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Berdel AF, Koch R, Gerss J, Hentrich M, Peceny R, Bartscht T, Steffen B, Bischoff M, Spiekermann K, Angenendt L, Mikesch JH, Kewitz T, Butterfass-Bahloul T, Serve H, Lenz G, Berdel WE, Krug U, Schliemann C. A randomized phase 2 trial of nintedanib and low-dose cytarabine in elderly patients with acute myeloid leukemia ineligible for intensive chemotherapy. Ann Hematol 2023; 102:63-72. [PMID: 36399194 PMCID: PMC9807538 DOI: 10.1007/s00277-022-05025-0] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
We investigated the safety and efficacy of nintedanib added to low-dose cytarabine (LDAC) in a phase 1/2 study in patients 60 years or older with newly diagnosed or relapsed/refractory (r/r) AML ineligible for intensive chemotherapy. The results of the dose-finding phase 1 part have been previously published. Patients were randomized 1:1 to LDAC plus nintedanib or LDAC plus placebo stratified by AML status (newly diagnosed vs r/r). LDAC was applied subcutaneously at 20 mg twice daily on days 1 to 10. Nintedanib/placebo was orally administered twice daily on days 1 to 28 in 28-day cycles. The primary endpoint was overall survival (OS). Between 05/2017 and 09/2019, 31 patients were randomized and 30 were treated, before the study was terminated prematurely due to slow recruitment. Median (range) age of patients was 76 (60-84) years. Twenty-two patients (73%) had r/r AML. Median OS in patients treated with LDAC and nintedanib was 3.4 months, compared with 3.6 months in those treated in the placebo arm, with a HR adjusted for AML status of 1.19 (corresponding confirmatory adjusted 95% CI, 0.55-2.56; univariate log-rank P = 0.96). In the 22 patients with r/r AML, median OS was 3.0 months in the nintedanib and 3.6 months in the placebo arm (P = 0.36). One patient in the nintedanib and two patients in the placebo arm achieved a CR and entered maintenance treatment. Nintedanib showed no superior therapeutic activity over placebo when added to LDAC in elderly AML patients considered unfit for intensive chemotherapy. The trial was registered at clinicaltrials.gov NCT01488344.
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Affiliation(s)
- Andrew F Berdel
- Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - Rudolf Peceny
- Department of Oncology, Hematology and Stem Cell Transplantation, Klinikum Osnabrück, Osnabrück, Germany
| | - Tobias Bartscht
- Department of Medicine I, University Hospital Lübeck, Lübeck, Germany
| | - Björn Steffen
- Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Marina Bischoff
- Department of Hematology and Oncology, Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Linus Angenendt
- Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Tobias Kewitz
- Centre for Clinical Trials, University of Münster, Münster, Germany
| | | | - Hubert Serve
- Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Utz Krug
- Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- Department of Medicine, III, Hospital Leverkusen, Leverkusen, Germany
| | - Christoph Schliemann
- Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
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Gerwing M, Krähling T, Schliemann C, Harrach S, Schwöppe C, Berdel AF, Klein S, Hartmann W, Wardelmann E, Heindel WL, Lenz G, Berdel WE, Wildgruber M. Multiparametric Magnetic Resonance Imaging for Immediate Target Hit Assessment of CD13-Targeted Tissue Factor tTF-NGR in Advanced Malignant Disease. Cancers (Basel) 2021; 13:cancers13235880. [PMID: 34884988 PMCID: PMC8657298 DOI: 10.3390/cancers13235880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Since the knowledge of tumor biology has advanced, a variety of targeted therapies has been developed. These do not immediately affect the tumor size, so optimized oncological imaging is needed. In this phase I study of patients with advanced malignant disease, a multiparametric imaging approach was used to assess changes in tumor perfusion after vessel-occluding therapy with the CD13 targeted truncated tissue factor with a C-terminal NGR-peptide. It comprises different sequences and the use of two different contrast media, ferucarbotran and gadobutrol. This multiparametric MRI protocol enables assessing the therapy effectiveness as early as five hours after therapy initiation. Abstract Early assessment of target hit in anti-cancer therapies is a major task in oncologic imaging. In this study, immediate target hit and effectiveness of CD13-targeted tissue factor tTF-NGR in patients with advanced malignant disease enrolled in a phase I trial was assessed using a multiparametric MRI protocol. Seventeen patients with advanced solid malignancies were enrolled in the trial and received tTF-NGR for at least one cycle of five daily infusions. Tumor target lesions were imaged with multiparametric MRI before therapy initiation, five hours after the first infusion and after five days. The imaging protocol comprised ADC, calculated from DWI, and DCE imaging and vascular volume fraction (VVF) assessment. DCE and VVF values decreased within 5 h after therapy initiation, indicating early target hit with a subsequent decrease in tumor perfusion due to selective tumor vessel occlusion and thrombosis induced by tTF-NGR. Simultaneously, ADC values increased at five hours after tTF-NGR administration. In four patients, treatment had to be stopped due to an increase in troponin T hs, with subsequent anticoagulation. In these patients, a reversed effect, with DCE and VVF values increasing and ADC values decreasing, was observed after anticoagulation. Changes in imaging parameters were independent of the mean vessel density determined by immunohistochemistry. By using a multiparametric imaging approach, changes in tumor perfusion after initiation of a tumor vessel occluding therapy can be evaluated as early as five hours after therapy initiation, enabling early assessment of target hit.
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Affiliation(s)
- Mirjam Gerwing
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
- Correspondence:
| | - Tobias Krähling
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Saliha Harrach
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Christian Schwöppe
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Andrew F. Berdel
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Sebastian Klein
- Gerhard-Domagk-Institute for Pathology, University of Muenster, D-48149 Muenster, Germany; (S.K.); (W.H.); (E.W.)
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute for Pathology, University of Muenster, D-48149 Muenster, Germany; (S.K.); (W.H.); (E.W.)
| | - Eva Wardelmann
- Gerhard-Domagk-Institute for Pathology, University of Muenster, D-48149 Muenster, Germany; (S.K.); (W.H.); (E.W.)
| | - Walter L. Heindel
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
| | - Georg Lenz
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Wolfgang E. Berdel
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Moritz Wildgruber
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
- Department of Radiology, University Hospital, LMU Munich, D-81377 Munich, Germany
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Schliemann C, Hemmerle T, Berdel AF, Angenendt L, Kerkhoff A, Hering JP, Heindel W, Hartmann W, Wardelmann E, Chawla SP, de Braud F, Lenz G, Neri D, Kessler T, Berdel WE. Dose escalation and expansion phase I studies with the tumour-targeting antibody-tumour necrosis factor fusion protein L19TNF plus doxorubicin in patients with advanced tumours, including sarcomas. Eur J Cancer 2021; 150:143-154. [PMID: 33901793 DOI: 10.1016/j.ejca.2021.03.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/01/2021] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND L19TNF is a recombinant fusion protein composed of a human antibody fragment and human tumour necrosis factor. L19TNF targets the EDB domain of oncofetal fibronectin highly expressed in tumour vasculature and induces tumour remission in mouse tumours. We summarise two phase I trials testing a combination of L19TNF with doxorubicin in patients with solid tumours, particularly soft tissue sarcomas (STS). PATIENTS AND METHODS The first study, an open-label, dose-escalation and expansion phase I study of L19TNF plus doxorubicin, enrolled 27 patients. Three cohorts (10.4-17 μg/kg L19TNF) of patients received L19TNF intravenously at days 1, 3, and 5 and doxorubicin (75 mg/m2, then 60 mg/m2) on day 1 every 3 weeks. The expansion cohort enrolled patients with STS. The second study tried to re-escalate the doxorubicin dose to 75 mg/m2 with 13 μg/kg L19TNF. Among primary objectives was the establishment of a recommended dose (RD). RESULTS The combination was safely applicable. Dose-limiting toxicity occurred either at 17 μg/kg L19TNF or at 75 mg/m2 doxorubicin. RD is 13 μg/kg L19TNF plus 60 mg/m2 doxorubicin. In 15 STS patients of the extension cohort evaluable for efficacy, antitumour activity was observed with complete remission in 1, partial remission in 1 and minor tumour shrinkage in 7 patients. The median overall survival for this heavily pretreated cohort was 14.9 months. CONCLUSION L19TNF can be safely applied in combination with doxorubicin and induces encouraging tumour remissions in patients with soft tissue sarcomas.
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Affiliation(s)
- Christoph Schliemann
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany.
| | | | - Andrew F Berdel
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Linus Angenendt
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Andrea Kerkhoff
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Jan P Hering
- Institute for Clinical Radiology, University Hospital Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Walter Heindel
- Institute for Clinical Radiology, University Hospital Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute for Pathology, University Hospital of Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Eva Wardelmann
- Gerhard-Domagk-Institute for Pathology, University Hospital of Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Sant P Chawla
- Sarcoma Oncology Center, 2811 Wilshire Blvd, Santa Monica, CA, 90403, USA
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milano MI, 20133, Italy
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | | | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany.
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Schliemann C, Kessler T, Berdel AF, Hemmerle T, Angenendt L, Altvater B, Rossig C, Mikesch JH, Lenz G, Schäfers M, Neri D, Stelljes M, Berdel WE. Phase I study of F16IL2 antibody-cytokine fusion with very low-dose araC in acute myeloid leukaemia relapse after allogeneic stem cell transplantation. Br J Haematol 2021; 192:e148-e151. [PMID: 33618424 DOI: 10.1111/bjh.17365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Christoph Schliemann
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Torsten Kessler
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Andrew F Berdel
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Linus Angenendt
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Bianca Altvater
- Department of Paediatric Oncology and Haematology, University Children´s Hospital Muenster, Muenster, Germany
| | - Claudia Rossig
- Department of Paediatric Oncology and Haematology, University Children´s Hospital Muenster, Muenster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | | | - Matthias Stelljes
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Haematology, Oncology, University Hospital Muenster, Muenster, Germany
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