Pernelle Noize
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie médicale, F-33000 Bordeaux, France
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26
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Yang M, Yeatman TJ. Molecular stratification of colorectal cancer populations and its use in directing precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1362316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mingli Yang
- Gibbs Research Institute, Gibbs Cancer Center & Research Institute, Spartanburg, SC 29303, USA
| | - Timothy J Yeatman
- Gibbs Research Institute, Gibbs Cancer Center & Research Institute, Spartanburg, SC 29303, USA
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27
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van Helden EJ, Menke-van der Houven van Oordt CW, Heymans MW, Ket JCF, van den Oord R, Verheul HMW. Optimal use of anti-EGFR monoclonal antibodies for patients with advanced colorectal cancer: a meta-analysis. Cancer Metastasis Rev 2017; 36:395-406. [PMID: 28695301 PMCID: PMC5557867 DOI: 10.1007/s10555-017-9668-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This meta-analysis was performed to determine the optimal use of anti-EGFR mAb in the treatment of metastasized colorectal cancer (mCRC). Seventeen randomized clinical trials were included, all evaluating the added value of anti-EGFR mAb to standard treatment line in patients with KRAS wild-type mCRC. Hazard and odds ratios were pooled using a random effect model, weighted according to cohort size. Pooled data of six first- and two second-line studies demonstrated a significantly improved ORR (OR 1.62, CI 1.27-2.04; OR 4.78, CI 3.39-6.75, respectively) and PFS (HR 0.79, CI 0.67-0.94; HR 0.80, CI 0.71-0.91, respectively) with the addition of anti-EGFR mAb to chemotherapy, while OS remained similar. Two third-line anti-EGFR mAb monotherapy studies revealed an improved PFS and OS (HR 0.44, CI 0.35-0.52; HR 0.55, CI 0.41-0.74). Addition of anti-EGFR versus anti-VEGF mAb to first-line chemotherapy was evaluated in three studies; ORR and PFS were comparable, while OS was improved (HR 0.8, CI 0.65-0.97). The influence of the chemotherapy backbone on anti-EGFR mAb efficacy, evaluated with meta-regression, indicated a higher ORR with irinotecan-based versus oxaliplatin-based regimens, but comparable PFS and OS. Reported toxicity (≥3 grade) increased ~20% in all treatment lines with the addition of anti-EGFR mAb. Anti-EGFR treatment significantly improves response and survival outcome of patients with (K)RAS wild-type mCRC, regardless of treatment line or chemotherapeutic backbone. Saving anti-EGFR mAb as third-line monotherapy is a valid and effective option to prevent high treatment burden caused by combination therapy. Combination treatment with anti-EGFR mAb to achieve radical resection of metastases needs further investigation.
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Affiliation(s)
- E J van Helden
- Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - J C F Ket
- VU University, Medical Library, De Boelelaan 1117 (ZH3A-46), Postbus 7057, Amsterdam, 1081 HV, The Netherlands
| | - R van den Oord
- Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
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28
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Franko J, Shi Q, Meyers JP, Maughan TS, Adams RA, Seymour MT, Saltz L, Punt CJA, Koopman M, Tournigand C, Tebbutt NC, Diaz-Rubio E, Souglakos J, Falcone A, Chibaudel B, Heinemann V, Moen J, De Gramont A, Sargent DJ, Grothey A. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol 2016; 17:1709-1719. [PMID: 27743922 DOI: 10.1016/s1470-2045(16)30500-9] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with peritoneal metastatic colorectal cancer have reduced overall survival compared with patients with metastatic colorectal cancer without peritoneal involvement. Here we further investigated the effect of the number and location of metastases in patients receiving first-line systemic chemotherapy. METHODS We analysed individual patient data for previously untreated patients enrolled in 14 phase 3 randomised trials done between 1997 and 2008. Trials were included if protocols explicitly pre-specified and solicited for patients with peritoneal involvement in the trial data collection process or had done a formal peritoneum-focused review of individual pre-treatment scans. We used stratified multivariable Cox models to assess the prognostic associations of peritoneal metastatic colorectal cancer with overall survival and progression-free survival, adjusting for other key clinical-pathological factors (age, sex, Eastern Cooperative Oncology Group (ECOG) performance score, primary tumour location [colon vs rectum], previous treatment, and baseline BMI). The primary endpoint was difference in overall survival between populations with and without peritoneal metastases. FINDINGS Individual patient data were available for 10 553 patients. 9178 (87%) of 10 553 patients had non-peritoneal metastatic colorectal cancer (4385 with one site of metastasis, 4793 with two or more sites of metastasis), 194 (2%) patients had isolated peritoneal metastatic colorectal cancer, and 1181 (11%) had peritoneal metastatic colorectal cancer and other organ involvement. These groups were similar in age, ethnic origin, and use of targeted treatment. Patients with peritoneal metastatic colorectal cancer were more likely than those with non-peritoneal metastatic colorectal cancer to be women (565 [41%] of 1371 vs 3312 [36%] of 9169 patients; p=0·0003), have colon primary tumours (1116 [84%] of 1334 patients vs 5603 [66%]; p<0·0001), and have performance status of 2 (136 [10%] vs 521 [6%]; p<0·0001). We recorded a higher proportion of patients with mutated BRAF in patients with peritoneal-only (eight [18%] of 44 patients with available data) and peritoneal metastatic colorectal cancer with other sites of metastasis (34 [12%] of 289), compared with patients with non-peritoneal metastatic colorectal cancer (194 [9%] of 2230; p=0·028 comparing the three groups). Overall survival (adjusted HR 0·75, 95% CI 0·63-0·91; p=0·003) was better in patients with isolated non-peritoneal sites than in those with isolated peritoneal metastatic colorectal cancer. Overall survival of patients with two of more non-peritoneal sites of metastasis (adjusted HR 1·04, 95% CI 0·86-1·25, p=0.69) and those with peritoneal metastatic colorectal cancer plus one other site of metastasis (adjusted HR 1·10, 95% CI 0·89-1·37, p=0·37) was similar to those with isolated peritoneal metastases. Compared with patients with isolated peritoneal metastases, those with peritoneal metastases and two or more additional sites of metastasis had the shortest survival (adjusted HR 1·40; CI 1·14-1·71; p=0·0011). INTERPRETATION Patients with peritoneal metastatic colorectal cancer have significantly shorter overall survival than those with other isolated sites of metastases. In patients with several sites of metastasis, poor survival is a function of both increased number of metastatic sites and peritoneal involvement. The pattern of metastasis and in particular, peritoneal involvement, results in prognostic heterogeneity of metastatic colorectal cancer. FUNDING None.
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Affiliation(s)
- Jan Franko
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, IA, USA.
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey P Meyers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew T Seymour
- Gastrointestinal Cancer Research Unit, Cookridge Hospital, Leeds, UK
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Niall C Tebbutt
- Sydney Medical School, the University of Sydney, NSW, Australia
| | | | - John Souglakos
- University of Crete, School of Medicine, Heraklion, Greece
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Volker Heinemann
- University of Munich, Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | - Joseph Moen
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Daniel J Sargent
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Axel Grothey
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
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29
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Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, Aranda Aguilar E, Bardelli A, Benson A, Bodoky G, Ciardiello F, D'Hoore A, Diaz-Rubio E, Douillard JY, Ducreux M, Falcone A, Grothey A, Gruenberger T, Haustermans K, Heinemann V, Hoff P, Köhne CH, Labianca R, Laurent-Puig P, Ma B, Maughan T, Muro K, Normanno N, Österlund P, Oyen WJG, Papamichael D, Pentheroudakis G, Pfeiffer P, Price TJ, Punt C, Ricke J, Roth A, Salazar R, Scheithauer W, Schmoll HJ, Tabernero J, Taïeb J, Tejpar S, Wasan H, Yoshino T, Zaanan A, Arnold D. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27:1386-422. [PMID: 27380959 DOI: 10.1093/annonc/mdw235] [Citation(s) in RCA: 2178] [Impact Index Per Article: 272.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 02/11/2024] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.
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Affiliation(s)
- E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - A Cervantes
- Medical Oncology Department, INCLIVA University of Valencia, Valencia, Spain
| | - R Adam
- Hepato-Biliary Centre, Paul Brousse Hospital, Villejuif, France
| | - A Sobrero
- Medical Oncology, IRCCS San Martino Hospital, Genova, Italy
| | - J H Van Krieken
- Research Institute for Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - D Aderka
- Division of Oncology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - E Aranda Aguilar
- Medical Oncology Department, University Hospital Reina Sofia, Cordoba, Spain
| | - A Bardelli
- School of Medicine, University of Turin, Turin, Italy
| | - A Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - G Bodoky
- Department of Oncology, St László Hospital, Budapest, Hungary
| | - F Ciardiello
- Division of Medical Oncology, Seconda Università di Napoli, Naples, Italy
| | - A D'Hoore
- Abdominal Surgery, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - E Diaz-Rubio
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J-Y Douillard
- Medical Oncology, Institut de Cancérologie de l'Ouest (ICO), St Herblain
| | - M Ducreux
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - A Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy Division of Medical Oncology, Department of Oncology, University Hospital 'S. Chiara', Istituto Toscano Tumori, Pisa, Italy
| | - A Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, USA
| | - T Gruenberger
- Department of Surgery I, Rudolfstiftung Hospital, Vienna, Austria
| | - K Haustermans
- Department of Radiation Oncology, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium
| | - V Heinemann
- Comprehensive Cancer Center, University Clinic Munich, Munich, Germany
| | - P Hoff
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - C-H Köhne
- Northwest German Cancer Center, University Campus Klinikum Oldenburg, Oldenburg, Germany
| | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - P Laurent-Puig
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - B Ma
- Department of Clinical Oncology, Prince of Wales Hospital, State Key Laboratory in Oncology in South China, Chinese University of Hong Kong, Shatin, Hong Kong
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - K Muro
- Department of Clinical Oncology and Outpatient Treatment Center, Aichi Cancer Center Hospital, Nagoya, Japan
| | - N Normanno
- Cell Biology and Biotherapy Unit, I.N.T. Fondazione G. Pascale, Napoli, Italy
| | - P Österlund
- Helsinki University Central Hospital, Comprehensive Cancer Center, Helsinki, Finland Department of Oncology, University of Helsinki, Helsinki, Finland
| | - W J G Oyen
- The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - D Papamichael
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - P Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - T J Price
- Haematology and Medical Oncology Unit, Queen Elizabeth Hospital, Woodville, Australia
| | - C Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Ricke
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - A Roth
- Digestive Tumors Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - R Salazar
- Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - W Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - H J Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - J Tabernero
- Medical Oncology Department, Vall d' Hebron University Hospital, Vall d'Hebron Institute of Oncology (V.H.I.O.), Barcelona, Spain
| | - J Taïeb
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - S Tejpar
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - H Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - A Zaanan
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - D Arnold
- Instituto CUF de Oncologia (ICO), Lisbon, Portugal
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Hazama S, Maeda H, Iwamoto S, Kim HM, Takemoto H, Kobayashi K, Sakamoto J, Nagata N, Oba K, Mishima H. A Phase II Study of XELOX and Cetuximab as First-Line Therapy in Patients With KRAS Wild Type Metastatic Colorectal Cancer (FLEET2 Study). Clin Colorectal Cancer 2016; 15:329-336. [PMID: 27507128 DOI: 10.1016/j.clcc.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/23/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite the comparable clinical benefit of XELOX (capecitabine with oxaliplatin) and FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin), the value of XELOX treatment in combination with cetuximab for metastatic colorectal cancer (mCRC) remains largely unknown. PATIENTS AND METHODS In this clinical trial we evaluated the efficacy and safety of weekly/biweekly cetuximab administration combined with biweekly XELOX in patients with previously untreated v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) wild type mCRC. The primary end point was response rate (RR) with confirmation, and the secondary end points included progression-free survival (PFS), overall survival (OS), disease control rate (DCR), dose intensity, and the safety of the protocol treatment. RESULTS Forty patients who fulfilled the inclusion criteria participated in this study. The median treatment cycle number was 8 and the median dose intensities were 218 mg/m2/wk for cetuximab, 34 mg/m2/wk for oxaliplatin, and 821 mg/m2/d for capecitabine. One patient showed complete response and partial response was observed in 19 patients, giving an overall RR of 50% (95% confidence interval [CI], 33.8%-66.2%). Stable disease was obtained in 13 patients, resulting in a DCR of 82.5% (95% CI, 67.2%-92.7%). The PFS was 6.5 months (95% CI, 3.5-9.6 months), and the OS was 24.3 months (95% CI, 14.9-33.7 months). The safety profile revealed the common Grade 3/4 adverse events to be acneiform eruption (12.5%), peripheral neuropathy (7.5%), and elevated alanine transaminase levels (7.5%). Grade 3/4 thrombocytopenia and neutropenia occurred only in 5.0% and 2.5% of the patients, respectively. Grade 1 hand-foot syndrome (HFS) was not uncommon (20%), whereas Grade 2/3 HFS occurred in only 3 patients (7.5%). No deaths were reported within 30 days of the last dose. CONCLUSION Cetuximab with XELOX showed a confirmed overall RR of 50%, which was within the previously reported range of RR. The safety profile showed an acceptable rate and severity of adverse events. In light of the several advantages of XELOX, including convenience and the reported cost-saving aspects, further study of this combination therapy is warranted.
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Affiliation(s)
- Shoichi Hazama
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University, Graduate School of Medicine, Ube, Japan
| | | | | | - Ho Min Kim
- Division of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | | | - Kenji Kobayashi
- Department of Surgery, Matsunami General Hospital, Hashima, Japan
| | | | | | - Koji Oba
- Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Kwakman J, Punt C. Oral drugs in the treatment of metastatic colorectal cancer. Expert Opin Pharmacother 2016; 17:1351-61. [DOI: 10.1080/14656566.2016.1186649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Azadeh P, Mortazavi N, Tahmasebi A, Hosseini Kamal F, Novin K. Cetuximab Plus Various Chemotherapy Regimens for Patients with KRAS Wild-Type Metastatic Colorectal Cancer. Chemotherapy 2015; 61:51-6. [DOI: 10.1159/000440693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/27/2015] [Indexed: 11/19/2022]
Abstract
Background: The aim of this study was to compare the efficacy and hematologic toxicity of cetuximab combined with various types of chemotherapy regimens in patients with KRAS wild-type metastatic colorectal cancer (mCRC). Methods: The response rate, progression-free survival (PFS) and overall survival of the patients were analyzed. Results: In total, 45 patients were included in the study. The overall response rate for the combination of cetuximab and FOLFOX, FOLFIRI and CAPOX was 20, 46 and 30%, respectively, but the differences were not statistically significant. The median PFS for the three groups were 8, 6 and 3.5 months, respectively, but again these differences were not significant. All-grade leukopenia and anemia for the cetuximab plus FOLFOX group were significantly higher than for the other chemotherapy regimens. Conclusion: Our findings suggest that the combination of cetuximab and the three standard chemotherapy regimens resulted in the same outcomes in our patient population of mCRC, with higher hematologic toxicities among the FOLFOX subgroup.
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Rosa B, de Jesus JP, de Mello EL, Cesar D, Correia MM. Effectiveness and safety of monoclonal antibodies for metastatic colorectal cancer treatment: systematic review and meta-analysis. Ecancermedicalscience 2015; 9:582. [PMID: 26557880 PMCID: PMC4631576 DOI: 10.3332/ecancer.2015.582] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The effectiveness of chemotherapy (CT) for select cases of metastatic colorectal cancer (MCRC) has been well established in the literature, however, it provides limited benefits and in many cases constitutes a treatment with high toxicity. The use of specific molecular biological treatments with monoclonal antibodies (MA) has been shown to be relevant, particularly for its potential for increasing the response rate of the host to the tumour, as these have molecular targets present in the cancerous cells and their microenvironment thereby blocking their development. The combination of MA and CT can bring a significant increase in the rate of resectability of metastases, the progression-free survival (PFS), and the global survival (GS) in MCRC patients. OBJECTIVE To assess the effectiveness and safety of MA in the treatment of MCRC. METHODS A systematic review was carried out with a meta-analysis of randomised clinical trials comparing the use of cetuximab, bevacizumab, and panitumumab in the treatment of MCRC. RESULTS Sixteen randomised clinical trials were selected. The quality of the evidence on the question was considered moderate and data from eight randomised clinical trials were included in this meta-analysis. The GS and PFS were greater in the groups which received the MA associated with CT, however, the differences were not statistically significant between the groups (mean of 17.7 months versus 17.1 months; mean difference of 1.09 (CI: 0.10-2.07); p = 0.84; and 7.4 versus 6.9 months. mean difference of 0.76 (CI: 0.08-1.44); p = 0.14 respectively). The meta-analysis was not done for any of the secondary outcomes. CONCLUSION The addition of MA to CT for patients with metastatic colorectal cancer does not prolong GS and PFS.
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Affiliation(s)
- Bruno Rosa
- Instituto Nacional de Câncer, Rio de Janeiro 20230-130, Brazil
| | | | | | - Daniel Cesar
- Instituto Nacional de Câncer, Rio de Janeiro 20230-130, Brazil
| | - Mauro M Correia
- Instituto Nacional de Câncer, Rio de Janeiro 20230-130, Brazil
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Chan DL, Pavlakis N, Shapiro J, Price TJ, Karapetis CS, Tebbutt NC, Segelov E. Does the Chemotherapy Backbone Impact on the Efficacy of Targeted Agents in Metastatic Colorectal Cancer? A Systematic Review and Meta-Analysis of the Literature. PLoS One 2015; 10:e0135599. [PMID: 26275292 PMCID: PMC4537274 DOI: 10.1371/journal.pone.0135599] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/23/2015] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE The EGFR inhibitors (EGFR-I) cetuximab and panitumumab and the angiogenesis inhibitors (AIs) bevacizumab and aflibercept have demonstrated varying efficacy in mCRC. OBJECTIVE To document the overall impact of specific chemotherapy regimens on the efficacy of targeted agents in treating patients with mCRC. DATA SOURCES MEDLINE, EMBASE and Cochrane databases were searched to 2014, supplemented by hand-searching ASCO/ESMO conference abstracts. STUDY SELECTION Published RCTs of patients with histologically confirmed mCRC were included if they investigated either 1) chemotherapy with or without a biological agent or 2) different chemotherapy regimens with the same biological agent. EGFR-I trials were restricted to KRAS exon 2 wild-type (WT) populations. DATA EXTRACTION AND SYNTHESIS Data were independently abstracted by two authors and trial quality assessed according to Cochrane criteria. The primary outcome was overall survival with secondary endpoints progression free survival (PFS), overall response rate (ORR) and toxicity. RESULTS EGFR-I added to irinotecan-based chemotherapy modestly improved OS with HR 0.90 (95% CI 0.81-1.00, p = 0.04), but more so PFS with HR 0.77 (95% CI 0.69-0.86, p<0.00001). No benefit was evident for EGFR-I added to oxaliplatin-based chemotherapy (OS HR 0.97 (95% CI 0.87-1.09) and PFS HR 0.92 (95% CI 0.83-1.02)). Significant oxaliplatin-irinotecan subgroup interactions were present for PFS with I2 = 82%, p = 0.02. Further analyses of oxaliplatin+EGFR-I trials showed greater efficacy with infusional 5FU regimens (PFS HR 0.82, 95% CI 0.72-0.94) compared to capecitabine (HR 1.09; 95% CI 0.91-1.30) and bolus 5FU (HR 1.07; 95% CI 0.79-1.45); subgroup interaction was present with I2 = 72%, p = 0.03. The oxaliplatin-irinotecan interaction was not evident for infusional 5FU regimens. For AIs, OS benefit was observed with both oxaliplatin-based (HR 0.83) and irinotecan-based (HR 0.77) regimens without significant subgroup interactions. Oxaliplatin+AI trials showed no subgroup interactions by type of FP, whilst an interaction was present for irinotecan+AI trials although aflibercept was only used with infusional FP (I2 = 89.7%, p = 0.002). CONCLUSION AND RELEVANCE The addition of EGFR-I to irinotecan-based chemotherapy has consistent efficacy, regardless of FP regimen, whereas EGFR-I and oxaliplatin-based regimens were most active with infusional 5FU. No such differential activity was observed with the varying chemotherapy schedules when combined with AIs.
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Affiliation(s)
- David L. Chan
- Royal North Shore Hospital, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
- * E-mail:
| | - Nick Pavlakis
- Royal North Shore Hospital, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
| | - Jeremy Shapiro
- Department of Medical Oncology, Monash University, Victoria, Australia
| | - Timothy J. Price
- The Queen Elizabeth Hospital and University of Adelaide, South Australia, Australia
| | - Christos S. Karapetis
- Flinders University and Flinders Medical Centre, Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
| | | | - Eva Segelov
- St Vincent’s Clinical School, University of New South Wales, NSW, Australia
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Heinemann V, Stintzing S, Modest DP, Giessen-Jung C, Michl M, Mansmann UR. Early tumour shrinkage (ETS) and depth of response (DpR) in the treatment of patients with metastatic colorectal cancer (mCRC). Eur J Cancer 2015; 51:1927-36. [PMID: 26188850 DOI: 10.1016/j.ejca.2015.06.116] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/08/2015] [Accepted: 06/20/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Response evaluation criteria in solid tumours (RECIST) are used to define degrees of response to anti-tumour agents. In retrospective analyses, early tumour shrinkage (ETS) has been investigated as an alternative early-on-treatment predictor of treatment efficacy with regard to progression-free and overall survival. While cut-off based analysis of ETS facilitates the categorisation of patients into responders and non-responders after a defined period of treatment, depth of response (DpR) serves as a continuous measure, which defines the nadir of tumour response. METHODS A systematic literature search for 'early tumour shrinkage' or 'tumour size decrease' in 'metastatic colorectal cancer' reported from January 2000 to July 2014 was performed. The present review summarises available data concerning ETS and DpR and evaluates their potential as predictive markers for the clinical management of patients with metastatic colorectal cancer (mCRC). RESULTS A total of 10 clinical trials investigated the role of ETS as a marker of clinical outcome in patients with mCRC. In addition, DpR was investigated using the efficacy data from three of these trials. Available data show that ETS differentiates patients with high sensitivity to treatment and more favourable prognosis from a heterogeneous group of patients classified as non-ETS patients. ETS is an early indicator of the potentially achievable response. In contrast, DpR estimates the nadir of tumour response as a continuous measure, which may affect the subsequent disease history, thus translating into superior survival. CONCLUSIONS The concepts of ETS and DpR offer potential as clinical end-points to aid the clinical decision making process and thus further optimise mCRC patient management in the era of tailored therapy approaches.
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Affiliation(s)
- Volker Heinemann
- Department of Medical Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany, Marchioninistr. 15, 81377 Munich, Germany; Comprehensive Cancer Center, Klinikum Grosshadern, University of Munich, Germany, Marchioninistr. 15, 81377 Munich, Germany
| | - Sebastian Stintzing
- Department of Medical Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany, Marchioninistr. 15, 81377 Munich, Germany.
| | - Dominik P Modest
- Department of Medical Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany, Marchioninistr. 15, 81377 Munich, Germany.
| | - Clemens Giessen-Jung
- Department of Medical Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany, Marchioninistr. 15, 81377 Munich, Germany.
| | - Marlies Michl
- Department of Medical Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany, Marchioninistr. 15, 81377 Munich, Germany.
| | - Ulrich R Mansmann
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Germany, Marchioninistr. 15, 81377 Munich, Germany.
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Westwood M, van Asselt T, Ramaekers B, Whiting P, Joore M, Armstrong N, Noake C, Ross J, Severens J, Kleijnen J. KRAS mutation testing of tumours in adults with metastatic colorectal cancer: a systematic review and cost-effectiveness analysis. Health Technol Assess 2015; 18:1-132. [PMID: 25314637 DOI: 10.3310/hta18620] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Bowel cancer is the third most common cancer in the UK. Most bowel cancers are initially treated with surgery, but around 17% spread to the liver. When this happens, sometimes the liver tumour can be treated surgically, or chemotherapy may be used to shrink the tumour to make surgery possible. Kirsten rat sarcoma viral oncogene (KRAS) mutations make some tumours less responsive to treatment with biological therapies such as cetuximab. There are a variety of tests available to detect these mutations. These vary in the specific mutations that they detect, the amount of mutation they detect, the amount of tumour cells needed, the time to give a result, the error rate and cost. OBJECTIVES To compare the performance and cost-effectiveness of KRAS mutation tests in differentiating adults with metastatic colorectal cancer whose metastases are confined to the liver and are unresectable and who may benefit from first-line treatment with cetuximab in combination with standard chemotherapy from those who should receive standard chemotherapy alone. DATA SOURCES Thirteen databases, including MEDLINE and EMBASE, research registers and conference proceedings were searched to January 2013. Additional data were obtained from an online survey of laboratories participating in the UK National External Quality Assurance Scheme pilot for KRAS mutation testing. METHODS A systematic review of the evidence was carried out using standard methods. Randomised controlled trials were assessed for quality using the Cochrane risk of bias tool. Diagnostic accuracy studies were assessed using the QUADAS-2 tool. There were insufficient data for meta-analysis. For accuracy studies we calculated sensitivity and specificity together with 95% confidence intervals (CIs). Survival data were summarised as hazard ratios and tumour response data were summarised as relative risks, with 95% CIs. The health economic analysis considered the long-term costs and quality-adjusted life-years associated with different tests followed by treatment with standard chemotherapy or cetuximab plus standard chemotherapy. The analysis took a 'no comparator' approach, which implies that the cost-effectiveness of each strategy will be presented only compared with the next most cost-effective strategy. The de novo model consisted of a decision tree and Markov model. RESULTS The online survey indicated no differences between tests in batch size, turnaround time, number of failed samples or cost. The literature searches identified 7903 references, of which seven publications of five studies were included in the review. Two studies provided data on the accuracy of KRAS mutation testing for predicting response to treatment in patients treated with cetuximab plus standard chemotherapy. Four RCTs provided data on the clinical effectiveness of cetuximab plus standard chemotherapy compared with that of standard chemotherapy in patients with KRAS wild-type tumours. There were no clear differences in the treatment effects reported by different studies, regardless of which KRAS mutation test was used to select patients. In the 'linked evidence' analysis the Therascreen KRAS RGQ PCR Kit (QIAGEN) was more expensive but also more effective than pyrosequencing or direct sequencing, with an incremental cost-effectiveness ratio of £17,019 per quality-adjusted life-year gained. In the 'assumption of equal prognostic value' analysis the total costs associated with the various testing strategies were similar. LIMITATIONS The results assume that the differences in outcomes between the trials were solely the result of the different mutation tests used to distinguish between patients; this assumption ignores other factors that might explain this variation. CONCLUSIONS There was no strong evidence that any one KRAS mutation test was more effective or cost-effective than any other test. STUDY REGISTRATION PROSPERO CRD42013003663. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Thea van Asselt
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Caro Noake
- Kleijnen Systematic Reviews Ltd, York, UK
| | | | - Johan Severens
- Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Jos Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Grasso S, Martínez-Lacaci I, Barberá VM, Castillejo A, Soto JL, Gallego-Plazas J, López-Riquelme N, García-Morales P, Mata-Balaguer T, Ferragut JA, Saceda M. HGUE-C-1 is an atypical and novel colon carcinoma cell line. BMC Cancer 2015; 15:240. [PMID: 25885658 PMCID: PMC4394422 DOI: 10.1186/s12885-015-1183-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/12/2015] [Indexed: 12/27/2022] Open
Abstract
Background Colorectal carcinoma is a common cause of cancer. Adjuvant treatments include: 5-fluorouracil administered together with folinic acid, or more recently, oral fluoropyrimidines such as capecitabine, in combination with oxaliplatin or irinotecan. Metastatic colorectal cancer patients can benefit from other additional treatments such as cetuximab or bevacizumab. Methods Using cell culture techniques, we isolated clonal populations from primary cultures of ascitic effusion derived from a colon cancer patient and after several passages an established cell line, HGUE-C-1, was obtained. Genetic analysis of HGUE-C-1 cells was performed by PCR of selected exons and sequencing. Cell proliferation studies were performed by MTT assays and cell cycle analyses were performed by flow cytometry. Retinoblastoma activity was measured by luciferase assays and proteins levels and activity were analysed by Western blot or immunohistochemistry. Results We have established a new cell line from ascitic efussion of a colon cancer patient who did not respond to 5-fluorouracil or irinotecan. HGUE-C-1 cells did not show microsatellite instability and did not harbour mutations in KRAS, BRAF, PI3KCA or TP53. However, these cells showed loss of heterozygosity affecting Adenomatous Polyposis Coli and nuclear staining of β-catenin protein. The HGUE-C-1 cell line was sensitive to erlotinib, gefitinib, NVP-BEZ235, rapamycin and trichostatin, among other drugs, but partially resistant to heat shock protein inhibitors and highly resistant to AZD-6244 and oxaliplatin, even though the patient from which this cell line was derived had not been exposed to these drugs. Molecular characterization of this cell line revealed low expression levels and activity of Retinoblastoma protein and elevated basal levels of Erk1/2 activity and p70S6K expression and activity, which may be related to chemoresistance mechanisms. Conclusions HGUE-C-1 represents a novel and peculiar colon carcinoma model to study chemoresistance to chemotherapeutic agents and to novel anti-neoplasic drugs that interrupt signalling pathways such as the APC/βcatenin, Ras/Raf/Mek/Erk, PI3K/mTOR/p70S6K pathways as well as histone regulation mechanisms.
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Affiliation(s)
- Silvina Grasso
- Instituto de Biología Molecular y Celular, Universidad Miguel Hernández, 03202 Elche, Alicante, Spain.
| | - Isabel Martínez-Lacaci
- Instituto de Biología Molecular y Celular, Universidad Miguel Hernández, 03202 Elche, Alicante, Spain. .,Unidad AECC de Investigación Traslacional en Cáncer, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain.
| | - Víctor Manuel Barberá
- Unidad de Investigación, Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain.
| | - Adela Castillejo
- Unidad de Investigación, Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain.
| | - José Luis Soto
- Unidad de Investigación, Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain.
| | - Javier Gallego-Plazas
- Unidad de Investigación, Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain.
| | - Natividad López-Riquelme
- Servicio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, 30120, Murcia, Spain.
| | - Pilar García-Morales
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain.
| | - Trinidad Mata-Balaguer
- Instituto de Neurociencias, Universidad Miguel Hernández de Elche, 03550 San Juan, Alicante, Spain.
| | - José Antonio Ferragut
- Instituto de Biología Molecular y Celular, Universidad Miguel Hernández, 03202 Elche, Alicante, Spain.
| | - Miguel Saceda
- Instituto de Biología Molecular y Celular, Universidad Miguel Hernández, 03202 Elche, Alicante, Spain. .,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain.
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Shi Q, de Gramont A, Grothey A, Zalcberg J, Chibaudel B, Schmoll HJ, Seymour MT, Adams R, Saltz L, Goldberg RM, Punt CJA, Douillard JY, Hoff PM, Hecht JR, Hurwitz H, Díaz-Rubio E, Porschen R, Tebbutt NC, Fuchs C, Souglakos J, Falcone A, Tournigand C, Kabbinavar FF, Heinemann V, Van Cutsem E, Bokemeyer C, Buyse M, Sargent DJ. Individual patient data analysis of progression-free survival versus overall survival as a first-line end point for metastatic colorectal cancer in modern randomized trials: findings from the analysis and research in cancers of the digestive system database. J Clin Oncol 2015; 33:22-8. [PMID: 25385741 PMCID: PMC4482837 DOI: 10.1200/jco.2014.56.5887] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Progression-free survival (PFS) has previously been established as a surrogate for overall survival (OS) for first-line metastatic colorectal cancer (mCRC). Because mCRC treatment has advanced in the last decade with extended OS, this surrogacy requires re-examination. METHODS Individual patient data from 16,762 patients were available from 22 first-line mCRC studies conducted from 1997 to 2006; 12 of those studies tested antiangiogenic and/or anti-epidermal growth factor receptor agents. The relationship between PFS (first event of progression or death) and OS was evaluated by using R(2) statistics (the closer the value is to 1, the stronger the correlation) from weighted least squares regression of trial-specific hazard ratios estimated by using Cox and Copula models. RESULTS Forty-four percent of patients received a regimen that included biologic agents. Median first-line PFS was 8.3 months, and median OS was 18.2 months. The correlation between PFS and OS was modest (R(2), 0.45 to 0.69). Analyses limited to trials that tested treatments with biologic agents, nonstrategy trials, or superiority trials did not improve surrogacy. CONCLUSION In modern mCRC trials, in which survival after the first progression exceeds time to first progression, a positive but modest correlation was observed between OS and PFS at both the patient and trial levels. This finding demonstrates the substantial variability in OS introduced by the number of lines of therapy and types of effective subsequent treatments and the associated challenge to the use of OS as an end point to assess the benefit attributable to a single line of therapy. PFS remains an appropriate primary end point for first-line mCRC trials to detect the direct treatment effect of new agents.
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Affiliation(s)
- Qian Shi
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Aimery de Gramont
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Axel Grothey
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - John Zalcberg
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Benoist Chibaudel
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Hans-Joachim Schmoll
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Matthew T Seymour
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Richard Adams
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Leonard Saltz
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Richard M Goldberg
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Cornelis J A Punt
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Jean-Yves Douillard
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Paulo M Hoff
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Joel Randolph Hecht
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Herbert Hurwitz
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Eduardo Díaz-Rubio
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Rainer Porschen
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Niall C Tebbutt
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Charles Fuchs
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - John Souglakos
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Alfredo Falcone
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Christophe Tournigand
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Fairooz F Kabbinavar
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Volker Heinemann
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Eric Van Cutsem
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Carsten Bokemeyer
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Marc Buyse
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Daniel J Sargent
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium.
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Li W, Xu J, Shen L, Liu T, Guo W, Zhang W, Chen Z, Zhu X, Li J. Phase II study of weekly irinotecan and capecitabine treatment in metastatic colorectal cancer patients. BMC Cancer 2014; 14:986. [PMID: 25527007 PMCID: PMC4300831 DOI: 10.1186/1471-2407-14-986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 12/16/2014] [Indexed: 02/04/2023] Open
Abstract
Background The purpose of this phase II study was to evaluate the safety and efficacy of weekly irinotecan and capecitabine (wXELIRI) treatment in patients with metastatic colorectal cancer, specifically the rate of severe diarrhea. Methods Patients with unresectable histologically confirmed metastatic colorectal cancer with measurable disease received weekly irinotecan 90 mg/m2 on day 1 and capecitabine 1200 mg/m2 twice daily on days 1–5. Patients naïve to systemic chemotherapy for metastatic disease or who had failed FOLFOX (infusional 5-fluorouracil [5-FU], leucovorin, and oxaliplatin) or XELOX (capecitabine plus oxaliplatin) as first-line treatment were eligible. The primary endpoint was the rate of grade 3/4 diarrhea. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety. Results A total of 52 patients were enrolled, 30 of whom received wXELIRI as first-line treatment and 22 as second-line treatment. Grade 4 diarrhea was observed in one patient and the rate of grade 3/4 diarrhea was 7.7%. The other common grade 3/4 toxicities included leukopenia (9.6%), neutropenia (17.3%), nausea (3.8%), vomiting (3.8%), fatigue (1.9%), and hand-foot syndrome (1.9%). The median progression-free survival and overall survival for the 30 patients treated in the first-line setting was 8.5 and 16.3 months, while those for the 22 patients treated in the second-line setting was 5.0 and 10.7 months, respectively. Conclusions The wXELIRI regimen resulted in a low rate of severe diarrhea with an acceptable toxicity profile. This study provides a basis for a subsequent randomized controlled study of wXELIRI versus FOLFIRI (irinotecan, 5-FU, and folinic acid) to further explore the efficacy and safety of this regimen. Trial registration ClinicalTrials.gov: NCT01322152.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jin Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, China.
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De Stefano A, Carlomagno C. Beyond KRAS: Predictive factors of the efficacy of anti-EGFR monoclonal antibodies in the treatment of metastatic colorectal cancer. World J Gastroenterol 2014; 20:9732-43. [PMID: 25110411 PMCID: PMC4123362 DOI: 10.3748/wjg.v20.i29.9732] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/13/2014] [Accepted: 03/12/2014] [Indexed: 02/06/2023] Open
Abstract
Systematic analysis of the epidermal growth factor receptor (EGFR) pathway revealed that biomarkers could be used to predict the response to and outcome of anti-EGFR therapies in patients affected by metastatic colorectal cancer. We have conducted a review on the most recent findings and advances on this topic. To this aim, we searched the PubMed database for articles devoted to predictive and prognostic biomarkers for patients administered cetuximab- and panitumumab-based therapies. Here we review the state of the art and the controversies about the molecular factors known to be predictors of the efficacy of anti-EGFR therapy, namely, KRAS, BRAF, NRAS, PI3KCA and PTEN, and we discuss their prognostic value in colorectal cancer patients.
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Aguado C, García-Paredes B, Sotelo MJ, Sastre J, Díaz-Rubio E. Should capecitabine replace 5-fluorouracil in the first-line treatment of metastatic colorectal cancer? World J Gastroenterol 2014; 20:6092-6101. [PMID: 24876731 PMCID: PMC4033448 DOI: 10.3748/wjg.v20.i20.6092] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/13/2014] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
Fluoropyrimidines play a central role in the first-line treatment of metastatic colorectal cancer. Our aim was to review whether capecitabine was a safer, non-inferior, economically superior and more convenient alternative to 5-fluorouracil. Capecitabine has previously been compared to 5-fluorouracil-either as a monotherapy or in combination with oxaliplatin, irinotecan, or biological drugs-and has been found to have comparable efficacy and safety profiles. Furthermore, pharmacoeconomic data and patients’ preferences for oral chemotherapy further favor capecitabine. Therefore, capecitabine appears to be an effective and safe alternative to fluorouracil in the first-line treatment of metastatic colorectal cancer.
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von Einem JC, Heinemann V, von Weikersthal LF, Vehling-Kaiser U, Stauch M, Hass HG, Decker T, Klein S, Held S, Jung A, Kirchner T, Haas M, Holch J, Michl M, Aubele P, Boeck S, Schulz C, Giessen C, Stintzing S, Modest DP. Left-sided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy: an analysis of the AIO KRK-0104 trial. J Cancer Res Clin Oncol 2014; 140:1607-14. [PMID: 24816724 PMCID: PMC4131148 DOI: 10.1007/s00432-014-1678-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/28/2014] [Indexed: 02/06/2023]
Abstract
Purpose AIO KRK-0104 investigated first-line therapy of metastatic colorectal cancer (mCRC) with cetuximab, capecitabine and irinotecan versus cetuximab, capecitabine and oxaliplatin. This analysis investigated the impact of primary tumor location on outcome of patients. Patients and methods Left-sided primary tumors were defined as tumors from rectum to left flexure, while tumors in the remaining colon were regarded right sided. Overall survival (OS), progression-free survival (PFS) and response rate were correlated with primary tumor location. A Cox regression model was used to evaluate interaction between primary tumor location and KRAS mutation. Results Of 146 patients of the AIO KRK-0104 trial, 100 patients presented left-sided (of those 68 KRAS codon 12/13 wild-type) and 46 patients right-sided primary tumors (of those 27 KRAS codon 12/13 wild-type). Left-sided tumors were associated with significantly longer OS (p = 0.016, HR = 0.63) and PFS (p = 0.02, HR = 0.67) as compared to right-sided tumors. These effects were present in the KRAS codon 12/13 wild-type population (HR OS: 0.42; HR PFS: 0.54), while no impact of primary tumor location was evident in patients with KRAS codon 12/13 mutant tumors (HR OS: 1.3; HR PFS: 1.01). A significant interaction of KRAS status and primary tumor location concerning OS and PFS was observed. Conclusion Our findings suggest that primary tumor location and KRAS codon 12/13 mutational status interact on the outcome of patients with mCRC receiving cetuximab-based first-line therapy. Left-sided primary tumor location might be a predictor of cetuximab efficacy.
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Affiliation(s)
- J C von Einem
- Department of Medicine III, University Hospital Grosshadern, University of Munich, Munich, Germany,
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Evaluating the agreement between tumour volumetry and the estimated volumes of tumour lesions using an algorithm. Eur Radiol 2014; 24:1521-8. [PMID: 24816938 DOI: 10.1007/s00330-014-3195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 02/23/2014] [Accepted: 04/17/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the agreement between tumour volume derived from semiautomated volumetry (SaV) and tumor volume defined by spherical volume using longest lesion diameter (LD) according to Response Evaluation Criteria In Solid Tumors (RECIST) or ellipsoid volume using LD and longest orthogonal diameter (LOD) according to World Health Organization (WHO) criteria. MATERIALS AND METHODS Twenty patients with metastatic colorectal cancer from the CIOX trial were included. A total of 151 target lesions were defined by baseline computed tomography and followed until disease progression. All assessments were performed by a single reader. A variance component model was used to compare the three volume versions. RESULTS There was a significant difference between the SaV and RECIST-based tumour volumes. The same model showed no significant difference between the SaV and WHO-based volumes. Scatter plots showed that the RECIST-based volumes overestimate lesion volume. The agreement between the SaV and WHO-based relative changes in tumour volume, evaluated by intraclass correlation, showed nearly perfect agreement. CONCLUSIONS Estimating the volume of metastatic lesions using both the LD and LOD (WHO) is more accurate than those based on LD only (RECIST), which overestimates lesion volume. The good agreement between the SaV and WHO-based relative changes in tumour volume enables a reasonable approximation of three-dimensional tumour burden. KEY POINTS • Tumour response in patients undergoing chemotherapy is assessed using CT images • Measurements are based on RECIST (unidimensional)-based or WHO (bidimensional)-based criteria • We calculated tumour volume from bidimensional target lesion measurements • This formula provides good tumour volume approximation, based on semiautomated volumetry.
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Meimarakis G, Spelsberg F, Angele M, Preissler G, Fertmann J, Crispin A, Reu S, Kalaitzis N, Stemmler M, Giessen C, Heinemann V, Stintzing S, Hatz R, Winter H. Resection of Pulmonary Metastases from Colon and Rectal Cancer: Factors to Predict Survival Differ Regarding to the Origin of the Primary Tumor. Ann Surg Oncol 2014; 21:2563-72. [DOI: 10.1245/s10434-014-3646-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 12/18/2022]
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Temraz S, Mukherji D, Shamseddine A. Sequencing of treatment in metastatic colorectal cancer: Where to fit the target? World J Gastroenterol 2014; 20:1993-2004. [PMID: 24616571 PMCID: PMC3934469 DOI: 10.3748/wjg.v20.i8.1993] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/01/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is a lethal disease if not discovered early. Even though appropriate screening and preventive strategies are in place in many countries, a significant number of patients are still diagnosed at late stages of the disease. The management of metastatic colorectal cancer remains a significant clinical challenge to oncologists worldwide. While cytotoxic regimens constitute the main treatment of choice in this patient population, addition of the five biologics (bevacizumab, cetuximab, aflibercept, panitumumab and regorafenib) to these regimens has improved clinical outcomes. The most commonly used cytotoxic regimens include doublet combinations (FOLFOX/XELOX or FOLFIRI). Many clinical trials have been published and others are underway to compare the biologic agents with one another in order to prove the superiority of one regimen over another. Metastatic colorectal cancer patients have many treatment options; however, the optimal use and sequence of targeted agents remain to be determined. This review entails concise and updated clinical data on the management of metastatic colorectal cancer. The aim of the review is to determine where to fit the five biologic targets into the treatment algorithm of metastatic colorectal cancer patients and to derive treatment sequences that would achieve best clinical outcome based on the current available data.
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Karanicolas PJ, Metrakos P, Chan K, Asmis T, Chen E, Kingham TP, Kemeny N, Porter G, Fields RC, Pingpank J, Dixon E, Wei A, Cleary S, Zogopoulos G, Dey C, D'Angelica M, Fong Y, Dowden S, Ko YJ. Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement. ACTA ACUST UNITED AC 2014; 21:e129-36. [PMID: 24523610 DOI: 10.3747/co.21.1577] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite significant improvements in systemic therapy for patients with colorectal liver metastases (crlms), response rates in the first-line setting are not optimal, and response rates in the second-line setting remain disappointing. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms, but it remains infrequently used. We convened an expert panel to discuss the role of haip in the contemporary management of patients with crlm. Using a consensus process, we developed these statements: haip chemotherapy should be given in combination with systemic chemotherapy.haip chemotherapy should be offered in the context of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing, and nuclear medicine.haip chemotherapy in combination with systemic therapy should be considered in patients with unresectable crlms who have progressed on first-line systemic treatment. In addition, haip chemotherapy is acceptable as first-line treatment in patients with unresectable colorectal liver metastases.haip chemotherapy is not recommended in the setting of extrahepatic disease outside the context of a clinical trial.haip chemotherapy in combination with systemic therapy is an option for select patients with resected colorectal liver metastases. These consensus statements provide a framework that clinicians who treat patients with crlm can use when considering treatment with haip.
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Affiliation(s)
- P J Karanicolas
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - P Metrakos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - K Chan
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T Asmis
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - E Chen
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T P Kingham
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - N Kemeny
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - G Porter
- Nova Scotia: Department of Surgery (Porter), Dalhousie University, Halifax
| | - R C Fields
- Missouri: Department of Surgery (Fields), Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis
| | - J Pingpank
- Pennsylvania: Department of Surgery (Pingpank), University of Pittsburgh, Pittsburgh
| | - E Dixon
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - A Wei
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - S Cleary
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - G Zogopoulos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - C Dey
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - M D'Angelica
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - Y Fong
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S Dowden
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - Y J Ko
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
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The Presence of Mutations in the K-RAS Gene Does Not Affect Survival after Resection of Pulmonary Metastases from Colorectal Cancer. ISRN SURGERY 2014; 2014:157586. [PMID: 24649376 PMCID: PMC3932217 DOI: 10.1155/2014/157586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/05/2013] [Indexed: 12/27/2022]
Abstract
Introduction. Our objective was to identify mutations in the K-RAS gene in cases of pulmonary metastases from colorectal cancer (CRC) and determine whether their presence was a prognostic factor for survival. Methods. We included all patients with pulmonary metastases from CRC operated on between 1998 and 2010. K-RAS mutations were investigated by direct sequencing of DNA. Differences in survival were explored with the Kaplan-Meier method log-rank tests and multivariate Cox regression analysis. Results. 110 surgical interventions were performed on 90 patients. Factors significantly associated with survival were disease-free interval (P = 0.002), age (P = 0.007), number of metastases (P = 0.001), lymph node involvement (P = 0.007), size of the metastases (P = 0.013), and previous liver metastasis (P = 0.003). Searching in 79 patients, K-RAS mutations were found in 30 cases. We did not find statistically significant differences in survival (P = 0.913) comparing native and mutated K-RAS. We found a higher rate of lung recurrence (P = 0.040) and shorter time to recurrence (P = 0.015) in patients with K-RAS mutations. Gly12Asp mutation was associated with higher recurrence (P = 0.022) and lower survival (P = 0.389). Conclusions. The presence of K-RAS mutations in pulmonary metastases does not affect overall survival but is associated with higher rates of pulmonary recurrence.
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Sotelo Lezama MJ, Sastre Valera J, Díaz-Rubio García E. Impact of cetuximab in current treatment of metastatic colorectal cancer. Expert Opin Biol Ther 2014; 14:387-99. [PMID: 24479733 DOI: 10.1517/14712598.2014.883376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cetuximab is a chimeric monoclonal antibody targeting the EGFR, which has proven effective in patients with metastatic colorectal cancer (mCRC), wild-type Kirsten rat sarcoma viral oncogene homolog (KRAS). AREAS COVERED The aim of this manuscript is to discuss the current impact of cetuximab in the most important scenarios of mCRC. We review the currently available data regarding the role of other biomarkers, such as the mutational status of neuroblastoma RAS viral (v-ras) oncogene homolog in identifying patients who could benefit most from anti-EGFR. In addition, a review is included of the most relevant clinical trials that have assessed the effectiveness of cetuximab in the management of patients with potentially resectable metastatic disease and in the first-line treatment of wild-type KRAS mCRC, as well as the impact of this anti-EGFR agent on patient quality of life. EXPERT OPINION Cetuximab has had a progressive clinical development from the earliest to the later stages of the evolution of mCRC and has been consolidated as a therapeutic option for all scenarios of unresectable disease. Patient selection by analysis of KRAS mutations has been a fundamental event to increase efficiency, being a dynamic process that continues in assessment. There are few comparative data with other biological agents in combination with chemotherapy, although data from a recent study are promising.
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Arumugam P, Partelli S, Coleman SJ, Cataldo I, Beghelli S, Bassi C, Wijesuriya N, Aleong JAC, Froeling FEM, Scarpa A, Kocher HM. Ezrin expression is an independent prognostic factor in gastro-intestinal cancers. J Gastrointest Surg 2013; 17:2082-91. [PMID: 24155054 DOI: 10.1007/s11605-013-2384-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/04/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ezrin, a member of the ezrin-radixin-moesin (ERM) family of plasma membrane-cytoskeleton linker proteins, has been associated with metastatic behavior. METHODOLOGY Microarrayed pathological tissues of surgically resected colorectal cancer liver metastasis (CRLM) and whole tissue sections of cancer of the ampulla of Vater (CAV) were analyzed to determine ezrin expression levels and correlation with survival. The requirement of ezrin in invasive capability was assessed using in vitro assays. RESULTS Surgically resected CAV showing a low ezrin score have a better 5-year disease-specific survival than those showing a high ezrin score (P < 0.0001). Similarly, high ezrin expression at the invasive front of CRLM resulted in poor disease-free survival (P = 0.05). Multivariate analysis demonstrated high ezrin expression to be an independent adverse prognostic factor for CAV (hazard ratio (HR) 15.22 (95 % confidence interval (CI) 1.98-117.03), P < 0.01) and CRLM (HR 6.42 (95 % CI 1.01-52.43), P = 0.05), among other clinically relevant variables such as lymph node metastasis (for CAV) and the presence of extrahepatic disease, large hepatic metastases (>5 cm), and close surgical resection margins (<5 mm) (all for CRLM). In vitro experiments indicated that ezrin expression was vital for cellular processes such as adhesive and invasive activity. SIGNIFICANCE High ezrin expression indicates an adverse prognosis in primary CAV and CRLM.
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Affiliation(s)
- Prabhu Arumugam
- Centre for Tumour Biology, John Vane Science Centre, Barts Cancer Institute-a CR-UK Centre of Excellence, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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Giessen C, Graeven U, Laubender R, Modest D, Schulz C, Porschen R, Schmiegel W, Reinacher-Schick A, Hegewisch-Becker S, Stintzing S, Heinemann V. Prognostic factors for 60-day mortality in first-line treatment of metastatic colorectal cancer (mCRC): individual patient analysis of four randomised, controlled trials by the AIO colorectal cancer study group. Ann Oncol 2013; 24:3051-5. [DOI: 10.1093/annonc/mdt402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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