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Fidelman N, Atreya C, Griffith M, Milloy A, Carnevale J, Venook A, Van Loon K. Abstract No. 266 Phase I Prospective Trial of TAS-102 (Trifluridine and Tipiracil) and Radioembolization with 90Y Resin Microspheres for Chemo-Refractory Colorectal Liver Metastases. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.331] [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: 02/27/2023] Open
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2
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Karapetis C, Liu H, Sorich M, Fiskum J, Grothey A, Adams R, Venook A, Heinemann V, Lenz H, Yoshino T, Zalcberg J, Chibaudel B, Buyse M, De Gramont A, Shi Q. 434P Impact of molecular markers status on treatment effects comparing EGFR and VEGF monoclonal antibodies (mAbs) in untreated metastatic colorectal cancer (mCRC): Pooled individual patient data (IPD) analysis of randomized trials from the ARCAD database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Papamichael D, Lopes G, Olswold C, Chibaudel B, Zalcberg J, Van Cutsem E, Venook A, Maughan T, Heinemann V, Kaplan R, Bokemeyer C, Lenz H, Yoshino T, Adams R, Grothey A, De Gramont A, Shi Q. 432P Toxicity and efficacy of 1st line cetuximab (cetux)-based therapy in RAS wildtype (WT) older patients (pts) with metastatic colorectal cancer (mCRC): A pooled analysis from 1,274 pts in the ARCAD database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Savoie M, Paciorek A, Van Blarigan E, Smith J, Laffan A, Zhang L, Levin A, Kenfield S, Anwar M, Atreya C, Venook A, Van Loon K, Rowen T. 006 Sexual Function in Women after Treatment for Colorectal Cancer and Anal Cancer. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Innocenti F, Rashid N, Wancen M, Ou FS, Qu X, Denning S, Bertagnolli M, Blanke C, Venook A, Kabbarah O, Lenz H. Next-generation sequencing (NGS) in metastatic colorectal cancer (mCRC): Novel mutated genes and their effect on response to therapy (Alliance). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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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6
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Das R, Ou F, Washburn C, Innocenti F, Nixon A, Lenz H, Blanke C, Niedzwiecki D, Khalil I, Harms B, Venook A. Bayesian machine learning on CALGB/SWOG 80405 (Alliance) and PEAK data identify a heterogeneous landscape of clinical predictors of overall survival (OS) in different populations of metastatic colorectal cancer (mCRC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Das R, Furchtgott L, Ou FS, Swanson D, Hayete B, Harms B, Cunha D, Latourelle J, Wuest D, Khalil I, Washburn C, Rich K, Blanke C, Meyerhardt J, Niedzwiecki D, Nixon A, O’Reilly E, Innocenti F, Lenz HJ, Venook A. Causal modeling of CALGB/SWOG 80405 (Alliance) identifies primary (1°) side-related angiogenic drivers of metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.006] [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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Bekaii-Saab T, Marcello K, Fisher G, Kopetz S, Strickler J, Venook A, Obholz K. Variability of current global practice patterns in the management of metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.258] [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: 11/13/2022] Open
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9
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Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 2018; 28:1713-1729. [PMID: 28407110 DOI: 10.1093/annonc/mdx175] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There is increasing evidence that metastatic colorectal cancer (mCRC) is a genetically heterogeneous disease and that tumours arising from different sides of the colon (left versus right) have different clinical outcomes. Furthermore, previous analyses comparing the activity of different classes of targeted agents in patients with KRAS wild-type (wt) or RAS wt mCRC suggest that primary tumour location (side), might be both prognostic and predictive for clinical outcome. Methods This retrospective analysis investigated the prognostic and predictive influence of the localization of the primary tumour in patients with unresectable RAS wt mCRC included in six randomized trials (CRYSTAL, FIRE-3, CALGB 80405, PRIME, PEAK and 20050181), comparing chemotherapy plus EGFR antibody therapy (experimental arm) with chemotherapy or chemotherapy and bevacizumab (control arms). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) for patients with left-sided versus right-sided tumours, and odds ratios (ORs) for objective response rate (ORR) were estimated by pooling individual study HRs/ORs. The predictive value was evaluated by pooling study interaction between treatment effect and tumour side. Results Primary tumour location and RAS mutation status were available for 2159 of the 5760 patients (37.5%) randomized across the 6 trials, 515 right-sided and 1644 left-sided. A significantly worse prognosis was observed for patients with right-sided tumours compared with those with left-sided tumours in both the pooled control and experimental arms for OS [HRs = 2.03 (95% CI: 1.69-2.42) and 1.38 (1.17-1.63), respectively], PFS [HRs = 1.59 (1.34-1.88) and 1.25 (1.06-1.47)], and ORR [ORs = 0.38 (0.28-0.50) and 0.56 (0.43-0.73)]. In terms of a predictive effect, a significant benefit for chemotherapy plus EGFR antibody therapy was observed in patients with left-sided tumours [HRs = 0.75 (0.67-0.84) and 0.78 (0.70-0.87) for OS and PFS, respectively] compared with no significant benefit for those with right-sided tumours [HRs = 1.12 (0.87-1.45) and 1.12 (0.87-1.44) for OS and PFS, respectively; P value for interaction <0.001 and 0.002, respectively]. For ORR, there was a trend (P value for interaction = 0.07) towards a greater benefit for chemotherapy plus EGFR antibody therapy in the patients with left-sided tumours [OR = 2.12 (1.77-2.55)] compared with those with right-sided tumours [OR = 1.47 (0.94-2.29)]. Exclusion of the unique phase II trial or the unique second-line trial had no impact on the results. The predictive effect on PFS may depend of the type of EGFR antibody therapy and on the presence or absence of bevacizumab in the control arm. Conclusion This pooled analysis showed a worse prognosis for OS, PFS and ORR for patients with right-sided tumours compared with those with left-sided tumours in patients with RAS wt mCRC and a predictive effect of tumour side, with a greater effect of chemotherapy plus EGFR antibody therapy compared with chemotherapy or chemotherapy and bevacizumab, the effect being greatest in patients with left-sided tumours. These predictive results should be interpreted with caution due to the retrospective nature of the analysis, which was carried out on subpopulations of patients included in these trials, and because none of these studies contemplated a full treatment sequence strategy.
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Affiliation(s)
- D Arnold
- Institute of Oncology, CUF Hospitals, Lisbon, Portugal
| | - B Lueza
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | | | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles
| | - A Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - V Heinemann
- Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximillans-Universität, Munich, Germany
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - J-P Pignon
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain and CIBERONC, Institute of Health Carlos III, Madrid
| | - A Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia.,CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
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Fuchs MA, Yuan C, Sato K, Niedzwiecki D, Ye X, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Innocenti F, Warren RS, Bertagnolli MM, Ogino S, Giovannucci EL, Horvath E, Meyerhardt JA, Ng K. Predicted vitamin D status and colon cancer recurrence and mortality in CALGB 89803 (Alliance). Ann Oncol 2018; 28:1359-1367. [PMID: 28327908 DOI: 10.1093/annonc/mdx109] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Observational studies suggest that higher levels of 25-hydroxyvitamin D3 (25(OH)D) are associated with a reduced risk of colorectal cancer and improved survival of colorectal cancer patients. However, the influence of vitamin D status on cancer recurrence and survival of patients with stage III colon cancer is unknown. Patients and methods We prospectively examined the influence of post-diagnosis predicted plasma 25(OH)D on outcome among 1016 patients with stage III colon cancer who were enrolled in a National Cancer Institute-sponsored adjuvant therapy trial (CALGB 89803). Predicted 25(OH)D scores were computed using validated regression models. We examined the influence of predicted 25(OH)D scores on cancer recurrence and mortality (disease-free survival; DFS) using Cox proportional hazards. Results Patients in the highest quintile of predicted 25(OH)D score had an adjusted hazard ratio (HR) for colon cancer recurrence or mortality (DFS) of 0.62 (95% confidence interval [CI], 0.44-0.86), compared with those in the lowest quintile (Ptrend = 0.005). Higher predicted 25(OH)D score was also associated with a significant improvement in recurrence-free survival and overall survival (Ptrend = 0.01 and 0.0004, respectively). The benefit associated with higher predicted 25(OH)D score appeared consistent across predictors of cancer outcome and strata of molecular tumor characteristics, including microsatellite instability and KRAS, BRAF, PIK3CA, and TP53 mutation status. Conclusion Higher predicted 25(OH)D levels after a diagnosis of stage III colon cancer may be associated with decreased recurrence and improved survival. Clinical trials assessing the benefit of vitamin D supplementation in the adjuvant setting are warranted. ClinicalTrials.gov Identifier NCT00003835.
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Affiliation(s)
- M A Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - C Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
| | - K Sato
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - D Niedzwiecki
- Alliance Statistics and Data Center, Duke University Medical Center, Durham
| | - X Ye
- Alliance Statistics and Data Center, Duke University Medical Center, Durham
| | - L B Saltz
- Memorial Sloan-Kettering Cancer Center, New York
| | - R J Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - R B Mowat
- Toledo Community Hospital Oncology Program, Toledo, USA
| | - R Whittom
- Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - A Hantel
- Edward Cancer Center, Naperville
| | - A Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago
| | - D Atienza
- Virginia Oncology Associates, Norfolk
| | - M Messino
- Southeast Cancer Control Consortium, Mission Hospitals-Memorial Campus, Asheville
| | | | - A Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco
| | - F Innocenti
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina at Chapel Hill, Chapel Hill
| | - R S Warren
- University of California at San Francisco Comprehensive Cancer Center, San Francisco
| | - M M Bertagnolli
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - S Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston.,Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - E L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - E Horvath
- Alliance Protocol Operations Office, Chicago, USA
| | - J A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
| | - K Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston
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11
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Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 2017. [PMID: 28407110 DOI: 10.1093/annonc/mdx175.pmid:28407110;pmcid:pmc6246616] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND There is increasing evidence that metastatic colorectal cancer (mCRC) is a genetically heterogeneous disease and that tumours arising from different sides of the colon (left versus right) have different clinical outcomes. Furthermore, previous analyses comparing the activity of different classes of targeted agents in patients with KRAS wild-type (wt) or RAS wt mCRC suggest that primary tumour location (side), might be both prognostic and predictive for clinical outcome. METHODS This retrospective analysis investigated the prognostic and predictive influence of the localization of the primary tumour in patients with unresectable RAS wt mCRC included in six randomized trials (CRYSTAL, FIRE-3, CALGB 80405, PRIME, PEAK and 20050181), comparing chemotherapy plus EGFR antibody therapy (experimental arm) with chemotherapy or chemotherapy and bevacizumab (control arms). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) for patients with left-sided versus right-sided tumours, and odds ratios (ORs) for objective response rate (ORR) were estimated by pooling individual study HRs/ORs. The predictive value was evaluated by pooling study interaction between treatment effect and tumour side. RESULTS Primary tumour location and RAS mutation status were available for 2159 of the 5760 patients (37.5%) randomized across the 6 trials, 515 right-sided and 1644 left-sided. A significantly worse prognosis was observed for patients with right-sided tumours compared with those with left-sided tumours in both the pooled control and experimental arms for OS [HRs = 2.03 (95% CI: 1.69-2.42) and 1.38 (1.17-1.63), respectively], PFS [HRs = 1.59 (1.34-1.88) and 1.25 (1.06-1.47)], and ORR [ORs = 0.38 (0.28-0.50) and 0.56 (0.43-0.73)]. In terms of a predictive effect, a significant benefit for chemotherapy plus EGFR antibody therapy was observed in patients with left-sided tumours [HRs = 0.75 (0.67-0.84) and 0.78 (0.70-0.87) for OS and PFS, respectively] compared with no significant benefit for those with right-sided tumours [HRs = 1.12 (0.87-1.45) and 1.12 (0.87-1.44) for OS and PFS, respectively; P value for interaction <0.001 and 0.002, respectively]. For ORR, there was a trend (P value for interaction = 0.07) towards a greater benefit for chemotherapy plus EGFR antibody therapy in the patients with left-sided tumours [OR = 2.12 (1.77-2.55)] compared with those with right-sided tumours [OR = 1.47 (0.94-2.29)]. Exclusion of the unique phase II trial or the unique second-line trial had no impact on the results. The predictive effect on PFS may depend of the type of EGFR antibody therapy and on the presence or absence of bevacizumab in the control arm. CONCLUSION This pooled analysis showed a worse prognosis for OS, PFS and ORR for patients with right-sided tumours compared with those with left-sided tumours in patients with RAS wt mCRC and a predictive effect of tumour side, with a greater effect of chemotherapy plus EGFR antibody therapy compared with chemotherapy or chemotherapy and bevacizumab, the effect being greatest in patients with left-sided tumours. These predictive results should be interpreted with caution due to the retrospective nature of the analysis, which was carried out on subpopulations of patients included in these trials, and because none of these studies contemplated a full treatment sequence strategy.
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Affiliation(s)
- D Arnold
- Institute of Oncology, CUF Hospitals, Lisbon, Portugal
| | - B Lueza
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | | | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles
| | - A Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - V Heinemann
- Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximillans-Universität, Munich, Germany
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - J-P Pignon
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain and CIBERONC, Institute of Health Carlos III, Madrid
| | - A Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia.,CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
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Strosberg JR, Cives M, Hwang J, Weber T, Nickerson M, Atreya CE, Venook A, Kelley RK, Valone T, Morse B, Coppola D, Bergsland EK. A phase II study of axitinib in advanced neuroendocrine tumors. Endocr Relat Cancer 2016; 23:411-8. [PMID: 27080472 PMCID: PMC4963225 DOI: 10.1530/erc-16-0008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 12/17/2022]
Abstract
Neuroendocrine tumors (NETs) are highly vascular neoplasms overexpressing vascular endothelial growth factor (VEGF) as well as VEGF receptors (VEGFR). Axitinib is a potent, selective inhibitor of VEGFR-1, -2 and -3, currently approved for the treatment of advanced renal cell carcinoma. We performed an open-label, two-stage design, phase II trial of axitinib 5mg twice daily in patients with progressive unresectable/metastatic low-to-intermediate grade carcinoid tumors. The primary end points were progression-free survival (PFS) and 12-month PFS rate. The secondary end points included time to treatment failure (TTF), overall survival (OS), overall radiographic response rate (ORR), biochemical response rate and safety. A total of 30 patients were enrolled and assessable for toxicity; 22 patients were assessable for response. After a median follow-up of 29months, we observed a median PFS of 26.7months (95% CI, 11.4-35.1), with a 12-month PFS rate of 74.5% (±10.2). The median OS was 45.3 months (95% CI, 24.4-45.3), and the median TTF was 9.6months (95% CI, 5.5-12). The best radiographic response was partial response (PR) in 1/30 (3%) and stable disease (SD) in 21/30 patients (70%); 8/30 patients (27%) were unevaluable due to early withdrawal due to toxicity. Hypertension was the most common toxicity that developed in 27 patients (90%). Grade 3/4 hypertension was recorded in 19 patients (63%), leading to treatment discontinuation in six patients (20%). Although axitinib appears to have an inhibitory effect on tumor growth in patients with advanced, progressive carcinoid tumors, the high rate of grade 3/4 hypertension may represent a potential impediment to its use in unselected patients.
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Affiliation(s)
- J R Strosberg
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - M Cives
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - J Hwang
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - T Weber
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - M Nickerson
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - C E Atreya
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - A Venook
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - R K Kelley
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
| | - T Valone
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - B Morse
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - D Coppola
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - E K Bergsland
- Department of Medicine and The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, California, USA
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Fidelman N, Kerlan R, Taylor A, Kolli K, Kohi M, Hawkins R, Pampaloni M, Atreya C, Bergsland E, Kelley R, Ko A, Korn W, Van Loon K, Luan J, McWhirter R, Johanson C, Venook A. Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Lenz H, Niedzwiecki D, Innocenti F, Blanke C, Mahony M, O'Neil B, Shaw J, Polite B, Hochster H, Atkins J, Goldberg R, Mayer R, Schilsky R, Bertagnolli M, Venook A. Calgb/Swog 80405: Phase III Trial of Irinotecan/5-Fu/Leucovorin (Folfiri) or Oxaliplatin/5-Fu/Leucovorin (Mfolfox6) with Bevacizumab (Bv) or Cetuximab (Cet) for Patients (Pts) with Expanded Ras Analyses Untreated Metastatic Adenocarcinoma of the Colon Or Rectum (Mcrc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.13] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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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15
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Venook A, Niedzwiecki D, Lenz H, Mahoney M, Innocenti F, O'Neil B, Hochster H, Goldberg R, Schilsky R, Mayer R, Polite B, Atkins J, Shaw J, Bertagnolli M, Blanke C. Calgb/Swog 80405: Analysis of Patients Undergoing Surgery As Part of Treatment Strategy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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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Venook A, Niedzwiecki D, Lenz H, Innocenti F, Mahoney M, O'Neil B, Shaw J, Polite B, Hochster H, Atkins J, Goldberg R, Mayer R, Schilsky R, Bertagnolli M, Blanke C. CALGB/SWOG 80405: Phase III Trial of Irinotecan/5-FU/Leucovorin (FOLFIRI) or Oxaliplatin/5-FU/Leucovorin (MFOLFOX6) with Bevacizumab (BV) or Cetuximab (CET) for Patients (PTS) with KRAS Wild-Type (WT) Untreated Metastatic Adenocarcinoma of the Colon. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.19] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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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17
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Bronowicki J, Ye S, Kudo M, Marrero J, Venook A, Nakajima K, Lencioni R. Gideon (Global Investigation of Therapeutic Decisions in Hepatocellular Carcinoma [HCC] and of Its Treatment with Sorafenib [SOR]) 2nd Interim Analysis (IA): Subgroup Analysis by Disease Etiology. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Geschwind J, Lencioni R, Marrero J, Venook A, Ye S, Nakajima K, Kudo M. Abstract No. 196: Worldwide trends in locoregional therapy (LRT) for hepatocellular carcinoma (HCC): 2nd interim analysis (IA; 1500 patients [pts]) of the GIDEON (global investigation of therapeutic decisions in HCC and of its treatment with sorafenib) study. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.244] [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: 11/25/2022] Open
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Wang Y, Donner D, Venook A, Bergsland E, Warren R, Nakakura E. A Primary Xenograft Model of Pancreatic Neuroendocrine Carcinoma Maintains a Neuroendocrine Tumor Gene Expression Signature. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lencioni R, Marrero J, Venook A, Ye SL, Kudo M. Design and rationale for the non-interventional Global Investigation of Therapeutic DEcisions in Hepatocellular Carcinoma and Of its Treatment with Sorafenib (GIDEON) study. Int J Clin Pract 2010; 64:1034-41. [PMID: 20642705 PMCID: PMC2905618 DOI: 10.1111/j.1742-1241.2010.02414.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a complicated condition influenced by multiple confounding factors, making optimum patient management extremely challenging. Ethnicity, stage at diagnosis, comorbidities and tumour morphology affect outcomes and vary from region to region, and there is no common language to assess patient prognosis and make treatment recommendations. Despite recent efforts to reduce the incidence of HCC, most patients present with unresectable disease. Non-surgical treatments include ablation, transarterial chemoembolisation and the multikinase inhibitor, sorafenib, but their effects in all patient subgroups are not known and further information is needed to optimise the use of these treatments. AIMS The Global Investigation of Therapeutic DEcisions in Hepatocellular Carcinoma and Of its Treatment with SorafeNib (GIDEON) study (ClinicalTrials.gov identifier NCT00812175; http://clinicaltrials.gov/) is an ongoing global, prospective, non-interventional study of patients with unresectable HCC who are eligible for systemic therapy and for whom the decision has been taken to treat with sorafenib under real-life practice conditions. The aim of this study is to evaluate the safety and efficacy of sorafenib in different subgroups, especially Child-Pugh B where data are limited. DISCUSSION This study will recruit 3000 patients from > 40 countries and follow them for approximately 5 years to compile a large and robust database of information that will be used to analyse local, regional and global differences in baseline characteristics, disease aetiology, treatment practice patterns and treatment outcomes, with a view to improve the knowledge base used to guide physician treatment decisions and to improve patient outcomes.
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Affiliation(s)
- R Lencioni
- Division of Diagnostic Imaging and Intervention, Department of Liver Transplantation, Hepatology and Infectious Diseases, Pisa University School of Medicine, Cisanello Hospital, Pisa, Italy.
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Schrag D, Naughton M, Kesselheim A, Archer L, Niedzwiedcki D, Romanus D, Goldberg R, Venook A. Clinical trial participants’ strategies for coping with prescription drug costs: A companion study to CALGB 80405. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9503 Background: The strategies used by clinical trial participants to cope with the high costs of prescription drugs are poorly characterized. Methods: We identified a cohort of newly metastatic CRC patients participating in CALGB 80405, a phase III trial comparing first-line systemic chemotherapy with Bevacizumab, Cetuximab or both agents. We surveyed trial participants about their prescription drug insurance status and strategies they used to cope with out-of-pocket prescription drug costs. We surveyed patients before trial initiation and again 3 months later to assess the extent to which embarking on chemotherapy imposes additional financial burden requiring use of coping strategies. Results: Out of 1422 trial participants, 806 (57%) completed the baseline survey. The 515 enrolled before 09/01/2007 were asked to repeat the survey by phone at 3 months; 409/505 alive at 3 months (81%) did so. The 409 patients in the analytic cohort had similar clinical and demographic features to those not surveyed. 60/409 (15%) lacked prescription drug coverage and only 48/409 (12%) discussed prescription drug costs with their physicians. Conclusions: In the context of a trial in which costs of chemotherapy are covered and most participants had prescription drug insurance, patients rarely discuss prescription drug costs with their physicians. Although a considerable minority report having used coping strategies to lessen the cost burden, only a very small minority newly adopt such strategies after starting chemotherapy on trial. [Table: see text] [Table: see text]
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Affiliation(s)
- D. Schrag
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
| | - M. Naughton
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
| | - A. Kesselheim
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
| | - L. Archer
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
| | - D. Niedzwiedcki
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
| | - D. Romanus
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
| | - R. Goldberg
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
| | - A. Venook
- Dana-Farber Cancer Institute, Boston, MA; Wake Forest University, Wake Forest, NC; Brigham and Women's Hospital, Boston, MA; CALGB, Chicago, IL; University of North Carolina, Chapel Hill, NC; University of California at San Fransisco, San Fransisco, CA
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Meyerhardt JA, Jackson McCleary N, Niedzwiecki D, Hollis D, Venook A, Mayer R, Goldberg R. Impact of age and comorbidities on treatment effect, tolerance, and toxicity in metastatic colorectal cancer (mCRC) patients treated on CALGB 80203. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4038 Background: Little is known regarding the interaction of comorbid conditions (CC) and age when treating pts for mCRC. We sought to determine the impact of CC and age (<70 and ≥70 yrs) on survival and toxicity in these pts. Methods: We utilized a cohort of 238 pts with mCRC enrolled in CALGB 80203, a curtailed, multicenter 2x2 phase III trial of fluorouracil/leucovorin + oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) ± cetuximab. Endpoints were overall survival (OS; time to death), progression-free survival (PFS; time to recurrence or death), and grade 3/4 toxicity. Pts completed a self-administered questionnaire on diet and lifestyle that included a modified Charlson's comorbidity survey. Cox models were adjusted for treatment (rx) arm, gender, and prior rx. Results: In CALGB 80203, 77% were < 70 and 23% ≥70. Thirty-five percent of pts had at least one CC (34% < 70 yrs; 41% ≥ 70 yrs). At least one grade 3/4 toxicity was experienced by 87% of pts ≥70 v 66% <70 (p=0.002), primarily hematologic (56% v 31%, p=0.003). Amongst 238 pts, 94% and 84% experienced a PFS event and OS event, respectively. No pts are censored prior to 3 yrs. Median follow-up was 23 mos. The adjusted hazard ratio (HR) for ≥70 v <70 of PFS was 1.0 (0.7–1.4) and of OS was 1.1 (0.8–1.6). Similarly, there were no significant differences in HR for PFS and OS by # CC. The table demonstrates no evidence of interaction between CC and age. Conclusions: While the early closure of CALGB 80203 presents sample size limitations for subset analyses, we did not observe an impact on PFS or OS by age and/or CC. Older pts did experience more toxicity from rx. Further studies with larger datasets are warranted. [Table: see text] [Table: see text]
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Affiliation(s)
- J. A. Meyerhardt
- Dana-Farber Cancer Institute, Boston, MA; Cancer and Leukemia Group B, Chapel Hill, NC; University of California San Francisco, San Francisco, CA; University of North Carolina, Chapel Hill, NC
| | - N. Jackson McCleary
- Dana-Farber Cancer Institute, Boston, MA; Cancer and Leukemia Group B, Chapel Hill, NC; University of California San Francisco, San Francisco, CA; University of North Carolina, Chapel Hill, NC
| | - D. Niedzwiecki
- Dana-Farber Cancer Institute, Boston, MA; Cancer and Leukemia Group B, Chapel Hill, NC; University of California San Francisco, San Francisco, CA; University of North Carolina, Chapel Hill, NC
| | - D. Hollis
- Dana-Farber Cancer Institute, Boston, MA; Cancer and Leukemia Group B, Chapel Hill, NC; University of California San Francisco, San Francisco, CA; University of North Carolina, Chapel Hill, NC
| | - A. Venook
- Dana-Farber Cancer Institute, Boston, MA; Cancer and Leukemia Group B, Chapel Hill, NC; University of California San Francisco, San Francisco, CA; University of North Carolina, Chapel Hill, NC
| | - R. Mayer
- Dana-Farber Cancer Institute, Boston, MA; Cancer and Leukemia Group B, Chapel Hill, NC; University of California San Francisco, San Francisco, CA; University of North Carolina, Chapel Hill, NC
| | - R. Goldberg
- Dana-Farber Cancer Institute, Boston, MA; Cancer and Leukemia Group B, Chapel Hill, NC; University of California San Francisco, San Francisco, CA; University of North Carolina, Chapel Hill, NC
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Chung KY, Gore I, Fong L, Venook A, Dorazio P, Healey D, Pavlov D, Saltz LB. A phase II study of the anti-CTLA4 monoclonal antibody (mAb), CP-675,206, in patients with refractory metastatic adenocarcinoma of the colon or rectum. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
3035 Background: The antitumor activity of antibodies to cytotoxic T lymphocyte-associated antigen 4 (CTLA4) has been demonstrated in a variety of murine tumor models, including rejection of established tumors and secondary exposure to tumor cells. This suggests that blockade of the inhibitory effects of CTLA4 can promote effective antitumor immune responses. CP-675,206 has also been shown to induce durable tumor responses in patients (pts) with metastatic melanoma in phase 1 and phase 2 clinical studies. The purpose of this study was to assess safety and efficacy of CTLA4 blockade with the fully human mAb CP-675,206 as single-agent therapy in pts with relapsed/ refractory colorectal cancer. Methods: A single-arm, multicenter, phase II trial of CP-675,206 was conducted in pts with measurable adenocarcinoma of the colon or rectum failing standard treatments and with an ECOG performance status of 0 or 1. Patients received 15 mg/kg Q90 days via IV infusion until disease progression. The primary objective was response rate by RECIST criteria. Secondary objectives included safety, duration of response, progression-free survival, and overall survival. Results: A total of 47 pts who received a median of 4 previous therapies (range, 1 to 9) were treated, and 46 experienced disease progression or death because of disease before reaching the planned second dose at 3 months. Grade 3 or 4 adverse events attributed to study drug were limited to diarrhea (n = 3, 6.4%) and idiopathic thrombocytopenia purpura (n = 1, 2.1%). Four pts (8.5%) had grade 2 diarrhea. Four pts received steroids and 2 received infliximab. One patient was removed for toxicity (diarrhea in the setting of what appeared to be treatment-related ulcerative colitis that was responsive to steroids). One patient (2%; 95% CI = 0%, 11%) had a stable ovarian mass and a substantial regression in an adrenal mass. This patient is continuing on study and has received a second dose. Conclusions: In heavily pretreated pts with colorectal cancer and good performance status, CP- 675,206 was tolerable. However, in this setting, CP-675,206 at 15 mg/kg did not demonstrate substantial single-agent activity. No significant financial relationships to disclose.
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Affiliation(s)
- K. Y. Chung
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
| | - I. Gore
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
| | - L. Fong
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
| | - A. Venook
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
| | - P. Dorazio
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
| | - D. Healey
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
| | - D. Pavlov
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
| | - L. B. Saltz
- Memorial Sloan-Kettering Cancer Center, New York, NY; Birmingham Hematology Oncology Association, Birmingham, AL; University of California San Francisco, San Francisco, CA; Pfizer Global Research & Development, New London, CT
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Atencio IA, Grace M, Bordens R, Fritz M, Horowitz JA, Hutchins B, Indelicato S, Jacobs S, Kolz K, Maneval D, Musco ML, Shinoda J, Venook A, Wen S, Warren R. Biological activities of a recombinant adenovirus p53 (SCH 58500) administered by hepatic arterial infusion in a Phase 1 colorectal cancer trial. Cancer Gene Ther 2006; 13:169-81. [PMID: 16082381 DOI: 10.1038/sj.cgt.7700870] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The major focus of intrahepatic arterial (IHA) administration of adenoviruses (Ad) has been on safety. Currently, there is little published data on the biological responses to Ad when administered via this route. As part of a Phase I study, we evaluated biological responses to a replication-defective adenovirus encoding the p53 transgene (SCH 58500) when administered by hepatic arterial infusion to patients with primarily colorectal cancer metastatic to the liver. In analyzing biological responses to the Ad vector, we found that both total and neutralizing Ad antibodies increased weeks after SCH 58500 infusion. The fold increase in antibody titers was not dependent on SCH 58500 dosage. The proinflammatory cytokine interleukin-6 (IL-6) transiently peaked within 6 h of dosing. The cytokine sTNF-R2 showed elevation by 24 h post-treatment, and fold increases were directly related to SCH 58500 doses. Cytokines TNF-alpha, IL-1beta, and sTNF-R1 showed no increased levels over 24 h. Predose antibody levels did not appear to predict transduction, nor did serum Ad neutralizing factor (SNF). Delivery of SCH 58500 to tumor tissue occurred, though we found distribution more predominantly in liver tissues, as opposed to tumors. RT-PCR showed significantly higher expression levels (P<0.0001, ANOVA) for adenovirus type 2 and 5 receptor (CAR) in liver tissues, suggesting a correlation with transduction. Evidence of tumor-specific apoptotic activity was provided by laser scanning cytometry, which determined a coincidence of elevated nuclear p53 protein expression with apoptosis in patient tissue. IHA administration of a replication defective adenovirus is a feasible mode of delivery, allowing for exogenous transfer of the p53 gene into target tissues, with evidence of functional p53. Limited and transient inflammatory responses to the drug occurred, but pre-existing immunity to Ad did not preclude SCH 58500 delivery.
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Venook A, Niedzwiecki D, Hollis D, Sutherland S, Goldberg R, Alberts S, Benson A, Wade J, Schilsky R, Mayer R. Phase III study of irinotecan/5FU/LV (FOLFIRI) or oxaliplatin/5FU/LV (FOLFOX) ± cetuximab for patients (pts) with untreated metastatic adenocarcinoma of the colon or rectum (MCRC): CALGB 80203 preliminary results. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3509] [Citation(s) in RCA: 44] [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] [Indexed: 11/20/2022] Open
Abstract
3509 Background: FOLFIRI or FOLFOX are 1st-line treatments (Rx) for MCRC. Cetuximab is an IgG1 Mab that targets the epidermal growth factor receptor (EGFR) and is approved as monotherapy or in combination with irinotecan in irinotecan-refractory, EGFR + pts with MCRC. CALGB 80203 randomized untreated MCRC pts to FOLFOX or FOLFIRI ± cetuximab (independent of EGFR status.) Methods: Pts with performance status 0–1 with tumor blocks available for EGFR analysis received either irinotecan 180 mg/m2 over 1.5 hours (h) or oxaliplatin 85 mg/m2 over 2h combined with LV 400 mg/m2 over 2h and 5FU 400 mg/m2 bolus, then 46–48h CI 5FU 2400 mg/m2 q o w. Cetuximab dose: 400 mg/m2 loading dose, then 250 mg/m2 qw. Rx continued until progression or toxicity; subsequent Rx was not mandated although information was collected on such rx. Accrual goal was 2200 pts with intended 1° endpt of overall survival (OS). 80203 closed administratively in 1/05 (due to slow accrual) with 238 pts accrued. 2° endpts of response rate (RR), progression free survival (PFS), duration of R and toxicity are now able to be analyzed. Results: Accrual: FOLFIRI (A) - 61; FOLFIRI + cetuximab (B) - 59: FOLFOX (C) - 60; FOLFOX + cetuximab (D) - 58; approx median follow-up (f/u) is 12 months. RR (CR + PR, not all yet confirmed): A - 34%; B - 42%; C - 32%; D - 55%. RR was similar in the FOLFIRI or FOLFOX arms (A+B v. C+D; 38% v. 43%, p=0.44; chi-square) while C225 containing arms (B+D) v. non-C225 arms (A+C) had a superior RR (49% v. 33%; p=0.014, chi-square) It is too early to tell if there are differences in PFS, duration of response or OS. No significant differences in gr III diarrhea or any gr IV toxicities were seen. Conclusions: These results suggest that FOLFIRI and FOLFOX are similar in efficacy for pts with untreated MCRC and that adding cetuximab to either in1st-line Rx appears to increase response rates. PFS and duration of response do not appear different at this analysis. Further f/u and an analysis of prospective companion correlative studies may help to further clarify these results. [Table: see text]
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Affiliation(s)
- A. Venook
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - D. Niedzwiecki
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - D. Hollis
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - S. Sutherland
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - R. Goldberg
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - S. Alberts
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - A. Benson
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - J. Wade
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - R. Schilsky
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
| | - R. Mayer
- University of California San Fransisco, San Francisco, CA; CALGB Statistical Center, Durham, NC; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; Northwestern University, Chicago, IL; Central Illinois CCOP, Decatur, IL; University of Chicago, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA
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Malik I, Hecht JR, Patnaik A, Venook A, Berlin J, Croghan G, Navale L, MacDonald M, Jerian S, Meropol NJ. Safety and efficacy of panitumumab monotherapy in patients with metastatic colorectal cancer (mCRC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3520] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I. Malik
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - J. R. Hecht
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - A. Patnaik
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - A. Venook
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - J. Berlin
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - G. Croghan
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - L. Navale
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - M. MacDonald
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - S. Jerian
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
| | - N. J. Meropol
- Loma Linda Univ Cancer Institute, Loma Linda, CA; UCLA Sch of Medicine, Los Angeles, CA; Cancer Therapy & Research Ctr, San Antonio, TX; Univ of CA San Francisco, San Francisco, CA; Vanderbilt Univ Medcl Ctr, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Ctr, Philadelphia, PA
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Hecht JR, Patnaik A, Malik I, Venook A, Berlin J, Croghan G, Wiens BL, Visonneau S, Jerian S, Meropol NJ. ABX-EGF monotherapy in patients (pts) with metastatic colorectal cancer (mCRC): An updated analysis. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3511] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. R. Hecht
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - A. Patnaik
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - I. Malik
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - A. Venook
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - J. Berlin
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - G. Croghan
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - B. L. Wiens
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - S. Visonneau
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - S. Jerian
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - N. J. Meropol
- UCLA School of Medicine, Los Angeles, CA; Cancer Therapy and Research Center, San Antonio, TX; Loma Linda University Cancer Institute, Loma Linda, CA; University of California San Francisco, San Francisco, CA; Vanderbilt University Medical Center, Nashville, TN; Mayo Clinic, Rochester, MN; Amgen Inc., Thousand Oaks, CA; Fox Chase Cancer Center, Philadelphia, PA
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28
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Abstract
Hepatitis C virus (HCV) infection often goes undiagnosed in asymptomatic carriers, but may become clinically relevant during periods of immunosuppression or severe illness. We report the clinical course of HCV reactivation in a patient receiving chemotherapy for metastatic colon cancer. We also review other reports showing the significance of HCV infection in patients being treated with chemotherapy.
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Affiliation(s)
- M E Melisko
- Comprehensive Cancer Center, University of California, San Francisco, California 94115, USA.
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29
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Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33:1394-403. [PMID: 11391528 DOI: 10.1053/jhep.2001.24563] [Citation(s) in RCA: 1588] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
The precise staging of hepatocellular carcinoma (HCC) based on the size and number of lesions that predict recurrence after orthotopic liver transplantation (OLT) has not been clearly established. We therefore analyzed the outcome of 70 consecutive patients with cirrhosis and HCC who underwent OLT over a 12-year period at our institution. Pathologic tumor staging of the explanted liver was based on the American Tumor Study Group modified Tumor-Node-Metastases (TNM) Staging Classification. Tumor recurrence occurred in 11.4% of patients after OLT. The Kaplan-Meier survival rates at 1 and 5 years were 91.3% and 72.4%, respectively, for patients with pT1 or pT2 HCC; and 82.4% and 74.1%, respectively, for pT3 tumors (P =.87). Patients with pT4 tumors, however, had a significantly worse 1-year survival of 33.3% (P =.0001). An alpha-fetoprotein (AFP) level > 1,000 ng/mL, total tumor diameter > 8 cm, age > or = 55 years and poorly differentiated histologic grade were also significant predictors for reduced survival in univariate analysis. Only pT4 stage and total tumor diameter remained statistically significant in multivariate analysis. Patients with HCC meeting the following criteria: solitary tumor < or = 6.5 cm, or < or = 3 nodules with the largest lesion < or = 4.5 cm and total tumor diameter < or = 8 cm, had survival rates of 90% and 75.2%, at 1 and 5 years, respectively, after OLT versus a 50% 1-year survival for patients with tumors exceeding these limits (P =.0005). We conclude that the current criteria for OLT based on tumor size may be modestly expanded while still preserving excellent survival after OLT.
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Affiliation(s)
- F Y Yao
- Department of Medicine, University of California, San Francisco 94143-0538, USA.
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30
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Mulvihill S, Warren R, Venook A, Adler A, Randlev B, Heise C, Kirn D. Safety and feasibility of injection with an E1B-55 kDa gene-deleted, replication-selective adenovirus (ONYX-015) into primary carcinomas of the pancreas: a phase I trial. Gene Ther 2001; 8:308-15. [PMID: 11313805 DOI: 10.1038/sj.gt.3301398] [Citation(s) in RCA: 225] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2000] [Accepted: 11/05/2000] [Indexed: 12/18/2022]
Abstract
Novel therapies are needed for locally advanced pancreatic carcinoma. ONYX-015 (dl1520) is an E1B-55 kDa region-deleted adenovirus that selectively replicates in and lyses tumor cells with abnormalities in p53 function (eg gene mutation). We carried out a phase I dose escalation study of ONYX-015 in patients with unresectable pancreatic cancer. ONYX-015 was administered via CT-guided injection (n = 22 patients) or intraoperative injection (n = 1) into pancreatic primary tumors every 4 weeks until tumor progression. Interpatient dose escalation was carried out with at least three patients per dose level from 10(8) p.f.u. up to the 10(11) p.f.u. dose level (two patients treated at this dose). The majority of patients had abnormally low cellular immunity (CD4 counts and hypersensitivity skin testing). Injection of ONYX-015 into pancreatic carcinomas was well-tolerated. Mild, transient pancreatitis was noted in only one patient. Dose-escalation proceeded to the highest dose level. Neutralizing antibodies rose post-treatment in all patients. After injection, ONYX-015 was detectable in the blood 15 min later, but not between 1 and 15 days later. Viral replication was not documented, however, in contrast to trials in other tumor types. No objective responses were demonstrated. Intratumoral injection of an E1B-55 kDa region-deleted adenovirus into primary pancreatic tumors was feasible and well-tolerated at doses up to 10(11) p.f.u. (2 x 10(12) particles), but viral replication was not detectable.
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Affiliation(s)
- S Mulvihill
- University of California, San Francisco, Department of Surgery, USA
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31
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Benson AB, Choti MA, Cohen AM, Doroshow JH, Fuchs C, Kiel K, Martin EW, McGinn C, Petrelli NJ, Posey JA, Skibber JM, Venook A, Yeatman TJ. NCCN Practice Guidelines for Colorectal Cancer. Oncology (Williston Park) 2000; 14:203-12. [PMID: 11195411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The NCCN Colorectal Cancer Guidelines panel believes that a multidisciplinary approach is necessary for the management of the patient with colorectal cancer. The panel endorses the concept that treatment of patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection; laparoscopic surgery should be done only in the context of a clinical trial. For patients with stage III disease, 5-FU-based adjuvant therapy is recommended. A patient who has metastatic disease in the liver or lung should be considered for surgical resection if he or she is a candidate for surgery and if surgery can extend survival. Surgery should be followed by adjuvant chemotherapy. The panel advocates a conservative post-treatment surveillance program for colon and rectal carcinoma patients. Serial CEA determinations are appropriate if the patient is a candidate for aggressive surgical resection, should recurrence be detected. Abdominal and pelvic CT scans should be utilized only when there are clinical indications of possible recurrence. Patients whose disease progresses during 5-FU-based therapy should be treated with irinotecan or encouraged to participate in a phase I or phase II clinical trial.
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Affiliation(s)
- A B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
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32
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Kirn D, Venook A, Pena I. Pulmonary aspergillosis masquerading as progressive post-transplant lymphoma. Transpl Int 1996; 9:517-9. [PMID: 8875798 DOI: 10.1007/bf00336833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a patient with post-transplant lymphoma who was treated by renal allograft nephrectomy, discontinuation of immuno-suppressive therapy, and initiation of acyclovir administration. Despite these measures he appeared to have progressive lymphoma. Had a biopsy and cultures not been done, the diagnosis of aspergillosis would have been missed and the patient might have been treated with chemotherapy, with a potentially lethal outcome. Data from the Cincinnati Transplant Tumor Registry indicate that of 662 patients treated for posttransplant lymphoma, 277 patients died of cancer and 137 died of other causes, of which infection was a major factor. This case emphasizes the importance of proper work-up of patients with apparently progressive lymphomas.
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MESH Headings
- Adolescent
- Aspergillosis/diagnosis
- Aspergillosis/diagnostic imaging
- Aspergillosis/pathology
- Biopsy
- Diabetes Insipidus/complications
- Diabetes Insipidus/congenital
- Diagnosis, Differential
- Disease Progression
- Graft Rejection/drug therapy
- Herpesviridae Infections/complications
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/surgery
- Kidney Neoplasms/surgery
- Kidney Neoplasms/virology
- Kidney Transplantation
- Lung/diagnostic imaging
- Lung/microbiology
- Lung/pathology
- Lung Diseases, Fungal/diagnosis
- Lung Diseases, Fungal/diagnostic imaging
- Lung Diseases, Fungal/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/secondary
- Lymphadenitis/diagnostic imaging
- Lymphadenitis/etiology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/surgery
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Postoperative Complications/diagnosis
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/pathology
- Radiography
- Tumor Virus Infections/complications
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Affiliation(s)
- D Kirn
- Onyx Pharmaceuticals, Richmond, CA 94806, USA
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33
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Venook A, Goodnight J, Smith NG, Taylor C, Gilden R, Figlin RA. Practice guidelines for gastric cancer. Cancer J Sci Am 1996; 2:S45-S52. [PMID: 9166523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- A Venook
- University of California, San Francisco, Medical School, USA
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34
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Goodnight J, Venook A, Ames M, Taylor C, Gilden R, Figlin RA. Practice guidelines for esophageal cancer. Cancer J Sci Am 1996; 2:S37-43. [PMID: 9166522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J Goodnight
- University of California, Davis, School of Medicine, USA
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35
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Goodnight J, Venook A, Fringer J, Taylor C, Gilden R, Figlin RA. Practice guidelines for pancreatic cancer. Cancer J Sci Am 1996; 2:S53-60. [PMID: 9166524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J Goodnight
- University of California, Davis, School of Medicine, USA
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36
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Venook A, Goodnight J, Kumar S, Taylor C, Gilden R, Figlin RA. Practice guidelines for colorectal cancer. Cancer J Sci Am 1996; 2:S23-36. [PMID: 9166521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Venook
- University of California, San Francisco, School of Medicine, USA
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37
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Meyerhoff DJ, Karczmar GS, Valone F, Venook A, Matson GB, Weiner MW. Hepatic cancers and their response to chemoembolization therapy. Quantitative image-guided 31P magnetic resonance spectroscopy. Invest Radiol 1992; 27:456-64. [PMID: 1318873 DOI: 10.1097/00004424-199206000-00011] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES Hepatic embolization combined with intra-arterial administration of cytostatic drugs (chemoembolization) is frequently used to treat primary and metastatic cancers to the liver. Quantitative phosphorus-31 magnetic resonance spectroscopy (31P MRS) was used to assess the metabolic state of hepatic cancers and their metabolic response to chemoembolization. METHODS Fifteen localized 31P MRS studies were performed on five patients with liver tumors. Thirteen healthy volunteers served as controls. Metabolite ratios and molar metabolite concentrations were calculated. RESULTS Untreated hepatic tumors, relative to normal controls, showed elevated phosphomonoester/adenosine triphosphate (PME/ATP) ratios, reduced concentrations of ATP and inorganic phosphate (Pi), and normal phosphodiester (PDE) concentrations. As an acute response to chemoembolization, ATP, PME, and/or PDE concentrations diminished, whereas Pi concentrations increased or stayed relatively constant. Long-term follow-up after chemoembolization showed decreased PME/ATP and increased ATP concentrations in the absence of changes on standard magnetic resonance and computed tomographic images. CONCLUSIONS These preliminary spectroscopic data suggest that quantitative 31P MRS can be successfully used to monitor directly metabolic response to hepatic chemoembolization.
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Affiliation(s)
- D J Meyerhoff
- Magnetic Resonance Unit, DVA Medical Center, San Francisco, CA 94121
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