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Landré T, Karaboué A, Buchwald ZS, Innominato PF, Qian DC, Assié JB, Chouaïd C, Lévi F, Duchemann B. Effect of immunotherapy-infusion time of day on survival of patients with advanced cancers: a study-level meta-analysis. ESMO Open 2024; 9:102220. [PMID: 38232612 PMCID: PMC10937202 DOI: 10.1016/j.esmoop.2023.102220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have become the standard of care for numerous malignancies. Emerging evidence suggests that the time of day (ToD) of ICI administration could impact the outcomes of patients with cancer. The consistency of ToD effects on ICI efficacy awaits initial evaluation. MATERIALS AND METHODS This meta-analysis integrates progression-free survival (PFS) and overall survival (OS) data from studies with a defined 'cut-off' ToD. Hazard ratios (HRs) [95% confidence interval (CI)] of an earlier progression or death according to 'early' or 'late' ToD of ICIs were collected from each report and pooled. RESULTS Thirteen studies involved 1663 patients (Eastern Cooperative Oncology Group performance status 0-1, 83%; males/females, 67%/33%) with non-small-cell lung cancer (47%), renal cell carcinoma (24%), melanoma (20%), urothelial cancer (5%), or esophageal carcinoma (4%). Most patients received anti-programmed cell death protein 1 or anti-programmed death-ligand 1 (98%), and a small proportion also received anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) (18%). ToD cut-offs were 13:00 or 14:00 (i.e. ICI median infusion time), for six studies, and 16:00 or 16:30 (i.e. reported threshold for weaker vaccination responses) for seven studies. Pooled analyses revealed that the early ToD groups had longer OS (HR 0.50, 95% CI 0.42-0.58; P < 0.00001) and PFS (HR 0.51, 95% CI 0.42-0.61; P < 0.00001) compared with the late ToD groups. CONCLUSIONS Patients with selected metastatic cancers seemed to largely benefit from early ToD ICI infusions, which is consistent with circadian mechanisms in immune-cell functions and trafficking. Prospective randomized trials are needed to establish recommendations for optimal circadian timing of ICI-based cancer therapies.
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Affiliation(s)
- T Landré
- Hôpitaux Universitaires Paris Saint-Denis, UCOG, Assistance Publique - Hôpitaux de Paris, Sevran
| | - A Karaboué
- Medical Oncology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, Montfermeil; UPR 'Chronotherapy, Cancer and Transplantation', Paris-Saclay University Medical School, Villejuif, France
| | - Z S Buchwald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - P F Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor; Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - D C Qian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - J B Assié
- Pneumology Service, CHI Créteil, Créteil; Inserm U955, UPEC, IMRB, Créteil
| | - C Chouaïd
- Pneumology Service, CHI Créteil, Créteil; Inserm U955, UPEC, IMRB, Créteil
| | - F Lévi
- UPR 'Chronotherapy, Cancer and Transplantation', Paris-Saclay University Medical School, Villejuif, France; Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK; Gastro-intestinal and Medical Oncology Service, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif
| | - B Duchemann
- Thoracic and Medical Oncology Unit, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France.
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Bouchahda M, Karaboué A, Saffroy R, Hamelin J, Bosselut N, Lemoine A. Undetectable RAS mutant clones in plasma: Possible implication for therapy and prognosis in the patient with RAS mutant metastatic colorectal cancer? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ulusakarya A, Karray W, Abdou J, Karaboué A, Haydar M, Krimi S, Gumus Y, Almohamad W, Goldschmidt E, Biondani P, Morère J. FOLFIRINOX as a first-line chemotherapy for patients (pts) with advanced biliary tract cancer (BTC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Garufi C, Levi F, Karaboué A, Torsello A, Focan C, Chollet P, INNOMINATO P. Efficacy and tolerability of chronomodulated FOLFIRINOX (chronoIFLO) as 1st or 2nd line treatment in patients (pts) with metastatic colorectal cancer (MCC): Final results from an international trial (EORTC 05011). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Levi F, Garufi C, Karaboué A, Focan C, Chollet P, Li XM, INNOMINATO P. Sex-related differences in circadian-dependent tolerance of Irinotecan (I) added to chronomodulated (chrono) 5-Fluorouracil (F), Leucovorin (L) and Oxaliplatin (O): Final results from international randomised time-finding study in patients with metastatic colorectal cancer (MCC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Innominato P, Komarzynski S, Bouchahda M, Ulusakarya A, Haydar M, Karaboué A, Levi F. Multidimensional telemonitoring of cancer patients (pts) receiving chronomodulated (chrono) Irinotecan (I), 5-fluorouracil (F), leucovorin (L) and oxaliplatin (O; chronoIFLO4) combination at home. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lévi FA, Boige V, Hebbar M, Smith D, Lepère C, Focan C, Karaboué A, Guimbaud R, Carvalho C, Tumolo S, Innominato P, Ajavon Y, Truant S, Castaing D, De Baere T, Kunstlinger F, Bouchahda M, Afshar M, Rougier P, Adam R, Ducreux M. Conversion to resection of liver metastases from colorectal cancer with hepatic artery infusion of combined chemotherapy and systemic cetuximab in multicenter trial OPTILIV. Ann Oncol 2015; 27:267-74. [PMID: 26578731 DOI: 10.1093/annonc/mdv548] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Systemic chemotherapy typically converts previously unresectable liver metastases (LM) from colorectal cancer to curative intent resection in ∼15% of patients. This European multicenter phase II trial tested whether hepatic artery infusion (HAI) with triplet chemotherapy and systemic cetuximab could increase this rate to 30% in previously treated patients. PATIENTS AND METHODS Participants had unresectable LM from wt KRAS colorectal cancer. Main non-inclusion criteria were advanced extra hepatic disease, prior HAI and grade 3 neuropathy. Irinotecan (180 mg/m(2)), oxaliplatin (85 mg/m(2)) and 5-fluorouracil (2800 mg/m(2)) were delivered via an implanted HAI access port and combined with i.v. cetuximab (500 mg/m(2)) every 14 days. Multidisciplinary decisions to resect LM were taken after every three courses. The rate of macroscopic complete resections (R0 + R1) of LM, progression-free survival (PFS) and overall survival (OS) were computed according to intent to treat. RESULTS The patient population consisted of 42 men and 22 women, aged 33-76 years, with a median of 10 LM involving a median of six segments. Up to 3 extrahepatic lesions of <1 cm were found in 41% of the patients. A median of six courses was delivered. The primary end point was met, with R0-R1 hepatectomy for 19 of the 64 previously treated patients, 29.7% (95% confidence interval 18.5-40.9). Grade 3-4 neutropenia (42.6%), abdominal pain (26.2%), fatigue (18%) and diarrhea (16.4%) were frequent. Objective response rate was 40.6% (28.6-52.3). Median PFS and OS reached 9.3 (7.8-10.9) and 25.5 months (18.8-32.1) respectively. Those with R0-R1 hepatectomy had a median OS of 35.2 months (32.6-37.8), with 37.4% (23.6-51.2) alive at 4 years. CONCLUSION The coordination of liver-specific intensive chemotherapy and surgery had a high curative intent potential that deserves upfront randomized testing. PROTOCOL NUMBERS EUDRACT 2007-004632-24, NCT00852228.
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Affiliation(s)
- F A Lévi
- UMRS 776 'Biological Rhythms and Cancers', INSERM, Villejuif Université Paris Sud 11, Orsay Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France Cancer Chronotherapy Unit, Warwick Medical School, Coventry, UK
| | - V Boige
- Service d'Oncologie Digestive, Institut Gustave Roussy, Villejuif
| | - M Hebbar
- Department of Medical Oncology, Hôpital Huriez, Lille
| | - D Smith
- Hôpital Saint-André, Department of Medical Oncology, Centre Hospitalo-Universitaire, Bordeaux
| | - C Lepère
- Service d'Hépato-Gastro-Entérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - C Focan
- Department of Oncology, Centre Hospitalier Chrétien, Clinique Saint-Joseph, Liège, Belgium
| | - A Karaboué
- UMRS 776 'Biological Rhythms and Cancers', INSERM, Villejuif Université Paris Sud 11, Orsay Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France
| | - R Guimbaud
- Department of Oncology, University Hospital of Purpan, Toulouse, France
| | - C Carvalho
- Medical Oncology Unit, Hospital Fernando Foncesca, Amadora, Portugal
| | - S Tumolo
- Department of Oncology, Santa Maria Degli Angeli General Hospital, Pordenone, Italy
| | - P Innominato
- UMRS 776 'Biological Rhythms and Cancers', INSERM, Villejuif Université Paris Sud 11, Orsay Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France Cancer Chronotherapy Unit, Warwick Medical School, Coventry, UK
| | - Y Ajavon
- Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France
| | - S Truant
- Department of Medical Oncology, Hôpital Huriez, Lille
| | - D Castaing
- Université Paris Sud 11, Orsay Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France
| | - T De Baere
- Service d'Oncologie Digestive, Institut Gustave Roussy, Villejuif
| | - F Kunstlinger
- Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France
| | - M Bouchahda
- UMRS 776 'Biological Rhythms and Cancers', INSERM, Villejuif Université Paris Sud 11, Orsay Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France
| | - M Afshar
- Cancer Chronotherapy Unit, Warwick Medical School, Coventry, UK
| | - P Rougier
- Service d'Hépato-Gastro-Entérologie, Hôpital Européen Georges Pompidou, Paris, France Université René Descartes, Paris V, France
| | - R Adam
- UMRS 776 'Biological Rhythms and Cancers', INSERM, Villejuif Université Paris Sud 11, Orsay Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France
| | - M Ducreux
- Université Paris Sud 11, Orsay Assistance Publique-Hopitaux de Paris, Department of Medical Oncology, Department of Hepatobiliary Center and Radiology, Paul Brousse Hospital, Villejuif, France Service d'Oncologie Digestive, Institut Gustave Roussy, Villejuif
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Levi F, Karaboué A, Etienne-Grimaldi M, Chatelut E, Innominato PF, Paintaud G, Loukakos P, Adam R, Bouchahda M, Milano G. Pharmacokinetic-pharmacodynamic analysis of hepatic artery infusion of three-drug chronomodulated chemotherapy and intravenous cetuximab in patients with liver metastases from colorectal cancer registered in OPTILIV, a European multicenter phase II trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Innominato PF, Giacchetti S, Småland R, Focan CNJ, Garufi C, Bjarnason GA, Iacobelli S, Tumolo S, Karaboué A, Levi F. Chemotherapy-induced neutropenia (neutro) association with survival in metastatic colorectal cancer (MCC): Schedule dependency. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ducreux M, Rougier P, Smith D, Focan CNJ, Innominato PF, Bouchahda M, Ajavon Y, Castaing D, De Baere T, Karaboué A, Lepere C, Boige V, Adam R, Levi F. Safety and efficacy of neoadjuvant combination of hepatic artery infusion (HAI) of irinotecan, 5-fluorouracil, and oxaliplatin with intravenous (iv) cetuximab in patients with unresectable liver metastases from colorectal cancer (CRC): Interim report from OPTILIV—A European multicenter phase II trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Innominato PF, Giacchetti S, Smaaland R, Focan CN, Garufi C, Bjarnason GA, Iacobelli S, Tumolo S, Karaboué A, Levi F. Chemotherapy-induced neutropenia association with survival in metastatic colorectal cancer (MCC): Schedule dependency. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
454 Background: Circadian clocks control cellular proliferation and drug metabolism over 24 h. However, circadian chronomodulated chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin (chronoFLO4) offered no survival benefit as compared to the non-time stipulated FOLFOX2 in an international randomized trial involving patients (pts) with previously untreated MCC (EORTC05963). We hypothesized that treatment near maximum tolerated dose could disrupt circadian clocks thus impairing the efficacy of chronoFLO4 but not of FOLFOX2. Methods: Pts with available data (N=556) were categorized into three subgroups according to the worst grade of neutropenia experienced during treatment. Distinct multivariate models were constructed for each treatment schedule. Results: Neutropenia (all grades) occurred in 39% of the pts on chronoFLO4 as compared to 67% of those on FOLFOX2 (p< 0.0001), with G3-4 being encountered in 7% and 25%, respectively (p< 0.0001). In both schedules, neutropenia was more frequent and more severe in women than in men (p<0.04).The occurrence (but not the severity) of neutropenia was significantly associated with improved objective response rate, progression-free and overall survival in pts on FOLFOX2 (p< 0.0001), confirming previous results by others. In pts on chronoFLO4, the occurrence of neutropenia was not associated with any efficacy advantage (p=0.36), and worst survival was observed in pts developing severe neutropenia. Conclusions: Neutropenia was more frequent and severe in women than in men, and on FOLFOX2 than on chronoFLO4. Neutropenia was positively correlated with survival in pts on FOLFOX2 supporting intra-patient dose escalation to achieve toxicity for conventional chemotherapy. No survival prolongation was found in pts with neutropenia on chronoFLO4. Thus, reaching maximum tolerated dose was unnecessary to achieve optimal effectiveness of circadian-timed therapy, and should even be avoided. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- P. F. Innominato
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - S. Giacchetti
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - R. Smaaland
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - C. N. Focan
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - C. Garufi
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - G. A. Bjarnason
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - S. Iacobelli
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - S. Tumolo
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - A. Karaboué
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
| | - F. Levi
- INSERM U776, Paul Brousse Hospital, Villejuif, France; INSERM U776, Paris, France; University of Stavanger and Institute of Medicine, Stavanger, Norway; CHC Clinique Saint Joseph, Liege, Belgium; Regina Elena National Cancer Institute, Rome, Italy; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; G. D'Annunzio University, Chieti, Italy; Santa Maria Degli Angeli General Hospital, Pordenone, Italy; Medical Oncology Department, INSERM U776, Paul Brousse Hospital, Villejuif, France
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Bouchahda M, Macarulla T, Liedo G, Lévi F, Elez ME, Paule B, Karaboué A, Artru P, Tabernero J, Machover D, Innominato P, Goldschmidt E, Bonnet D, Ducreux M, Castagne V, Guimbaud R. Feasibility of cetuximab given with a simplified schedule every 2 weeks in advanced colorectal cancer: a multicenter, retrospective analysis. Med Oncol 2010; 28 Suppl 1:S253-8. [PMID: 21053102 DOI: 10.1007/s12032-010-9716-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 10/05/2010] [Indexed: 11/30/2022]
Abstract
Cetuximab was approved using a weekly schedule, alone or in combination with chemotherapy (CT). However, many CT regimens in metastatic colorectal cancer (CRC) are delivered every 2 weeks (q2wks). Preliminary data suggested that a simplified schedule using cetuximab q2wks, 500 mg/m² would be equivalent to the standard weekly administration. Medical data of all patients with advanced CRC who received cetuximab q2wks were retrospectively collected and checked for consistency by an independent monitor in 4 European centers. Ninety-one patients were treated between 2005 and 2007 when the K-RAS mutational status of tumors was not determined routinely. They received a median of 4 (0-5) previous drugs, including previous weekly cetuximab in 38.5% of patients. Cetuximab q2wks was associated with an irinotecan-based regimen in 85.7% of patients. The median number of cetuximab administrations was 6 (1-23). Skin toxicity was observed in 68.2% of evaluable patients (grade 3 in 15%). Only one grade 1 allergy was reported. In the 84 patients beyond first-line therapy, response rate was 29.3%. The median progression-free survival was 3.0 months (range 2.2-3.8), and median overall survival was 9.0 months (range 6.2-11.8). Cetuximab q2wks appears safe and effective in heavily pretreated patients and convenient in combination with q2wks CT schedules.
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Affiliation(s)
- M Bouchahda
- Service d'Oncologie Médicale, Oncology Unit, Hopital Paul Brousse, 12 avenue Paul Vaillant Couturier, 94800 Villejuif, France.
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Levi F, Bouchahda M, Ducreux M, Karaboué A, Focan CN, Rougier P, Innominato P, Smith D, Awad S, Adam R. Optimal control of liver metastases with intravenous cetuximab and hepatic artery infusion of three-drug chemotherapy in patients with liver-only metastases from colorectal cancer: A European multicenter phase II trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bouchahda M, Macarulla T, LIedo G, Lévi F, Elez ME, Karaboué A, Artru P, Tabernero J, Castagne V, Gimbaud R. Efficacy and safety of cetuximab (C) given with a simplified, every other week (q2w), schedule in patients (pts) with advanced colorectal cancer (aCRC): A multicenter, retrospective study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Castagné V, Goldschmidt E, Lévi F, Brahimi N, Almohamad W, Machover D, Karaboué A, Habert H, Bonhomme-Faivre L, Bouchahda M. Medico-pharmaceutical approach to reduce costs of infusion-related reactions (IRR) associated with cetuximab at Paul Brousse hospital. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lévi F, Parganiha A, Innominato P, Karaboué A, Poncet A, Moreau T, Garufi C, Focan C, Coudert B, Bjarnason GA. Relevance of circadian coordination for the outcome of patients with advanced gastro-intestinal (GI) cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bouchahda M, Macarulla T, Spano JP, Bachet JB, Lledo G, Andre T, Landi B, Tabernero J, Karaboué A, Domont J, Levi F, Rougier P. Cetuximab efficacy and safety in a retrospective cohort of elderly patients with heavily pretreated metastatic colorectal cancer. Crit Rev Oncol Hematol 2008; 67:255-62. [PMID: 18400508 DOI: 10.1016/j.critrevonc.2008.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 02/05/2008] [Accepted: 02/06/2008] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Few data are available from clinical trials for elderly patients receiving cetuximab. PATIENTS AND METHODS The clinical data of consecutive patients aged > or =70 years given cetuximab for metastatic CRC were retrospectively captured from hospital pharmacy registries in seven centers. RESULTS Fifty-six patients received cetuximab+/-with irinotecan. Median age was 76 years (70-84), 86% of patients were pretreated with fluoropyrimidines, irinotecan and oxaliplatin and 69.6% had documented resistance to irinotecan. Objective response rate was 21% (95% CI: 11-32%). The median progression-free survival was 4.4 months (95% CI: 3.0-5.7 months) and the median overall survival was 16.0 months (95% CI: 13.5-18.5 months). Skin rash occurred in 75% of the patients (11% grade 3) and diarrhea in 80% (20% grades 3-4). CONCLUSION Tolerability of cetuximab was acceptable in elderly patients with pretreated metastatic CRC. Efficacy appeared similar to that observed in younger patients.
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Affiliation(s)
- M Bouchahda
- Hôpital Paul Brousse,Villejuif, Paris, France
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Lévi FA, Karaboué A, Bralet M, Innominato P, Herelle MO, Giacchetti S, Adam R, Jasmin C, Guettier C, Bouchahda M. Cetuximab reversal of resistance to chronomodulated chemotherapy in heavily-pretreated patients with metastatic colorectal cancer (MCC) without amplification of epidermal growth factor receptor (EGFR) gene. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13104 Background Skin toxicity and EGFR amplification reportedly predicted for Cetux-reversal of MCC resistance to standard chemotherapy. We explored these relations for Cetux reversal of resistance to chronomodulated chemotherapy (Chrono) with irinotecan (CPT11, peak at 5 am), 5-fluorouracil-leucovorin (FU-LV, peak at 4 am) and oxaliplatin (l-OHP, peak at 4 pm). Methods: 40 pts with progressive MCC on 3 prior chemotherapy lines received weekly Cetux (250 mg/m2) and q2–3 wks CPT11-based (30 pts) or oxaliplatin-based (10 pts) Chrono. Toxicities and response were assessed q2–3 wks and q2 months (mo) respectively. Tumor EGFR expression was determined by immunohistochemistry for all pts and gene copies by fluorescent in situ hybridization (FISH) for 25 pts. Results: All pts had prior progression on CPT11, FU-LV and l-OHP. Median age: 61 yo; M/F: 24/16; WHO PS 0/1/2: 27/9/4; colon/rectum: 21/19; M sites 1/2/≥ 3: 12/15/13; liver/lung: 32/29; pre-existing peripheral sensory neuropathy grade ≥ 2: 11 pts. A median of 8 courses of Cetux-Chrono was given (1 to 22). Three pts withdrew for grade 4 allergy. 37 pts were assessable for other toxicities and 36 for response (1 too early). Gr 2–3 acneiform skin rash occurred in 27 pts (73%), with gr3 in 11 pts (29.7%). Other main gr 3–4 toxicities were diarrhea (27% of the pts), neutropenia (24.3%) and neuropathy (21.6%). Disease progressed in 12 pts (33.3%) and was controlled in 24 pts (66.7%) including 13 stable disease (36.1%) and 10 objective responses (8 PR and 2 CR) - 27.8% [95% C.L. 12.9 to 42.7]. EGFR was expressed in 32 pts (80%), with >10% + tumor cells for 14 pts (35%). 3/6 EGFR- pts (50%) and 7/32 EGFR+ pts (21.9%) responded. No gene amplification was documented in the 25 tumors (7 responders). A positive correlation between skin rash and disease control was suggested (p from χ2 = 0.08). Median progression free and overall survival (mo) are 5.3 [2.9–8.4] and 11.1 [8.6–13.6] respectively. Conclusions: Cetux partly alleviated MCC resistance to Chrono, independently of tumor EGFR protein expression or gene amplification, possibly through interfering with TGFα. This EGFR ligand carries poor prognosis for MCC and alters circadian clock function. [Table: see text]
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Affiliation(s)
- F. A. Lévi
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - A. Karaboué
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - M. Bralet
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - P. Innominato
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - M. O. Herelle
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - S. Giacchetti
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - R. Adam
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - C. Jasmin
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - C. Guettier
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
| | - M. Bouchahda
- INSERM U 776 & Hôpital Paul Brousse Cancérologie, Villejuif, France; Hôpital Paul Brousse Service d’Anatomie Pathologique, Villejuif, France; Hôpital Paul Brousse Service de Cancérologie, Villejuif, France; Hôpital Paul Brousse Centre Hépato Biliaire, Villejuif, France; Hôpital Paul Brousse & Merck Lipha Santé, Villejuif & Lyon, France
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