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Reddy JP, Hernandez M, Gunther JR, Dabaja BS, Martin GV, Jiang W, Akhtari M, Allen PK, Atkinson BJ, Smith GL, Pinnix CC, Milgrom SA, Abou Yehia Z, Osborne EM, Oki Y, Lee H, Hagemeister F, Fanale MA. Pre-treatment neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are prognostic of progression in early stage classical Hodgkin lymphoma. Br J Haematol 2017; 180:545-549. [DOI: 10.1111/bjh.15054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jay P. Reddy
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Mike Hernandez
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Jillian R. Gunther
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Bouthaina S. Dabaja
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Geoffrey V. Martin
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Wen Jiang
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Mani Akhtari
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Radiation Oncology; The University of Texas Medical Branch at Galveston; Galveston TX USA
| | - Pamela K. Allen
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Bradley J. Atkinson
- Department of Clinical Pharmacy Services; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Grace L. Smith
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Chelsea C. Pinnix
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Sarah A. Milgrom
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Zeinab Abou Yehia
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Eleanor M. Osborne
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Yasuhiro Oki
- Department of Lymphoma Medical Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Hun Lee
- Department of Lymphoma Medical Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Fredrick Hagemeister
- Department of Lymphoma Medical Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Michelle A. Fanale
- Department of Lymphoma Medical Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
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Watkins JL, Atkinson BJ, Pagliaro LC. Rhabdomyolysis in a Prostate Cancer Patient Taking Ketoconazole and Simvastatin: Case Report and Review of the Literature. Ann Pharmacother 2017; 45:e9. [DOI: 10.1345/aph.1p433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kalra S, Verma J, Atkinson BJ, Matin SF, Wood CG, Karam JA, Lin SH, Satcher RL, Tamboli P, Sircar K, Rao P, Corn PG, Tannir NM, Jonasch E. Outcomes of Patients With Metastatic Renal Cell Carcinoma and Bone Metastases in the Targeted Therapy Era. Clin Genitourin Cancer 2017; 15:363-370. [PMID: 28216278 DOI: 10.1016/j.clgc.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bone metastases (BMs) occur commonly in patients with metastatic renal cell carcinoma (mRCC). Tyrosine kinase inhibitors (TKIs) have improved the outcomes for patients with mRCC. However, data on the outcomes of mRCC patients with BMs treated with TKIs are limited. We describe the outcomes of patients with BMs treated with TKI therapy and compare them with the outcomes from a pre-TKI group. PATIENTS AND METHODS Using an institutional tumor registry, a retrospective review of patients with mRCC from 2002 to 2003 and 2006 to 2007 was performed. The baseline characteristics were analyzed, and overall survival (OS) was estimated using the Kaplan-Meier method. The predictors of OS were analyzed using Cox regression analysis. RESULTS The data from 375 patients were reviewed. Of these patients, 188 (50%) started treatment with TKIs and 187 (50%) had started treatment in the pre-TKI era. The distribution of patient characteristics was similar. The sites of organ metastases were equally distributed, including BMs in 48% of the patients in each cohort. The median OS for the patients treated in the TKI era was 22 months (95% confidence interval [CI], 17-25 months) compared with 14 months (95% CI, 10-19 months; P < .01) for the historical controls. A subset analysis of patients with BM in the TKI era demonstrated a median OS of 24 months (95% CI, 17-28 months) compared with 18 months (95% CI, 10-21 months; P < .01) in pre-TKI era. The predictors of shorter OS were a higher Memorial Sloan Kettering Cancer Center score; liver, lung, and brain metastases; and multiple sites of BMs (hazard ratio, 1.38; 95% CI, 1.02-1.91; P = .04). The rate of new BM development was the same in the pre- and post-TKI era. CONCLUSION The rate of BM development was the same in the pre- and post-TKI era. The management of BMs in patients with mRCC remains challenging.
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Affiliation(s)
- Sarathi Kalra
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Jonathan Verma
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - Bradley J Atkinson
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher G Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sue-Hwa Lin
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert L Satcher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pheroze Tamboli
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanishka Sircar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Rao
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul G Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Bilen MA, Cauley DH, Atkinson BJ, Chen HC, Kaya DH, Wang X, Vikram R, Tu SM, Corn PG, Kim J. Safety of Same-day Pegfilgrastim Administration in Metastatic Castration-resistant Prostate Cancer Treated With Cabazitaxel With or Without Carboplatin. Clin Genitourin Cancer 2016; 15:e429-e435. [PMID: 28038931 DOI: 10.1016/j.clgc.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/17/2016] [Accepted: 12/03/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Although myeloid growth factors are commonly used to treat metastatic castration-resistant prostate cancer (mCRPC), the optimal timing of administration has not been well studied. We assessed the effects of same-day pegfilgrastim, a neutrophil stimulator, after cabazitaxel treatment with or without carboplatin in patients with mCRPC. We also evaluated the frequency of urinary tract inflammation during treatment. PATIENTS AND METHODS Between September 2010 and September 2014, 151 consecutive patients with mCRPC underwent cabazitaxel treatment with or without the addition of carboplatin at a single institution. We assessed absolute neutrophil count recovery, incidence of neutropenia, neutropenic fever, antibiotic usage, treatment delays or discontinuation, dose reduction, and hospitalization with pegfilgrastim administration. Radiologists blinded to therapy reviewed computed tomography scans to detect urinary tract inflammation. RESULTS The median patient age was 69 years (range, 41-88 years); 78% of patients were white, and 54% had a Gleason score ≥ 9. Median overall survival was 9 months (95% confidence interval, 8-11 months). One patient (< 1%) had neutropenia; 38 patients (25%) had infection. During cycle 1, a significantly higher proportion of patients receiving pegfilgrastim after 24 hours developed infection than did those receiving pegfilgrastim the same day (26% vs. 6%; P = .01). CONCLUSION Same-day pegfilgrastim administration after cabazitaxel treatment with or without carboplatin in patients with mCRPC is feasible. The urinary tract inflammation rate (21%) was higher than that reported anecdotally. Results need to be prospectively validated.
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Affiliation(s)
- Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Diana H Cauley
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bradley J Atkinson
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hsiang-Chun Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diana H Kaya
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raghu Vikram
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shi-Ming Tu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul G Corn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeri Kim
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Bilen MA, Cauley DH, Atkinson BJ, Chen HC, Kaya D, Wang X, Vikram R, Tu SM, Corn PG, Kim J. Safety of same-day pegfilgrastim administration and incidence of cystitis and ureteritis in mCRPC treated with cabazitaxel ± carboplatin. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 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)
| | - Diana H. Cauley
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Diana Kaya
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raghu Vikram
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shi-Ming Tu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeri Kim
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Kalra S, Atkinson BJ, Matrana MR, Matin SF, Wood CG, Karam JA, Tamboli P, Sircar K, Rao P, Corn PG, Tannir NM, Jonasch E. Prognosis of patients with metastatic renal cell carcinoma and pancreatic metastases. BJU Int 2015; 117:761-5. [PMID: 26032863 DOI: 10.1111/bju.13185] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 12/29/2022]
Abstract
OBJECTIVES To identify the clinical outcomes of patients with metastatic renal cell carcinoma (mRCC) with pancreatic metastases (PM) treated with either pazopanib or sunitinib and assess whether PM is an independent prognostic variable in the current therapeutic environment. PATIENTS AND METHODS A retrospective review of patients with mRCC in an outpatient clinic was carried out for the period January 2006 to November 2011. Patient characteristics, including demographics, laboratory data and outcomes, were analysed. Baseline characteristics were compared using chi-squared and t-tests and overall survival (OS) and cancer-specific survival (CSS) rates were estimated using Kaplan-Meier methods. Predictors of OS were analysed using Cox regression. RESULTS A total of 228 patients were reviewed, of whom 44 (19.3%) had PM and 184 (81.7%) had metastases to sites other than the pancreas. The distribution of baseline characteristics was equal in both groups, with the exception of a higher incidence of previous nephrectomy, diabetes and number of metastatic sites in the PM group. Four patients had isolated PM, but the majority of patients (68%) with PM had at least three different organ sites of metastases, as compared with 29% in patients without PM (P < 0.01). The distribution of organ sites of metastases was similar, excluding the pancreas, in those with and those without PM (P > 0.05). The median OS was 39 months (95% confidence interval [CI] 24-57, hazard ratio 0.66, 95% CI 0.42-0.94; P = 0.02) for patients with PM, compared with 26 months (95% CI 21-31) for patients without PM (P < 0.01). CSS was 42 months (95% CI 30-57) in the PM group and 27 months (95% CI 22-33) in the control group (P = 0.05). CONCLUSIONS Despite a higher number of affected organ sites in the PM cohort, mRCC behaviour in this cohort appears to be more indolent, as demonstrated by a higher median OS. These findings suggest that host or tumour features associated with PM may represent a less aggressive tumour phenotype.
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Affiliation(s)
- Sarathi Kalra
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Surena F Matin
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jose A Karam
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pheroze Tamboli
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kanishka Sircar
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Rao
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul G Corn
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nizar M Tannir
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Jonasch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Wolfe AR, Atkinson RL, Reddy JP, Debeb BG, Larson R, Li L, Masuda H, Brewer T, Atkinson BJ, Brewster A, Ueno NT, Woodward WA. High-density and very-low-density lipoprotein have opposing roles in regulating tumor-initiating cells and sensitivity to radiation in inflammatory breast cancer. Int J Radiat Oncol Biol Phys 2015; 91:1072-80. [PMID: 25832697 DOI: 10.1016/j.ijrobp.2014.12.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 12/15/2014] [Accepted: 12/17/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE We previously demonstrated that cholesterol-lowering agents regulate radiation sensitivity of inflammatory breast cancer (IBC) cell lines in vitro and are associated with less radiation resistance among IBC patients who undergo postmastectomy radiation. We hypothesized that decreasing IBC cellular cholesterol induced by treatment with lipoproteins would increase radiation sensitivity. Here, we examined the impact of specific transporters of cholesterol (ie lipoproteins) on the responses of IBC cells to self-renewal and to radiation in vitro and on clinical outcomes in IBC patients. METHODS AND MATERIALS Two patient-derived IBC cell lines, SUM 149 and KPL4, were incubated with low-density lipoproteins (LDL), very-low-density lipoproteins (VLDL), or high-density lipoproteins (HDL) for 24 hours prior to irradiation (0-6 Gy) and mammosphere formation assay. Cholesterol panels were examined in a cohort of patients with primary IBC diagnosed between 1995 and 2011 at MD Anderson Cancer Center. Lipoprotein levels were then correlated to patient outcome, using the log rank statistical model, and examined in multivariate analysis using Cox regression. RESULTS VLDL increased and HDL decreased mammosphere formation compared to untreated SUM 149 and KPL4 cells. Survival curves showed enhancement of survival in both of the IBC cell lines when pretreated with VLDL and, conversely, radiation sensitization in all cell lines when pretreated with HDL. In IBC patients, higher VLDL values (>30 mg/dL) predicted a lower 5-year overall survival rate than normal values (hazard ratio [HR] = 1.9 [95% confidence interval [CI]: 1.05-3.45], P=.035). Lower-than-normal patient HDL values (<60 mg/dL) predicted a lower 5-year overall survival rate than values higher than 60 mg/dL (HR = 3.21 [95% CI: 1.25-8.27], P=.015). CONCLUSIONS This study discovered a relationship among the plasma levels of lipoproteins, overall patient response, and radiation resistance in IBC patients and IBC patient-derived cell lines. A more expansive study is needed to verify these observations.
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Affiliation(s)
- Adam R Wolfe
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel L Atkinson
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay P Reddy
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bisrat G Debeb
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard Larson
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Li Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hiroko Masuda
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Takae Brewer
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradley J Atkinson
- Department of Clinical Pharmacy Services, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abeena Brewster
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naoto T Ueno
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy A Woodward
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Abstract
Background Vascular endothelial growth factor receptor inhibitors, mammalian target of rapamycin inhibitors, and tyrosine kinase inhibitors are approved for metastatic renal cell cancer. Proteinuria can occur, but there is limited data regarding the incidence, monitoring, and management in metastatic renal cell cancer patients. Objective Our primary objective was to describe the incidence and severity of proteinuria in metastatic renal cell cancer patients treated in the first-line setting with pazopanib, bevacizumab, or everolimus. Methods We conducted a retrospective review of patients with metastatic renal cell cancer enrolled from January 2011–April 2013 in a phase II trial. Baseline and toxicity data were extracted from the electronic medical record. Descriptive statistics were used. Results In all, 129 patients were eligible for analysis. The overall incidence of proteinuria was 81%, with most events being Grade 1 or 2. The incidence of proteinuria was 80% ( n = 35) for pazopanib, 64% ( n = 25) for bevacizumab, and 96% ( n = 44) for everolimus. At peak proteinuria, 80% ( n = 28), 64% ( n = 16), and 80% ( n = 35) of patients on pazopanib, bevacizumab, and everolimus, respectively, were managed with continued monitoring at the same dose. The overall incidence of Grades 3 and 4 events was 24% ( n = 6) and found in the bevacizumab group. Conclusion A high incidence of proteinuria with minor severity within each class was demonstrated. It may be reasonable to continue therapy at the same dose for Grade 1 or 2 proteinuria. Treatment modification or discontinuation of therapy may be warranted with Grade 3 or 4 proteinuria.
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Affiliation(s)
- Josiah D Land
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adrienne H Chen
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bradley J Atkinson
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana H Cauley
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Bilen MA, Hess KR, Aparicio A, Kim J, Zurita AJ, Pagliaro LC, Araujo JC, Corn PG, Atkinson BJ, Tannir NM, Sharma P, Lin SH, Logothetis C, Tu SM. Sipuleucel-T cellular immunotherapy: Clinical predictors of survival in patients with castration-resistant prostate cancer (CRPC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e16046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | - Kenneth R. Hess
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ana Aparicio
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeri Kim
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - John C. Araujo
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Padmanee Sharma
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sue-Hwa Lin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Shi-Ming Tu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Atkinson BJ, Cauley DH, Ng C, Millikan RE, Xiao L, Corn P, Jonasch E, Tannir NM. Mammalian target of rapamycin (mTOR) inhibitor-associated non-infectious pneumonitis in patients with renal cell cancer: predictors, management, and outcomes. BJU Int 2014; 113:376-82. [PMID: 24053120 PMCID: PMC3944913 DOI: 10.1111/bju.12420] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterise the incidence, onset, management, predictors, and clinical impact of mammalian target of rapamycin (mTOR) inhibitor-associated non-infectious pneumonitis (NIP) on patients with metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS Retrospective review of 310 patients with mRCC who received temsirolimus and/or everolimus between June 2007 and October 2010. Clinical correlations were made with serial radiological imaging. Fisher's exact, Wilcoxon rank-sum, and logistic regression analyses were used to evaluate the association of NIP with demographic or clinical factors. Log-rank and Cox proportional hazards regression analyses were used for the time-to-event analysis. RESULTS NIP occurred in 6% of temsirolimus-treated and 23% of everolimus-treated patients. Symptoms included cough, dyspnoea, and fever (median of two and three symptoms per patient, respectively). The median National Cancer Institute Common Toxicity Criteria for Adverse Events pneumonitis grade was 2 for both groups. Older age and everolimus treatment were predictive of NIP. Patients who developed NIP had a significantly longer time on treatment (median 4.1 vs 2 months) and overall survival (OS) (median 15.4 vs 7.4 months). NIP was a predictor of improved OS by multivariate analysis. CONCLUSIONS There was an increased incidence of NIP in everolimus-treated patients. Improved OS in patients who developed NIP is an intriguing finding and should be further investigated. Given the incidence, morbidity, and outcomes seen in patients on everolimus who develop NIP, management should include proactive monitoring and treatment of NIP with the goal of preserving mTOR inhibitor therapy.
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Affiliation(s)
- Bradley J. Atkinson
- Department of Pharmacy Clinical Programs, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diana H. Cauley
- Department of Pharmacy Clinical Programs, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chaan Ng
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Randall E. Millikan
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul Corn
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
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Kalra S, Verma J, Atkinson BJ, Matin SF, Wood CG, Karam JA, Tamboli P, Sircar K, Rao P, Corn PG, Tannir NM, Jonasch E. Outcomes of patients with metastatic renal cell carcinoma and bone metastases in the targeted-therapy era. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.528] [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
528 Background: Bone metastases (BM) occur commonly in patients with metastatic renal cell carcinoma (mRCC). Tyrosine kinase inhibitors (TKIs) have improved outcomes for patients with mRCC. Data on outcomes of mRCC patients with BM treated with TKIs are limited, but suggest a worse outcome compared to non-BM groups. Herein, we describe outcomes of patients with BM treated with TKI therapy, and compare to outcomes in a pre-TKI control group. Methods: Retrospective review of patients with mRCC in the intervals of 2002-2003 and 2006-2007 was performed using the institutional tumor registry. Patient characteristics including demographics, laboratory data, and outcomes were analyzed. Overall survival (OS) was estimated using Kaplan-Meier methods. Predictors of OS were analyzed using Cox regression. Results: 375 patients were reviewed; 187 patients (50%) started treatment with TKIs and 188 patients (50%) started treatment in pre-TKI era. Distribution of patient characteristics was similar. Organ metastases were equally distributed, including BM in 48% of patients in each cohort. Median OS of patient treated with TKI therapy was 22 mo (95% CI: 17-25) compared to 14 mo (95% CI: 10-19; p<0.01) for historical controls. Subset analysis of patients with BM treated with TKI therapy demonstrated a median OS of 24 mo (95% CI: 17-28) compared to 18 mo (95% CI: 10-21; p<0.01), in non TKI treated group. Predictors of shorter OS were higher MSKCC score; liver, lung, and brain metastases; and multiple sites of BM (HR 1.38; 95% CI: 1.02-1.91; p=0.04). Rate of new BM development was the same in the pre-versus-post TKI era. Conclusions: Median survival of patients with BM appears to be slightly longer than the median, irrespective of systemic therapy received. Rate of BM development was the same in the pre-versus post-TKI era. The slightly prolonged OS with BM contradicts published data. The management of bone metastases in mRCC remains a challenge. [Table: see text]
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Affiliation(s)
- Sarathi Kalra
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Surena F. Matin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jose A. Karam
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pheroze Tamboli
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanishka Sircar
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Rao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Kalra S, Atkinson BJ, Matrana MR, Matin SF, Wood CG, Karam JA, Tamboli P, Sircar K, Rao P, Corn PG, Tannir NM, Jonasch E. Prognosis of patients with metastatic renal cell carcinoma and pancreatic metastases. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
527 Background: Pancreatic metastases are seen in a relatively small percentage of patients with renal cell carcinoma (mRCC). The prognostic impact of pancreatic metastases in patients receiving treatment for mRCC has not been extensively studied, and drivers of pancreatic metastases are not known. Methods: Retrospective review of mRCC patients in an outpatient clinic was done from January 2006 to November 2011. Patient characteristics including demographics, laboratory data, and outcomes were analyzed. Comparison of baseline characteristics was done using chi2and t-test and overall survival (OS) was estimated using Kaplan-Meier methods. Predictors of OS were analyzed using Cox regression. Results: A total of 228 patients were reviewed of which 44 (19.3%) had metastases to the pancreas and 184 (81.7%) had metastasis to sites other than the pancreas. The distribution of baseline characteristics and other factors was equal in both cohorts. 4 patients had isolated metastases to the pancreas, however, the majority of patients (68%) with pancreatic metastases had at least three different organ sites of metastases, as compared to 29% in patients without pancreatic metastases (p<0.01). Distribution of organ sites of metastases was similar (p>0.05), excluding pancreas. Median OS was 39 months (95% confidence interval [CI], 24-57) for patients with pancreatic metastases, compared to 26 months (95% CI, 21-31) for patients without pancreatic metastases (p-value <0.01). Conclusions: Despite a higher number of affected organ sites in the pancreatic metastasis cohort, mRCC behavior in this cohort appears to be more indolent, as demonstrated by a higher median OS. These findings suggest that host or tumor features associated with pancreatic metastases induce a less aggressive tumor phenotype. [Table: see text]
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Affiliation(s)
- Sarathi Kalra
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Surena F. Matin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jose A. Karam
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pheroze Tamboli
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanishka Sircar
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Rao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Shetty AV, Matrana MR, Atkinson BJ, Flaherty AL, Jonasch E, Tannir NM. Outcomes of patients with metastatic renal cell carcinoma and end-stage renal disease receiving dialysis and targeted therapies: a single institution experience. Clin Genitourin Cancer 2014; 12:348-53. [PMID: 24565697 DOI: 10.1016/j.clgc.2014.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Limited data are available regarding patients with renal cell carcinoma and ESRD treated with TTs. The objective of this study was to explore the tolerability and safety of TT in patients with mRCC and ESRD. PATIENTS AND METHODS We retrospectively identified patients with mRCC and ESRD treated at the University of Texas M.D. Anderson Cancer Center from 2002 to 2012. Patient characteristics including demographic, histology, treatment, and adverse events are reported. Duration of treatment (TOT) was determined from date of drug initiation to discontinuation. Overall survival (OS) was determined from initiation of TT to death. Statistics are descriptive. RESULTS Fourteen patients were identified. Ten patients had clear-cell histology and 4 had papillary histology. The median number of TTs per patient was 3 (range, 1-4) with median TOT of 28 months for all TTs. Eighty-eight percent of all toxicities were Grade 1 to 2; no Grade 4 toxicities were noted. Treatment discontinuations included 3 patients treated with sorafenib due to hand-foot syndrome, intolerable fatigue, and squamous cell skin cancer development; 2 patients treated with pazopanib due to intolerable fatigue and increased transaminase levels; and 1 patient treated with everolimus due to pneumonitis. Eight patients died from progressive disease. Median OS from initiation of TT was 28.5 months and 35 months from time of diagnosis. CONCLUSION Toxicities were mild to moderate and consistent with those reported in previous studies. TTs appear to be safe, well tolerated and produce antitumor response in patients with mRCC and ESRD receiving dialysis.
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Affiliation(s)
- Aditya V Shetty
- Internal Medicine Residency Program, University of Texas Medical School at Houston, Houston, TX
| | - Marc R Matrana
- Department of Hematology and Oncology, Ochsner Medical Center, New Orleans, LA.
| | - Bradley J Atkinson
- Department of Pharmacy Clinical Programs, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Amber L Flaherty
- Hematology and Medical Oncology Fellowship Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
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Atkinson BJ, Kalra S, Wang X, Bathala T, Corn P, Tannir NM, Jonasch E. Clinical outcomes for patients with metastatic renal cell carcinoma treated with alternative sunitinib schedules. J Urol 2013; 191:611-8. [PMID: 24018239 DOI: 10.1016/j.juro.2013.08.090] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE We identified sunitinib alternative schedules that maintained dose intensity while decreasing adverse events in patients with metastatic renal cell cancer. We also determined the impact of alternative schedules on clinical outcomes. MATERIALS AND METHODS We retrospectively reviewed the records of patients 18 years old or older with clear cell metastatic renal cell cancer who received first line sunitinib between January 26, 2006 and March 1, 2011 at our major comprehensive cancer center. A subset of patients was switched at the first intolerable adverse event from the traditional schedule of 28 days on and 14 days off to a schedule of 14 days on and 7 days off or other alternative schedules. A control group underwent standard dose reduction. We estimated progression-free and overall survival by the Kaplan-Meier method. Predictors of progression-free and overall survival were analyzed using Cox regression. RESULTS A total of 187 patients were included in analysis, of whom 87% were on the traditional schedule at baseline. During treatment 53% of patients continued on the traditional schedule and 47% began or were transitioned to alternative schedules. Baseline characteristics were similar. Adverse events prompting schedule modification included fatigue in 64% of cases, hand-foot syndrome in 38% and diarrhea in 32%. Median time to alternative schedules was 5.6 months. Median overall survival was 17.7 months (95% CI 10.8-22.2) on the traditional schedule compared to 33.0 months (95% CI 29.3-not estimable) on alternative schedules (p <0.0001). On multivariable analysis poor Eastern Cooperative Oncology Group (ECOG) performance status, increased lactate dehydrogenase, decreased albumin, unfavorable Heng criteria and the traditional schedule were associated with decreased overall survival (p <0.05). CONCLUSIONS Sunitinib administered on alternative schedules may mitigate adverse events while achieving outcomes comparable to those of the traditional schedule in patients with metastatic renal cell cancer. Prospective investigations of alternate dosing schemas are warranted.
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Affiliation(s)
- Bradley J Atkinson
- Department of Pharmacy Clinical Programs, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sarathi Kalra
- Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Xuemei Wang
- Division of Quantitative Sciences, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Tharakeswara Bathala
- Division of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Paul Corn
- Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
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Matrana MR, Duran C, Shetty A, Xiao L, Atkinson BJ, Corn P, Pagliaro LC, Millikan RE, Charnsangave C, Jonasch E, Tannir NM. Outcomes of patients with metastatic clear-cell renal cell carcinoma treated with pazopanib after disease progression with other targeted therapies. Eur J Cancer 2013; 49:3169-75. [PMID: 23810246 DOI: 10.1016/j.ejca.2013.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/11/2013] [Accepted: 06/03/2013] [Indexed: 11/26/2022]
Abstract
AIM The multi-tyrosine kinase inhibitor pazopanib prolongs progression-free survival (PFS) versus placebo in treatment-naive and cytokine-refractory metastatic clear-cell renal cell carcinoma (ccRCC). Outcomes and safety data with pazopanib after targeted therapy (TT) are limited. METHODS We retrospectively evaluated records of consecutive patients with metastatic ccRCC who had progressive disease (PD) after TT and received pazopanib from November 2009 through November 2011. Tumour response was assessed by a blinded radiologist using Response Evaluation Criteria In Solid Tumours (RECIST). PFS and overall survival (OS) were estimated by Kaplan-Meier methods. RESULTS Ninety-three patients were identified. Median number of prior TTs was 2 (range, 1-5). There were 68 events (PD or death). Among 85 evaluable patients, 13 (15%) had a partial response. Median PFS was 6.5 months (95% CI: 4.5-9.7); median OS was 18.1 months (95% CI: 10.26-NA). Common adverse events (AEs) included fatigue (44%), elevated transaminases (35%), diarrhoea (30%), hypothyroidism (18%), nausea/vomiting (17%), anorexia (14%) and hypertension exacerbation (14%); 91% of AEs were grade 1/2. Eleven patients (12%) discontinued therapy due to AEs. There were no treatment-related deaths. CONCLUDING STATEMENT Pazopanib demonstrated efficacy in patients with metastatic ccRCC after PD with other TTs. Toxicity overall was mild/moderate and manageable.
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Affiliation(s)
- M R Matrana
- Hematology and Medical Oncology Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Atkinson BJ, Kalra S, Wang X, Bathala T, Perpich J, Corn PG, Tannir NM, Jonasch E. Outcomes associated with sunitinib alternative schedule compared to traditional schedule: a single-center experience. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15611] [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
e15611 Background: Sunitinib is a front-line therapy for metastatic renal cell cancer (mRCC). Recommended dose is 50 mg daily; 28 days (d) on/14 d off (traditional schedule; TS). Sunitinib is associated with several adverse events (AEs). An ideal treatment modification algorithm is not known. We sought to identify 1) common AEs, 2) alternative schedules (AS) that maintained dose intensity while decreasing AEs, and 3) the impact of AS on outcomes. Methods: Single-center retrospective review of mRCC pts performed from 1/26/06 to 3/1/11. Pts > 18 years of age with mRCC who received first-line antiangiogenic therapy with sunitinib were eligible. A subset of pts were switched at first intolerable AE from TS to a 14 d/7 d, or further adjusted to 7 d /3 d, or other AS. Control group underwent standard dose reduction. Pt characteristics including demographics, disease status, laboratory data, AEs, AS, and treatment outcomes were analyzed. Results: 186 eligible pts were identified. At baseline, 87% received sunitinib 50 mg and 88% were on TS. 99 pts (53%) continued TS and 87 pts (47%) were switched to AS. Baseline characteristics were similar. Median age was 61 yrs; by MSKCC criteria 5% were good, 50% intermediate, and 45% poor prognosis. Pts had median 2 visceral mets and 42% had primary tumor in place. AEs included fatigue (47%), diarrhea (24%), and hand-foot syndrome (26%). Median time to AS was 126 d with 14 d/7 d the most common (82%). Median time on treatment was 14.9 months (mo) (95% CI:10.2 – 17.0 mo) in AS pts vs 4.2 mo (95% CI: 3.6 – 5.7 mo), respectively (p < 0.0001). Median OS was 32.9 mo (95% CI:28.3-54.1 mo) vs 18.5 mo (95% CI: 10.3-21.5 mo), respectively (p = 0.0001). ECOG PS > 2 (HR 3.9), elevated LDH (HR 2.04), and > 2 mets (HR 1.79) were associated with decreased OS. MSKCC intermediate vs poor (HR 0.57) and AS (HR 0.54) were associated with improved OS by multivariate regression analysis (p < 0.05). Conclusions: In our cohort study, AS sunitinib significantly prolonged time on treatment and was predictive of OS. Prospective investigations of alternate dosing schemas are warranted.
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Affiliation(s)
| | - Sarathi Kalra
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - John Perpich
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Cauley DH, Atkinson BJ, Ng CS, Millikan RE, Xiao L, Corn PG, Jonasch E, Tannir NM. mTOR inhibitor-associated noninfectious pneumonitis in patients with metastatic renal cell cancer: A single-center experience. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15612] [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
e15612 Background: Noninfectious pneumonitis (NIP) is a known adverse effect of mTOR inhibitors, with a reported incidence of 25-45%. The goal of this review was to characterize the incidence, onset, management, and clinical outcomes of pts with mRCC who experienced mTOR inhibitor-associated NIP at our tertiary cancer center. Methods: Retrospective review of 310 mRCC pts who received everolimus and/or temsirolimus between 6/1/2007 and 10/1/2010. Clinical correlation was made in conjunction with serial radiologic imaging studies. Results: 36 mRCC pts (12%) treated with an mTOR inhibitor developed NIP with a median time to symptom onset of 65 d (21-855) and radiographic appearance of 62.5 d (35-736). 23 pts (21%) received everolimus compared to 13 pts (6%) who received temsirolimus (P<0.0001). Median time to onset, radiographic appearance, and NCI CTCAE pneumonitis grade did not differ significantly between treatments (P=NS). Increased age (OR 1.04; 95% CI: 1.004-1.08) and everolimus (OR 4.106; 95% CI: 1.96-8.6) were associated with a greater risk of NIP. NCI CTCAE grade 2 NIP severity was most common (78%). mTOR inhibitor therapy was discontinued in 9 pts (25%); continued at same dose in 7 pts (19%), dose reduced in 2 pts (6%); held and resumed at lower dose in 2 pts (6%), and held and then resumed at same dose in 1 pt (3%). Median time on treatment was greater for pts who developed NIP; 4.1 vs 2 mo (P=0.035). Median OS was significantly greater for NIP pts; 15.4 vs 7.4 mo (P<0.0001). 3-yr survival of NIP pts was 35.4% vs 7.2% (P<0.0001). Predictors of improved OS included NIP (HR 0.315; 95% CI: 0.2-0.495; P<0.0001). Conclusions: A higher incidence of NIP was observed in mRCC pts treated with everolimus than temsirolimus. The finding of improved OS in pts who developed NIP is intriguing and should be further investigated.
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Affiliation(s)
- Diana H. Cauley
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Chaan S. Ng
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lianchun Xiao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Atkinson BJ, Kalra S, Wang X, Tannir NM, Jonasch E. A single-center retrospective review of outcomes associated with sunitinib alternative schedule compared to traditional schedule. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.381] [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
381 Background: Sunitinib is a front-line therapy for metastatic renal cell cancer (mRCC). Recommended dose is 50 mg daily; 28 days (d) on/14 d off (traditional schedule; TS). Sunitinib is associated with several adverse events (AEs). An ideal treatment modification algorithm is not known. We sought to identify (1) common AEs, (2) alternative schedules (AS) that maintained dose intensity while decreasing AEs, and (3) the impact of AS on outcomes. Methods: Single-center retrospective review of mRCC pts performed from January 26, 2006 to March 1, 2011. Pts > 18 years of age with mRCC who received first-line antiangiogenic therapy with sunitinib were eligible. A subset of pts were switched at first intolerable AE from TS to a 14 d/7 d, or further adjusted to 7 d /3 d, or other AS. Control group underwent standard dose reduction. Pt characteristics including demographics, disease status, laboratory data, AEs, AS, and treatment outcomes were analyzed. Results: 186 eligible pts were identified. At baseline, 87% received sunitinib 50 mg and 88% were on TS. 99 pts (53%) continued TS and 87 pts (47%) were switched to AS. Baseline characteristics were similar. Median age was 61 yrs; by MSKCC criteria 5% were good, 50% intermediate, and 45% poor prognosis. Pts had median 2 visceral mets and 42% had primary tumor in place. AEs included fatigue (47%), diarrhea (24%), and hand-foot syndrome (26%). Median time to AS was 126 d with 14 d/7 d the most common (82%). Median time on treatment was 14.9 months (mo) (95% CI:10.2 – 17.0 mo) in AS pts vs. 4.2 mo (95% CI: 3.6 – 5.7 mo), respectively (p < 0.0001). Median OS was 32.9 mo (95% CI:28.3-54.1 mo) vs. 18.5 mo (95% CI: 10.3-21.5 mo), respectively (p = 0.0001). ECOG PS > 2 (HR 3.9), elevated LDH (HR 2.04), and > 2 mets (HR 1.79) were associated with decreased OS. MSKCC intermediate vs. poor (HR 0.57) and AS (HR 0.54) were associated with improved OS by multivariate regression analysis (p < 0.05). Conclusions: In our cohort study, AS sunitinib significantly prolonged outcomes and was predictive of OS. Prospective investigations of alternate dosing schemas are warranted.
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Affiliation(s)
| | - Sarathi Kalra
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Matrana MR, Duran C, Shetty A, Xiao L, Atkinson BJ, Corn PG, Charnsangavej C, Jonasch E, Tannir NM. Outcomes of patients (pts) with metastatic renal cell carcinoma (mRCC) treated with pazopanib after progression on other targeted therapies (TT): Updated results. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.367] [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
367 Background: Pazopanib is an multi-tyrosine kinase inhibitor shown to prolong progression-free survival (PFS) compared to placebo in treatment-naive and cytokine-refractory mRCC. Outcomes and safety on its use after TT are limited. Methods: We retrospectively reviewed records of consecutive pts with mRCC who were treated with pazopanib between November 2009-November 2011 after having progressive disease (PD) with other TT. Radiographic response was assessed by a blinded radiologist using RECIST v1.1 criteria. PFS and overall survival (OS) were estimated by the Kaplan-Meier method. Hazard ratios (HR) were estimated by fitting univariable and multivariable Cox proportional hazards models to evaluate the association of PFS with patient co-variates. Results: 112 pts (median age 63 years, 67% male, 83% clear cell) met inclusion criteria. Median number of previous TT was 2 (range 1-5). 85 events (PD or death) occurred. 14 pts (12.5%) had a partial response. Median PFS was 5.7 months (95% CI: 4.3-8.9 months). PFS was significantly associated with male gender (HR=0.55; 95% CI: 0.34-0.87; p=0.011), clear-cell histology (HR=0.42; 95% CI: 0.24-0.74; p=0.0031), number of metastatic sites (HR= 1.26; 95% CI: 1.05-1.52; p=0.0123), pancreatic metastases (HR=0.40; 95% CI: 0.18-0.85;p=0.0185), Karnofsky PS< 80 (HR=2.07; 95% CI: 1.22-3.48; p=0.0062), and elevated LDH (HR=1.63; 95% CI: 1.03-2.573; p=0.035). Median OS was 16.9 months (95% CI: 10.3–21.9). 26% of pts were still receiving pazopanib at the time of analysis. 51% discontinued pazopanib due to PD and 12% died of PD on treatment. 11% discontinued pazopanib due to adverse events (AEs). There were no treatment related deaths. Common AEs included fatigue (43%), increase LFTs (34%), diarrhea (28%), nausea/vomiting (14%), anorexia (14%), hypertension exacerbation (12%), and hypothyroidism (11%). 89% of AEs were grade 1/2. Conclusions: Pazopanib demonstrated meaningful clinical activity in heavily pretreated pts with mRCC following PD with other TT. AEs were mild/moderate and manageable.
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Affiliation(s)
| | - Cihan Duran
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aditya Shetty
- The University of Texas MD Anderson Cancer Center, Houston, TX, Afghanistan
| | - Lianchun Xiao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Paul G. Corn
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Matrana MR, Shetty AV, Atkinson BJ, Xiao L, Corn PG, Millikan RE, Jonasch E, Tannir NM. Outcomes of patients (pts) with metastatic renal cell carcinoma (mRCC) treated with pazopanib after progression on other targeted therapies (TT): A single-institution experience. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4615] [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
4615 Background: Pazopanib is an approved multi-tyrosine kinase inhibitor that prolongs progression-free survival (PFS) compared to placebo in treatment-naive and cytokine-refractory mRCC. Outcomes and safety data on its use after TT are limited. Methods: We retrospectively reviewed pts with mRCC who received salvage pazopanib between 11/09-11/11. Kaplan-Meier method was used to estimate survival outcomes. PFS was calculated from start of pazopanib until progressive disease (PD) or death. Univariable and multivariable Cox proportional hazards models were fitted to evaluate associations of PFS with covariables. Results: 114 consecutive pts met inclusion criteria (median age 62.6 years, 66% males, 83% clear cell). All pts had PD after other TT (median # of prior TT 2, range 1-5; median time on prior TT 23.3 mos). 79% of pts had PD on sunitinib, 39% on sorafenib, 19% on temsirolimus, 59% on everolimus, and 23% on bevacizumab. 25% received prior chemotherapy and 16% received prior cytokines in addition to TT. 87% had prior nephrectomy. 11% had favorable-risk, 68% intermediate-risk, and 21% poor-risk per MSKCC criteria. 85 events (PD or death) occurred. Median OS was 17 mos (95% CI: 10.3-NA). Median PFS was 6.4 mos (95% CI: 4.5-9.5). By multivariable analysis, PFS was associated with male gender (HR=0.433, 95%CI: 0.269-0.696; p=0.0006), # of metastatic sites (HR=1.252; 95%CI: 1.04-1.503; p=0.016), hypertension exacerbation (HR=0.378; CI: 0.175-0.813; p=0.0128) and PS 2+ vs.0-1 (HR=2.067; CI: 1.243-3.437; p=0.0052). 58% discontinued pazopanib due to PD, 12% died of PD on treatment, and 11% discontinued pazopanib due to adverse events (AEs), mostly GI complaints or fatigue. There were no treatment related deaths. Common AEs included: fatigue (44%), diarrhea (29%), nausea/vomiting (15%), anorexia (14%), hypertension exacerbation (11%), hypothyroidism (11%), hand-foot skin reaction (9%), and increase LFTs (4%). 86% of AEs were grade 1/2. Conclusions: In this retrospective study, pazopanib demonstrated efficacy in mRCC following PD with other TT. AEs were mild/moderate and manageable.
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Affiliation(s)
| | | | | | - Lianchun Xiao
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Paul G. Corn
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - Eric Jonasch
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Flaherty A, Matrana MR, Atkinson BJ, Tannir NM. Treatment of patients with metastatic renal cell carcinoma (RCC) and end-stage renal disease (ESRD) with targeted therapy (TT): A case series. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.453] [Citation(s) in RCA: 2] [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
453 Background: Studies have shown that RCC is more prevalent in patients with ESRD, and RCC outcomes in patients with ESRD differ from those of the general RCC population. There is limited data regarding the use of TT in patients with metastatic RCC (mRCC) who are maintained on dialysis for ESRD. Methods: We retrospectively reviewed records of patients with mRCC who were seen at UT MD Anderson Cancer Center and received TT (sunitinib, sorafenib, pazopanib, temsirolimus, everolimus, erlotinib, or bevacizumab) over the last eight years (2003-2011) and who also had ESRD and underwent hemodialysis (HD) or peritoneal dialysis (PD). Overall survival (OS) was determined from initiation of TT to death. Results: Eleven patients (6 males; 8 with clear cell, 3 with papillary) were identified who met the above inclusion criteria. Median age was 57.4 years. Comorbidities included hypertension in 10, diabetes in 4, and hyperlipidemia in 6. Median number of TT was 4 (range, 1-6). Median time on treatment (TOT) was 769 days (range, 73-1792), Seven patients have died. Seven patients were on both HD and TT for over 1 year. Median OS was 1075 days (95% CI, 722-1428). TT related adverse events (AEs) included hypertension (HTN), hand-foot skin reaction (HFS), fatigue, diarrhea, rash and pneumonitis [Table]. There were no treatment related deaths. Conclusions: In this small retrospective series of patients with mRCC and ESRD who were treated with TT, adverse events were acceptable, and relatively prolonged disease courses were noted. [Table: see text]
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Affiliation(s)
- Amber Flaherty
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | | | - Nizar M. Tannir
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Matrana MR, Rao P, Atkinson BJ, Guo C, Tannir NM. Therapies and outcomes of non-renal cell carcinoma (non-RCC) neoplasms of the kidney: A single-institution experience. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
431 Background: Non-RCC neoplasms of the kidney include neuroendocrine tumors (small cell carcinoma and carcinoid) and Primitive Neuroectodermal Tumors (PNET). Small cell carcinoma and renal carcinoids are small blue cell tumors that rarely occur as primary renal neoplasms. PNET, known as extraskeletal Ewing sarcoma, is characterized by t(11;22), the gold standard for diagnosis. It is a small round cell tumor derived from the neural crest and treated with chemotherapy; the role of nephrectomy is unclear. Methods: We reviewed records of patients seen at MDACC between 01/01/2001 and 01/01/2011 for PNET, small cell carcinomas, and carcinoid tumors of the kidney. Overall survival (OS) was determined from diagnosis to death. Results: 21 pts met inclusion criteria. Disease-specific data is shown in the table. Common treatments included: carboplatin/etoposide for small cell carcinomas; vincristine/doxorubicin/ifosfamide, vincristine/doxorubicin/cyclophosphamide, and doxorubicin/ifosfamide alternating with cisplatin/etoposide for PNET. Irinotecan was a common salvage agent in PNET. Most carcinoid tumors were treated with surgery alone. Two patients with small cell received whole brain radiation for brain metastases. Conclusions: Carcinoid tumors of the kidney had better outcomes compared to renal small cell carcinomas or PNET. Local carcinoid tumors of the kidney were generally managed with surgery alone. Renal small cell carcinomas and PNET were treated with systemic therapies. [Table: see text]
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Affiliation(s)
| | - Priya Rao
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - Charles Guo
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Cauley DH, Atkinson BJ, Ng CS, Wang X, Xiao L, Corn PG, Jonasch E, Tannir NM. Everolimus (E) and temsirolimus (T) associated pneumonitis (P) in patients with metastatic renal cell cancer (mRCC): A single-center experience. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
401 Background: P is a known adverse effect (AE) of mammalian target-of-rapamycin inhibitors, with a literature reported incidence of 25-45%. The goal of this review was to characterize the incidence, timing, management, and overall survival (OS) of pts treated at our center. Methods: Retrospective review of 332 patients (pts) with complete, evaluable records, who received E and/or T between 6/1/2007 and 10/1/2010. Clinical correlation was made in conjunction with serial radiologic imaging studies. Results: P occurred in 25.2 of E and 8.1 % of T pts. 10.7 of E and 11.1 % of T pts reported no symptoms (sx). 60.7 and 72.2 % reported cough, 67.9 and 61.1 % dyspnea, 17.9 and 5.6 % fever, and 67.9 and 88.9 % fatigue, with E and T, respectively. The median # of sx/pt was 2 and 3; 42.9 and 50 % received steroids, 35.7 and 22.2 % received antibiotics, 21.4 and 27.8 % had a pulmonary consult, and 10.7 and 16.7 % received oxygen, with E and T, respectively. Providers discontinued tx in 75 and 38.9%, continued tx in 17.9 and 27.8%, continued at reduced dose in 0 and 5.6%, held and later dose reduced in 7.1 and 16.7%, and held then resumed at same dose in 0 and 11.1% of pts, with E and T, respectively. The median NCI-CTC P grade was 2 (range 1–3) in both groups. No patients died from P. Conclusions: A higher incidence of P was observed in pts treated with E than T. The finding of improved OS in pts who develop P with E is intriguing and should be further investigated. [Table: see text]
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Affiliation(s)
- Diana H. Cauley
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - Chaan S. Ng
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Paul G. Corn
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Abstract
In April 2010, sipuleucel-T became the first anticancer vaccine approved by the United States Food and Drug Administration. Different from the traditional chemotherapy agents that produce widespread cytotoxicity to kill tumor cells, anticancer vaccines and immunotherapies focus on empowering the immune system to overcome the tumor. The immune system consists of innate and adaptive components. The CD4(+) and CD8(+) T cells are the most crucial components of the adaptive arm of the immune system that act to mediate antitumor responses. However, T-cell responses are regulated by intrinsic and extrinsic mechanisms, which may interfere with effective antitumor responses. Many anticancer immunotherapies use tumor-associated antigens as vaccines in order to stimulate an immune response against tumor cells. Sipuleucel-T is composed of autologous mononuclear cells incubated with a fusion protein consisting of a common prostate cancer antigen (prostatic acid phosphatase) linked to an adjuvant (granulocyte-macrophage colony-stimulating factor). It is postulated that when the vaccine is infused into the patient, the activated antigen-presenting cells displaying the fusion protein will induce an immune response against the tumor antigen. In a recent randomized, double-blind, placebo-controlled, phase III clinical trial, sipuleucel-T significantly improved median overall survival by 4.1 months in men with metastatic castration-resistant prostate cancer compared with placebo. Although overall survival was improved, none of the three phase III clinical trials found a significant difference in time to disease progression. This, along with cost and logistic issues, has led to an active discussion. Although sipuleucel-T was studied in the metastatic setting, its ideal place in therapy is unknown, and clinical trials are being conducted in patients at different stages of disease and in combination with radiation therapy, antiandrogen therapy, and chemotherapy. Various other anticancer vaccines and immunotherapies for other tumor types are currently under investigation and in clinical trials. These immunotherapies were formulated to incorporate tumor-associated antigens aimed at stimulating effector T-cell responses or to block regulatory mechanisms that suppress the function of effector T cells. Additional studies will determine how these therapies can best improve clinical outcomes in patients with cancer.
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Affiliation(s)
- Aimee E Hammerstrom
- Division of Pharmacy, University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA
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Atkinson BJ, Tu SM. Radiopharmaceuticals: present and future. J Support Oncol 2011; 9:206-207. [PMID: 22005215 DOI: 10.1016/j.suponc.2011.06.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 06/16/2011] [Indexed: 05/31/2023]
Affiliation(s)
- Bradley J Atkinson
- Department of Genitourinary, Medical Oncology, Unit 1374, The University of Texas MD Anderson Cancer Center, P.O. Box 301439, 1155 Pressler Street, Houston, TX 77230-1439, USA
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Jonasch E, Lal LS, Atkinson BJ, Byfield SD, Miller LA, Pagliaro LC, Feng C, Tannir NM. Treatment of metastatic renal carcinoma patients with the combination of gemcitabine, capecitabine and bevacizumab at a tertiary cancer centre. BJU Int 2010; 107:741-747. [PMID: 21355978 DOI: 10.1111/j.1464-410x.2010.09626.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To investigate the effect of combining gemcitabine plus capecitabine (GX) with bevacizumab (A) in patients with metastatic RCC previously treated with cytokines and targeted agents. METHODS • The combination of GX + A was evaluated in patients with metastatic RCC using institutional databases. • Data included demographics, previous therapies, number of metastatic sites, Memorial Sloan-Kettering Cancer Center risk stratification variables, and previous nephrectomy status. • Descriptive statistics and survival analysis were employed for data analysis. RESULTS • Between January 2005 and October 2008, 28 patients were identified. Mean age was 55.7 years. Fifteen (53.57%) patients had been given tyrosine kinase inhibitor (TKI) previously. Nine (32.14%) patients had clear cell histology, 10 (35.71%) patients had sarcomatoid features on histopathology, and 19 patients (67.86%) had a prior nephrectomy. • Initial treatment consisted of G (mean dose 786.07 mg/m²) every 2 weeks, X (mean dose 2.73 g/day), and A (mean dose 10 mg/kg) every 2 weeks. Median progression-free survival (PFS) was 5.9 months and the median overall survival (OS) was 10.4 months. • In patients with previous TKI therapy, median PFS was 6.2 months and median OS was 11.7 months. • In patients with sarcomatoid features, median PFS was 3.9 months and OS was 9.0 months. • Three patients discontinued one or more of the drugs because of adverse reactions. CONCLUSIONS • The combination of GX + A shows potential efficacy and acceptable tolerability in patients with intermediate and poor prognosis metastatic RCC. • Based on these observations, a phase II trial is now underway assessing this combination in patients with sarcomatoid RCC.
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Affiliation(s)
- Eric Jonasch
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Lincy S Lal
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Bradley J Atkinson
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Stacey DaCosta Byfield
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Lesley Ann Miller
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Lance C Pagliaro
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Chun Feng
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Nizar M Tannir
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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Atkinson BJ, Lewis RE, Kontoyiannis DP. Candida lusitaniaefungemia in cancer patients: risk factors for amphotericin B failure and outcome. Med Mycol 2008; 46:541-6. [DOI: 10.1080/13693780801968571] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Affiliation(s)
- B J Atkinson
- Department of Human and Family Resources, Northern Illinois University, DeKalb 60115
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