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Reni M, Riess H, O'Reilly EM, Park JO, Hatoum H, Saez BL, Salminen T, Oettle H, Lopez R, Dowden SD, Karthaus M, Tabernero J, Van Cutsem E, Philip PA, Goldstein D, Berlin J, Tempero MA. Phase III APACT trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P + Gem) versus gemcitabine (Gem) alone for patients with resected pancreatic cancer (PC): Outcomes by geographic region. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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
4515 Background: The APACT trial was one of the largest and most geographically diverse trials of adjuvant chemotherapy for resected PC, allowing for comparison of outcomes by geographic region. In this analysis, we report updated overall survival (OS) results for the intent-to-treat (ITT) population and examine outcomes by geographic region. Methods: Treatment-naive patients with histologically confirmed PC, macroscopic complete resection, Eastern Cooperative Oncology Group performance status 0 or 1, and carbohydrate antigen 19-9 < 100 U/mL were eligible. Stratification factors were resection status (R0/R1) and lymph node status (positive/negative). Treatment was initiated ≤ 12 weeks postsurgery. Patients received nab-P 125 mg/m2 + Gem 1000 mg/m2 or Gem 1000 mg/m2 on days 1, 8, and 15 of six 28-day cycles. The primary endpoint was disease-free survival by independent review. Secondary endpoints were OS and safety. Results: The updated OS analysis (data cutoff date, January 2020) revealed a median OS of 41.8 months with nab-P + Gem compared with 37.7 months with Gem alone (hazard ratio [HR] 0.81; 95% CI, 0.68 - 0.97; nominal P = 0.047; Table). In each geographic region, the median OS with nab-P + Gem was numerically longer than with Gem alone. Conclusions: The updated OS analysis of the ITT population supports the previously reported trend favoring nab-P + Gem. The geographic regional analyses reveal numerically longer OS with nab-P + Gem vs Gem alone and variable outcomes by region; however, the differences do not support the trend observed in the ITT population, potentially due to limited sample sizes. Registration: EudraCT (2013-003398-91). Clinical trial information: NCT01964430 . [Table: see text]
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Affiliation(s)
- Michele Reni
- IRCCS Ospedale, San Raffaele Scientific Institute, Milan, Italy
| | - Hanno Riess
- Charité Universitätsmedizin, Berlin, Germany
| | | | - Joon Oh Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hassan Hatoum
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Helmut Oettle
- Onkologische und Hamatologische Schwerpunktpraxis, Friedrichshafen, Germany
| | - Rafael Lopez
- Head of Medical Oncology Department, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Scot D. Dowden
- University of Calgary Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Meinolf Karthaus
- Hematology, Oncology, and Palliative Medicine, Klinikum Neuperlach and Harlaching, Munich, Germany
| | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven, KU Leuven, Leuven, Belgium
| | | | - David Goldstein
- Nelune Cancer Centre, Prince of Wales Hospital and University of New South Wales, Randwick, NSW, Australia
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Vives M, Ginestà MM, Gracova K, Graupera M, Casanovas O, Capella G, Serrano T, Vinyals F, Saez BL. Metronomic chemotherapy following the maximum tolerated dose as a multitarget antitumor therapy affecting angiogenesis, tumor dissemination, and cancer stem cells. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e22057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22057 Background: Metronomic chemotherapy has been suggested as a maintenance administration strategy after the Maximum Tolerated Dose (MTD) treatment in a multi-targeted chemo-switch schedule (C-S). We report the effectiveness of this chemo-switch schedule in mice models of human pancreatic and ovarian cancer. Methods: In pancreas cancer models, Gemcitabine (G) was administered on four different schedules: metronomic (METG), Maximum Tolerated Dose (MTDG), chemo-switch schedule (C-SG, MTDG dosing followed by the METG) and anti-angiogenic (MTDG followed by the administration of monoclonal anti-VEGF receptor antibody DC101). In ovarian cancer model, animals were treated following a Cyclophosphamide chemo-switch schedule (C-S CTX). Results: In all these models C-S schedule had the most favorable effect, reaching at least 80% of tumor growth inhibition in absence of increased toxicity. Moreover, in the pancreas cancer model while peritoneal metastases were observed in control and MTD groups, no dissemination was observed in the MET and C-S groups. C-S treatment caused a decrease in angiogenesis and its effect on tumor growth was similar to obtained by the MTD followed by anti-angiogenic DC101 treatment. At the molecular level, C-S treatment combined an increase in thrombospondin-1 expression with a decrease in number of CD133+ cancer cells and triple positive CD133+/CD44+/CD24+ cancer stem cells. Conclusions: These findings provide confirmation that the chemo-switch schedule is a challenging clinical strategy with demonstrated inhibitory effects on tumor dissemination, angiogenesis and cancer stem cells.
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Affiliation(s)
- Marta Vives
- Translational Research Laboratory,Catalan Institute of Oncology-IDIBELL, Barcelona, Spain
| | | | - Kristina Gracova
- Translational Research Laboratory,Catalan Institute of Oncology-IDIBELL, Hospital Duran i Reynals, Barcelona, Spain
| | - Mariona Graupera
- Molecular Oncology Department, Bellvitge Biomedicine Institute (IDIBELL), Barcelona, Spain
| | - Oriol Casanovas
- IDIBELL, Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain
| | - Gabriel Capella
- Translational Research Laboratory, Institut Català d´Oncologia-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Teresa Serrano
- Anatomy and Pathology Department, Universitary Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Francesc Vinyals
- Translational Research Laboratory, Physiologial Sciences II DepartmentBarcelona University-IDIBELL, Catalan Institute of Oncology-IDIBELL, Hospital Duran i Reynals., Barcelona, Spain
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Verslype C, Hammel P, Hidalgo M, Macarulla T, Garcia-Carbonero R, André T, Van Den Eynde M, Saez BL, Milella M, Raymond E, Faivre T, Milner A, Tarabaric D, Locatelli G, Richter OV, Laffranchi B, Van Cutsem E. Pimasertib plus gemcitabine in metastatic pancreatic adenocarcinoma: Results of a safety run-in part of a phase II trial. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4041] [Citation(s) in RCA: 3] [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
4041 Background: Activating MAPK pathway mutations (predominantly RAS) occur with a high incidence in metastatic pancreatic adenocarcinoma (mPaCa). Pimasertib is a MEK1/2 inhibitor with potent activity in cell lines and xenografts with an activated MAPK pathway. This two-part trial in patients (pts) with mPaCa comprises a dose-escalation safety run-in and a randomized phase II part (EudraCT 2009-011992-61). We defined the maximum tolerated dose (MTD), safety, pharmacokinetics (PK) and antitumor activity of two pimasertib dosing schedules (S), and the recommended phase II dose (RP2D). Methods: Dose-escalation (3+3 design) in two dosing S of oral pimasertib: once-daily (qd) - 5 days on, 2 days off (S1); and twice-daily (bid) - continuous (S2) combined with the standard dose of gemcitabine (gem). Results: 53 pts (median age 61 years and ECOG performance status 0-1) have been treated at six dose levels in S1 (15 to 120 mg qd) and at 60 and 75 mg bid in S2. MTDs were defined as 120 mg qd and 75 mg bid. Two pts had a dose-limiting toxicity (DLT) in the DLT observation period: a grade (G) 3 confusion with ataxia and disorientation at 60 mg bid and a G4 suicidal ideation at 75 mg bid. G3-4 adverse events (AEs) in >5% of pts were: neutropenia (32%), thrombocytopenia (25%), asthenia (19%), dyspnea (9%), transaminitis (9%), anemia (8%), and diarrhea, pulmonary embolism, pulmonary sepsis (6% each). Most common AEs were asthenia (70%), ocular AEs (68%), skin rash (62%), nausea (58%), diarrhea (58%), peripheral edema (51%), thrombocytopenia (49%), vomiting (45%), mucositis (43%), neutropenia (38%), decreased appetite (36%) and anemia (34%). The main ocular AE was serous retinal detachment (58%); manageable retinal vein occlusion occurred in five pts. PK data were comparable to pimasertib monotherapy and published gem data. Partial responses were noted in 10 pts and stabilisation ≥3 months in 13 pts. Hot spot mutations in genes activating the MAPK and PI3K/AKT pathway and correlation with clinical outcome are being investigated. Conclusions: Pimasertib MTDs were reached. The RP2D was defined as 60 mg bid. PK was dose proportional and associated with target inhibition. Sustained responses were seen in both dosing schedules. Clinical trial information: 2009-011992-61.
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Affiliation(s)
| | | | - Manuel Hidalgo
- START Madrid, Centro Integral Oncológico Clara Campal, Madrid, Spain
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Contero CC, Trias de Bes IT, Galeote MS, Corominas Torres JM, Saez BL, Ezquerra MB, Mayol XF, Figueras SS, Ristol FS. Characterization of HER2/neu and topoisomerase IIα status by FISH in locally advanced breast cancer. Clin Transl Oncol 2004. [DOI: 10.1007/bf02711836] [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: 11/27/2022]
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