1
|
Yanagita M, Muto S, Nishiyama H, Ando Y, Hirata S, Doi K, Fujiwara Y, Hanafusa N, Hatta T, Hoshino J, Ichioka S, Inoue T, Ishikura K, Kato T, Kitamura H, Kobayashi Y, Koizumi Y, Kondoh C, Matsubara T, Matsubara K, Matsumoto K, Okuda Y, Okumura Y, Sakaida E, Shibagaki Y, Shimodaira H, Takano N, Uchida A, Yakushijin K, Yamamoto T, Yamamoto K, Yasuda Y, Oya M, Okada H, Nangaku M, Kashihara N. Correction to: Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022. Clin Exp Nephrol 2024; 28:123-124. [PMID: 38070021 PMCID: PMC10808267 DOI: 10.1007/s10157-023-02436-9] [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: 01/26/2024]
Affiliation(s)
- Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan.
| | - Satoru Muto
- Department of Urology, Graduate School of Medicine, Juntendo University, Bunkyo City, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Sumio Hirata
- Department of Academic Education, I and H Co., Ltd, Ashiya, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo City, Tokyo, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Shinjuku City, Tokyo, Japan
| | - Takahiro Hatta
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku City, Tokyo, Japan
| | - Satoko Ichioka
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takamitsu Inoue
- Department of Renal and Urologic Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Minato, Kanagawa, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Minato, Tokyo, Japan
| | - Yuichi Koizumi
- Department of Pharmacy, Seichokai Fuchu Hospital, Izumi, Japan
| | - Chihiro Kondoh
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Matsubara
- Department of Pharmacy, Wakayama Medical University Hospital, Wakayama, Japan
| | | | - Yusuke Okuda
- Department of Pediatrics, Kitasato University School of Medicine, Minato, Kanagawa, Japan
| | - Yuta Okumura
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, Saint Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hideki Shimodaira
- Division of Medical Oncology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Nao Takano
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiko Uchida
- Department of Nursing, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Kimikazu Yakushijin
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Takehito Yamamoto
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo City, Tokyo, Japan
| | | | - Yoshinari Yasuda
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Minato, Tokyo, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
2
|
Yanagita M, Muto S, Nishiyama H, Ando Y, Hirata S, Doi K, Fujiwara Y, Hanafusa N, Hatta T, Hoshino J, Ichioka S, Inoue T, Ishikura K, Kato T, Kitamura H, Kobayashi Y, Koizumi Y, Kondoh C, Matsubara T, Matsubara K, Matsumoto K, Okuda Y, Okumura Y, Sakaida E, Shibagaki Y, Shimodaira H, Takano N, Uchida A, Yakushijin K, Yamamoto T, Yamamoto K, Yasuda Y, Oya M, Okada H, Nangaku M, Kashihara N. Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022. Clin Exp Nephrol 2024; 28:85-122. [PMID: 37878114 PMCID: PMC10808569 DOI: 10.1007/s10157-023-02415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan.
| | - Satoru Muto
- Department of Urology, Graduate School of Medicine, Juntendo University, Bunkyo City, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Sumio Hirata
- Department of Academic Education, I and H Co., Ltd, Ashiya, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo City, Tokyo, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University, Shinjuku City, Tokyo, Japan
| | - Takahiro Hatta
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku City, Tokyo, Japan
| | - Satoko Ichioka
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takamitsu Inoue
- Department of Renal and Urologic Surgery, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Minato, Kanagawa, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Minato, Tokyo, Japan
| | - Yuichi Koizumi
- Department of Pharmacy, Seichokai Fuchu Hospital, Izumi, Japan
| | - Chihiro Kondoh
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Matsubara
- Department of Pharmacy, Wakayama Medical University Hospital, Wakayama, Japan
| | | | - Yusuke Okuda
- Department of Pediatrics, Kitasato University School of Medicine, Minato, Kanagawa, Japan
| | - Yuta Okumura
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, Saint Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hideki Shimodaira
- Division of Medical Oncology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Nao Takano
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiko Uchida
- Department of Nursing, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Kimikazu Yakushijin
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Takehito Yamamoto
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo City, Tokyo, Japan
| | | | - Yoshinari Yasuda
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Minato, Tokyo, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
3
|
Uematsu M, Nakajima H, Hosono A, Kiyohara H, Hirota A, Takahashi N, Fukuda M, Kusuhara S, Nakao T, Funasaka C, Kondoh C, Harano K, Matsubara N, Naito Y, Akimoto T, Mukohara T. Safety of immune checkpoint inhibitors after proton beam therapy in head and neck mucosal melanoma: a case series. Melanoma Res 2023; 33:547-552. [PMID: 37696254 DOI: 10.1097/cmr.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Proton beam therapy (PBT) has shown promising efficacy in treating locally advanced head and neck mucosal melanoma despite its poor prognosis. Although PBT may improve the efficacy of subsequent immune checkpoint inhibitors (ICIs), the safety of ICIs in patients who have previously received PBT has not been established. Hence, this study evaluated the safety of ICIs in patients who had recurrent mucosal melanoma after PBT. Between April 2013 and June 2022, we retrospectively reviewed the medical records of patients diagnosed with cutaneous or mucosal melanoma at the National Cancer Center Hospital East. Seven patients were treated with ICIs after their head and neck mucosal melanoma (HNMM) recurred after PBT. Four of the seven patients experienced grade immune-related adverse events (irAEs). Due to irAE in the irradiation field, two patients had grade 3 hypopituitarism. Other grade 3 or higher irAEs included an increase in serum alanine aminotransferase in two patients and gastritis in one, and two patients discontinued ICI due to the irAEs. All irAEs were resolved with appropriate management. Although administering ICIs after PBT may increase the risk of irAEs, especially in the irradiation field, they appear manageable. These findings could help in the development of a treatment strategy for locally advanced HNMM that includes PBT and subsequent ICIs.
Collapse
Affiliation(s)
- Mao Uematsu
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Hiromichi Nakajima
- Department of Medical Oncology, National Cancer Center Hospital East
- Department of Experimental Therapeutics, National Cancer Center Hospital East
| | - Ako Hosono
- Department of Medical Oncology, National Cancer Center Hospital East
- Department of Pediatric Oncology, National Cancer Center Hospital East
| | - Hikari Kiyohara
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Akira Hirota
- Department of Medical Oncology, National Cancer Center Hospital East
| | | | - Misao Fukuda
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Shota Kusuhara
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Takehiro Nakao
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Chikako Funasaka
- Department of Medical Oncology, National Cancer Center Hospital East
- Department of Experimental Therapeutics, National Cancer Center Hospital East
| | - Chihiro Kondoh
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Kenichi Harano
- Department of Medical Oncology, National Cancer Center Hospital East
- Department of Experimental Therapeutics, National Cancer Center Hospital East
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East
| | - Yoichi Naito
- Department of Medical Oncology, National Cancer Center Hospital East
- Department of Experimental Therapeutics, National Cancer Center Hospital East
- Department of General Internal Medicine, National Cancer Center Hospital East
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Mukohara
- Department of Medical Oncology, National Cancer Center Hospital East
| |
Collapse
|
4
|
Ishikura K, Omae K, Sasaki S, Shibagaki Y, Ichioka S, Okuda Y, Koitabashi K, Suyama K, Mizukami T, Kondoh C, Hirata S, Matsubara T, Hoshino J, Yanagita M. Chapter 4: CKD treatment in cancer survivors, from Clinical Practice Guidelines for the Management of Kidney Injury During Anticancer Drug Therapy 2022. Int J Clin Oncol 2023; 28:1333-1342. [PMID: 37418141 DOI: 10.1007/s10147-023-02375-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
Chronic kidney disease (CKD) is one of the most disabling disorders with significant comorbidity and mortality. Incidence and prevalence of CKD in cancer survivors are remarkably high in both adults and pediatric patients. The reasons for this high incidence/prevalence are multifold but kidney damage by cancer itself and cancer treatment (pharmacotherapy/surgery/radiation) are the main reasons. Since cancer survivors commonly have significant comorbidities, risk of cancer recurrence, limited physical function or life expectancy, special attentions should be paid when considering the treatment of CKD and its complications. Especially, shared decision-making should be considered when selecting the renal replacement therapies with as much information/facts/evidence as possible.
Collapse
Affiliation(s)
- Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kawasaki, Japan
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees, Fukushima Medical University Hospital, Fukushima, Japan
| | - Sho Sasaki
- Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, Saint Marianna University School of Medicine, Kanagawa, Japan.
| | - Satoko Ichioka
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yusuke Okuda
- Department of Pediatrics, Kitasato University School of Medicine, Kawasaki, Japan
| | | | - Koichi Suyama
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Takuro Mizukami
- Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sumio Hirata
- Department of Academic Education, I & H Co., Ltd, Ashiya, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
| |
Collapse
|
5
|
Izawa N, Masuishi T, Takahashi N, Shoji H, Yamamoto Y, Matsumoto T, Sugiyama K, Kajiwara T, Kawakami K, Aomatsu N, Kondoh C, Kawakami H, Takegawa N, Esaki T, Shimokawa M, Nishio K, Narita Y, Hara H, Sunakawa Y, Boku N, Moriwaki T, Eguchi Nakajima T, Muro K. A Phase II Trial of Trifluridine/Tipiracil in Combination with Cetuximab Rechallenge in Patients with RAS Wild-Type mCRC Refractory to Prior Anti-EGFR Antibodies: WJOG8916G Trial. Target Oncol 2023; 18:369-381. [PMID: 37148491 DOI: 10.1007/s11523-023-00963-9] [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] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Trifluridine/tipiracil (FTD/TPI) improved the overall survival in patients with metastatic colorectal cancer (mCRC) who had previously received standard chemotherapies; however, the clinical outcomes remain poor. OBJECTIVE A multicenter phase II study aimed to assess the efficacy and safety of FTD/TPI plus cetuximab rechallenge. PATIENTS AND METHODS Patients with histologically confirmed RAS wild-type mCRC refractory to prior anti-epidermal growth factor receptor (anti-EGFR) antibody were enrolled and treated with FTD/TPI (35 mg/m2 twice daily on days 1-5 and 8-12) plus cetuximab (initially 400 mg/m2, followed by weekly 250 mg/m2) every 4 weeks. The primary endpoint was disease control rate (DCR), expecting a target DCR of 65% and null hypothesis of 45% with 90% power and 10% one-sided alpha error. Gene alterations of RAS, BRAF, EGFR, PIK3CA, ERBB2, and MET in pre-treatment circulating tumor DNA were evaluated using the Guardant360 assay. RESULTS A total of 56 patients (median age 60 years; left-sided tumors 91%; objective partial or complete response during the prior anti-EGFR therapy 61%) were enrolled. The DCR was 54% (80% confidence interval [CI] 44-63; P = 0.12), with a partial response rate of 3.6%. Median progression-free survival (PFS) was 2.4 months (95% CI 2.1-3.7). In the circulating tumor DNA analysis, patients without any alterations of the six genes (n = 20) demonstrated higher DCR (75% vs. 39%; P = 0.02) and longer PFS (median 4.7 vs. 2.1 months; P < 0.01) than those with any gene alterations (n = 33). The most common grade 3/4 hematologic adverse event was neutropenia (55%). No treatment-related deaths occurred. CONCLUSIONS FTD/TPI plus cetuximab rechallenge did not demonstrate clinically meaningful efficacy in all mCRC patients, but might be beneficial for the molecularly selected population.
Collapse
Affiliation(s)
- Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Naoki Takahashi
- Department of Gastroenterology, Saitama Cancer Center Hospital, Kita-Adachi, Japan
| | - Hirokazu Shoji
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiyuki Yamamoto
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Keiji Sugiyama
- Department of Medical Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Takeshi Kajiwara
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Kentaro Kawakami
- Department of Medical Oncology, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Naoki Aomatsu
- Department of Surgery, Aomatsu memorial hospital, Izumisano, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Hisato Kawakami
- Department of Medical Oncology Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Naoki Takegawa
- Department of Gastroenterology, Hyogo Cancer Center Hospital, Akashi, Japan
| | - Taito Esaki
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Yukiya Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center Hospital, Kita-Adachi, Japan
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshikazu Moriwaki
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
- Department of Early Clinical Development, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
6
|
Baba K, Kawamoto M, Mamishin K, Uematsu M, Kiyohara H, Hirota A, Takahashi N, Fukuda M, Kusuhara S, Nakajima H, Funasaka C, Nakao T, Kondoh C, Harano K, Matsubara N, Naito Y, Hosono A, Kawasaki T, Mukohara T. The impact of the COVID-19 pandemic on perioperative chemotherapy for breast cancer. Cancer Med 2023. [PMID: 37012214 DOI: 10.1002/cam4.5898] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Since it was first reported in December 2019, coronavirus disease 2019 (COVID-19) spread rapidly across the globe resulting in a pandemic. As of August 2022, seven outbreak peaks have been confirmed in Tokyo, and the numbers of new cases in the fifth and later outbreak periods have been far greater than in the preceding periods. This retrospective study examined the impact of the COVID-19 pandemic on perioperative chemotherapy for breast cancer. METHODS Patients with breast cancer who received perioperative chemotherapy at the National Cancer Center Hospital East were divided into 2 groups: 120 and 384 patients who started chemotherapy before and during the pandemic, respectively. The incidence of critical events that had potential detrimental effects on the prognosis, such as start of adjuvant chemotherapy ≥91 days after surgery and relative dose intensity of chemotherapy <85% were compared between groups. RESULTS No significant difference in the incidence of critical events was found. When stratified by outbreak period, the incidence of critical events was positively correlated with the increasing number of new cases of COVID-19 (r = 0.83, p = 0.04). Moreover, 25/173 patients (14%) who started perioperative chemotherapy during the fifth and sixth outbreak periods developed COVID-19 infection, 80% of whom (20/25) had a delay or interruption to their surgery or other perioperative treatments. CONCLUSIONS Although the impact of the COVID-19 pandemic on perioperative chemotherapy on whole groups of patients was not evident when comparing periods before and after the pandemic, the impact is becoming prominent in parallel with increasing numbers of new COVID-19 cases.
Collapse
Affiliation(s)
- Kaede Baba
- Department of Pharmacy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Megumi Kawamoto
- Department of Pharmacy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kanako Mamishin
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Mao Uematsu
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Hikari Kiyohara
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Akira Hirota
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Nobuyuki Takahashi
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Misao Fukuda
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Shota Kusuhara
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Hiromichi Nakajima
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Experimental Therapeutics, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Chikako Funasaka
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Experimental Therapeutics, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Takehiro Nakao
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Experimental Therapeutics, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kenichi Harano
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Experimental Therapeutics, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yoichi Naito
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Experimental Therapeutics, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of General Internal Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Ako Hosono
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Pediatric Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Toshikatsu Kawasaki
- Department of Pharmacy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Toru Mukohara
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| |
Collapse
|
7
|
Funasaka C, Naito Y, Kusuhara S, Nakao T, Nakajima H, Kawamoto M, Baba K, Mamishin K, Kondoh C, Harano K, Matsubara N, Hosono A, Sasaki T, Kawasaki T, Mukohara T. Clinical features of CDK4/6 inhibitor-related interstitial lung disease in patients with breast cancer: a case series study. Jpn J Clin Oncol 2023; 53:105-114. [PMID: 36373891 DOI: 10.1093/jjco/hyac168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/03/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors are the standard treatment for advanced hormone receptor-positive breast cancer. Although interstitial lung disease is a rare (1-3.3%) but serious adverse event associated with CDK4/6 inhibitors, the incidence of interstitial lung disease in Japanese patients in the real world and the risk factors of interstitial lung disease are not clear. METHODS We retrospectively investigated the incidence of interstitial lung disease in 224 patients with advanced breast cancer who received CDK4/6 inhibitors at our hospital between 31 January 2017 and 31 January 2021. The correlation of age (>50 vs ≤50 years), presence or absence of previous history of interstitial lung disease, lung metastasis, smoking history and chest radiation with the development of interstitial lung disease was evaluated. RESULTS In total, 177 cases received palbociclib, 39 cases received abemaciclib and 8 cases received both palbociclib and abemaciclib, constituting a palbociclib group (n = 185) and an abemaciclib group (n = 47). At a median observation period of 607 days, 8.0% (18/224) cases (13 definite and 5 probable cases) had interstitial lung disease; 6.5% (12/185) of palbociclib-treated and 13% (6/47) of abemaciclib-treated cases. The median time to interstitial lung disease onset was 178 (range, 14-750) days. There was no significant correlation between the background factors studied and the development of interstitial lung disease. CONCLUSION The frequency of CDK4/6 inhibitor-induced interstitial lung disease was higher than that reported in clinical trials. We did not identify any risk factors for the development of interstitial lung disease in this study, and thus, larger studies that include patient predisposition are required.
Collapse
Affiliation(s)
- Chikako Funasaka
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoichi Naito
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shota Kusuhara
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takehiro Nakao
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiromichi Nakajima
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Megumi Kawamoto
- Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kaede Baba
- Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kanako Mamishin
- Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chihiro Kondoh
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenichi Harano
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuaki Matsubara
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ako Hosono
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Pediatric Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomoaki Sasaki
- Departments of Diagnostic Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshikatsu Kawasaki
- Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Mukohara
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
8
|
Kondoh C, Ishikura K, Ichioka S, Omae K, Okuda Y, Koitabashi K, Sasaki A, Suyama K, Tanizawa M, Mizukami T, Shibagaki Y, Hirata S, Ando Y, Furuichi K, Nishiyama H, Matsubara T, Hoshino J, Yanagita M. [Management of Chronic Kidney Disease in Cancer Survivors]. Gan To Kagaku Ryoho 2022; 49:1200-1204. [PMID: 36412020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Chronic kidney disease(CKD)associated with cancer and its treatment affects life after cancer treatment. There is inconclusive opinion on whether CKD treatment in survivors after cancer treatment needs special care differently than in the general population with CKD. Several topics were discussed by nephrologists, urologists and medical oncologists, pediatricians, pharmaceutical specialists, and others based on the results of a literature search, and the consensus was documented in the "Clinical Practice Guidelines for the Management for Kidney Injury During Anticancer Drug Therapy, 2022". The prevalence of CKD among adult cancer survivors is reported to be 4-7%. The characteristics include(1)elderly and physically impaired patients(, 2)a high risk of cancer recurrence, and(3)frequently cancer treatment-related CKD. Although there are no cancer survivor-specific indications or contraindications in the selection of renal replacement therapy, renal transplantation is often preferred in pediatric cancer survivors. It was determined that it is not appropriate to recommend or not recommend the administration of erythropoietin stimulating agents for renal anemia in cancer survivors based on a systematic review and discussion between panelists. When used in individual cases, its application should be well examined and consideration should be given to avoiding high hemoglobin level and to monitoring for cancer development.
Collapse
Affiliation(s)
- Chihiro Kondoh
- Dept. of Medical Oncology, National Cancer Center Hospital East
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Niguma K, Mamishin K, Naito Y, Nomura S, Wakabayashi M, Kusuhara S, Funasaka C, Nakao T, Fukasawa Y, Kondoh C, Harano K, Kogawa T, Matsubara N, Hosono A, Onishi T, Kawasaki T, Mukohara T. Impact of Older Age and Medico-social Factors on the Decision to Offer Adjuvant Chemotherapy to Patients With Breast Cancer. Anticancer Res 2022; 42:3743-3751. [PMID: 35790267 DOI: 10.21873/anticanres.15864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Although clinicians are expected to set a higher threshold for administering adjuvant chemotherapy to older than younger patients with breast cancer, the extent to which older patients are less likely to be offered adjuvant chemotherapy and the medico-social factors that influence decision-making are unclear. PATIENTS AND METHODS We retrospectively evaluated the correlations of clinicopathological factors, including age (≥75 years vs. <75 years), for all candidates for adjuvant chemotherapy, and of additional medico-social factors, including the number of family members living together, for older patients, with the rate of referral from breast surgeons to medical oncologists. RESULTS Among 872 candidates for adjuvant chemotherapy, age ≥75 years was significantly correlated with a lower referral rate (24 % vs. 44%, p<0.001). In the analysis by age group, we did not identify specific medicosocial factors that were differentially emphasized, but older patients who lived with ≥2 other family members tended not to be referred to a medical oncologist compared to those who lived alone or with one family member (1/23 vs. 15/47). Although 5 of 22 older patients (23%) who were referred to a medical oncologist actually received adjuvant chemotherapy (vs. 60% of younger patients), all needed treatment modifications. CONCLUSION Breast surgeons regard age ≥75 years as a key factor for avoiding adjuvant chemotherapy but they also consider similar medico-social factors irrespective of the patient's age regarding the decision to refer patients to medical oncologists.
Collapse
Affiliation(s)
- Kumi Niguma
- Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan;
| | - Kanako Mamishin
- Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoichi Naito
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shogo Nomura
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Masashi Wakabayashi
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Shota Kusuhara
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chikako Funasaka
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takehiro Nakao
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoko Fukasawa
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chihiro Kondoh
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenichi Harano
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Kogawa
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuaki Matsubara
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ako Hosono
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Departments of Pediatric Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tatsuya Onishi
- Departments of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshikatsu Kawasaki
- Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Mukohara
- Departments of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
10
|
Nakajima H, Harano K, Nakai T, Kusuhara S, Nakao T, Funasaka C, Kondoh C, Matsubara N, Naito Y, Hosono A, Mitsunaga S, Ishii G, Mukohara T. Impacts of clinicopathological factors on efficacy of trastuzumab deruxtecan in patients with HER2-positive metastatic breast cancer. Breast 2022; 61:136-144. [PMID: 34999427 PMCID: PMC8753267 DOI: 10.1016/j.breast.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The previous second-line treatment for HER2-positive metastatic breast cancer were ado-trastuzumab emtansine (T-DM1); however, its activity is decreased in tumors with heterogenous, reduced, or loss of HER2 expression. Trastuzumab deruxtecan (T-DXd) has recently been developed as a novel antibody-drug conjugate to overcome resistance to T-DM1. However, clinical evidence on its ability to overcome this resistance is limited. MATERIALS AND METHODS We retrospectively analyzed data for patients with HER2-positive metastatic breast cancer who received T-DXd at our institution from April 2020 to March 2021. We evaluated the associations between clinicopathological and molecular biomarkers and the efficacy of T-DXd. RESULTS Twenty-two patients were enrolled in this study. The median progression-free survival (PFS) was 9.7 months (95% confidence interval [CI], 7.0-not reached [NR]), and the objective response rate (ORR) was 61.9%. The ORR and PFS were comparable between patients with HER2 immunohistochemistry scores of 3+ and 2+/1+ at initial diagnosis (ORR: 50.0% vs. 72.7%, p = 0.39; median PFS, 9.7 months [95%CI, 2.6-NR] vs. 8.3 months [95%CI, 7.1-NR]; hazard ratio, 1.86 [95%CI, 0.53-6.57], p = 0.34). Two patients with heterogenous HER2 expression had a partial response or long stable disease (≥6 months). Three of four patients with re-biopsy samples after anti-HER2 targeted therapy and with latest HER2 immunohistochemistry scores of 1+ experienced partial responses (75.0%) to T-DXd, but none had responded to prior T-DM1. CONCLUSIONS T-DXd demonstrated favorable activity in clinical practice. Moreover, T-DXd showed meaningful benefit in patients with heterogeneity, reduction, or loss of HER2 expression.
Collapse
Affiliation(s)
- Hiromichi Nakajima
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan; Courses of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenichi Harano
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan; Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shota Kusuhara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takehiro Nakao
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chikako Funasaka
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoichi Naito
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan; Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan; Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ako Hosono
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan; Department of Pediatric Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shuichi Mitsunaga
- Courses of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Mukohara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
11
|
Hirata K, Hamamoto Y, Shoji H, Hara H, Kondoh C, Yasui H, Kajiwara T, Baba E, Ando T, Sugimoto N, Okano N, Kawakami H, Katsuya H, Nagase M, Moriwaki T, Yoshimura K, Ando M, Yamazaki K, Hironaka S, Muro K. A randomized phase II trial of paclitaxel plus ramucirumab versus nab-paclitaxel plus ramucirumab for gastric cancer with peritoneal dissemination refractory to first-line therapy (WJOG10617G/P-SELECT). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.280] [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
280 Background: Combination of ramucirumab (RAM) + weekly paclitaxel (PTX) is recommended as a standard second-line therapy for unresectable or recurrent gastric cancer (GC). A recent phase II trial evaluating nab-PTX and RAM combination showed that nab-PTX+RAM is promising efficacy and tolerability as well as PTX+RAM. In subgroup analysis of another phase III trial (ABSOLUTE) comparing different nab-PTX scheduling with PTX, weekly nab-PTX was especially effective for the patients with peritoneal dissemination compared to PTX without RAM combination. Therefore, we hypothesized that nab-PTX+RAM would be more effective than PTX+RAM for patients with peritoneal dissemination. Methods: The P-SELECT trial (WJOG10617G) is an open-label randomized phase II study evaluating the safety and efficacy of PTX+RAM and nab-PTX+RAM in GC patients with peritoneal metastasis. Key eligibility criteria were: 1) histologically proven adenocarcinoma, 2) unresectable or recurrent gastric cancer, 3) peritoneal dissemination, 4) intolerance or refractory to first-line therapy including fluoropyrimidines, 5) PS 0–2. Peritoneal dissemination was confirmed by either contrast enema/enterography, CT scan, clinical signs, or operative findings (including exploratory laparoscopy). The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), ascites control rate, safety, and neuropathy-specific quality of life. 105 subjects were required to maintain the power of ≥70% expecting the hazard ratio (HR) of 0.90 in OS. The study was conducted in 58 centers of the West Japan Oncology Group. Results: A total of 105 patients (median age 67; M:F 66:39) were randomized (53 patients in PTX+RAM and 52 in nab-PTX+RAM). Moderate and massive amount of ascites was observed in 39.0% of patients. Median OS was 8.1 months in PTX+RAM and 7.2 months in nab-PTX+RAM (HR 1.04, 95% confidence interval [CI] 0.67–1.61, P = 0.63). Median PFS was 5.1 months in PTX+RAM and 3.9 months in nab-PTX+RAM (HR 1.04, 95% CI 0.69–1.56, P = 0.89). The ORR and DCR for PTX+RAM and nab-PTX+RAM were 20.7% vs. 20.0% (P = 0.99) and 77.4% vs. 63.5% (P = 0.15), respectively. The ascites control rate was 86.1% in PTX+RAM and 70.3% in nab-PTX+RAM (P = 0.07). The incidence of grade 3/4 neuropathy was higher in nab-PTX+RAM (7.5% vs 17.6%, P = 0.14), whereas there was no difference in neuropathy-specific quality of life between the two groups. The incidence of febrile neutropenia was higher in PTX+RAM (11.3% vs 5.9%, P = 0.49). Conclusions: The potential difference in efficacies between nab-PTX+RAM and PTX+RAM was not shown in advanced gastric cancer with peritoneal dissemination. The results of the pre-planned translational research will be available soon. Clinical trial information: jRCTs031180022.
Collapse
Affiliation(s)
- Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Hirokazu Shoji
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kajiwara
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takayuki Ando
- Third Department of Internal Medicine, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Naotoshi Sugimoto
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, MN, Japan
| | - Hiroo Katsuya
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Michitaka Nagase
- Department of Medical Oncology, Saku Central Hospital Advanced Care Center, Shimotsuke, Japan
| | - Toshikazu Moriwaki
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenichi Yoshimura
- Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shuichi Hironaka
- Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Yufu, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
12
|
Tamada S, Kondoh C, Matsubara N, Mizuno R, Kimura G, Anai S, Tomita Y, Oyama M, Masumori N, Kojima T, Matsumoto H, Chen M, Li M, Matsuda K, Tanaka Y, Rini BI, Uemura H. Pembrolizumab plus axitinib versus sunitinib in metastatic renal cell carcinoma: outcomes of Japanese patients enrolled in the randomized, phase III, open-label KEYNOTE-426 study. Int J Clin Oncol 2022; 27:154-164. [PMID: 34800178 PMCID: PMC8732816 DOI: 10.1007/s10147-021-02014-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND In the phase III open-label KEYNOTE-426 (NCT02853331) study, first-line pembrolizumab and axitinib improved overall survival (OS) and progression-free survival (PFS) versus sunitinib for metastatic renal cell carcinoma (mRCC). KEYNOTE-426 evaluated patients enrolled from 25 sites in Japan. METHODS Patients enrolled in Japan were included in this post hoc subgroup analysis. Adults with clear cell mRCC were randomly assigned 1:1 to receive intravenous pembrolizumab 200 mg every 3 weeks plus oral axitinib 5 mg twice daily or oral sunitinib 50 mg once daily (4 weeks on/2 weeks off). Dual primary endpoints were OS and PFS as assessed by blinded independent central review. Objective response rate (ORR) and safety were secondary endpoints. RESULTS The Japanese subgroup comprised 94 patients (pembrolizumab-axitinib, n = 44; sunitinib, n = 50; 11% of the intent-to-treat population). Median time from randomization to data cutoff (January 6, 2020) was 29.5 months (range 24.6-37.3). Consistent with the intent-to-treat population, the OS, PFS, and ORR suggested improvement with pembrolizumab-axitinib versus sunitinib in the Japanese subgroup. Grade ≥ 3 treatment-related adverse events (TRAEs) occurred in 70% of patients receiving pembrolizumab-axitinib versus 78% receiving sunitinib; 11 (25%) patients receiving pembrolizumab-axitinib and 13 (27%) patients receiving sunitinib discontinued the study medication due to AEs. TRAEs led to the discontinuation of pembrolizumab, axitinib, pembrolizumab-axitinib, or sunitinib in 32%, 34%, 14%, and 20%, respectively. No deaths from TRAEs occurred. CONCLUSIONS Efficacy outcomes for the Japanese subgroup were consistent with those of the global population. Safety in Japanese patients was consistent with the results from the global population.
Collapse
Affiliation(s)
- Satoshi Tamada
- Bell Land General Hospital, Higashiyama 500-3, Naka-ku, Sakai, Osaka, 599-8247, Japan.
| | - Chihiro Kondoh
- Toranomon Hospital, 2 Chome-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Nobuaki Matsubara
- National Cancer Center Hospital East, 6 Chome Kashiwanoha, Kashiwa, Chiba, 277-0882, Japan
| | - Ryuichi Mizuno
- Keio University Hospital, Shinanomachi, Shinjuku City, Tokyo, 〒160-8582, Japan
| | - Go Kimura
- Nippon Medical School Hospital, 1-1-5 Sendagi Bunkyo, Tokyo, 113-8603, Japan
| | - Satoshi Anai
- Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yoshihiko Tomita
- Niigata University Medical & Dental Hospital, 1-757 Asahimachi, Chuou-ku, Niigata, 951-8510, Japan
| | - Masafumi Oyama
- Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Naoya Masumori
- Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takahiro Kojima
- University of Tsukuba, 1 Chome-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Hiroaki Matsumoto
- Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Mei Chen
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Mengran Li
- MSD K.K., Kitanomaru Square, 1 Chome-13-12 Kudankita, Chiyoda City, Tokyo, 102-0073, Japan
| | - Kenji Matsuda
- MSD K.K., Kitanomaru Square, 1 Chome-13-12 Kudankita, Chiyoda City, Tokyo, 102-0073, Japan
| | - Yoshinobu Tanaka
- MSD K.K., Kitanomaru Square, 1 Chome-13-12 Kudankita, Chiyoda City, Tokyo, 102-0073, Japan
| | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, CA Building, 10201 Carnegie Ave, Cleveland, OH, 44106, USA
- Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA
| | - Hirotsugu Uemura
- Kindai University, 3 Chome-4-1 Kowakae, Higashiosaka, Osaka, 577-8502, Japan
| |
Collapse
|
13
|
Mamishin K, Naito Y, Nomura S, Ogawa G, Niguma K, Baba K, Sakaeda S, Nakajima H, Kusuhara S, Funasaka C, Nakao T, Fukasawa Y, Kondoh C, Harano K, Kogawa T, Matsubara N, Hosono A, Kawasaki T, Mukohara T. Comparison of Treatment Completion Rate Between Conventional and Dose-dense Doxorubicin and Cyclophosphamide (AC) Followed by a Taxane in Patients With Breast Cancer: A Propensity Score-matched Analysis. Anticancer Res 2021; 41:6217-6224. [PMID: 34848476 DOI: 10.21873/anticanres.15441] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To maximize the effect of perioperative chemotherapy in breast cancer, it is critical to keep the relative dose intensity (RDI) high. While bi-weekly doxorubicin and cyclophosphamide, dose-dense AC (ddAC), instead of tri-weekly conventional AC (cAC) followed by a taxane has been adopted as standard perioperative chemotherapy, postponement or discontinuation are sometimes experienced during ddAC or subsequent taxane phase. This study aimed at evaluating whether ddAC, compared to cAC, was associated with reduced RDI. PATIENTS AND METHODS We compared ddAC and cAC, both followed by a taxane, for perioperative breast cancer regarding the proportion of completion of planned treatment (%completion), defined as an RDI ≥85% for both AC and taxane phases. RESULTS There was no remarkable difference between the groups in patient characteristics after propensity score matching (n=46 in ddAC, and n=86 in cAC). The %completion was similar between the groups (67.4% vs. 65.1%). Most other endpoints related to RDI were similar between groups. The incidence of pneumonia was higher in the ddAC group (13% vs. 3%) including one Pneumocystis jiroveci pneumonia. CONCLUSION ddAC followed by a taxane can be considered with sufficient supportive measures and precautions for pneumonia.
Collapse
Affiliation(s)
- Kanako Mamishin
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoichi Naito
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan.,Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shogo Nomura
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Gakuto Ogawa
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Kumi Niguma
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kaede Baba
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Saeko Sakaeda
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiromichi Nakajima
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shota Kusuhara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chikako Funasaka
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takehiro Nakao
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoko Fukasawa
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenichi Harano
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Kogawa
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ako Hosono
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Pediatric Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshikatsu Kawasaki
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Mukohara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan;
| |
Collapse
|
14
|
Rini BI, Atkins MB, Plimack ER, Soulières D, McDermott RS, Bedke J, Tartas S, Alekseev B, Melichar B, Shparyk Y, Kondoh C, Langiewicz P, Wood LA, Hammers H, Silber CG, Haber B, Jensen E, Chen M, Powles T. Characterization and Management of Treatment-emergent Hepatic Toxicity in Patients with Advanced Renal Cell Carcinoma Receiving First-line Pembrolizumab plus Axitinib. Results from the KEYNOTE-426 Trial. Eur Urol Oncol 2021; 5:225-234. [PMID: 34244116 DOI: 10.1016/j.euo.2021.05.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pembrolizumab plus axitinib improved efficacy over sunitinib in treatment-naive advanced renal cell carcinoma in the KEYNOTE-426 (NCT02853331) study. However, a relatively high incidence of grade 3/4 aminotransferase elevations was observed. OBJECTIVE To further characterize treatment-emergent aminotransferase elevations in patients treated with pembrolizumab-axitinib. DESIGN, SETTING, AND PARTICIPANTS Patients enrolled in KEYNOTE-426 were included in this study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three Standardized MedDRA Queries for potential hepatic disorders were used to identify patients for the hepatic event analysis subpopulation (HEAS). Alanine aminotransferase events were characterized for time to onset, time to recovery, corticosteroid use, and rechallenge with study treatment(s). RESULTS AND LIMITATIONS The HEAS comprised 189/429 (44%) pembrolizumab-axitinib patients and 128/425 (30%) sunitinib patients. Grade 3/4 hepatic adverse events were more common in the combination arm: 22% (94/429) versus 7% (29/425); 3% (13/429) discontinued the combination due to hepatic adverse events. In the pembrolizumab-axitinib arm, 125/426 patients (29%) had alanine aminotransferase (ALT) ≥3× upper limit of normal (ULN), with median time to onset of 84 d (range, 7-840 d). Among patients with ALT ≥3× ULN, 120/125 (96%) recovered to <3× ULN following study treatment interruption/discontinuation, with a median time to recovery of 15 d (3-176 d): 68/120 (57%) received corticosteroids. One hundred patients were rechallenged with one or both study treatment(s): 45/100 (45%) had ALT ≥3× ULN recurrence, and all 45 recovered to ALT <3× ULN following study treatment interruption/discontinuation. No fatal hepatic events occurred. CONCLUSIONS A higher incidence of grade 3/4 aminotransferase elevations occurs with pembrolizumab-axitinib. These events should be carefully evaluated and managed with prompt study treatment interruption or discontinuation, with or without corticosteroid treatment. The decision to rechallenge with one or both drugs should be based on severity of event and thorough causality assessment. PATIENT SUMMARY Renal cell carcinoma patients receiving pembrolizumab-axitinib are at a higher risk of liver enzyme elevations, which could be reversed with appropriate management.
Collapse
Affiliation(s)
- Brian I Rini
- Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | - Denis Soulières
- Centre Hospitalier de l'Universite de Montréal, Montréal, QC, Canada
| | | | - Jens Bedke
- Eberhard Karls University of Tübingen, Tübingen, Germany
| | | | - Boris Alekseev
- Federal Medical Research Center n.a. P.A. Hertsen, Moscow, Russia
| | - Bohuslav Melichar
- Lekarska fakulta Univerzity Palackeho a Fakultni nemocnice Olomouc, Czech Republic
| | - Yaroslav Shparyk
- Lviv State Oncology Regional Treatment and Diagnostic Center, Lviv, Ukraine
| | | | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | - Hans Hammers
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Mei Chen
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Thomas Powles
- Barts Health and the Royal Free NHS Trusts, Barts Cancer Institute, and Queen Mary University of London, London, UK
| |
Collapse
|
15
|
Masuishi T, Izawa N, Takahashi N, Shoji H, Yamamoto Y, Matsumoto T, Sugiyama K, Kajiwara T, Kawakami K, Aomatsu N, Kondoh C, Kawakami H, Takegawa N, Esaki T, Narita Y, Hara H, Sunakawa Y, Boku N, Moriwaki T, Shimokawa M, Nakajima T, Muro K. SO-19 A multicenter phase Ⅱ trial of trifluridine/tipiracil in combination with cetuximab in RAS wild-type metastatic colorectal cancer patients refractory to prior anti-EGFR antibody therapy: The WJOG8916G trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
16
|
Funasaka C, Naito Y, Kusuhara S, Nakao T, Fukasawa Y, Mamishin K, Komuro A, Okunaka M, Kondoh C, Harano K, Kogawa T, Matsubara N, Hosono A, Kawasaki T, Mukohara T. The efficacy and safety of paclitaxel plus bevacizumab therapy in breast cancer patients with visceral crisis. Breast 2021; 58:50-56. [PMID: 33901922 PMCID: PMC8095047 DOI: 10.1016/j.breast.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/10/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022] Open
Abstract
Background Visceral crisis in metastatic breast cancer (MBC) is defined as severe organ dysfunction requiring rapidly efficacious therapy. Although weekly paclitaxel plus bevacizumab (wPTX + BV) achieves a high response rate in human epidermal growth factor receptor 2 (HER2)-negative MBC, the efficacy and safety of wPTX + BV for visceral crisis is unclear. Methods We retrospectively investigated patients with MBC with visceral crisis who received wPTX + BV. Visceral crisis was defined as follows: liver dysfunction (aspartate or alanine aminotransferase >200 U/L or total bilirubin >1.5 mg/dl), respiratory dysfunction (carcinomatous lymphangiomatosis, SpO2 <93% in ambient air or required thoracentesis), superior vena cava (SVC) syndrome, or bone marrow carcinomatosis. The primary outcome was the proportion of patients on-treatment with wPTX + BV after 12 weeks. We also investigated time to treatment failure (TTF), overall survival (OS), objective response rate (ORR), and adverse events. Results A total of 44 patients with respiratory dysfunction (n = 29), liver dysfunction (n = 10), bone marrow carcinomatosis (n = 7), and SVC syndrome (n = 2) were eligible for this investigation. The proportion of patients on-treatment with wPTX + BV after 12 weeks was 63% (30/44), and the other patients discontinued wPTX + BV because of adverse events (n = 5) and disease progression (n = 9). Median TTF and OS, and the ORR were 131 days and 323 days, and 41%, respectively. No treatment-related death occurred. Conclusion: wPTX + BV achieved favorable efficacy and safety for treating patients with visceral crisis and may therefore be considered an option for the treatment of this acutely severe clinical condition. Visceral crisis is a severe organ dysfunction requiring rapidly efficacious therapy. The efficacy of chemotherapy in visceral crisis is unclear. Weekly paclitaxel plus bevacizumab (wPTX + BV) achieved favorable efficacy and safety. wPTX + BV may be considered an option for breast cancer patients with visceral crisis.
Collapse
Affiliation(s)
- Chikako Funasaka
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Yoichi Naito
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan; Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan; Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shota Kusuhara
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Takehiro Nakao
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan; Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoko Fukasawa
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Kanako Mamishin
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ayumi Komuro
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mashiro Okunaka
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chihiro Kondoh
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Kenichi Harano
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan; Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Kogawa
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan; Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuaki Matsubara
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Ako Hosono
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan; Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshikatsu Kawasaki
- Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Mukohara
- Department of Medical Onology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan.
| |
Collapse
|
17
|
Mukohara T, Hosono A, Mimaki S, Nakayama A, Kusuhara S, Funasaka C, Nakao T, Fukasawa Y, Kondoh C, Harano K, Naito Y, Matsubara N, Tsuchihara K, Kuwata T. Effects of Ado-Trastuzumab Emtansine and Fam-Trastuzumab Deruxtecan on Metastatic Breast Cancer Harboring HER2 Amplification and the L755S Mutation. Oncologist 2021; 26:635-639. [PMID: 33559918 DOI: 10.1002/onco.13715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/25/2021] [Indexed: 11/08/2022] Open
Abstract
Somatic mutations in human epidermal growth factor receptor 2 (HER2) are present in approximately 3% of breast cancers. Some HER2 mutations are activating, and they represent a mechanism of resistance to conventional anti-HER2 therapies such as trastuzumab and lapatinib. Consistently, in patients with HER2-amplified breast cancer, these mutations are predominantly observed in metastatic tumors obtained after exposure to anti-HER2 systemic therapies, possibly after clonal selection. Therefore, it is rare to find coexistent HER2 mutation and amplification in the early clinical course, and thus, the clinical relevance of HER2 mutation to the sensitivity to HER2-targeted drugs, particularly antibody-drug conjugates (ADCs) such as ado-trastuzumab emtansine (T-DM1) and the recently approved fam-trastuzumab deruxtecan (T-DXd), remains unclear. In this article, we describe a patient with de novo metastatic breast cancer who exhibited both HER2 amplification and the L755S mutation in the untreated primary breast tumor obtained at the initial diagnosis, and the lesion responded to T-DM1 and T-DXd after exhibiting clinical resistance to other HER2-targeted drugs. Our current case findings suggested that anti-HER2 ADCs should be prioritized over conventional trastuzumab- or lapatinib-based therapies for patients with HER2-amplified and comutated tumors. KEY POINTS: Although HER2 mutations were implicated in resistance to anti-HER2 monoclonal antibodies or HER2 tyrosine kinase inhibitors in preclinical studies, their clinical impact on sensitivity to anti-HER2 drugs is unclear owing to the rarity of concomitant HER2 mutation and HER2 amplification. A case of de novo metastatic breast cancer harboring both HER2 amplification and the L755S mutation in an untreated breast primary tumor displayed clinical resistance to standard trastuzumab- or lapatinib-based therapies but good responses to ado-trastuzumab emtansine (T-DM1) and fam-trastuzumab deruxtecan (T-DXd). Anti-HER2 antibody-drug conjugates such as T-DM1 and T-DXd may be prioritized over conventional trastuzumab- or lapatinib-containing therapies for patients with HER2-amplified and comutated tumors.
Collapse
Affiliation(s)
- Toru Mukohara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Genetic Medicine and Services, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Pediatric Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ako Hosono
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Pediatric Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sachiyo Mimaki
- Department of Genetic Medicine and Services, National Cancer Center Hospital East, Kashiwa, Japan.,Division of Translational Informatics, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Akiko Nakayama
- Department of Genetic Medicine and Services, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shota Kusuhara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chikako Funasaka
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takehiro Nakao
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoko Fukasawa
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenichi Harano
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoichi Naito
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan.,General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Katsuya Tsuchihara
- Department of Genetic Medicine and Services, National Cancer Center Hospital East, Kashiwa, Japan.,Division of Translational Informatics, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Takeshi Kuwata
- Department of Genetic Medicine and Services, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
18
|
Hayashi H, Takiguchi Y, Minami H, Akiyoshi K, Segawa Y, Ueda H, Iwamoto Y, Kondoh C, Matsumoto K, Takahashi S, Yasui H, Sawa T, Onozawa Y, Chiba Y, Togashi Y, Fujita Y, Sakai K, Tomida S, Nishio K, Nakagawa K. Site-Specific and Targeted Therapy Based on Molecular Profiling by Next-Generation Sequencing for Cancer of Unknown Primary Site: A Nonrandomized Phase 2 Clinical Trial. JAMA Oncol 2020; 6:1931-1938. [PMID: 33057591 DOI: 10.1001/jamaoncol.2020.4643] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Although profiling of gene expression and gene alterations by next-generation sequencing (NGS) to predict the primary tumor site and guide molecularly targeted therapy might be expected to improve clinical outcomes for cancer of unknown primary site (CUP), to our knowledge, no clinical trial has previously evaluated this approach. Objective To assess the clinical use of site-specific treatment, including molecularly targeted therapy based on NGS results, for patients with CUP. Design, Setting, and Participants This phase 2 clinical trial was conducted at 19 institutions in Japan and enrolled 111 previously untreated patients with the unfavorable subset of CUP between March 2015 and January 2018, with 97 patients being included in the efficacy analysis. Eligibility criteria included a diagnosis of unfavorable CUP after mandatory examinations, including pathological evaluation by immunohistochemistry, chest-abdomen-pelvis computed tomography scans, and a positron emission tomography scan. Interventions RNA and DNA sequencing for selected genes was performed simultaneously to evaluate gene expression and gene alterations, respectively. A newly established algorithm was applied to predict tumor origin based on these data. Patients received site-specific therapy, including molecularly targeted therapy, according to the predicted site and detected gene alterations. Main Outcomes And Measures The primary end point was 1-year survival probability. Secondary end points included progression-free survival (PFS), overall survival (OS), objective response rate, safety, efficacy according to predicted site, and frequency of gene alterations. Results Of 97 participants, 49 (50.5%) were women and the median (range) age was 64 (21-81) years. The cancer types most commonly predicted were lung (21 [21%]), liver (15 [15%]), kidney (15 [15%]), and colorectal (12 [12%]) cancer. The most frequent gene alterations were in TP53 (45 [46.4%]), KRAS (19 [19.6%]), and CDKN2A (18 [18.6%]). The 1-year survival probability, median OS, and median PFS were 53.1% (95% CI, 42.6%-62.5%), 13.7 months (95% CI, 9.3-19.7 months), and 5.2 months (95% CI, 3.3-7.1 months), respectively. Targetable EGFR mutations in tumor specimens were detected in 5 patients with predicted non-small-cell lung cancer (5.2%), 4 of whom were treated with afatinib; 2 of these patients achieved a durable PFS of longer than 6 months. Conclusions and Relevance This study's findings suggest that site-specific treatment, including molecularly targeted therapy based on profiling gene expression and gene alterations by NGS, can contribute to treating patients with the unfavorable subset of CUP. Trial Registration UMIN Identifier: UMIN000016794.
Collapse
Affiliation(s)
- Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Akiyoshi
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiko Segawa
- Department of Medical Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroki Ueda
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasuo Iwamoto
- Department of Medical Oncology, Hiroshima City Hospital Organization, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Koji Matsumoto
- Medical Oncology Division, Hyogo Cancer Center, Akashi, Japan
| | - Shin Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshiyuki Sawa
- Department of Respiratory Medicine and Medical Oncology, Gifu Municipal Hospital, Gifu, Japan
| | - Yusuke Onozawa
- Division of Clinical Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Japan
| | | | - Yoshihiko Fujita
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuko Sakai
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shuta Tomida
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| |
Collapse
|
19
|
Izawa N, Shitara K, Yonesaka K, Yamanaka T, Yoshino T, Sunakawa Y, Masuishi T, Denda T, Yamazaki K, Moriwaki T, Okuda H, Kondoh C, Nishina T, Makiyama A, Baba H, Yamaguchi H, Nakamura M, Hyodo I, Muro K, Nakajima TE. Early Tumor Shrinkage and Depth of Response in the Second-Line Treatment for KRAS exon2 Wild-Type Metastatic Colorectal Cancer: An Exploratory Analysis of the Randomized Phase 2 Trial Comparing Panitumumab and Bevacizumab in Combination with FOLFIRI (WJOG6210G). Target Oncol 2020; 15:623-633. [PMID: 32960408 DOI: 10.1007/s11523-020-00750-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Predictive markers for the clinical outcomes of second-line treatment in patients with metastatic colorectal cancer (mCRC) remain unclear. OBJECTIVE This retrospective biomarker study was conducted to explore predictive markers for patients with KRAS exon 2 wild-type mCRC who were treated with FOLFIRI plus panitumumab (Pani) or bevacizumab (Bev) in the WJOG6210G trial. PATIENTS AND METHODS The associations of early tumor shrinkage (ETS), tumor location, and VEGF-D with progression-free survival (PFS) and overall survival (OS) were analyzed using a Cox proportional hazards model. Spearman's correlation coefficient was used to analyze the association of depth of response (DpR) with PFS and OS. Serum VEGF-D levels were measured in samples collected before treatment using magnetic bead panel Milliplex xMAP kits. RESULTS In total, 101 patients (Pani, n = 49; Bev, n = 52) were enrolled in this study. Patients with ETS had longer PFS (Pani: hazard ratio (HR) 0.40, P = 0.009; Bev: HR 0.078, P = 0.0002) and OS (Pani: HR 0.49, P = 0.044; Bev: HR 0.35, P = 0.048) than patients without ETS. The DpR was moderately correlated with PFS and OS in Pani (rs = 0.75, P < 0.001; rs = 0.60, P < 0.001) and Bev groups (rs = 0.68, P < 0.001; rs = 0.44, P = 0.002). No significant differences were observed in PFS and OS between the two treatment groups even if in left-sided tumors. No significant interaction between VEGF-D levels and treatment was observed in PFS and OS. CONCLUSIONS ETS and DpR serve as surrogate markers of PFS and OS in the second-line treatment with FOLFIRI plus targeted agent for mCRC.
Collapse
Affiliation(s)
- Naoki Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kimio Yonesaka
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tadamichi Denda
- Department of Gastroenterology, Chiba Cancer Center Hospital, Chiba, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shimonagakubo, Japan
| | - Toshikazu Moriwaki
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Okuda
- Department of Medical Oncology, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Akitaka Makiyama
- Department of Hematology/Oncology, Japan Community Healthcare Organization Kyushu Hospital, Kita-Kyushu, Japan
- Cancer Center, Gifu University Hospital, Gifu, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hironori Yamaguchi
- Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Masato Nakamura
- Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | - Ichinosuke Hyodo
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
- Kyoto Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy (Ki-CONNECT), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| |
Collapse
|
20
|
Yamanaka T, Tatsushima K, Kondoh C, Takemura K, Masuda J, Ozaki Y, Tanabe Y, Miura Y, Takano T. [Hypopituitarism]. Gan To Kagaku Ryoho 2020; 47:885-890. [PMID: 32541161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In recent years, the role ofimmune checkpoint inhibitors(ICIs)has become crucial in cancer therapy. However, ICIs are known to trigger a wide variety of autoimmune side effects, termed immune-related adverse events(irAEs), which can influence multiple organs. Hypophysitis induced by ICIs, which is defined as the inflammation of the pituitary gland and is the cause ofhypopituitarism, is one ofthe important toxicities, because it can be life-threatening event when it is not diagnosed or managed properly. Therefore, ICIs-induced hypophysitis should be recognized as one ofthe oncologic emergencies. Symptoms, laboratory data, hormone level measurement, and pituitary magnetic resonance imaging are necessary for diagnosis. It should be taken into consideration that types of agents in ICIs have an effect on patterns of symptoms, onset timing, and hormone deficiencies. Replacement of appropriate hormones according to severity is fundamental strategy. Patient education especially about sick day rules is vital, because adrenal insufficiency secondary to adrenocorticotropic hormone deficiency usually remains permanently. There is no established predictive biomarker for irAEs yet. Thus, for an early awareness of the symptoms ofirAEs and a proper management in clinical practice, interprofessional collaboration among oncologists, endocrinologists, nurses, pharmacists, and other health care workers must be essential.
Collapse
|
21
|
Mitani S, Kadowaki S, Komori A, Kondoh C, Oze I, Kato K, Masuishi T, Honda K, Narita Y, Taniguchi H, Ando M, Tanaka T, Tajika M, Muro K. A Phase II Study of Modified FOLFOX6 for Advanced Gastric Cancer Refractory to Standard Therapies. Adv Ther 2020; 37:2853-2864. [PMID: 32378071 DOI: 10.1007/s12325-020-01358-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION In patients with advanced gastric cancer refractory to chemotherapy, the treatment options are limited. Via this phase II study, we aimed to assess the efficacy and safety of oxaliplatin in combination with 5-fluorouracil and l-leucovorin (modified FOLFOX6). METHODS Patients who had histologically confirmed metastatic gastric cancer refractory to ≥ two previous chemotherapy regimens were included. The primary endpoint was the overall response rate (ORR) by an independent central review. According to an assumption of a threshold ORR of 10% and expected ORR of 25%, with α = 0.05 and β = 0.20, at least 33 patients were required. The secondary endpoints included overall survival (OS), progression-free survival (PFS), quality of life measured by EQ-5D, and safety. RESULTS Among the 35 enrolled patients, 33 were included in the primary analysis. All patients previously received fluoropyrimidines, cisplatin, and taxanes, and 24 (73%) were pretreated with irinotecan. The confirmed ORR was 27% [95% confidence interval (CI) 13-46]. The median PFS and OS were 2.2 (95% CI 1.2-3.2) and 5.6 (95% CI 4.1-7.0) months, respectively. In the multivariate analyses, immunotherapy within 90 days and a Glasgow Prognostic Score of 0 were associated with better treatment outcomes. The most common grade ≥ 3 adverse event was neutropenia (36%), and no febrile neutropenia was observed. The median EQ-5D scores did not change from baseline at 2, 4, and 8 weeks (p value = 0.38, 0.79, and 0.98, respectively). CONCLUSION Modified FOLFOX6 (mFOLFOX6) showed substantial activity and acceptable toxicity for chemotherapy-refractory advanced gastric cancer. TRIAL REGISTRATION UMIN Clinical Trial Registry (UMIN000016416).
Collapse
Affiliation(s)
- Seiichiro Mitani
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Shigenori Kadowaki
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Azusa Komori
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan
| | - Chihiro Kondoh
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center, Nagoya, Japan
| | - Kyoko Kato
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazunori Honda
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yukiya Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroya Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masashi Ando
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tsutomu Tanaka
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
22
|
Aoyama Y, Kondoh C, Anno M, Takahashi T, Yoshino K, Kizawa R, Ozaki Y, Tanabe Y, Miura Y, Takano T. [Malignant Spinal Cord Compression]. Gan To Kagaku Ryoho 2020; 47:875-880. [PMID: 32541159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Malignant spinal cord compression(MSCC)is defined as a compression of the spinal cord or cauda equina with neuropathy caused by tumor spreading to the vertebral body. The common symptoms of MSCC are back pain, neck pain, muscle weakness, sensory reduction, bladder and rectal disturbance. The risk of MSCC is relatively high in patients with lung cancer, breast cancer, and prostate cancer. MSCC is one of the oncologic emergencies that requires prompt diagnosis and treatment to preserve and improve neurological function. Evaluation by magnetic resonance imaging(MRI)and computed tomography( CT)are useful for the diagnosis. The prognosis of these patients is often poor at the time of diagnosis of MSCC, thus it is important for deciding the treatment strategy to consider the prognosis and background of the patient in addition to the objective findings including the degree of MSCC and spinal instability. Treatment options consist of medical, surgical, and radiation therapy. We need a multidisciplinary approach because the pathology of MSCC involves multiple departments, such as medical oncology, orthopedics, and radiology. Supportive care including rehabilitation and preventing skeletal related events are also important. The cancer board, in which each physician and multidisciplinary health care professionals regularly have a discussion and review the cases, is required.
Collapse
|
23
|
Oya M, Tamada S, Tatsugami K, Nakaigawa N, Osawa T, Kanayama HO, Kondoh C, Sassa N, Nishimura K, Nozawa M, Masumori N, Miyoshi Y, Kimura A, Kuroda S, Motzer RJ, Choueiri TK, Tomita Y. A pooled analysis of the efficacy and safety of cabozantinib post immunotherapy in patients with advanced renal cell carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
5089 Background: While studies have demonstrated survival benefits of first-line regimens including immuno-oncology agents (IO) in advanced renal cell carcinoma (aRCC), optimal treatment following IO is unknown. In the phase 3 METEOR trial, cabozantinib improved progression-free survival (PFS), objective response rate (ORR), and overall survival (OS) versus everolimus in patients (pts) with aRCC, after VEGFR-TKI therapy. The Japanese phase II C2001 study (NCT03339219), targeting a population similar to that of METEOR, showed similar efficacy and safety results. Here, we present a post-hoc pooled analysis of pts who had received prior IO therapy from METEOR and C2001. Methods: A pooled analysis was performed in pts who received 60mg/day of oral cabozantinib once daily enrolled in the METEOR or C2001. Patients were divided into two groups with previous IO treatment (pre-w/ IO subgroup) or without previous IO treatment (pre-w/o IO subgroup). Analyses of ORR, PFS, OS, and safety were performed as measures of clinical outcome in each subgroup. Results: 365 pts (pre-w/ IO subgroup: 33 pts, pre-w/o IO subgroup:332 pts) were included for efficacy analysis and 366 pts (pre-w/ IO subgroup: 33 pts, pre-w/o IO subgroup:333 pts) for safety analysis. Minor differences in baseline characteristics were noted between the analysis subgroups but are not expected to substantially affect efficacy outcomes. The ORR was 21.2% (95% CI: 9.0-38.9%) for pre-w/ IO subgroup, and 17.2% (95% CI: 13.3-21.7%) for pre-w/o IO subgroup. PFS rate and OS rate at 6 months pre-w/ IO was 65.5%, 90.8% and pre-w/o IO was 58.3%, 90.6%, respectively. Although there were some differences in the safety profile, almost all AEs were manageable by dose modifications. There were no differences in AEs associated with IO treatment, such as pneumonitis, endocrinolopathy or infusion related reaction. No new safety signals were noted in any subgroups. Conclusions: Safety and treatment efficacy of cabozantinib were maintained in the pooled analysis of pts from METEOR and C2001 irrespective of prior IO treatment. Funded by Takeda Pharmaceutical Company Limited, Tokyo, Japan. Clinical trial information: NCT03339219, NCT01865747 .
Collapse
Affiliation(s)
- Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Tamada
- Department of Urology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medicine Science, Kyushu University, Fukuoka, Japan
| | - Noboru Nakaigawa
- Department of Urology, School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary surgery, Hokkaido University, Hokkaido, Japan
| | - Hiro-Omi Kanayama
- Department of Urology, Graduate School, The University of Tokushima, Tokushima, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Naoto Sassa
- Department of Urology, Graduate School of Medicine, Nagoya University, Aichi, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiro Nozawa
- Department of Urology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Naoya Masumori
- Department of Urology, School of Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Yasuhide Miyoshi
- Department of Urology and Renal Transportation, Medical Center, Yokohama City University, Kanagawa, Japan
| | - Akiko Kimura
- Oncology Clinical Research Department, Oncology Therapeutic Area Unit for Japan and Asia, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - Shingo Kuroda
- Biostatistics, Takeda Development Center, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | | | | | - Yoshihiko Tomita
- Department of Urology, Department of Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
24
|
Hara H, Takeno A, Yasui H, Imamura H, Akamatsu H, Fujitani K, Nakane M, Kondoh C, Yukisawa S, Nasu J, Miyata Y, Makiyama A, Ishida H, Yoshida N, Matsumura E, Ishigami M, Sugihara M, Ochiai A, Doi T. DS-Screen: Prospective analysis of the expression status of FGFR2 and HER2 in colorectal and gastric cancer population. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.431] [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
431 Background: FGFR2 and HER2 proteins are well-known molecular targets for cancer therapy, and there are emerging attractive protein-targeted agents such as second generation antibody-drug conjugates. However, there are still limited information about the expression status of FGFR2 and HER2 in gastrointestinal cancer and their relationship to patient background with cancer. In this study, expression status of FGFR2 and HER2 in advanced/metastatic gastric cancer (GC) and colorectal cancer (CRC) were prospectively analyzed in clinical setting. Moreover, eligible patients for the clinical trials of DS-1123 or DS-8201, which are FGFR2- or HER2-targeting anti-cancer agent respectively, were screened. Methods: Patients with advanced/metastatic GC, gastroesophageal junctional cancer (GEJ), and CRC were enrolled. Expression status of FGFR2 and HER2 were prospectively analyzed by IHC and/or FISH. Results: A total of 565 patients (GC; 160, GEJ; 16, CRC; 389) have been enrolled in this study from November 2016 to June 2018. FGFR2 expression (IHC 1+~3+) was observed in 24%, 44%, and 3% of GC, GEJ, and CRC respectively. HER2 expression (IHC 2+, 3+) was observed in 24%, 44%, and 17% of GC, GEJ, and CRC respectively. Expression levels of FGFR2 and HER2 seemed to be not correlated with each other in all 3 types of cancer. Distributions of expression level of FGFR2 or HER2 were slightly different among the histological types in GC. In CRC, distribution of HER2 expression level was also slightly different among the histological types and HER2 expression level was higher in KRAS/NRAS wild type compared to KRAS/NRAS mutant. There was no association between HER2 expression level and primary tumor sites in patients with CRC. Slight concordance of HER2 expression was observed between IHC and FISH in CRC. A total of 7 patients have been enrolled in clinical trials of DS-1123 or DS-8201 through this study based on the analysis findings. Conclusions: This study showed insights into the expression status of FGFR2 and HER2 in GC and CRC as a large-scale prospective analysis. Seven patients who had no standard therapy could access exploratory new drug based on targetable agents through this study. Clinical trial information: 163380.
Collapse
Affiliation(s)
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | | | | | - Minoru Nakane
- Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Seigo Yukisawa
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | | | | | - Akitaka Makiyama
- Department of Hematology/Oncology, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Izawa N, Shitara K, Masuishi T, Denda T, Yamazaki K, Moriwaki T, Okuda H, Kondoh C, Nishina T, Makiyama A, Baba H, Yamaguchi H, Nakamura M, Tsuji A, Esaki T, Miyata Y, Kotaka M, Yamanaka T, Nakajima TE, Muro K. Analysis of early tumor shrinkage (ETS) and depth of response (DpR) in metastatic colorectal cancer (mCRC) patients (pts) treated with second-line FOLFIRI plus panitumumab (Pani) or bevacizumab (Bev): Results from a randomized phase II WJOG6210G trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.201] [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
201 Background: The WJOG 6210G trial demonstrated a similar efficacy between Pani and Bev arms at 2nd-line setting in pts with KRAS exon2 wild-type mCRC (Shitara K, et al, Cancer Sci 2016). The exploratory analyses of clinical trials evaluating 1st-line chemotherapy for mCRC have shown significant associations of ETS and DpR with prognosis; however, there is few data in 2nd-line treatment. We investigated whether ETS and DpR are associated with clinical outcomes in mCRC pts treated with 2nd-line treatment using the data of WJOG 6210G trial. Methods: ETS was defined as tumor reduction of 20% at week 8 compared to baseline in the sum of longest diameters of target lesions according to the RECIST criteria. DpR was defined as the percentage of maximum tumor shrinkage of target lesions. Fisher’s exact test and t-test were used to compare ETS and DpR between Pani and Bev arms. A Cox regression model was used to evaluate associations between ETS and progression-free survival (PFS), and overall survival (OS). The association of DpR with PFS and OS was analyzed using Spearman’s rank correlation coefficient. Results: Eighty-seven pts were evaluable for ETS and DpR (Pani, n = 41; Bev, n = 46) among 121 pts enrolled in the WJOG6210G. Pts in the Pani arm had a higher ETS rate (39.0 % vs. 8.7 %, p < 0.001) and greater DpR [median: 23.7 % (range: -49.0 to 100) vs. 0 % (range: -40.7 to 61.5), p < 0.001] than pts in the Bev arm. Pts with ETS achieved longer PFS [median: 10.5 vs. 5.4 m, HR: 0.40 (95% CI: 0.20-0.80), p = 0.009] and OS [median: 22.3 vs. 14.5 m, HR: 0.49 (95% CI: 0.23-0.98), p = 0.044] than pts without ETS in the Pani arm. Similarly, the Bev arm pts with ETS had longer PFS [median: 17.1 vs. 5.6 m, HR: 0.078 (95% CI: 0.004-0.38), p = 0.0002] and OS [median: 30.9 vs. 13.2 m, HR: 0.35 (95% CI: 0.083-0.99), p = 0.048]. There were moderately linear correlations of DpR with PFS and OS in both Pani (PFS: r = 0.75, p < 0.001; OS: r = 0.60, p < 0.001) and Bev arms (PFS: r = 0.68, p < 0.001; OS: r = 0.44, p = 0.002). Conclusions: ETS and DpR were significantly associated with PFS and OS in mCRC pts treated with 2nd-line FOLFIRI in combination with Pani or Bev. Clinical trial information: UMIN000031621.
Collapse
Affiliation(s)
- Naoki Izawa
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | | | | | | | | | - Tomohiro Nishina
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Akitaka Makiyama
- Japan Community Healthcare Organization Kyushu Hospital, Kita-Kyushu, Japan
| | | | | | - Masato Nakamura
- Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | | | - Taito Esaki
- National Kyushu Cancer Center, Fukuoka, Japan
| | | | | | | | | | - Kei Muro
- Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
26
|
Izawa N, Shitara K, Masuishi T, Denda T, Yamazaki K, Moriwaki T, Okuda H, Kondoh C, Nishina T, Makiyama A, Baba H, Yamaguchi H, Nakamura M, Sunakawa Y, Akiyoshi K, Sato M, Yonesaka K, Yoshino T, Yamanaka T, Muro K. Vascular endothelial growth factor (VEGF)-D and clinical outcomes in metastatic colorectal cancer (mCRC) patients (pts) treated with second-line FOLFIRI plus bevacizumab (Bev): A biomarker study of the WJOG 6210G trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
226 Background: The WJOG 6210G trial demonstrated a similar efficacy between FOLFIRI plus Bev and FOLFIRI plus panitumumab (Pani) at 2nd-line treatment in pts with KRAS exon2 wild-type mCRC (Shitara K, et al, Cancer Sci 2016). Recently, angiogenesis biomarker studies of clinical trials have identified VEGF-D as a potential predictor for angiogenesis inhibitors in mCRC. We evaluated whether VEGF-D level are associated with clinical outcomes in the WJOG 6210G trial. Methods: Plasma samples which were collected at pre-treatment were analyzed. VEGF-D level in plasma was measured by means of magnetic bead panel (G & G SCIENCE CO., LTD.). The correlations of VEGF-D level with progression-free survival (PFS) and overall survival (OS) were evaluated by cox regression analyses. Results: Ninety-nine pts were evaluable for VEGF-D level (Bev, n = 51; Pani, n = 48) among 121 pts enrolled in the WJOG6210G. The median VEGF-D level was 441 pg/ml (range 60-1570). VEGF-D level was not affected by the period from last administration of 1st-line Bev to start of 2nd-line treatment. When the median VEGF-D level was adopted as cut-off value, pts with high VEGF-D achieved a shorter PFS and OS than pts with low VEGF-D in the Bev arm [HR: 0.58 (95%CI 0.32-1.07), p = 0.08; HR: 0.62 (95%CI 0.34-1.11), p = 0.10]. In pts with high VEGF-D, the Bev arm tended to have a shorter OS and PFS compared to Pani arm [median: 12.4 m vs. 17.5 m, HR: 1.58 (95%CI 0.87-2.88); median: 4.7 m vs. 5.5 m, HR: 1.31 (95%CI 0.72-2.40)]; whereas, comparable OS and PFS in pts with low VEGF-D [median: 18.9 m vs. 16.5 m, HR: 1.08 (95%CI 0.59-2.01); median: 5.9 m vs. 7.2 m, HR: 1.10 (95%CI 0.62-1.99)]. OS was stratified by VEGF-D level quartile, then OS of Bev arm in each quartile was compared with that of Pani arm (Table). Clinical trial information: UMIN000031621. Conclusions: Our study suggests clinically meaningful association between VEGF-D level and clinical outcomes in mCRC pts treated with 2nd-line FOLFIRI plus Bev. [Table: see text]
Collapse
Affiliation(s)
- Naoki Izawa
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | | | | | | | | | - Tomohiro Nishina
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Akitaka Makiyama
- Japan Community Healthcare Organization Kyushu Hospital, Kita-Kyushu, Japan
| | | | | | - Masato Nakamura
- Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan
| | - Yu Sunakawa
- St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Mikio Sato
- Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | | | | | | | - Kei Muro
- Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
27
|
Suzuki T, Sukawa Y, Imamura CK, Masuishi T, Satake H, Kumekawa Y, Funakoshi S, Kotaka M, Horie Y, Kawai S, Okuda H, Terazawa T, Kondoh C, Kato K, Yoshimura K, Ishikawa H, Hamamoto Y, Boku N, Takaishi H, Kanai T. A Phase II Study of Regorafenib With a Lower Starting Dose in Patients With Metastatic Colorectal Cancer: Exposure-Toxicity Analysis of Unbound Regorafenib and Its Active Metabolites (RESET Trial). Clin Colorectal Cancer 2019; 19:13-21.e3. [PMID: 31732439 DOI: 10.1016/j.clcc.2019.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/19/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Regorafenib demonstrated survival benefits as salvage therapy for patients with metastatic colorectal cancer. However, severe toxicities frequently occurred early in the treatment with the standard dose (160 mg/day), resulting in a dose reduction or interruption. To improve the tolerability and maintain sufficient efficacy, we conducted a phase II study of regorafenib with a lower starting dose (120 mg/day). PATIENTS AND METHODS Regorafenib was initiated at 120 mg/day, and the dosage was increased to 160 mg/day on day 15 of the first cycle for patients who had met the dose escalation criteria. The primary endpoint was the disease control rate (DCR). The pharmacokinetics of the total and unbound regorafenib and its active metabolites (M2, M5) were assessed. RESULTS A total of 70 patients were enrolled from September 2016 to December 2017. Only 6 patients achieved dose escalation to 160 mg on day 15 as planned. For the 68 evaluable patients, the DCR was 32.4% (95% confidence interval, 21.5%-44.8%), which was less than the threshold (30%) of our statistical hypothesis. The serum concentrations of total regorafenib for patients whose dose was escalated to 160 mg/day were significantly lower than those of the patients whose dose was not escalated (median, 3978 vs. 7244 nM; P = .027). The serum unbound concentrations of the sum of regorafenib and the active metabolites correlated significantly with the maximum grade of regorafenib-related symptomatic adverse events in the first cycle (11,138 vs. 19,096 pM; P = .035). CONCLUSION Regorafenib with a low starting dose of 120 mg/day did not achieve the expected DCR. A relationship of unbound exposure with toxicity was found.
Collapse
Affiliation(s)
- Takeshi Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Keio, Japan
| | - Yasutaka Sukawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Keio, Japan.
| | - Chiyo K Imamura
- Department of Clinical Pharmacokinetics and Pharmacodynamics, Keio University School of Medicine, Keio, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Hironaga Satake
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe City, Japan
| | - Yosuke Kumekawa
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Shinsuke Funakoshi
- Division of Medical Oncology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Yoshiki Horie
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sadayuki Kawai
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Okuda
- Department of Medical Oncology, Keiyukai Sapporo Hospital, Sapporo, Japan
| | | | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Ken Kato
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenichi Yoshimura
- Department of Biostatistics, Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Keio, Japan
| | - Narikazu Boku
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Keio, Japan
| |
Collapse
|
28
|
Takahashi M, Ozaki Y, Kizawa R, Masuda J, Sakamaki K, Kinowaki K, Umezu T, Kondoh C, Tanabe Y, Tamura N, Miura Y, Shigekawa T, Kawabata H, Baba N, Iguchi H, Takano T. Atypical femoral fracture in patients with bone metastasis receiving denosumab therapy: a retrospective study and systematic review. BMC Cancer 2019; 19:980. [PMID: 31640606 PMCID: PMC6805596 DOI: 10.1186/s12885-019-6236-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/03/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND While denosumab has been shown to prevent skeletal-related events in patients with bone metastasis, there is a concern that it may cause atypical femoral fracture (AFF). While AFF has been reported in patients with osteoporosis receiving denosumab, data are scarce in the context of AFF occurring in patients with bone metastasis receiving monthly denosumab therapy. METHODS To analyze the incidence of AFF in patients with bone metastasis, we reviewed the medical records of patients who had received monthly denosumab (120 mg) treatment from May 2012 to June 2017 at any of the three participant institutions. RESULTS The study population consisted of 277 patients who had received a median of 10 doses (range, 1-79) of denosumab. Five patients were diagnosed as having AFF or symptomatic atypical femoral stress reaction (AFSR) needing surgical intervention, representing an incidence rate of 1.8% (95% confidence interval, 0.77-4.2). These patients had received 15, 45, 45, 46 or 47 doses of denosumab, respectively. Four of the patients had received prior zoledronic acid treatment. The results of our analysis suggested that long-term use of denosumab, especially for more than 3.5 years, and prior use of zoledronic acid were risk factors for the development of AFF. CONCLUSIONS We found the AFF events in 5 patients (1.8%) among 277 cancer patients who had received monthly denosumab (120 mg) treatment. Long-term denosumab treatment and prior zoledronic acid treatment were identified as risk factors for the development of AFF.
Collapse
Affiliation(s)
- Momoko Takahashi
- Department of Palliative Care, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukinori Ozaki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Rika Kizawa
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Jun Masuda
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Taro Umezu
- Department of Orthopedic Surgery, Saiseikai Yokohama-shi Tobu Hospital, Tokyo, Kanagawa, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Nobuko Tamura
- Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | | | - Hidetaka Kawabata
- Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan
| | - Noriyuki Baba
- Department of Breast Oncology, Tokyo Kyosai Hospital, Tokyo, Japan
| | - Haruo Iguchi
- Department of Medical Oncology, Sasebo Kyosai Hospital, Nagasaki, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| |
Collapse
|
29
|
Kizawa R, Miura Y, Oda Y, Nagaoka Y, Masuda J, Ozaki Y, Kondoh C, Moriguchi S, Takahashi Y, Ogawa K, Hashimoto YT, Taniguchi S, Okaneya T, Kishi A, Hayashi N, Takaya H, Takano T. Eosinophilia during treatment of immune checkpoint inhibitors (ICIs) predicts succeeding onset of immune-related adverse events (irAEs). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Kondoh C, Ichinari Y, Morita H, Suyama H, Yoshii Y, Ezura M, Fujisawa Y, Iihara H, Kariya M, Matsumoto N, Nakajima S, Osato Y, Terasaki F, Yamagami M, Futamura M, Saji S, Ueno NT. Expectations and challenges for TeamOncology workshops. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz343.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Hirata K, Hamamoto Y, Tsuchihashi K, Kondoh C, Yamazaki K, Hironaka S, Ando M, Imamura C, Yoshimura K, Muro K. Randomized phase II trial of weekly paclitaxel + ramucirumab versus weekly nab-paclitaxel + ramucirumab for unresectable advanced or recurrent gastric cancer with peritoneal dissemination refractory to first-line therapy: WJOG10617G/P-SELECT. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
32
|
Satake H, Suzuki T, Imamura CK, Sukawa Y, Masuishi T, Kumekawa Y, Funakoshi S, Kotaka M, Horie Y, Kawai S, Okuda H, Terazawa T, Kondoh C, Kato K, Yoshimura K, Ishikawa H, Hamamoto Y, Boku N, Takaishi H, Kanai T. Abstract 3882: Exposure-toxicity analysis of unbound regorafenib and its active metabolites by dose escalation strategy with low starting dose in patients with colorectal cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3882] [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: 11/16/2022]
Abstract
Abstract
Background: As regorafenib (REG) and its active metabolites are extensively bound to serum proteins, their unbound exposure are considered to be more relevant to pharmacological and toxicological responses than total (unbound plus bound) exposure. We thus investigated the relationships between toxicity and serum unbound concentrations of REG and active metabolites M-2 and M-5 in patients with colorectal cancer.
Patients and Methods: REG was administered orally once daily for the first 21 days of each 28-day cycle. The dose was started at 120 mg/day, and escalated to standard dose of 160 mg/day on day 15 of the first cycle in patients who experienced neither hand-foot skin reaction nor grade ≥2 REG-related adverse events (AEs) without dose reduction or interruption until day 14. Serum concentrations of REG, M-2 and M-5 were evaluated on days 8, 15, and 22 of the first cycle in patients without interruption of REG treatment until each sampling point. Unbound fraction was obtained by equilibrium dialysis, and concentrations were determined by the UPLC-MS/MS method. AEs were graded according to CTCAE ver. 4.0.
Results: Among all 68 enrolled patients, 57 patients on day 8, 42 patients on day 15, and 23 patients on day 22 were assessable. On day 8, the median total concentrations of REG, M-2 and M-5 in serum were 6801 nM (range, 2487-17621), 2596 nM (321-12107), and 834 nM (49-12315), respectively. Unbound fraction of REG, M-2 and M-5 varied from 0.019-0.441 %, 0.000-0.477 % and 0.041-2.381 %, respectively, showing no association with levels of serum albumin (28-50 mg/mL) which is a major binding protein. Serum concentrations of total REG or sum of total REG, M-2 and M-5 (total SUM) on day 8 were not related with maximum grade (grade ≤2 vs. grade ≥3) of AEs (excluding laboratory abnormalities) in the first cycle. On the other hand, higher serum concentrations of unbound REG on day 8 tended to associate with severity of maximum grade of AEs in the first cycle (P=0.0711), and concentrations of sum of unbound REG, M-2 and M-5 (unbound SUM) on day 8 were significantly correlated with maximum grade of AEs in the first cycle (P=0.0345). In addition, concentrations of total REG and unbound REG on day 8 in six patients whose dose were escalated to 160 mg/day on day 15 were significantly lower than those in 50 patients whose dose were not escalated (total, 3978 vs. 7005 nM in median, P=0.0270; unbound, 2834 vs. 7244 pM in median, P=0.0455). There were also significant association between concentrations of unbound REG or unbound SUM on day 15 and severity of REG-related AEs (grade 1 vs. grade ≥2) on day 15 (P=0.0495, P=0.0126, respectively).
Conclusion: Unbound exposure was well correlated with toxicity in patients treated with REG. Exposure of sum of REG, M-2 and M-5 was associated with toxicity more than exposure of REG alone. Serum albumin levels didn’t affect unbound fraction of REG, M-2 and M-5.
Citation Format: Hironaga Satake, Takeshi Suzuki, Chiyo K. Imamura, Yasutaka Sukawa, Toshiki Masuishi, Yosuke Kumekawa, Shinsuke Funakoshi, Masahito Kotaka, Yoshiki Horie, Sadayuki Kawai, Hiroyuki Okuda, Tetsuji Terazawa, Chihiro Kondoh, Ken Kato, Kenichi Yoshimura, Hideki Ishikawa, Yasuo Hamamoto, Narikazu Boku, Hiromasa Takaishi, Takanori Kanai. Exposure-toxicity analysis of unbound regorafenib and its active metabolites by dose escalation strategy with low starting dose in patients with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3882.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ken Kato
- 12National Cancer Center Hospital, Japan
| | | | | | | | | | | | | |
Collapse
|
33
|
Kizawa R, Miura Y, Oda Y, Nagaoka Y, Ozaki Y, Kondoh C, Moriguchi S, Takahashi Y, Ogawa K, Tanabe-Hashimoto Y, Taniguchi S, Okaneya T, Kishi A, Hayashi N, Kishi K, Takano T, Masuda J. Eosinophilia during treatment of immune checkpoint inhibitors (ICIs) to predict succeeding onset of immune-related adverse events (irAEs). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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
e14110 Background: ICIs such as anti-PD-1/-L1 Inhibitor and anti-CTLA-4 Inhibitor have been used in many types of cancer, and irAEs occur in a considerable proportion of patients. Predictive biomarkers could help us to manage irAEs promptly. Methods: We retrospectively analyzed the consecutive patients treated with nivolumab, pembrolizumab, atezolizumab or ipilimumab, not used as investigational drugs, between March 2015 and December 2018 based on the electric medical records in our institution. We evaluated the relationship between clinical and laboratory factors (gender, age, body mass index, lymphocyte-to-monocyte ratio and eosinophilia) and the occurrence of irAEs using univariate and multivariate analyses. Eosinophilia was defined as absolute eosinophil count over 500/mm3 at least once between initiation of treatment and the occurrence of irAEs. We graded irAEs according to CTCAE v. 5.0. Results: Among 139 patients analyzed in this study, 136, 13 and 6 patients were treated with PD-1, PD-L1 and CTLA-4 inhibitors, respectively (cumulative total of 155 patients). This study included non-small cell lung cancer (n = 78; 56.1%), renal cell carcinoma (n = 17; 12.2%), melanoma (n = 16; 11.5%), gastric cancer (n = 15; 10.8%), Hodgkin lymphoma (n = 7; 5.0%), urothelial carcinoma (n = 3; 2.2%), head and neck carcinoma (n = 3; 2.2%) and mesothelioma (n = 1; 0.7%). Any grade and grade 3-5 irAEs occurred in 60 (38.7%) and 23 (14.8%) cumulative patients, respectively. The most common irAEs in any grade were endocrine disorders including thyroid dysfunction and adrenal insufficiency (n = 21) and skin disorders (n = 20). Eosinophilia occurred in 43 cumulative patients (27.7%). Eighteen patients out of them had eosinophilia from baseline. Among the clinical and laboratory factors, only eosinophilia was significantly associated with the occurrence of any grade of irAEs in both univariate (p = 0.0193) and multivariate (p = 0.0464) analysis. Notably, endocrine irAEs were significantly related to eosinophilia (p = 0.0287). Conclusions: Eosinophilia after the initiation of treatment with ICIs predicts succeeding onset of irAEs.
Collapse
Affiliation(s)
- Rika Kizawa
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Yasuhiro Oda
- Department of Pharmacy, Toranomon Hospital, Tokyo, Japan
| | | | - Yukinori Ozaki
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Shuhei Moriguchi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Yui Takahashi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Kazumasa Ogawa
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | - Akiko Kishi
- Department of Dermatology, Toranomon Hospital, Tokyo, Japan
| | | | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Jun Masuda
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| |
Collapse
|
34
|
Ozaki Y, Miura Y, Yamanaka T, Takemura K, Kizawa R, Takahashi M, Masuda J, Kondoh C, Tanabe Y, Takano T. Combined treatment of patients with bone metastases from various cancers with nivolumab plus denosumab: A retrospective study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14153] [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
e14153 Background: Monoclonal antibodies against the programmed cell death protein-1 (PD-1), e.g., nivolumab, have been shown to exhibit antitumor immunity and improve survival in patients with various cancers. Recently, it was reported that bone metastases are unlikely to respond to immunotherapy, while other reports have suggested that synergistic antitumor effect can be obtained by administration of denosumab in combination with PD-1 blockade using nivolumab. However, there are still very limited data on the efficacy and effects on the prognosis of nivolumab administered in combination with denosumab in patients with bone metastases. Methods: We reviewed the medical records and pharmacy database of patients who had received nivolumab plus denosumab treatment from April 2011 to March 2018 at our institution, in order to analyze the prognosis of patients with bone metastases from various cancers. The primary objective was to compare the progression-free survival between patients with and without bone metastases. The impact of combined nivolumab plus denosumab therapy was evaluated as an exploratory endpoint. Results: We extracted 201 patients who had received denosumab for bone metastasis and 45 patents who had received immune checkpoint inhibitor. We analyzed the data of 39 patients who had received nivolumab treatment; of these 39 patients, 10 had additionally also received denosumab for the treatment of bone metastases. The median age of the patients was 65 years (range 41-87); the primary disease was renal cell carcinoma in 17 patients, gastric cancer in 9 patients, melanoma in 6 patients, non-small cell lung cancer in 4 patients, and head and neck cancer in 3 patients. The median progression-free survival following treatment with nivolumab was 2.1 months in the group with bone metastases and 3.5 months in the group without bone metastases (log-rank test; p = 0.0779); the 6-month progression-free survival rate was 26.7% (95% CI: 21.6-69.2) in the patients with bone metastases and 39.3% (95% CI: 10.4-53.3) in those without bone metastases. Concurrent administration of denosumab, age, and the primary disease had no influence on the progression-free survival rate. Conclusions: This retrospective analysis revealed a trend towards lower immune responses in patients with bone metastases, even when nivolumab is administered in combination with denosumab. Immunotherapy for bone metastasis needs to be further explored.
Collapse
Affiliation(s)
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Rika Kizawa
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | | - Jun Masuda
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Yuko Tanabe
- Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | |
Collapse
|
35
|
Esaki T, Tsukuda H, Machida N, Ishida H, Kadowaki S, Minashi K, Tokunaga S, Ozaki Y, Kondoh C, Makiyama A, Sukawa Y, Yamanaka T, Yamazaki K, Hironaka S, Muro K. A randomized phase II study to assess trastuzumab beyond progression in HER2-positive advanced gastric cancer: WJOG7112G. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy374.017] [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: 11/15/2022] Open
|
36
|
Masuishi T, Suzuki T, Sukawa Y, Imamura C, Satake H, Kumekawa Y, Funakoshi S, Kotaka M, Horie Y, Kawai S, Okuda H, Terazawa T, Kondoh C, Kato K, Yoshimura K, Ishikawa H, Hamamoto Y, Boku N, Kanai T, Takaishi H. Prospective evaluation of regorafenib dose escalation strategy with low starting dose in patients with colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
37
|
Oka S, Inoshita N, Miura Y, Oki R, Miyama Y, Nagamoto S, Ogawa K, Sakaguchi K, Kondoh C, Kurosawa K, Urakami S, Takano T, Okaneya T. The loss of BAP1 protein expression predicts poor prognosis in patients with nonmetastatic clear cell renal cell carcinoma with inferior vena cava tumor thrombosis. Urol Oncol 2018; 36:365.e9-365.e14. [PMID: 29853346 DOI: 10.1016/j.urolonc.2018.04.015] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/18/2018] [Accepted: 04/24/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Renal cell carcinoma (RCC) is characterized by a propensity for extension into the renal vein and inferior vena cava (IVC) and is associated with poor prognosis. BAP1 mutation, which occurs in about 15% of patients with clear cell RCC (ccRCC), also predicts poor prognosis. The aim of this study was to elucidate the association between BAP1 protein expression and clinicopathological outcomes in patients with nonmetastatic ccRCC with an IVC tumor thrombus (IVCTT). MATERIAL AND METHODS Thirty-five patients with nonmetastatic ccRCC with an IVCTT who underwent radical nephrectomy and tumor thrombectomy at our institution from 1999 to 2010 were retrospectively evaluated. Immunohistochemical (IHC) analyses were performed for the expression of BAP1 protein, and the associations between the expression of BAP1 and clinical outcomes were assessed. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate analyses of the associations between disease-free survival (DFS) and clinical variables including BAP1 protein expression, tumor size, Karnofsky performance status (KPS) score, and the extension level of the tumor thrombus were performed using a Cox proportional hazard model. RESULTS The median follow-up time was 58.8 months (range: 2-130 months). The median age was 68 years (range: 37-80 years). The median size of the primary tumor was 9.6cm (range: 3.0-15.0cm). The IVCTT extended above and below the diaphragm in 10 (28.6%) and 25 (71.4%) patients, respectively. The KPS score was>80 in 23 patients (65.7%). BAP1 protein expression on IHC was positive in 24 cases (68.8%) and negative in 11 cases (31.2%). The median overall survival in cases with BAP1-negative and -positive tumor on IHC staining were 44.7 and 81.5 months, respectively (P = 0.052). BAP1-negative tumor on IHC staining was associated with a significantly shorter DFS than BAP1-positive tumor (median DFS = 10.0 vs. 26.0 months, respectively; P = 0.011). Multivariate analysis showed that only BAP1-negative tumor on IHC staining was significantly associated with shorter DFS (P = 0.004). CONCLUSIONS Patients whose tumors had loss of BAP1 protein expression were significantly associated with poor prognosis in patients with ccRCC with an IVCTT who underwent radical nephrectomy and tumor thrombectomy.
Collapse
Affiliation(s)
- Suguru Oka
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Naoko Inoshita
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.
| | - Ryosuke Oki
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Yu Miyama
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kohei Ogawa
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | | | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | |
Collapse
|
38
|
Ozaki Y, Shindoh J, Gonoi W, Nishioka Y, Kondoh C, Tanabe Y, Matoba S, Kuroyanagi H, Hashimoto M, Takano T. Changes in CT morphology can be an independent response marker for patients receiving regorafenib for colorectal liver metastases: retrospective pilot study. BMC Cancer 2018; 18:138. [PMID: 29402244 PMCID: PMC5800281 DOI: 10.1186/s12885-018-4067-5] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/29/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Regorafenib is a multi-kinase inhibitor, which was shown to be effective for patients with metastatic colorectal cancer refractory to standard therapies. However, its patterns of response has not yet been fully understood. METHODS Clinical records of 10 patients who received regorafenib for evaluable colorectal liver metastases were reviewed. Response to chemotherapy was evaluated with the RECIST and morphologic response criteria, and its clinical relevance was analyzed. RESULTS All patients received multiple lines of fluorouracil-based chemotherapy before regorafenib. The median follow-up duration after introduction of regorafenib was 4.9 months (range, 2 to 12.5 months). Median number of chemotherapy cycles was 2 (range, 1 to 15). In size-based response evaluation, 4 patients presented SD and 6 patients showed PD according to the RECIST. In non-size-based response evaluation, 3 patients were classified as optimal morphologic response and 7 patients were categorized as suboptimal morphologic response. Patients who presented optimal morphologic response showed significantly longer progression-free survival compared with those presented suboptimal response (median, 4.9 months vs. 0.7 months; P = 0.028), while size-based response evaluation could not well stratify patient prognosis. CONCLUSION Non-size-based CT morphologic response could be a potential alternative response marker for patients treated with regorafenib.
Collapse
Affiliation(s)
- Yukinori Ozaki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Junichi Shindoh
- Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. .,Okinaka Memorial Institute for Medical Disease, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Wataru Gonoi
- Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongou, Bunkyou-ku, Tokyo, 113-8655, Japan
| | - Yujiro Nishioka
- Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Shuichiro Matoba
- Colorectal Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Hiroya Kuroyanagi
- Colorectal Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masaji Hashimoto
- Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| |
Collapse
|
39
|
Nakajima H, Inoshita N, Kondoh C, Ozaki Y, Tomizawa K, Hanaoka Y, Toda S, Tanabe Y, Miura Y, Moriyama J, Matoba S, Kuroyanagi H, Takano T. Combined analysis of tumor budding and tumor microenvironment in patients with stage III colorectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.652] [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
652 Background: Tumor budding (TB) represents the epithelial-mesenchymal transition (EMT) and is a novel marker that predicts metastasis and poor survival in patients with colorectal cancer. Although recent preclinical studies have elucidated the interaction between the EMT process and tumor microenvironment (TME), the clinicopathological correlation between TB and TME remains unclear. Methods: Formalin-fixed paraffin-embedded blocks of specimens were obtained from patients with stage III colorectal cancer who underwent surgical resection and adjuvant chemotherapy at our institution between January 2009 and July 2012. TB, tumor stroma percentage (TSP), and inflammatory reaction (IR) graded using the Klintrup-Mäkinen method were evaluated on hematoxylin and eosin sections. The densities of CD8+ T-cells at the tumor centers and invasive margins were analyzed using immunohistochemistry and digital image analysis. Cox proportional hazards models were used to assess the effect of clinicopathological variables on relapse-free survival (RFS). Results: One hundred and ninety-five patients were included in this analysis. The median age was 62 years (range 32–84 years). The median follow-up duration of this study was 5.8 years. High TB ( > 5 buds/0.785 mm2) was observed in 106 patients (54.4%) and was associated with high TSP (P < 0.01), but not with IR and CD8 expression. Multivariate analysis, including clinicopathological factors such as histology, TB, TSP, and IR revealed that high TB was an independent poor prognostic factor (hazard ratio, 1.89; 95% confidence interval, 1.04–3.45; P = 0.04). Patients with high TB and low IR (21.0%) exhibited a shorter survival than others; the 5-year RFS rates were 82.7%, 81.1%, 78.4%, and 40.8% in patients with low TB and high IR, low TB and IR, high TB and high IR, and high TB and low IR, respectively. Conclusions: Our study demonstrated that high TB was an adverse prognostic factor, regardless of TME status. The combined analysis of TB plus IR could improve prognostic value in patients with stage III colorectal cancer. Patients with high TB and low IR may need novel therapeutic approaches.
Collapse
|
40
|
Kizawa R, Ozaki Y, Kondoh C, Tanabe Y, Takano T. [I. Dose-Dense Chemotherapy as Perioperative Treatment in Breast Cancer]. Gan To Kagaku Ryoho 2017; 44:2073-2076. [PMID: 29361620] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Rika Kizawa
- Dept. of Medical Oncology, Toranomon Hospital
| | | | | | | | | |
Collapse
|
41
|
Ozaki Y, Shindoh J, Miura Y, Nakajima H, Oki R, Uchiyama M, Masuda J, Kinowaki K, Kondoh C, Tanabe Y, Tanaka T, Haruta S, Ueno M, Kitano S, Fujii T, Udagawa H, Takano T. Serial pseudoprogression of metastatic malignant melanoma in a patient treated with nivolumab: a case report. BMC Cancer 2017; 17:778. [PMID: 29162045 PMCID: PMC5696908 DOI: 10.1186/s12885-017-3785-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/14/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pseudoprogression refers to a specific pattern of response sometimes observed in malignant melanoma patients receiving treatment with immune-checkpoint inhibitors. Although cases with pseudoprogression documented once have been reported previously, there have been no case reports yet of pseudoprogression events documented twice during treatment. CASE PRESENTATION A 55-year-old man underwent surgery for locally advanced esophageal malignant melanoma and received postoperative adjuvant interferon therapy. However, he presented with multiple liver and bone metastases at 6 months after the surgery, and was initiated on treatment with nivolumab 2 mg/kg every 3 weeks as the first-line treatment for recurrent disease. Follow-up computed tomography revealed that the liver metastases initially increased transiently in size, but eventually regressed. However, while the liver metastases continued to shrink, a new peritoneal nodule emerged, that also subsequently shrinked during the course of treatment with nivolumab. With only grade 1 pruritus, the patient continues to be on nivolumab treatment at 15 months after the induction therapy, with no progression observed after the second episode of pseudoprogression in the liver and peritoneal nodule. CONCLUSIONS We present the case of a patient with metastatic malignant melanoma who showed the unique response pattern of serial pseudoprogression during treatment with nivolumab. This case serves to highlight the fact that development of a new lesion may not always signify failure of disease control during treatment with nivolumab.
Collapse
Affiliation(s)
- Yukinori Ozaki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
- Okinaka Memorial Institute for Medical Disease, Tokyo, Japan
| | - Junichi Shindoh
- Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Disease, Tokyo, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Hiromichi Nakajima
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Ryosuke Oki
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Miyuki Uchiyama
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Jun Masuda
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | | | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| | - Tsuyoshi Tanaka
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shigehisa Kitano
- Department of Experimental Therapeutics, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Tsukiji Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470 Japan
| |
Collapse
|
42
|
Ozaki Y, Takahashi M, Nakajima H, Ohki R, Masuda J, Kondoh C, Miura Y, Tanabe Y, Takano T. Retrospective study of atypical femoral fracture in patients with malignant bone metastasis receiving denosumab therapy: Case series. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx676.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
43
|
Yukinori O, Takahashi M, Nakajima H, Ohki R, Masuda J, Kondoh C, Miura Y, Tanabe Y, Takano T. Atypical femoral fracture in patients with malignant bone metastasis receiving denosumab therapy: Retrospective study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.220] [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
220 Background: While denosumab prevent skeletal-related events in patients with malignant bone metastasis, there are concerns that it may be associated with atypical femoral fracture (AFF). AFF in osteoporotic patients receiving denosumab is reported, but few data have been reported in the context of monthly denosumab therapy for patients with malignant tumor and bone metastasis. Methods: We reviewed the medical records and pharmacy database of patients who received denosumab at 120mg monthly for management of bone metastasis from May 2012 to June 2017 at our institution to analyze the incidence of AFF. To identify the risk factors and optimal management of AFF, we reviewed the clinical features and skeletal images of the patients. Results: We analyzed the data of 204 patients receiving a median of 7 doses (range; 1-60) of denosumab, and 150 (74%) patients received more than three times of denosumab. Four patients were diagnosed as AFF and incidence rate was 2.0%. Five limbs of the 4 patients were diagnosed as AFF and performed intramedullary nail fixation, and 2 limbs of the patients were diagnosed of atypical femoral stress reaction (AFSR) with surgical indication. These patients with AFF received 15, 44, 45 and 45 doses of denosumab, which showed higher doses of denosumab (median: 44.5 doses), compared to the patients without AFF or AFSR (median: 6 doses). Median age of the four patients was 59 (range: 50-66), and primary disease were breast cancer in three patients and non-small lung cell cancer in one patient. Conclusions: We experienced four AFF events among 204 patients receiving denosumab 120mg monthly and incident rate was 2.0%. More data are needed about the occurrence of AFF in these patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | |
Collapse
|
44
|
Oki R, Kondoh C, Miura Y, Ozaki Y, Tanabe Y, Sakaguchi K, Kurosawa K, Urakami S, Okaneya T, Takano T. S-1 plus cisplatin combination therapy in patients with urachal carcinoma: A retrospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx661.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
45
|
Nakajima H, Kondoh C, Ozaki Y, Tanabe Y, Miura Y, Sakaguchi K, Uragami S, Inoshita N, Okaneya T, Takano T. Adjuvant Chemotherapy in Patients with Neuroendocrine Carcinoma of the Urinary Tract. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx697.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
Oka S, Inoshita N, Miura Y, Oki R, Miyama Y, Nagamoto S, Ogawa K, Sakaguchi K, Kondoh C, Kurosawa K, Urakami S, Takano T, Okaneya T. Prognostic value of BAP1 expression in clear cell renal cell carcinoma with inferior vena cava tumor thrombosis. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e16080] [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
e16080 Background: Renal cell carcinoma (RCC) is characterized by a propensity for extension into the renal vein and inferior vena cava (IVC), and affected patients have a poor prognosis. BAP1 mutation, which occurs in about 15% of patients with clear cell RCC (ccRCC), also predicts a poor prognosis. The aim of this study was to elucidate the association between BAP1 expression and clinicopathologic outcomes in patients with ccRCC with an IVC tumor thrombus. Methods: Thirty-nine patients with ccRCC with an IVC tumor thrombus who underwent radical nephrectomy and tumor thrombectomy at our institution from 1999 to 2010 were retrospectively evaluated. Immunohistochemical analyses were performed for the expression of BAP1, and the associations between the expression of BAP1 and clinical outcomes were assessed. Survival analyses were performed using the Kaplan–Meier method and log-rank test. Multivariate analyses of the associations between overall survival (OS) and clinical variables were performed using a Cox proportional hazard model. For all analyses, P < 0.05 was considered statistically significant. Results: The median follow-up time was 58.8 months (range, 2–130 months). The median age was 66 years (range, 37–80 years). Four patients (10.3%) had lung metastasis at the initial diagnosis. The primary tumor was right-sided in 27 (69.2%) patients and left-sided in 12 (30.8%). The IVC tumor thrombus extended above and below the diaphragm in 11 (28.2%) and 28 (71.8%) patients, respectively. The KPS score was > 80 in 23 patients (59.0%). BAP1 expression was positive in 26 (67.0%) cases and negative in 13 (33.0%). BAP1-negative tumors were associated with a significantly shorter OS than BAP1-positive tumors (median OS, 42.0 vs. 81.5 months, respectively; P = 0.019). The median disease-free survival in BAP1-negative and -positive tumors was 10.0 and 19.0 months, respectively (P = 0.019). Multivariate analysis showed that only a BAP1-negative status was significantly associated with shorter OS (P = 0.026). Conclusions: A BAP1-negative tumor status was significantly associated with a poor prognosis in patients with ccRCC with an IVC tumor thrombus who underwent radical nephrectomy and tumor thrombectomy.
Collapse
Affiliation(s)
- Suguru Oka
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Naoko Inoshita
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yuji Miura
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Ryosuke Oki
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Yu Miyama
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Kohei Ogawa
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | | | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | | | | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | | |
Collapse
|
47
|
Gyawali B, Shimokata T, Honda K, Kondoh C, Hayashi N, Yoshino Y, Sassa N, Nakano Y, Gotoh M, Ando Y. Loss of muscle mass associated with the long term use of mTOR inhibitors. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw521.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Kondoh C, Tsuihiji M, Hamajima N, Amano M, Ota H, Kushihara H, Machii H, Nagase M, Nakano Y, Goto Y, Nomura F. A case of cancer education for high school students who joined the cancer awareness event in a community hospital. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw522.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Gyawali B, Shimokata T, Honda K, Kondoh C, Hayashi N, Yoshino Y, Sassa N, Nakano Y, Gotoh M, Ando Y. Muscle wasting associated with the long-term use of mTOR inhibitors. Mol Clin Oncol 2016; 5:641-646. [PMID: 27900103 DOI: 10.3892/mco.2016.1015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 05/18/2016] [Accepted: 08/10/2016] [Indexed: 01/06/2023] Open
Abstract
Some targeted therapies alter muscle mass due to interference with pathways of muscle metabolism. The effects of mammalian target of ra pamycin (mTOR) inhibitors on muscle mass have yet to be fully elucidated. In the present study, the computerized tomography (CT) scans of patients receiving mTOR inhibitors for at least 6 months taken at baseline and post-therapy were retrospectively retrieved, and body composition analyses were performed using the software, sliceOmatic version 5.0 (TomoVision, Inc., Magog, QC, Canada). The difference in body composition parameters was evaluated for significance. The time to treatment (TTF) failure was also compared between the sarcopenic and non-sarcopenic patients at the baseline. Of the 75 patients studied, 20 matched the inclusion criteria (including 16 males). The mean duration between the CT scans was 14.4±2.0 months. A total of 12 (60%) patients were sarcopenic at the baseline, whereas three more (75% in total) became sarcopenic following treatment. The use of mTOR inhibitors significantly decreased the skeletal muscle area (P=0.011) and lean body mass (P=0.007), although it had no effect on adipose tissue (P=0.163) or body weight (P=0.262). The rate of skeletal muscle wasting was 2.6 cm2/m2, or 2.3 kg in 6 months. The TTF did not differ between sarcopenic and non-sarcopenic patients, and was not significantly associated with any other parameter. To the best of our knowledge, this is the first study to demonstrate that the long-term use of mTOR inhibitors induces a marked loss of muscle mass. Due to the predictive and prognostic role of sarcopenia in cancer patients, these findings may have important clinical implications.
Collapse
Affiliation(s)
- Bishal Gyawali
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Tomoya Shimokata
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Kazunori Honda
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi 453-8511, Japan
| | - Naomi Hayashi
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Yasushi Yoshino
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Naoto Sassa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Yasuyuki Nakano
- Department of Medical Oncology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi 453-8511, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| |
Collapse
|
50
|
Kondoh C, Kawada K, Nagase M, Kato H, Funahashi Y, Nakano Y. Efficacy and safety of etoposide in patients with platinum-pretreated metastatic or recurrent urothelial cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv472.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|