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Bokemeyer C, Ciardiello F, Dubreuil O, Guigay J, Kasper S, Pfeiffer P, Pinto C, Yamaguchi K, Yoshino T, Zielinski C, Esser R, Tabernero J. Cetuximab every 2 weeks versus standard weekly dosing administration schedule. Future Oncol 2024; 20:393-407. [PMID: 37850363 DOI: 10.2217/fon-2023-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Cetuximab every 2 weeks (Q2W) dosing schedule is approved by the US FDA and by the Japanese Pharmaceuticals and Medical Devices Agency in patients with metastatic colorectal cancer and squamous cell carcinoma of the head and neck. Phase II trials have found comparable efficacy and safety for the weekly (Q1W) and Q2W schedules, and real-world studies have shown noninferiority of the Q2W compared with the Q1W schedule. Several guidelines recommend cetuximab Q2W administration as an alternative to the Q1W dosing schedule. Cetuximab Q2W can be administered with a Q2W dose of chemotherapy, making it a more convenient option to the Q1W schedule, potentially resulting in reduced costs for administration, increased flexibility for clinical staff and improved patient adherence.
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Affiliation(s)
- Carsten Bokemeyer
- The II Medical Clinic, Department of Oncology, Hematology & BMT with section of Pneumology, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Olivier Dubreuil
- Medical Oncology Unit, Diaconesses-Croix St Simon Hospital, Paris, France
| | - Joel Guigay
- Groupe d'Oncologie Radiothérapie Tête Et Cou (GORTEC), Tours, France
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Center, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Kensei Yamaguchi
- Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Yoshino
- Department of Gastroenterology & Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron Hospital Campus & Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
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2
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Abbasi K, Ali P, Barbour V, Benfield T, Bibbins-Domingo K, Hancocks S, Horton R, Laybourn-Langton L, Mash R, Sahni P, Sharief WM, Yonga P, Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. Ann Oncol 2023; 34:1094-1096. [PMID: 38072512 DOI: 10.1016/j.annonc.2023.10.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
| | - P Ali
- Editor-in-Chief, International Nursing Review
| | - V Barbour
- Editor-in-Chief, Medical Journal of Australia
| | | | | | | | | | | | - R Mash
- Editor-in-Chief, African Journal of Primary Health Care & Family Medicine
| | - P Sahni
- Editor-in-Chief, National Medical Journal of India
| | | | - P Yonga
- Editor-in-Chief, East African Medical Journal
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3
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Zielinski C, Preusser M, Berghoff A. ESMO Open: from Cancer Horizons to Science for Optimal Cancer Care-a tale stretching over 8 years. ESMO Open 2023; 8:102072. [PMID: 38103485 PMCID: PMC10764984 DOI: 10.1016/j.esmoop.2023.102072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Affiliation(s)
- C Zielinski
- Central European Cooperative Oncology Group, Vienna; Medical University of Vienna, Vienna.
| | - M Preusser
- Clinical Division of Oncology, Department of Medicine I, Medical University Vienna, Austria
| | - A Berghoff
- Clinical Division of Oncology, Department of Medicine I, Medical University Vienna, Austria
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4
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Abbasi K, Ali P, Barbour V, Benfield T, Bibbins-Domingo K, Hancocks S, Horton R, Laybourn-Langton L, Mash R, Sahni P, Sharief WM, Yonga P, Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. J Small Anim Pract 2023. [PMID: 37986558 DOI: 10.1111/jsap.13687] [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] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Affiliation(s)
| | - P Ali
- International Nursing Review, USA
| | | | | | | | | | | | | | - R Mash
- African Journal of Primary Health Care & Family Medicine, USA
| | - P Sahni
- National Medical Journal of India, USA
| | | | - P Yonga
- East African Medical Journal, USA
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5
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Abbasi K, Ali P, Barbour V, Benfield T, Bibbins-Domingo K, Hancocks S, Horton R, Laybourn-Langton L, Mash R, Sahni P, Sharief WM, Yonga P, Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. Anaesthesia 2023. [PMID: 37962064 DOI: 10.1111/anae.16168] [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] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Affiliation(s)
| | - P Ali
- International Nursing Review
| | | | | | | | | | | | | | - R Mash
- African Journal of Primary Health Care & Family Medicine
| | - P Sahni
- National Medical Journal of India
| | | | - P Yonga
- East African Medical Journal
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6
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Pascual J, Gil-Gil M, Proszek P, Zielinski C, Reay A, Ruiz-Borrego M, Cutts R, Ciruelos Gil EM, Feber A, Muñoz-Mateu M, Swift C, Bermejo B, Herranz J, Margeli Vila M, Antón A, Kahan Z, Csöszi T, Liu Y, Fernandez-Garcia D, Garcia-Murillas I, Hubank M, Turner NC, Martín M. Baseline Mutations and ctDNA Dynamics as Prognostic and Predictive Factors in ER-Positive/HER2-Negative Metastatic Breast Cancer Patients. Clin Cancer Res 2023; 29:4166-4177. [PMID: 37490393 PMCID: PMC10570672 DOI: 10.1158/1078-0432.ccr-23-0956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Prognostic and predictive biomarkers to cyclin-dependent kinases 4 and 6 inhibitors are lacking. Circulating tumor DNA (ctDNA) can be used to profile these patients and dynamic changes in ctDNA could be an early predictor of treatment efficacy. Here, we conducted plasma ctDNA profiling in patients from the PEARL trial comparing palbociclib+fulvestrant versus capecitabine to investigate associations between baseline genomic landscape and on-treatment ctDNA dynamics with treatment efficacy. EXPERIMENTAL DESIGN Correlative blood samples were collected at baseline [cycle 1-day 1 (C1D1)] and prior to treatment [cycle 1-day 15 (C1D15)]. Plasma ctDNA was sequenced with a custom error-corrected capture panel, with both univariate and multivariate Cox models used for treatment efficacy associations. A prespecified methodology measuring ctDNA changes in clonal mutations between C1D1 and C1D15 was used for the on-treatment ctDNA dynamic model. RESULTS 201 patients were profiled at baseline, with ctDNA detection associated with worse progression-free survival (PFS)/overall survival (OS). Detectable TP53 mutation showed worse PFS and OS in both treatment arms, even after restricting population to baseline ctDNA detection. ESR1 mutations were associated with worse OS overall, which was lost when restricting population to baseline ctDNA detection. PIK3CA mutations confer worse OS only to patients on the palbociclib+fulvestrant treatment arm. ctDNA dynamics analysis (n = 120) showed higher ctDNA suppression in the capecitabine arm. Patients without ctDNA suppression showed worse PFS in both treatment arms. CONCLUSIONS We show impaired survival irrespective of endocrine or chemotherapy-based treatments for patients with hormone receptor-positive/HER2-negative metastatic breast cancer harboring plasma TP53 mutations. Early ctDNA suppression may provide treatment efficacy predictions. Further validation to fully demonstrate clinical utility of ctDNA dynamics is warranted.
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Affiliation(s)
- Javier Pascual
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
| | - Miguel Gil-Gil
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Institut Català d'Oncologia (ICO), Barcelona, Spain
- IDIBELL, L'Hospitalet, Barcelona, Spain
| | - Paula Proszek
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | - Christoph Zielinski
- Medical Oncology, Central European Cancer Center, Wiener Privatklinik Hospital, Vienna, Austria
- CECOG Central European Cooperative Oncology Group, Vienna, Austria
| | - Alistair Reay
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | - Manuel Ruiz-Borrego
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Medical Oncology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Rosalind Cutts
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Eva M. Ciruelos Gil
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Andrew Feber
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | - Montserrat Muñoz-Mateu
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Department of Medical Oncology and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Claire Swift
- Ralph Lauren Centre for Breast Cancer Research, London, United Kingdom
| | - Begoña Bermejo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
- Medical Oncology, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
- Medicine Department, Universidad de Valencia, Valencia, Spain
| | | | - Mireia Margeli Vila
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- B-ARGO Group, Catalan Institute of Oncology-Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antonio Antón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
- Medical Oncology, Hospital Universitario Miguel Servet, Medicine Department, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Zsuzsanna Kahan
- CECOG Central European Cooperative Oncology Group, Vienna, Austria
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Tibor Csöszi
- CECOG Central European Cooperative Oncology Group, Vienna, Austria
- Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet, Szolnok, Hungary
| | - Yuan Liu
- Pfizer, La Jolla, San Diego, California
| | | | - Isaac Garcia-Murillas
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Michael Hubank
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | - Nicholas C. Turner
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
- Ralph Lauren Centre for Breast Cancer Research, London, United Kingdom
| | - Miguel Martín
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Medicine Department, Universidad Complutense, Madrid, Spain
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Zielinski C, Thallinger C, Rödiger A. "What's measured gets done": a call for a European semester for cancer to improve cancer outcomes in Central and Southeastern Europe. Arch Public Health 2023; 81:142. [PMID: 37553609 PMCID: PMC10408064 DOI: 10.1186/s13690-023-01165-5] [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: 04/21/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
Cancer mortality varies widely across Europe, and survival depends on where you live. In particular, the inequality between countries in Central and South-Eastern Europe (CEE) and Western Europe (WE) is striking. The COVID-19 pandemic has brought existing inequalities into sharp focus, and the economic disruption it has caused threatens to deepen them. The Central European Cooperative Oncology Group (CECOG) has created a platform with the aim to reduce health inequalities and to improve patient access to cancer care. The subject of discussion is the value of new treatments to create willingness to invest in improving cancer outcomes while managing the budget. The platform includes various stakeholders as scientific leaders, policy makers, payers, patients and industry.
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Affiliation(s)
- Christoph Zielinski
- Central European Cooperative Oncology Group (CECOG), Ohmanngasse 26, HQ, Vienna, 1190, Austria
| | - Christiane Thallinger
- Central European Cooperative Oncology Group (CECOG), Ohmanngasse 26, HQ, Vienna, 1190, Austria.
- Department of Internal Medicine I, Medical University Vienna, 18-20 Waehringer Guertel, 1090, Vienna, Austria.
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8
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Bartl T, Grimm C, Mader RM, Zielinski C, Prager G, Unseld M, Herac-Kornauth M. Interactions of EGFR/PTEN/mTOR-Pathway Activation and Estrogen Receptor Expression in Cervical Cancer. J Pers Med 2023; 13:1186. [PMID: 37623437 PMCID: PMC10455725 DOI: 10.3390/jpm13081186] [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: 07/03/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Objective: Late-line chemotherapy rechallenge in recurrent cervical cancer is associated with modest therapy response but significant side effects. As mTOR pathways modulate cellular growth via estrogen receptor (ER) signaling and combined mTOR and ER inhibition previously demonstrated survival benefits in breast cancer, this exploratory study evaluates mTOR pathway and ER expression interactions in a preclinical cervical cancer model. (2) Methods: Immunostaining of a 126-tumor core tissue microarray was performed to assess phosphorylated-mTOR and ER expression. To identify tumor subsets with different clinical behavior, expression results were matched with clinicopathologic patient characteristics, and both univariate and multivariable survival statistics were performed. (3) Results: phosphorylated-mTOR correlates with ER (r = 0.309, p < 0.001) and loss of PTEN expression (r = -2.09, p = 0.022) in tumor samples across stages but not in matched negative controls. Positive ER expression is observed significantly more often in phosphorylated-mTOR positive samples (30.0% vs. 6.3%, p = 0.001). In the subgroup of phosphorylated-mTOR positive tumors (n = 60), ER expression is associated with improved survival (p = 0.040). (4) Conclusion: ER expression appears closely intertwined with EGFR/PTEN/mTOR-pathway activation and seems to define a subgroup with clinically distinct behavior. Considering limited therapeutic options in recurrent cervical cancer, further validation of combined mTOR and ER inhibition in selected patients could appear promising.
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Affiliation(s)
- Thomas Bartl
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Christoph Grimm
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Robert M. Mader
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Christoph Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, 1090 Wien, Austria
| | - Matthias Unseld
- Academy for Ageing Research, Haus der Barmherzigkeit, 1160 Wien, Austria
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9
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Guerrero-Zotano Á, Belli S, Zielinski C, Gil-Gil M, Fernandez-Serra A, Ruiz-Borrego M, Ciruelos Gil EM, Pascual J, Muñoz-Mateu M, Bermejo B, Margeli Vila M, Antón A, Murillo L, Nisenbaum B, Liu Y, Herranz J, Fernandez Garcia D, Caballero R, López-Guerrero JA, Bianco R, Formisano L, Turner N, Martín M. CCNE1 and PLK1 mediates resistance to palbociclib in HR+/HER2- metastatic breast cancer. Clin Cancer Res 2023; 29:1557-1568. [PMID: 36749874 PMCID: PMC10102847 DOI: 10.1158/1078-0432.ccr-22-2206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/10/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE In HR+/HER2- metastatic breast cancer (MBC) is imperative to identify patients who respond poorly to CDK4/6i and to discover therapeutic targets to reverse this resistance. Non-luminal breast cancer subtype and high levels of CCNE1 are candidate biomarkers in this setting but further validation is needed. EXPERIMENTAL DESIGN We performed mRNA gene expression profiling and correlation with progression-free-survival (PFS) on 455 tumor samples included in the phase III PEARL study, that assigned HR+/HER2- MBC patients to receive palbociclib+ET vs capecitabine. ER+/HER2- breast cancer cell lines were used to generate and characterize resistance to palbociclib+ET. RESULTS Non-luminal subtype was more prevalent in metastatic (14%) than in primary tumor samples (4%). Patients with non-luminal tumors had median PFS of 2.4months (m) with palbociclib+ET and 9.3m with capecitabine; HR:4.16, adjusted p-value<0.0001. Tumors with high CCNE1 expression (above median) had also worse median PFS with palbociclib+ET (6.2m) than with capecitabine (9.3m); HR:1.55, adjusted p-value=0.0036. In patients refractory to palbociclib+ET (PFS in the lower quartile) we found higher levels of Polo Like Kinase 1 (PLK1). In an independent data set (PALOMA3), tumors with high PLK1 show worse median PFS than those with low PLK1 expression under palbociclib+ET treatment. In ER+/HER2- cell line models we show that PLK1 inhibition reverses resistance to palbociclib+ET. CONCLUSIONS We confirm the association of non-luminal subtype and CCNE1 with resistance to CDK4/6i+ET in HR+ MBC. High levels of PLK1 mRNA identify patients with poor response to palbociclib, suggesting PLK1 could also play a role in the setting of resistance to CDK4/6i.
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Affiliation(s)
| | | | | | - Miguel Gil-Gil
- INSTITUT CATALÀ D'ONCOLOGIA Hospitalet de Llobregat, Hospitalet de Llobregat, Spain
| | | | | | | | - Javier Pascual
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Malaga, Spain, Malaga, Spain
| | - Montserrat Muñoz-Mateu
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Mireia Margeli Vila
- Catalan Institute of Oncology(ICO)-Badalona; B-ARGO (Badalona Applied Research group in Oncology) Research Group, Badalona, Spain
| | - Antonio Antón
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Yuan Liu
- Pfizer Oncology, La Jolla, CA, United States
| | | | | | | | | | | | | | - Nicholas Turner
- Breast Unit, The Royal Marsden NHS Foundation Trust, and Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Miguel Martín
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigacion Sanitaria Gregorio Marañon, CIBERONC, Universidad Complutense, Madrid,, Madrid, Spain
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10
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Kasper S, Foch C, Esser R, Lamy FX, Zhang A, Cheng AL, Rouyer M, Brodowicz T, Zielinski C. Overall survival with cetuximab every-2-weeks versus standard once-weekly administration schedule for first-line treatment of RAS wild-type metastatic colorectal cancer in patients with left- and right-sided primary tumour location. Eur J Cancer 2023; 180:85-88. [PMID: 36563490 DOI: 10.1016/j.ejca.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Stefan Kasper
- West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Germany.
| | | | | | | | - Aimar Zhang
- Merck Serono (Beijing) Pharmaceutical R&D Co., Ltd, Beijing, China
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, University of Bordeaux, Bordeaux, France
| | - Thomas Brodowicz
- Internal Medicine, Vienna General Hospital and Medical University of Vienna, Austria
| | - Christoph Zielinski
- Comprehensive Cancer Centre, Vienna General Hospital and Medical University of Vienna, Austria
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11
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Atwoli L, Erhabor GE, Gbakima AA, Haileamlak A, Kayembe Ntumba JM, Kigera J, Laybourn-Langton L, Mash B, Muhia J, Mulaudzi FM, Ofori-Adjei D, Okonofua F, Rashidian A, El-Adawy M, Sidibé S, Snouber A, Tumwine J, Yassien MS, Yonga P, Zakhama L, Zielinski C. COP27 Climate Change Conference: urgent action needed for Africa and the world. Ann Oncol 2023; 34:7-9. [PMID: 36334703 DOI: 10.1016/j.annonc.2022.10.504] [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] [Received: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - B Mash
- African Journal of Primary Health Care & Family Medicine
| | - J Muhia
- London School of Medicine and Tropical Hygiene
| | | | | | | | | | | | | | - A Snouber
- Journal de la Faculté de Médecine d'Oran
| | | | | | - P Yonga
- East African Medical Journal
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12
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Dalloul I, Strzalkowski TJC, von Bergwelt-Baildon M, Nüssler V, Zielinski C, Kobold S. 9th Immunotherapy of Cancer conference (ITOC): A meeting report. Hum Vaccin Immunother 2022; 18:2159706. [PMID: 36576266 PMCID: PMC9891670 DOI: 10.1080/21645515.2022.2159706] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The Immunotherapy of Cancer conference (ITOC) is an European meeting providing a global platform for discussions where all those dedicated to the immunotherapy of cancer can exchange their knowledge and the latest findings about immuno-oncology. The 9th ITOC was held in Munich in September 2022. Major highlights of the 2022 edition included the key note address and life time achievement to Laurence Zitvogel on her contributions on the understanding of the role of microbiota in cancer development and therapy resistance. Her research has paved the way for therapeutic exploitation of the microbiome.
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Affiliation(s)
- Iman Dalloul
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Thaddäus Jan Clemens Strzalkowski
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michael von Bergwelt-Baildon
- German Center for Translational Cancer Research (DKTK), partner site Munich, Germany,Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Christoph Zielinski
- Central European Cooperative Oncology Group (CECOG), Wiener Privatklinik, Vienna, Austria
| | - Sebastian Kobold
- Center of Integrated Protein Science Munich (CIPS-M) and Division of Clinical Pharmacology, Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität München, Member of the German Center for Lung Research (DZL), Munich, Germany,German Center for Translational Cancer Research (DKTK), partner site Munich, Germany,Einheit für Klinische Pharmakologie (EKLiP), Helmholtz Zentrum München, Germany,Research Center for Environmental Health (HMGU), Neuherberg, Germany,CONTACT Sebastian Kobold Division of Clinical Pharmacology, Klinikum der Universität München, Lindwurmstraße 2a, München80337
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13
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Caglevic C, Rolfo C, Gil-Bazo I, Cardona A, Sapunar J, Hirsch FR, Gandara DR, Morgan G, Novello S, Garassino MC, Mountzios G, Leighl NB, Bretel D, Arrieta O, Addeo A, Liu SV, Corrales L, Subbiah V, Aboitiz F, Villarroel-Espindola F, Reyes-Cosmelli F, Morales R, Mahave M, Raez L, Alatorre J, Santos E, Ubillos L, Tan DS, Zielinski C. The Armed Conflict and the Impact on Patients With Cancer in Ukraine: Urgent Considerations. JCO Glob Oncol 2022; 8:e2200123. [PMID: 35994695 PMCID: PMC9470147 DOI: 10.1200/go.22.00123] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
On February 24, 2022, a war began within the Ukrainian borders. At least 3.0 million Ukrainian inhabitants have already fled the country. Critical infrastructure, including hospitals, has been damaged. Children with cancer were urgently transported to foreign countries, in an effort to minimize interruption of their life-saving treatments. Most adults did not have that option. War breeds cancer—delaying diagnosis, preventing treatment, and increasing risk. We project that a modest delay in care of only 4 months for five prevalent types of cancer will lead to an excess of over 3,600 cancer deaths in the subsequent years. It is critical that we establish plans to mitigate that risk as soon as possible. Ukraine conflict may cost 3600 lives or more because of a delay and lack of access for patients with cancer.![]()
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Affiliation(s)
- Christian Caglevic
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Christian Rolfo
- Clinical Research Center for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Andrés Cardona
- Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center—CTIC, ONCOLGroup/FICMAC, Bogota, Colombia
| | - Jorge Sapunar
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Fred R. Hirsch
- Center for Thoracic Oncology. Mount Sinai Cancer, Mount Sinai Health System, Icahn School of Medicine, Joe Lowe and Louis Price Professor of Medicine, Tisch Cancer Institute, New York, NY
| | - David R. Gandara
- Center for Experimental Therapeutics in Cancer, UC Davis Comprehensive Cancer Center, Translational and Clinical Research Program, University of Hawaii Cancer Center, International Society of Liquid Biopsy, Sacramento, CA
| | - Gilberto Morgan
- Skåne University Hospital, Department of Oncology, Lund, Sweden
| | - Silvia Novello
- Oncology Department, AOU San Luigi, University of Turin, Turin, Italy
| | | | - Giannis Mountzios
- 4th Oncology Department and Clinical Trials Unit Henry Dunant Hospital Center, Athens, Greece
| | - Natasha B. Leighl
- Medical Oncology Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, IHPME, Dalla Lana School of Public Health, Toronto, Canada
| | | | - Oscar Arrieta
- Toracic Oncology Unit, Instituto Nacional de Cancerologia de Mexico, Mexico City, Mexico
| | - Alfredo Addeo
- Oncology department, University Hospital Geneva, Geneva, Switzerland
| | - Stephen V. Liu
- Lombardi Comprehensive Cancer Center of Georgetown University, Washington, DC
| | - Luis Corrales
- Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, Medical Oncology Research, MD Anderson Cancer Network, Clinical Center For Targeted Therapy, Division of Pediatrics UT MD Anderson Cancer Center, Houston, TX
| | - Francisco Aboitiz
- Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | | | - Felipe Reyes-Cosmelli
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Ricardo Morales
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Mauricio Mahave
- Cancer Research Department, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
- Clinical Trials Unit, Instituto Oncologico Fundacion Arturo Lopez Perez, Santiago, Chile
| | - Luis Raez
- Memorial Cancer Institute/Memorial Health Care System, MCIFAU Florida Cancer Center of Excellence, Florida International University, Miami, FL
| | - Jorge Alatorre
- Instituto Nacional de Enfermedades Respiratorias (INER) Clínica de Oncología Torácica, México D.F., Mexico
| | - Edgardo Santos
- Florida Precision Oncology/a Division of Genesis Care USA, Research Services Thoracic and Head/Neck Cancer Programs Clinical, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Luis Ubillos
- Instituto Nacional del Cancer, Montevideo, Uruguay
| | - Daniel S.W. Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Christoph Zielinski
- Central European Cancer Center, Wiener Privatklinik, Vienna, and Central European Cooperative Oncology Group, HQ, Vienna, Austria
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Pascual J, Martin M, Proszek P, Gil-Gil M, Reay A, Zielinski C, Herranz J, Cutts R, Ruiz-Borrego M, Feber A, Ciruelos EM, Swift C, Muñoz M, Bermejo B, Margelí M, Liu Y, Garcia-Murillas I, Hubank M, Turner NC. Baseline and longitudinal ctDNA biomarkers in GEICAM/2013-02 (PEARL) trial cohort 2 comparing palbociclib and fulvestrant (PAL + FUL) versus capecitabine (CAPE). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1019] [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
1019 Background: The randomized PEARL trial found no superiority of PAL plus endocrine therapy over CAPE in patients (pts) with metastatic HR-positive, HER2-negative breast cancer resistant to aromatase inhibitors (Martin M, Ann Oncol 2020). We investigated associations between baseline genomic landscape and on-treatment plasma ctDNA dynamics with progression free survival, in pts from cohort 2 of the trial. Methods: Plasma was collected for ctDNA analysis from -7 days to cycle 1-day 1 (C1D1) for baseline prognostic analysis and cycle 1-day 15 (C1D15) when available, and sequenced with an in-house error-corrected targeted capture panel encompassing 21 genes commonly altered in breast cancer. For predictive ctDNA dynamics analysis, a pre-specified criteria of 14 minimum days of treatment in first cycle was required and variants with VAF <0.5% in C1D1, set as limit of detection, were excluded. The circulating DNA ratio (CDR) was calculated as a weighted mean for potentially clonal mutations at C1D1. The optimal cut-off for predicting PFS was assessed by fitting a range of cut-offs, identifying the one with lower p-value on the log-rank test. Adjusted p-values, potential overestimation corrected by a shrinkage factor and bootstrapping techniques to calculate the CI95% were used in the cutpoint Cox regression model. Results: A total of 201 pts had a C1D1 sample sequenced for baseline prognostic analysis, 146 (73%) had baseline mutations identified and 55 (27%) had no mutations. 187 (93%) pts had a paired C1D15 sample for CDR calculations. Of these, 134 (72%) had baseline mutations detected, 120 of them (90%) above 0.5%, 14 (10%) had no calls, 1 pair failed sequencing. Both baseline and CDR subsets were representative of the overall study population. Pts with TP53 mutations had worse PFS in the overall population (4.4 vs 9.3 months, logrank p= 0.04), with no differences between treatments. For on-treatment ctDNA dynamic analysis, median CDR (suppression) was lower in the CAPE arm (0.07 vs 0.21, p<0.01). There was an association between optimal cut-offs predicting PFS both in CAPE (suppressed 16.6 months vs high ctDNA 4.2 months, HR 2.37, CI95% 0.96-5.83, p=0.05) and PAL + FUL arms (suppressed 15.7 months vs high ctDNA 5.5 months, HR 2.14, CI95% 0.92-5, p=0.06). More ctDNA suppression associated with likelihood of objective responses (median CDR 0.1 in objective responders vs median CDR 0.2 in progressive disease p=0.03), with no statistical significance when stratified per treatment. Conclusions: In PEARL cohort 2, TP53 mutations associated with poor outcome regardless of treatment allocation, suggesting aggressive behaviour not specifically linked to endocrine resistance. Lack of ctDNA suppression associated with worse outcome in both patient groups. Capecitabine resulted in greater ctDNA suppression at C1D15, likely reflecting faster ctDNA suppression.
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Affiliation(s)
- Javier Pascual
- Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Universidad Complutense de Madrid, GEICAM Breast Cancer Group, Madrid, Spain
| | - Paula Proszek
- The Institute of Cancer Research, London, United Kingdom
| | - Miguel Gil-Gil
- Instituto Catalán de Oncología, Hospital Duran i Reynalds, IDIBELL; GEICAM Breast Cancer Group, Barcelona, Spain
| | - Alistair Reay
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Ros Cutts
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, United Kingdom
| | | | - Andrew Feber
- The Institute of Cancer Research, London and Sutton, United Kingdom
| | - Eva M. Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain
| | - Claire Swift
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden, London, United Kingdom
| | - Montserrat Muñoz
- Hospital Clínic Barcelona. GEICAM Breast Cancer Group, Barcelona, Spain
| | - Begona Bermejo
- Hospital Clinico Universitario de Valencia, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Mireia Margelí
- Instituto Catalán de Oncología, Hospital Germans Trias i Pujol; GEICAM Breast Cancer Group, Badalona, Spain
| | | | | | - Michael Hubank
- The Institute of Cancer Research, London and Sutton, United Kingdom
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15
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Martín M, Zielinski C, Ruiz-Borrego M, Carrasco E, Ciruelos EM, Muñoz M, Bermejo B, Margelí M, Csöszi T, Antón A, Turner N, Casas MI, Morales S, Alba E, Calvo L, de la Haba-Rodríguez J, Ramos M, Murillo L, Santaballa A, Alonso-Romero JL, Sánchez-Rovira P, Corsaro M, Huang X, Thallinger C, Kahan Z, Gil-Gil M. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer 2022; 168:12-24. [DOI: 10.1016/j.ejca.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
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16
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Wagner A, Garner-Spitzer E, Schötta AM, Orola M, Wessely A, Zwazl I, Ohradanova-Repic A, Weseslindtner L, Tajti G, Gebetsberger L, Kratzer B, Tomosel E, Kutschera M, Tobudic S, Pickl WF, Kundi M, Stockinger H, Novacek G, Reinisch W, Zielinski C, Wiedermann U. SARS-CoV-2-mRNA Booster Vaccination Reverses Non-Responsiveness and Early Antibody Waning in Immunocompromised Patients – A Phase Four Study Comparing Immune Responses in Patients With Solid Cancers, Multiple Myeloma and Inflammatory Bowel Disease. Front Immunol 2022; 13:889138. [PMID: 35634285 PMCID: PMC9133631 DOI: 10.3389/fimmu.2022.889138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
BackgroundIndividuals with secondary immunodeficiencies belong to the most vulnerable groups to succumb to COVID-19 and thus are prioritized for SARS-CoV-2 vaccination. However, knowledge about the persistence and anamnestic responses following SARS-CoV-2-mRNA vaccinations is limited in these patients.MethodsIn a prospective, open-label, phase four trial we analyzed S1-specific IgG, neutralizing antibodies and cytokine responses in previously non-infected patients with cancer or autoimmune disease during primary mRNA vaccination and up to one month after booster.Results263 patients with solid tumors (SOT, n=63), multiple myeloma (MM, n=70), inflammatory bowel diseases (IBD, n=130) and 66 controls were analyzed. One month after the two-dose primary vaccination the highest non-responder rate was associated with lower CD19+ B-cell counts and was found in MM patients (17%). S1-specific IgG levels correlated with IL-2 and IFN-γ responses in controls and IBD patients, but not in cancer patients. Six months after the second dose, 18% of patients with MM, 10% with SOT and 4% with IBD became seronegative; no one from the control group became negative. However, in IBD patients treated with TNF-α inhibitors, antibody levels declined more rapidly than in controls. Overall, vaccination with mRNA-1273 led to higher antibody levels than with BNT162b2. Importantly, booster vaccination increased antibody levels >8-fold in seroresponders and induced anamnestic responses even in those with undetectable pre-booster antibody levels. Nevertheless, in IBD patients with TNF-α inhibitors even after booster vaccination, antibody levels were lower than in untreated IBD patients and controls.ConclusionImmunomonitoring of vaccine-specific antibody and cellular responses seems advisable to identify vaccination failures and consequently establishing personalized vaccination schedules, including shorter booster intervals, and helps to improve vaccine effectiveness in all patients with secondary immunodeficiencies.Trial registrationEudraCT Number: 2021-000291-11
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Affiliation(s)
- Angelika Wagner
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
- *Correspondence: Ursula Wiedermann, ; Angelika Wagner,
| | - Erika Garner-Spitzer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Anna-Margarita Schötta
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Maria Orola
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Andrea Wessely
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Ines Zwazl
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Anna Ohradanova-Repic
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | | | - Gabor Tajti
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Laura Gebetsberger
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Bernhard Kratzer
- Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Elena Tomosel
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Maximilian Kutschera
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
| | - Selma Tobudic
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Winfried F. Pickl
- Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University Vienna, Vienna, Austria
| | - Hannes Stockinger
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Gottfried Novacek
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
| | - Walter Reinisch
- Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria
| | - Christoph Zielinski
- Central European Cancer Center, Wiener Privatklinik, Vienna, Austria
- The Central European Cancer Center, Central European Cooperative Oncology Group, Headquater (HQ), Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
- *Correspondence: Ursula Wiedermann, ; Angelika Wagner,
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17
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Zielinski C, Preusser M, Berghoff A. Introducing pro and con discussions in ESMO Open—Cancer Horizons. ESMO Open 2022; 7:100467. [PMID: 35798470 PMCID: PMC9271473 DOI: 10.1016/j.esmoop.2022.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- C Zielinski
- Wiener Privatklinik and Central European Cancer Center, Vienna, Austria.
| | - M Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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18
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Gaiger A, Lubowitzki S, Krammer K, Zeilinger EL, Acel A, Cenic O, Schrott A, Unseld M, Rassoulian AP, Skrabs C, Valent P, Gisslinger H, Marosi C, Preusser M, Prager G, Kornek G, Pirker R, Steger GG, Bartsch R, Raderer M, Simonitsch-Klupp I, Thalhammer R, Zielinski C, Jäger U. The cancer survival index-A prognostic score integrating psychosocial and biological factors in patients diagnosed with cancer or haematologic malignancies. Cancer Med 2022; 11:3387-3396. [PMID: 35315594 PMCID: PMC9487871 DOI: 10.1002/cam4.4697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022] Open
Abstract
Objective We aimed to investigate whether (1) psychological and social indicators influence survival in patients diagnosed with cancer or haematologic malignancies when important biological aspects are controlled for, (2) psychological, social and biological indicators can be utilised to design one collated index for survival, usable in clinical practice to identify patients at risk of shorter survival and to improve personalised healthcare provision. Methods In this cross‐sectional study, 2263 patients with cancer or haematologic malignancies participated. We analysed 15 biological, psychological and social indicators as risk factors for survival with a Cox proportional hazards model. Indicators significantly associated with survival were combined to compute models for the identification of patient groups with different risks of death. The training sample contained 1122 patients. Validation samples included the remaining 1141 patients, the total sample, as well as groups with different cancer entities. Results Five indicators were found to significantly impact survival: Cancer site (HR: 3.56), metastatic disease (HR: 1.88), symptoms of depression (HR: 1.34), female sex (HR: 0.73) and anaemia (HR: 0.48). Combining these indicators to a model, we developed the Cancer Survival Index, identifying three distinct groups of patients with estimated survival times of 47.2 months, 141 months and 198.2 months (p < 0.001). Post hoc analysis of the influence of depression on survival showed a mediating effect of the following four factors, related to both depression and survival: previous psychiatric conditions, employment status, metastatic disease and haemoglobin levels. Conclusions Psychosocial and biological factors impact survival in various malignancies and can be utilised jointly to compute an index for estimating the survival of each patient individually—the Cancer Survival Index.
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Affiliation(s)
- Alexander Gaiger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Katharina Krammer
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth L Zeilinger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Andras Acel
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Olivera Cenic
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Unseld
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Anahita Paula Rassoulian
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Heinz Gisslinger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Gabriela Kornek
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Robert Pirker
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Günther G Steger
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | | | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Ulrich Jäger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
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Thallinger C, Berzinec P, Bicakcic E, Dan A, Fabian G, Gales LN, Kuhar CG, Janzic U, Kahan Z, Mencinger M, Penthedourakis G, Sgouros J, Simetic L, Sirbu D, Vosmik M, Wrona A, Zielinski C. Establishment of a virtual transborder tumor board for cancer patients in Central and Southeastern Europe : An initiative of the Central European Cooperative Oncology Group (CECOG). Wien Klin Wochenschr 2022; 134:697-704. [PMID: 35312859 PMCID: PMC8936045 DOI: 10.1007/s00508-022-02016-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/02/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To establish a transborder virtual tumor board (VTB) fostering state-of-the-art management of cancer patients by exchanging knowledge and expertise among oncologists in Central and Southeastern Europe (CEE). METHODS We established and implemented a VTB based on the WebEx platform. This allowed for password-protected and secure upload of patient cases to be presented and discussed among colleagues from various oncology centers scattered throughout CEE in order to arrive at a recommendation for further diagnoses and/or treatment. RESULTS A total of 73 cases from 16 oncology centers located in 11 CEE countries were uploaded by 22 physicians; 71 were discussed over the course of 17 virtual meetings between June 2018 and May 2019 and 12 different kinds of malignant diseases were discussed with lung cancer (46.6%), melanoma (19.2%) and bladder cancer (13.6%) being the most commonly presented tumor entities. Of the discussed patients, 93.3% had stage IV disease at the time of presentation, 62.6% received chemotherapy or targeted treatment and 67.1% were treated with immune checkpoint inhibitors (ICPIs). The most common causes for presentation and discussion of patient cases were related to the use of ICPIs (80%). CONCLUSION When the need for expertise exceeds locally available resources, web-based VTBs provide a feasible way to discuss patient cases and arrive at conclusions regarding diagnoses and/or treatment across large geographic distances. Moreover, VTBs provide an innovative way for proper, state-of-the-art management of patients with malignant diseases in times of social distancing and the resulting need for restricted interaction during the current SARS-CoV‑2 (severe acute respiratory syndrome coronavirus type 2) pandemic.
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Affiliation(s)
- Christiane Thallinger
- Central European Cooperative Oncology Group, Ohmanngasse 26, 1190, Vienna, Austria.
- Department of Medicine I, Medical University Vienna-General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Peter Berzinec
- Department of Oncology at the Hospital of St Zoerardus Zobor, Nitra, Teaching Base of the Slovak Medical University Bratislava, Bratislava, Slovakia
| | - Emina Bicakcic
- Oncology Unit, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Adelina Dan
- Department of Medical Oncology at Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Gabriella Fabian
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Cvetka Grasic Kuhar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Urska Janzic
- Department of Medical Oncology, University Clinic Golnik, Golnik, Slovenia
| | - Zsusanna Kahan
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Marina Mencinger
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Joseph Sgouros
- 3rd Medical Oncology Department, "Agii Anargiri" General Hospital and Cancer Center, Athens, Greece
| | - Luka Simetic
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Milan Vosmik
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Anna Wrona
- Department of Oncology and Radiotherapy, Medical University Gdansk, Gdansk, Poland
| | - Christoph Zielinski
- Central European Cooperative Oncology Group, Ohmanngasse 26, 1190, Vienna, Austria
- Vienna Cancer Center, Vienna Hospital Association and Medical University Vienna, Vienna, Austria
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Fischer A, Hertwig A, Hahn R, Anwar M, Siebenrock T, Pesta M, Liebau K, Timmermann I, Brugger J, Posch M, Ringl H, Tamandl D, Hiesmayr M, Roth D, Zielinski C, Jäger U, Staudinger T, Schellongowski P, Lang I, Gottsauner-Wolf M, Mascherbauer J, Heinz G, Oberbauer R, Trauner M, Ferlitsch A, Zauner C, Wolf Husslein P, Krepler P, Shariat S, Gnant M, Sahora K, Laufer G, Taghavi S, Huk I, Radtke C, Markstaller K, Rössler B, Schaden E, Bacher A, Faybik P, Ullrich R, Plöchl W, Ihra G, Schäfer B, Mouhieddine M, Neugebauer T, Mares P, Steinlechner B, Schiferer A, Tschernko E. Validation of bedside ultrasound to predict lumbar muscle area in the computed tomography in 200 non-critically ill patients: The USVALID prospective study. Clin Nutr 2022; 41:829-837. [PMID: 35263692 DOI: 10.1016/j.clnu.2022.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/12/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Skeletal muscle area (SMA) in the computed tomography (CT) at the third lumbar vertebra (L3) level is a proxy for whole-body muscle mass but is only performed for clinical reasons. Ultrasound is a promising tool to determine muscle mass at the bedside. It is still unclear how well ultrasound and which ultrasound measuring points can predict CT L3 SMA. METHODS This prospective observational trial included 200 non-critically ill patients, who underwent an abdominal CT scan for any clinical reason within 48 h before the ultrasound examination. Ultrasound muscle thickness was evaluated at 3 measuring points on the thigh and 2 measuring points on the upper arm with minimal compression. On the CT scan, the entire L3 SMA was measured based on Hounsfield units. Using a model selection algorithm based on the Bayesian information criterion (BIC) and clinical considerations, a linear prediction model for CT L3 SMA based on the ultrasound muscle thickness and other independent variables was fitted and assessed with cross-validation. RESULTS 67,5% and 32,5% of the patients were from surgical and medical wards, respectively. Mean ultrasound muscle thickness values were between 2,2 and 3,6 cm on the thigh and between 1,4 and 2,8 cm on the upper arm. All ultrasound muscle thickness values were higher in men than in women (P < 0,05). CT L3 SMA was 40 cm2 higher in men than in women (P < 0,001). The final prediction model for CT L3 SMA included the following 4 independent variables: ultrasound muscle thickness at the ventral measuring point of the thigh in the short-axis plane, sex, weight, and height. It had a similar BIC (BIC of 1515) compared to larger models with 6-8 independent variables including multiple ultrasound measuring points (BIC of 1506-1519). Additional clinical considerations to choose the final model were less time consumption when measuring a single ultrasound measuring point and better anatomical overview at the short-axis plane. The final model predicted CT L3 SMA with a R2 of 0,74 (P < 0,001) and a cross-validated R2 of 0,65. CONCLUSIONS One single ultrasound measuring point at the thigh together with sex, height and weight very well predicts CT L3 SMA across different clinical populations. Ultrasound is a safe and bedside method to measure muscle thickness longitudinally to monitor the effects of nutrition and physical therapy.
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Affiliation(s)
- Arabella Fischer
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Anatol Hertwig
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Ricarda Hahn
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Martin Anwar
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Timo Siebenrock
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Maximilian Pesta
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Konstantin Liebau
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Isabel Timmermann
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Martin Posch
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Helmut Ringl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Michael Hiesmayr
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria.
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Pentheroudakis G, Curigliano G, Zielinski C. ESMO Clinical Practice Guidelines: adapting and adopting new approaches for development, implementation and audit. ESMO Open 2022; 7:100344. [PMID: 35026722 PMCID: PMC8760392 DOI: 10.1016/j.esmoop.2021.100344] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano and European Institute of Oncology, IRCCS, Milano, Italy
| | - C Zielinski
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria.
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22
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Kasper S, Cheng AL, Rouyer M, Foch C, Lamy FX, Esser R, Batech M, Wong C, Zhang A, Brodowicz T, Zielinski C. 415P Comparison of cetuximab every 2 weeks versus standard once-weekly administration for the first-line treatment of RAS wild-type metastatic colorectal cancer among patients with left- and right-sided primary tumor location. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kahan Z, Gil-Gil M, Ruiz-Borrego M, Carrasco E, Ciruelos E, Muñoz M, Bermejo B, Margeli M, Antón A, Casas M, Csöszi T, Murillo L, Morales S, Calvo L, Lang I, Alba E, de la Haba-Rodriguez J, Ramos M, López IÁ, Gal-Yam E, Garcia-Palomo A, Alvarez E, González-Santiago S, Rodríguez CA, Servitja S, Corsaro M, Rodrigálvarez G, Zielinski C, Martín M. Health-related quality of life with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive metastatic breast cancer: Patient-reported outcomes in the PEARL study. Eur J Cancer 2021; 156:70-82. [PMID: 34425406 DOI: 10.1016/j.ejca.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/21/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The PEARL study showed that palbociclib plus endocrine therapy (palbociclib/ET) was not superior to capecitabine in improving progression-free survival in postmenopausal patients with metastatic breast cancer resistant to aromatase inhibitors, but was better tolerated. This analysis compared patient-reported outcomes. PATIENTS AND METHODS The PEARL quality of life (QoL) population comprised 537 patients, 268 randomised to palbociclib/ET (exemestane or fulvestrant) and 269 to capecitabine. Patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 and EQ-5D-3L questionnaires. Changes from the baseline and time to deterioration (TTD) were analysed using linear mixed-effect and stratified Cox regression models, respectively. RESULTS Questionnaire completion rate was high and similar between treatment arms. Significant differences were observed in the mean change in global health status (GHS)/QoL scores from the baseline to cycle 3 (2.9 for palbociclib/ET vs. -2.1 for capecitabine (95% confidence interval [CI], 1.4-8.6; P = 0.007). The median TTD in GHS/QoL was 8.3 months for palbociclib/ET versus 5.3 months for capecitabine (adjusted hazard ratio, 0.70; 95% CI, 0.55-0.89; P = 0.003). Similar improvements for palbociclib/ET were also seen for other scales as physical, role, cognitive, social functioning, fatigue, nausea/vomiting and appetite loss. No differences were observed between the treatment arms in change from the baseline in any item of the EQ-5D-L3 questionnaire as per the overall index score and visual analogue scale. CONCLUSION Patients receiving palbociclib/ET experienced a significant delay in deterioration of GHS/QoL and several functional and symptom scales compared with capecitabine, providing additional evidence that palbociclib/ET is better tolerated. TRIAL REGISTRATION NUMBER NCT02028507 (ClinTrials.gov). EUDRACT STUDY NUMBER 2013-003170-27.
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Affiliation(s)
- Zsuzsanna Kahan
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.
| | - Miguel Gil-Gil
- Institut Catalá d'Oncologia (ICO), L'Hospitalet de Llobregat, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Manuel Ruiz-Borrego
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Carrasco
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Eva Ciruelos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; HM Hospitales Madrid, Spain; SOLTI Group on Breast Cancer Research, Spain
| | - Montserrat Muñoz
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitari Clinic de Barcelona, Institut Clinic de Malalties Hemato-Oncològiques-ICHMO, Barcelona, Spain
| | - Begoña Bermejo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria-INCLIVA Valencia, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain
| | - Mireia Margeli
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Badalona Applied Research Group in Oncology (ARGO Group), Institut Catalá d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antonio Antón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain; Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón-IISA, Zaragoza, Spain
| | | | - Tibor Csöszi
- Department of Oncology, Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelőintezet, Szolnok, Hungary
| | - Laura Murillo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Clínico de Zaragoza Lozano Blesa, Zaragoza, Spain
| | - Serafín Morales
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Lourdes Calvo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Istvan Lang
- Istenhegyi Géndiagnosztika Private Health Center Oncology Clinic, Hungary
| | - Emilio Alba
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain; UGCI Medical Oncology, Hospitales Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Juan de la Haba-Rodriguez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Instituto Maimonides de Investigacion Biomedica, Hospital Reina Sofia Hospital, Universidad de Córdoba, Córdoba, Spain
| | - Manuel Ramos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro Oncológico de Galicia, A Coruña, Spain
| | - Isabel Álvarez López
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario Donostia-Biodonostia, San Sebastián, Spain
| | - Einav Gal-Yam
- Institute of Oncology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Andrés Garcia-Palomo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology. Hospital de León, León, Spain
| | - Elena Alvarez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Santiago González-Santiago
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Universitario San Pedro de Alcantara, Cáceres, Spain
| | - César A Rodríguez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital Clínico Universitario de Salamanca-IBSAL, Spain
| | - Sonia Servitja
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Hospital del Mar, Barcelona, Spain
| | | | | | - Christoph Zielinski
- Vienna Cancer Center, Medical University Vienna and Vienna Hospital Association, Vienna, Austria; CECOG Central European Cooperative Oncology Group, Vienna, Austria
| | - Miguel Martín
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII, Madrid, Spain; Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain
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Morgan G, Preusser M, Zielinski C. Announcing the ESMO Open special issue on upcoming molecular targets for cancer treatment. ESMO Open 2021; 5:S2059-7029(20)30001-6. [PMID: 32312740 PMCID: PMC7204807 DOI: 10.1136/esmoopen-2020-000734] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
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Affiliation(s)
- C. Zielinski
- Central European Cooperative Oncology Group, Vienna, Austria
- Central European Cancer Center, Wiener Privatklinik, Vienna, Austria
- Editor in Chief, ESMO Open - Cancer Horizons
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Pascual J, Gil-Gil M, Zielinski C, Hills M, Ruiz-Borrego M, Ciruelos EM, Garcia-Murillas I, Muñoz M, Bermejo B, Swift C, Vila MM, Antón Torres A, Nissenbaum B, Murillo L, Liu Y, Herranz J, Caballero R, Guerrero-Zotano A, Turner NC, Martin M. CCNE1 mRNA and cyclin E1 protein expression as predictive biomarkers for efficacy of palbociclib plus fulvestrant versus capecitabine in the phase III PEARL study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1014] [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
1014 Background: The randomized PEARL trial found no superiority of palbociclib plus endocrine therapy over capecitabine in patients (pts) with metastatic HR-positive, HER2-negative breast cancer resistant to prior aromatase inhibitors (Martin M, Ann Oncol 2020). Gene expression analysis showed high CCNE1 mRNA ( CCNE1) conferring relative resistance to palbociclib in the PALOMA-3 trial (Turner N, JCO 2019), but further validation is needed. Cyclin E1 protein (cyclin E1) expression in this context has not been studied in randomized trials. We explored CCNE1 and cyclin E1 as predictive biomarkers in tumor samples from the PEARL study. Methods: Formalin-fixed paraffin-embeded tumor samples were retrieved from pts enrolled in PEARL cohort 2 (palbociclib (PAL) + fulvestrant (FUL) vs capecitabine (CAPE)). We measured CCNE1 using the HTG EdgeSeq Oncology Biomarker Panel (HTG Molecular Diagnostics). Cyclin E1 immunohistochemistry (IHC) staining was performed using specific mouse monoclonal antibody HE12 (Abcam) and scored as percentage of invasive nuclei stained (0-100%). CCNE1 and cyclin E1 correlations were explored using Pearson coefficients. Cox regression models were used for progression free-survival (PFS) analyses using expression levels split by median, to define high ( > median values) vs. low expression. Site of disease and prior chemotherapy were used as confounders in multivariate models. Results: Analyses were conducted in 219 pts (47% receiving PAL + FUL and 53% CAPE) with available tumors, with the analysed patients representative of the overall study. Most samples were from the archival primary (72%), obtained > 5 years before this analysisº (74%). CCNE1 and cyclin E1 were only moderately correlated (r = 0.5). Median CCNE1 was higher in metastatic vs primary (7.37 vs 6.94, p < 0.01), and in luminal B and non-luminal subtypes compared to luminal A (p < 0.001). In patients with high CCNE1 expression, median PFS on CAPE was 10.35 and PAL + FUL was 5.68 (HR = 1.63, 95% CI 1.02-2.59, p = 0.042). In patients with low CCNE1 expression, median PFS on CAPE was 9.43 and PAL + FUL was 8.97 (adjusted HR = 0.93, 95% CI 0.59-1.48, p = 0.762, interaction p = 0.072). Median cyclin E1 protein was higher in luminal B and non-luminal subtypes compared to luminal A (p < 0.01). Cyclin E1 protein expression was not predictive of treatment effect (high cyclin E1 expression CAPE vs PAL + FUL HR = 1.17, low cyclin E1 expression CAPE vs PAL + FUL HR = 1.21, interaction p = 0.977). Conclusions: High tumor CCNE1 mRNA expression identified patients with relative resistance to palbociclib plus fulvestrant, validating prior observations although without statistical significance for interaction. Assessment of Cyclin E1 protein expression did not show predictive value. Investigation treatments to enhance CDK4/6 inhibitor efficacy in tumors with high CCNE1 expression is warranted. Clinical trial information: NCT02028507 .
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Affiliation(s)
- Javier Pascual
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Miguel Gil-Gil
- Instituto Catalán de Oncología, Hospital Duran i Reynalds, IDIBELL. GEICAM Breast Cancer Group, Barcelona, Spain
| | - Christoph Zielinski
- Vienna Cancer Center, Medical University Vienna and Vienna Hospital Association. Central European Cooperative Oncology Group (CECOG), Vienna, Austria
| | - Margaret Hills
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Manuel Ruiz-Borrego
- Hospital Universitario Virgen del Rocio, GEICAM Breast Cancer Group, Seville, Spain
| | | | | | - Montserrat Muñoz
- Hospital Clínic Barcelona. GEICAM Breast Cancer Group, Barcelona, Spain
| | - Begoña Bermejo
- Hospital Clinico Universitario Valencia. Biomedical Research Institute INCLIVA. CIBERONC ISCIII. GEICAM, Breast Cancer Group, Valencia, Spain
| | - Claire Swift
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden, London, United Kingdom
| | - Mireia Margeli Vila
- Instituto Catalán de Oncología, Hospital Germans Trias i Pujol. GEICAM Breast Cancer Group, Badalona, Spain
| | - Antonio Antón Torres
- Hospital Universitario Miguel Servet. Geicam Breast Cancer Group, Zaragoza, Spain
| | | | - Laura Murillo
- Hospital General Universitario San Jorge, GEICAM Breast Cancer Group, Huesca, Spain
| | | | | | | | | | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Universidad Complutense de Madrid. GEICAM Breast Cancer Group, Madrid, Spain
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Gyawali B, de Vries EGE, Dafni U, Amaral T, Barriuso J, Bogaerts J, Calles A, Curigliano G, Gomez-Roca C, Kiesewetter B, Oosting S, Passaro A, Pentheroudakis G, Piccart M, Roitberg F, Tabernero J, Tarazona N, Trapani D, Wester R, Zarkavelis G, Zielinski C, Zygoura P, Cherny NI. Biases in study design, implementation, and data analysis that distort the appraisal of clinical benefit and ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) scoring. ESMO Open 2021; 6:100117. [PMID: 33887690 PMCID: PMC8086024 DOI: 10.1016/j.esmoop.2021.100117] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background The European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) is a validated, widely used tool developed to score the clinical benefit from cancer medicines reported in clinical trials. ESMO-MCBS scores assume valid research methodologies and quality trial implementation. Studies incorporating flawed design, implementation, or data analysis may generate outcomes that exaggerate true benefit and are not generalisable. Failure to either indicate or penalise studies with bias undermines the intention and diminishes the integrity of ESMO-MCBS scores. This review aimed to evaluate the adequacy of the ESMO-MCBS to address bias generated by flawed design, implementation, or data analysis and identify shortcomings in need of amendment. Methods As part of a refinement of the ESMO-MCBS, we reviewed trial design, implementation, and data analysis issues that could bias the results. For each issue of concern, we reviewed the ESMO-MCBS v1.1 approach against standards derived from Helsinki guidelines for ethical human research and guidelines from the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, the Food and Drugs Administration, the European Medicines Agency, and European Network for Health Technology Assessment. Results Six design, two implementation, and two data analysis and interpretation issues were evaluated and in three, the ESMO-MCBS provided adequate protections. Seven shortcomings in the ability of the ESMO-MCBS to identify and address bias were identified. These related to (i) evaluation of the control arm, (ii) crossover issues, (iii) criteria for non-inferiority, (iv) substandard post-progression treatment, (v) post hoc subgroup findings based on biomarkers, (vi) informative censoring, and (vii) publication bias against quality-of-life data. Conclusion Interpretation of the ESMO-MCBS scores requires critical appraisal of trials to understand caveats in trial design, implementation, and data analysis that may have biased results and conclusions. These will be addressed in future iterations of the ESMO-MCBS. We reviewed trial design, implementation, and data analysis issues that could bias the results of trials. These issues could skew the results of ESMO-MCBS scores. Six design, two implementation, and two analysis issues were reviewed, and seven shortcomings were identified. These issues will be addressed in future versions of the MCBS scale. Interpretation of MCBS scores requires critical appraisal of trials.
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Affiliation(s)
- B Gyawali
- Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada.
| | - E G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens; Frontier Science Foundation-Hellas, Athens, Greece
| | - T Amaral
- Skin Cancer Center, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - J Barriuso
- The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - J Bogaerts
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - A Calles
- Medical Oncology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan; European Institute of Oncology, IRCCS, Milan, Italy
| | - C Gomez-Roca
- Institut Universitaire du Cancer de Toulouse (IUCT), Toulouse, France
| | - B Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - S Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Passaro
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - M Piccart
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - F Roitberg
- WHO Cancer Management Consultant, Geneva, Switzerland; Instituto do Cancer do Estado de São Paulo (ICESP HCFMUSP), São Paulo, Brazil
| | - J Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), UVic-UCC, IO-Quiron, Barcelona, Spain
| | - N Tarazona
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, CIBERONC, University of Valencia, Valencia, Spain
| | - D Trapani
- European Institute of Oncology, IRCCS, Milan, Italy
| | - R Wester
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - G Zarkavelis
- University of Ioannina-Department of Medical Oncology, Ioannina, Greece
| | - C Zielinski
- Central European Cooperative Oncology Group and Central European Cancer Center, Wiener Privatklinik, Vienna, Austria
| | - P Zygoura
- Frontier Science Foundation-Hellas, Athens, Greece
| | - N I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
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Guerrero- Zotano A, Zielinski C, Gil-Gil M, Ruiz-Borrego M, Ciruelos EM, Munoz M, Bermejo B, Margeli M, Antón A, Csöszi T, García-Palomo A, Santaballa A, Alonso JL, Fernández A, Corsaro M, Herranz J, López P, Caballero R, Thallinger C, Martin M. Abstract PS2-01: Plk1 expression & efficacy of palbociclib in advanced hormonal receptor-positive breast cancer patients from PEARL study (GEICAM 2012-03). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps2-01] [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: CDK 4/6 inhibitors (CDK 4/6i) with endocrine therapy (ET) combination therapy have improved outcomes in patients (pts) with hormonal receptor positive (HR+)/human epidermal growth factor receptor negative (HER2-) advanced breast cancer (ABC). However, most pts eventually develop resistance to these drugs, and one third never respond. Aside from HR positivity, predictive markers of clinical benefit from CDK 4/6i remains elusive. We aimed to identify biomarkers of response to palbociclib (PAL) and analyze potential therapeutic targets to reverse resistance. Methods: PEARL trial is a multicenter phase 3 study that assigned 601 postmenopausal HR+/HER2- ABC pts, whose disease progressed on aromatase inhibitors (AIs), to receive PAL + ET vs capecitabine (CAPE). We performed a differential gene expression analysis in pre-treatment tumors in extreme responders to PAL using the HTG EdgeSeq Oncology Biomarker Panel (HTG Molecular Diagnostics, Inc.), containing 2534 cancer related genes. Samples were subset in 2 categories: refractory (progressive disease as best response) vs sensitive (progression-free survival (PFS) within the upper quartile). Cox regression and Significance Analysis of Microarrays (SAM) analysis adjusting for multiple comparisons were performed. Results: We analyzed 455 (75.7%) pts with pre-treatment tumors available [from them, PAL + ET arm: 229 (50.3%) pts; CAPE arm: 226 (49.7%) pts]. Fifty genes (false discovery rate (FDR)<0.05) were differentially expressed in pts sensitive vs refractory to PAL (E2F target genes, epithelial-to-mesenchymal transition (EMT) and cell cycle genes, mainly). Unsupervised hierarchical clustering of pts based on the expression of these genes revealed two clusters. Cluster 1 is composed mostly of resistant tumors, highly proliferative (Ki67≥20%: 70%) with a great proportion of luminal B (59%) and non-luminal tumors (19%). Cluster 2 is composed of sensitive, low proliferative (Ki67<20%: 58%), mostly luminal A tumors (75%). There was no difference in ESR1 mutations distribution between the two clusters (Table 1). Forty genes were up-regulated and associated with resistance, including CCNE1 and PLK1 (Polo Like Kinase 1). In the whole cohort, pts with high levels (> median) of PLK1 (PLK1-high) treated with PAL, had a worse PFS in a multivariate model (5.7 months (m) vs 9.3 m of median PFS in PLK1-High vs -Low; HR=1.64, 95% CI (1.25-2.34), p=0.0008; adjusted model for confounders: age, site of disease, sites of metastasis, prior chemotherapy and Ki67). There were no differences in population treated with CAPE (9.9 m vs 9.4 m, PLK1-High vs -Low; HR=0.82, 95% CI (0.56-1.21), p=0.3189). In the METABRIC cohort, PLK1-High was associated with worse overall survival in HR+/HER2- BC but not in triple negative nor in HER2+ tumors. Among HR+/HER2- tumors, PLK1 expression was higher in luminal B and HER2-enriched intrinsic subtypes. We interrogated DepMap database and found that in BC cells lines there was an inverse correlation between PLK1 expression and effect on cell viability of CDK4 CRISPR knock-out (Pearson correlation r:0.54, p=0.009), but not of CDK6 knock-out. Also, HR+/HER2-/High Ki67 BC cell lines (HCC1428, EFM19 and MCF7) showed resistance to PAL on cell proliferation assays but sensitivity to the PLK1 inhibitor BI-2536. Conclusion: High expression of PLK1 is associated with intrinsic resistance to PAL and ET, this might be overcome with PLK1 inhibition.
Table 1PATIENT CHARACTERISTICSCluster 1Cluster 2ALLn=57n=47n=104RespondersSensitive42 (73.68%)14 (29.79%)56 (53.85%)Refractory15 (26.32%)33 (70.21%)48 (46.15%)ESR1Mutated9 (15.79%)13 (27.66%)22 (21.15%)Wild type45 (78.95%)34 (72.34%)79 (75.96%)Unknown3 (5.26%)0 (0%)3 (2.88%)PriorQTN42 (73.68%)31 (65.96%)73 (70.19%)Y15 (26.32%)16 (34.04%)31 (29.81%)SubtypeLumA43 (75.44%)10 (21.28%)53 (50.96%)LumB14 (24.56%)28 (59.57%)42 (40.38%)Non Luminal0 (0%)9 (19.15%)9 (8.65%)MetastasisOne21 (36.84%)15 (31.91%)36 (34.62%)Multiple36 (63.16%)32 (68.09%)68 (65.38%)KI67 20%KI67<2033 (57.89%)7 (14.89%)40 (38.46%)KI67≥2016 (28.07%)33 (70.21%)49 (47.12%)Unknown8 (14.04%)7 (14.89%)15 (14.42%)Objective ResponseComplete1 (1.75%)0 (0%)1 (0.96%)Partial16 (28.07%)6 (12.77%)22 (21.15%)Progressive15 (26.32%)33 (70.21%)48 (46.15%)Stable25 (43.86%)8 (17.02%)33 (31.73%)
Citation Format: Angel Guerrero- Zotano, Christoph Zielinski, Miguel Gil-Gil, Manuel Ruiz-Borrego, Eva M. Ciruelos, Montserrat Munoz, Begoña Bermejo, Mireia Margeli, Antonio Antón, Tibor Csöszi, Andrés García-Palomo, Ana Santaballa, Jose Luis Alonso, Antonio Fernández, Massimo Corsaro, Jesús Herranz, Paula López, Rosalia Caballero, Christiane Thallinger, Miguel Martin. Plk1 expression & efficacy of palbociclib in advanced hormonal receptor-positive breast cancer patients from PEARL study (GEICAM 2012-03) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-01.
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Affiliation(s)
- Angel Guerrero- Zotano
- 1Instituto Valenciano de Oncologia (IVO). GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Christoph Zielinski
- 2Vienna Cancer Center, Medical University Vienna and Vienna Hospital Association. Central European Cooperative Oncology Group (CECOG), Vienna, Austria
| | - Miguel Gil-Gil
- 3Institut Catalá d’Oncologia (ICO), L’Hospitalet de Llobregat. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Manuel Ruiz-Borrego
- 4Hospital Universitario Virgen del Rocío. GEICAM Spanish Breast Cancer Group, Sevilla, Spain
| | - Eva M. Ciruelos
- 5Hospital Universitario 12 de Octubre. HM Hospitales. SOLTI Group on Breast Cancer Research. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Montserrat Munoz
- 6Hospital Universitari Clinic.Translational Genomics and Targeted Theraputics in Solid Tumor (IDIBAPS). GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Begoña Bermejo
- 7Hospital Clínico Universitario de Valencia, INCLIVA. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Mireia Margeli
- 8ARGO Group, Catalan Institut of Oncology, Hospital Universitari Germans Trias i Pujol, Badalona. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Antonio Antón
- 9Medical Oncology Department, Miguel Servet University Hospital, Aragon Health Research Institute. GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Tibor Csöszi
- 10Jász_Nagykun-Szolnok Megyei Hetényi Géza, Szolnok, Hungary
| | | | - Ana Santaballa
- 12Hospital Universitario y Politécnico La Fe. GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Jose Luis Alonso
- 13Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca. GEICAM Spanish Breast Cancer Group, Murcia, Spain
| | - Antonio Fernández
- 14Complejo Hospitalario Universitario de Albacete. GEICAM Spanish Breast Cancer Group, Albacete, Spain
| | | | | | - Paula López
- 16GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | | | - Miguel Martin
- 18Instituto de Investigación Sanitaria Gregorio Marañón. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group, Madrid, Spain
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Kasper S, Foch C, Messinger D, Esser R, Lamy FX, Rothe V, Chen W, Cheng AL, Rouyer M, Brodowicz T, Zielinski C. Noninferiority of cetuximab every-2-weeks versus standard once-weekly administration schedule for the first-line treatment of RAS wild-type metastatic colorectal cancer. Eur J Cancer 2021; 144:291-301. [PMID: 33383349 DOI: 10.1016/j.ejca.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 02/08/2023]
Abstract
AIM This study assessed whether cetuximab 500 mg/m2 administered every 2 weeks (Q2W), when combined with chemotherapy as a first-line (1L) treatment, was noninferior to the approved dose (400 mg/m2 followed by 250 mg/m2 once weekly [Q1W]) for overall survival (OS) in adults with RAS wild-type metastatic colorectal cancer (mCRC). METHODS This pooled analysis included patients receiving 1L treatment with cetuximab Q1W or Q2W in combination with chemotherapy from post-authorisation studies with patient-level data available to the sponsor. Baseline characteristics were adjusted with a propensity score using inverse probability of treatment weighting (IPTW). Noninferiority in terms of OS was tested with a noninferiority margin for the hazard ratio (HR) of 1.25 using a Cox proportional hazards regression model. Secondary outcomes were progression-free survival (PFS), overall response rate (ORR) and rates of lung/liver metastases resection and serious adverse events. RESULTS OS time was noninferior in the Q2W cohort (n = 554) compared to the Q1W cohort (n = 763), with a HR after IPTW (95% confidence interval) of 0.827 (0.715-0.956) and median OS times of 24.7 (Q1W) and 27.9 (Q2W) months. There were no major differences in PFS (HR: 0.915 [0.804-1.042]). The odds ratios (ORs) after IPTW for ORR (1.292 [1.031-1.617]) and the rates of lung/liver metastases resection (1.419 [1.043-1.932]) favoured the Q2W regimen. No differences were noted in the occurrence rate of any SAE between groups; the OR after IPTW was 1.089 (0.858-1.382). CONCLUSIONS The cetuximab Q2W regimen was noninferior to the Q1W regimen for OS in the 1L treatment of mCRC.
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Affiliation(s)
- Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.
| | | | | | | | | | | | | | - Ann-Lii Cheng
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, University of Bordeaux, Bordeaux, France
| | - Thomas Brodowicz
- Department of Medical Oncology, Internal Medicine 1, General Hospital - Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Medical Oncology, Internal Medicine 1, General Hospital - Medical University of Vienna, Vienna, Austria
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Martin M, Zielinski C, Ruiz-Borrego M, Carrasco E, Turner N, Ciruelos EM, Muñoz M, Bermejo B, Margeli M, Anton A, Kahan Z, Csöszi T, Casas MI, Murillo L, Morales S, Alba E, Gal-Yam E, Guerrero-Zotano A, Calvo L, de la Haba-Rodriguez J, Ramos M, Alvarez I, Garcia-Palomo A, Huang Bartlett C, Koehler M, Caballero R, Corsaro M, Huang X, Garcia-Sáenz JA, Chacón JI, Swift C, Thallinger C, Gil-Gil M. Palbociclib in combination with endocrine therapy versus capecitabine in hormonal receptor-positive, human epidermal growth factor 2-negative, aromatase inhibitor-resistant metastatic breast cancer: a phase III randomised controlled trial-PEARL. Ann Oncol 2020; 32:488-499. [PMID: 33385521 DOI: 10.1016/j.annonc.2020.12.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 09/01/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Palbociclib plus endocrine therapy (ET) is the standard treatment of hormone receptor-positive and human epidermal growth factor receptor 2-negative, metastatic breast cancer (MBC). However, its efficacy has not been compared with that of chemotherapy in a phase III trial. PATIENTS AND METHODS PEARL is a multicentre, phase III randomised study in which patients with aromatase inhibitor (AI)-resistant MBC were included in two consecutive cohorts. In cohort 1, patients were randomised 1 : 1 to palbociclib plus exemestane or capecitabine. On discovering new evidence about estrogen receptor-1 (ESR1) mutations inducing resistance to AIs, the trial was amended to include cohort 2, in which patients were randomised 1 : 1 between palbociclib plus fulvestrant and capecitabine. The stratification criteria were disease site, prior sensitivity to ET, prior chemotherapy for MBC, and country of origin. Co-primary endpoints were progression-free survival (PFS) in cohort 2 and in wild-type ESR1 patients (cohort 1 + cohort 2). ESR1 hotspot mutations were analysed in baseline circulating tumour DNA. RESULTS From March 2014 to July 2018, 296 and 305 patients were included in cohort 1 and cohort 2, respectively. Palbociclib plus ET was not superior to capecitabine in both cohort 2 [median PFS: 7.5 versus 10.0 months; adjusted hazard ratio (aHR): 1.13; 95% confidence interval (CI): 0.85-1.50] and wild-type ESR1 patients (median PFS: 8.0 versus 10.6 months; aHR: 1.11; 95% CI: 0.87-1.41). The most frequent grade 3-4 toxicities with palbociclib plus exemestane, palbociclib plus fulvestrant and capecitabine, respectively, were neutropenia (57.4%, 55.7% and 5.5%), hand/foot syndrome (0%, 0% and 23.5%), and diarrhoea (1.3%, 1.3% and 7.6%). Palbociclib plus ET offered better quality of life (aHR for time to deterioration of global health status: 0.67; 95% CI: 0.53-0.85). CONCLUSIONS There was no statistical superiority of palbociclib plus ET over capecitabine with respect to PFS in MBC patients resistant to AIs. Palbociclib plus ET showed a better safety profile and improved quality of life.
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Affiliation(s)
- M Martin
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Medicine Department, Universidad Complutense, Madrid, Spain; Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain.
| | - C Zielinski
- Medical Oncology, Central European Cancer Center, Wiener Privatklinik Hospital, Vienna, Austria; CECOG Central European Cooperative Oncology Group, Vienna, Austria
| | - M Ruiz-Borrego
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - E Carrasco
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - N Turner
- Institute of Cancer Research and Royal Marsden, London, UK
| | - E M Ciruelos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain; Medical Oncology, HM Hospitales Madrid, Madrid, Spain; SOLTI Group on Breast Cancer Research, Barcelona, Spain
| | - M Muñoz
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors (IDIBAPS), Barcelona, Spain
| | - B Bermejo
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Biomedical Research Institute INCLIVA, Valencia, Spain
| | - M Margeli
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; B-ARGO Group, Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A Anton
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Z Kahan
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - T Csöszi
- Department of Oncology, Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelőintezet, Szolnok, Hungary
| | - M I Casas
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - L Murillo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Clínico de Zaragoza Lozano Blesa, Zaragoza, Spain
| | - S Morales
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - E Alba
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; UGCI Medical Oncology, Hospitales Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - E Gal-Yam
- Department of Oncology, Institute of Oncology, Sheba Medical Center, Tel-Hashomer, Israel
| | - A Guerrero-Zotano
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Instituto Valenciano de Oncología, Valencia, Spain
| | - L Calvo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Complejo Hospitalario A Coruña, Coruña, Spain
| | - J de la Haba-Rodriguez
- Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain; GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario Reina Sofia, Córdoba; Instituto Maimonides de Investigación Biomédica (IMIBIC); Universidad de Córdoba, Córdoba, Spain
| | - M Ramos
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Centro Oncológico de Galicia, A Coruña, Coruña, Spain
| | - I Alvarez
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Universitario Donostia-Biodonostia, San Sebastián, Spain
| | - A Garcia-Palomo
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital de León, León, Spain
| | | | - M Koehler
- Pfizer, USA; Repare Therapeutics, Cambridge, USA
| | - R Caballero
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | | | - J A Garcia-Sáenz
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - J I Chacón
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Medical Oncology, Hospital Virgen de la Salud, Toledo, Spain
| | - C Swift
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden, London, UK
| | - C Thallinger
- CECOG Central European Cooperative Oncology Group, Vienna, Austria; Department of Oncology, Medical University of Vienna, Department of Oncology, Vienna, Austria
| | - M Gil-Gil
- GEICAM Spanish Breast Cancer Group, Madrid, Spain; Institut Català d'Oncologia (ICO) & IDIBELL, L'Hospitalet, Barcelona, Spain
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Dediu M, Zielinski C. Reply to the Correspondence by Untch et al. "Concerning Dediu M, Zielinski C: A Proposal to Redefine Pathologic Complete Remission as Endpoint following Neoadjuvant Chemotherapy in Early Breast Cancer" [Breast Care 2019; DOI 10.1159/000500624]. Breast Care (Basel) 2020; 15:314-316. [PMID: 32774227 DOI: 10.1159/000502508] [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] [Received: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Christoph Zielinski
- Vienna Cancer Center, Vienna Hospital Association and Medical University Vienna, Vienna, Austria
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Peters S, Danson S, Hasan B, Dafni U, Reinmuth N, Majem M, Tournoy KG, Mark MT, Pless M, Cobo M, Rodriguez-Abreu D, Falchero L, Moran T, Ortega Granados AL, Monnet I, Mohorcic K, Sureda BM, Betticher D, Demedts I, Macias JA, Cuffe S, Luciani A, Sanchez JG, Curioni-Fontecedro A, Gautschi O, Price G, Coate L, von Moos R, Zielinski C, Provencio M, Menis J, Ruepp B, Pochesci A, Roschitzki-Voser H, Besse B, Rabaglio M, O'Brien MER, Stahel RA. A Randomized Open-Label Phase III Trial Evaluating the Addition of Denosumab to Standard First-Line Treatment in Advanced NSCLC: The European Thoracic Oncology Platform (ETOP) and European Organisation for Research and Treatment of Cancer (EORTC) SPLENDOUR Trial. J Thorac Oncol 2020; 15:1647-1656. [PMID: 32565388 DOI: 10.1016/j.jtho.2020.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/07/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Receptor activator of NF-kB ligand stimulates NF-kB-dependent cell signaling and acts as the primary signal for bone resorption. Retrospective analysis of a large trial comparing denosumab versus zoledronic acid in bone metastatic solid tumors suggested significant overall survival (OS) advantage for patients with lung cancer with denosumab (p = 0.01). The randomized open-label phase III SPLENDOUR trial was designed to evaluate whether the addition of denosumab to standard first-line platinum-based doublet chemotherapy improved OS in advanced NSCLC. METHODS Patients with stage IV NSCLC were randomized in a 1:1 ratio to either chemotherapy with or without denosumab (120 mg every 3-4 wks), stratified by the presence of bone metastases (at diagnosis), Eastern Cooperative Oncology Group performance status, histology, and region. To detect an OS increase from 9 to 11.25 months (hazard ratio [HR] = 0.80), 847 OS events were required. The trial closed prematurely owing to decreasing accrual rate. RESULTS A total of 514 patients were randomized, with 509 receiving one or more doses of the assigned treatment (chemotherapy: 252, chemotherapy-denosumab: 257). The median age was 66.1 years, 71% were men, and 59% were former smokers. Bone metastases were identified in 275 patients (53%). Median OS (95% confidence interval [CI]) was 8.7 (7.6-11.0) months in the control arm versus 8.2 (7.5-10.4) months in the chemotherapy-denosumab arm (HR = 0.96; 95% CI: 0.78-1.19; one-sided p = 0.36). For patients with bone metastasis, HR was 1.02 (95% CI: 0.77-1.35), whereas for those without, HR was 0.90 (95% CI: 0.66-1.23). Adverse events grade 3 or greater were observed in 40.9%, 5.2%, 8.7% versus 45.5%, 10.9%, 10.5% of patients. Conditional power for OS benefit was less than or equal to 10%. CONCLUSIONS Denosumab was well-tolerated without unexpected safety concerns. There was no OS improvement for denosumab when added to chemotherapy in the intention-to-treat population and the subgroups with and without bone metastases. Our data do not provide evidence of a clinical benefit for denosumab in patients with NSCLC without bone metastases.
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Affiliation(s)
- Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - Sarah Danson
- Department of Oncology and Metabolism & Sheffield Experimental Cancer Medicine Centre, University of Sheffield, Weston Park Hospital, Sheffield, United Kingdom
| | - Baktiar Hasan
- European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Urania Dafni
- School of Health Sciences, National and Kapodistrian University of Athens & Frontier Science Foundation-Hellas, Athens, Greece
| | - Niels Reinmuth
- Asklepios Kliniken GmbH, Asklepios Fachkliniken Muenchen, Gauting, Germany
| | - Margarita Majem
- Department of Medical Oncology, Hospital De La Santa Creu I Sant Pau, Barcelona, Spain; Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain
| | - Kurt G Tournoy
- Faculty of Medicine and Life Sciences, Ghent University and Onze-Lieve-Vrouwziekenhuis (OLV), Aalst, Belgium
| | - Michael T Mark
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Department of Medical Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Miklos Pless
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Department of Medical Oncology and Hematology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Manuel Cobo
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; Unidad Gestion Intercentros of Medical Oncology. Regional and Virgen de la Victoria University Hospitals (IBIMA), Málaga, Spain
| | - Delvys Rodriguez-Abreu
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Lionel Falchero
- Department of Pneumology and Thoracic Oncology, Hopital Nord-Ouest, Villefranche-sur-Saône Cedex, France
| | - Teresa Moran
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; Department of Medical Oncology, Institut Català d'Oncologia (ICO) Badalona, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona Applied Research Group in Oncology (B-ARGO), Barcelona, Spain
| | - Ana Laura Ortega Granados
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; Department of Medical Oncology, Hospital Universitario de Jaén, Jaén, Spain
| | - Isabelle Monnet
- Department of Pneumology, Centre Hopitalier Intercommunal De Créteil, Créteil, France
| | - Katja Mohorcic
- Department of Medical Oncology, University Clinic Golnik, Golnik, Slovenia
| | - Bartomeu Massutí Sureda
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; El Instituto de Investigación Sanitaria y Biomédica de Alicante (SABIAL), Hospital Universitario Alicante, Alicante, Spain
| | - Daniel Betticher
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Department of Medical Oncology, Fribourg Cantonal Hospital (HFR), Fribourg, Switzerland
| | - Ingel Demedts
- Department of Pulmonary Diseases, AZ Delta, Roeselare, Belgium
| | - Jose Antionio Macias
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; Department of Hematology and Oncology, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Sinead Cuffe
- Cancer Trials Ireland, Dublin, Ireland; Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Andrea Luciani
- Department of Medical Oncology, Ospedale San Paolo, Milano, Italy
| | - Jose Garcia Sanchez
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; Department of Medical Oncology, University Hospital Arnau de Vilanova, Valencia, Spain
| | - Alessandra Curioni-Fontecedro
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Department for Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Oliver Gautschi
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cantonal Hospital Lucerne, Lucern, Switzerland
| | - Gillian Price
- Department of Medical Oncology, Aberdeen Royal Infirmary NHS Grampian, Aberdeen, United Kingdom
| | - Linda Coate
- Cancer Trials Ireland, Dublin, Ireland; Mid-Western Cancer Centre, University Hospital Limerick, Limerick, Ireland
| | - Roger von Moos
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Department of Medical Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Zielinski
- Clinical Division of Oncology, Medical University Vienna, Vienna, Austria; Central European Cooperative Oncology Group, Vienna, Austria
| | - Mariano Provencio
- Spanish lung cancer group (Grupo Español de Cancer de Pulmón (GECP)), Barcelona, Spain; Department of Medical Oncology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jessica Menis
- European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology Department, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Barbara Ruepp
- European Thoracic Oncology Platform (ETOP), Bern, Switzerland
| | - Alessia Pochesci
- European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | - Benjamin Besse
- European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Gustave Roussy Cancer Center Villejuif, Paris Saclay University, Orsay, France
| | | | - Mary E R O'Brien
- Department of Medical Oncology, Royal Marsden Hospital, Sutton, United Kingdom
| | - Rolf A Stahel
- Department for Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
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33
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Moik F, Posch F, Zielinski C, Pabinger I, Ay C. Direct oral anticoagulants compared to low-molecular-weight heparin for the treatment of cancer-associated thrombosis: Updated systematic review and meta-analysis of randomized controlled trials. Res Pract Thromb Haemost 2020; 4:550-561. [PMID: 32548553 PMCID: PMC7292654 DOI: 10.1002/rth2.12359] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 04/13/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background Low‐molecular‐weight‐heparins (LMWHs) have been established for the treatment of cancer‐associated venous thromboembolism (VTE). Recently published randomized controlled trials (RCTs) have compared direct oral anticoagulants (DOACs) with LMWHs. The aim of this systematic review and meta‐analysis was to evaluate efficacy and safety of DOACs versus LMWHs and update the evidence for treatment of VTE in cancer. Methods Biomedical databases were screened for RCTs evaluating DOACs for cancer‐associated VTE. Primary efficacy and safety outcomes of this meta‐analysis were recurrent VTE and major bleeding at 6 months. Secondary outcomes comprised clinically relevant nonmajor bleeding (CRNMB), major gastrointestinal (GI) and genitourinary bleeding, mortality, fatal bleeding/pulmonary embolism, and treatment discontinuation rate. We performed prespecified subgroup analyses. Pooled relative risk (RR) and 95% confidence intervals (CIs) were obtained by the Mantel‐Haenszel method within a random‐effect model. Results We screened 759 articles and included 4 RCTs (n = 2894). DOACs significantly reduced recurrent VTEs compared to LMWHs (5.2% vs 8.2%; RR, 0.62 [95% CI, 0.43‐0.91]), but were associated with a nonsignificant increase in major bleedings (4.3% vs 3.3%; RR, 1.31 [95% CI, 0.83‐2.08]) and a significant increase in CRNMB (10.4% vs 6.4%; RR, 1.65 [95% CI, 1.19‐2.28]). Mortality risks were comparable between groups (RR, 0.99 [95% CI, 0.83‐1.18]). Preterm treatment discontinuation was less common with DOACs (RR, 0.88 [95% CI, 0.81‐0.96]). Major bleeding was more frequent in patients with GI cancer treated with DOACs (RR, 2.30 [95% CI, 1.08‐4.88]). Conclusion In patients with cancer‐associated VTE, DOACs are more effective in preventing recurrent VTE compared to LMWH. However, risk of bleeding is increased with DOACs, especially in patients with GI cancer.
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Affiliation(s)
- Florian Moik
- Clinical Division of Haematology and Haemostaseology Department of Medicine I Comprehensive Cancer Center Vienna Medical University of Vienna Vienna Austria
| | - Florian Posch
- Division of Oncology Department of Internal Medicine Comprehensive Cancer Center Graz Medical University of Graz Graz Austria
| | - Christoph Zielinski
- Vienna Cancer Center Vienna Hospital Association and Medical University Vienna Vienna Austria
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology Department of Medicine I Comprehensive Cancer Center Vienna Medical University of Vienna Vienna Austria
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology Department of Medicine I Comprehensive Cancer Center Vienna Medical University of Vienna Vienna Austria
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Martin M, Zielinski C, Ruiz-Borrego M, Carrasco EM, Ciruelos E, Muñoz M, Bermejo B, Vila MM, Turner NC, Casas M, Anton A, Murillo Jaso L, Lang I, Bartlett CH, Koehler M, Martin N, Corsaro M, Swift C, Nisenbaum B, Gil Gil MJ. Prognostic and predictive value of ESR1 mutations in postmenopausal metastatic breast cancer (MBC) patients (pts) resistant to aromatase inhibitors (AI), treated with palbociclib (PAL) in combination with endocrine therapy (ET) or capecitabine (CAP) in the PEARL study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1022] [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
1022 Background: Prior retrospective data has shown ESR1 mutation is an acquired resistant mechanism to AI. However, little is known about ist prognostic and predictive value to endocrine-based therapy and chemotherapy. PEARL study compared PAL+ET vs CAP in AI resistant patients. Here we wxplored prospectively the ESR1 mutational status based on updated PFS and OS. Methods: PEARL is a phase 3 study with 2 subsequent cohorts: cohort 1 with 296 pts randomized to PAL+Exemestane (EXE) vs CAP and cohort 2 with 305 pts randomized to PAL+ Fulvestran (FUL) vs CAP. ESR1 hotspot mutations were analyzed in circulating free DNA at baseline by digital PCR. Cox regresion analysis for PFS and OS were performed. Adjusted hazard ratios (aHR) and interaction test between treatment and ESR1 status were calculated. Results: ESR1 mutational status was assessed in 557 pts, 91% and 94% treated with CAP and PAL+ET, respectively; 164 (29%) had ESR1 mutations. Characteristics between ESR1 wild-type (WT) and mutated pts were balanced except for ECOG, prior sensitivity to ET, treatment line, prior AI for metastatic disease and time from first metastatic diagnosis to randomization. Median follow-up was 22.5 months (m). Median PFS was 9.6 vs. 7.5 m (HR: 1.06 [0.88 - 1.28], p = 0.522) and median OS was 30.2 vs 30.3 (HR: 0.99 [0.78 - 1.26] p = 0.934), for CAP vs. PAL+ET, respectively. No interaction was seen between treatment arm and ESR1 status either for PFS (p = 0.538) or OS (p = 0.957). Conclusions: In luminal MBC, ESR1-mutated pts had poorer OS than ESR1-WT pts regardless of treatment received. Clinical trial information: NCT02028507 . [Table: see text]
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Affiliation(s)
- Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERONC, Madrid, Spain
| | | | - Manuel Ruiz-Borrego
- Hospital Universitario Virgen del Rocio, GEICAM Spanish Breast Cancer Group, Seville, Spain
| | | | - Eva Ciruelos
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Montserrat Muñoz
- Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques Pi i Sunyer-IDIBAPS, GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Begoña Bermejo
- Hospital Clinico Universitario de Valencia, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Mireia Margeli Vila
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, GEICAM Spanish Breast Cancer Group, Badalona, Spain
| | - Nicholas C. Turner
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | - Antonio Anton
- Hospital Universitario Miguel Servet, Geicam Spanish Breast Cancer Group, Zaragoza, Spain
| | - Laura Murillo Jaso
- Hospital Clínico Universitario Lozano Blesa, GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Istvan Lang
- Istenhegyi Géndiagnosztika Private Health Center Oncology Clinic, Budapest, Hungary
| | | | | | - Nuria Martin
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | - Claire Swift
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden, London, United Kingdom
| | | | - Miguel J. Gil Gil
- Breast Cancer Unit & Medical Oncology Department, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
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35
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Anker MS, Frey MK, Goliasch G, Bartko PE, Prausmüller S, Gisslinger H, Kornek G, Strunk G, Raderer M, Zielinski C, Hülsmann M, Pavo N. Increased resting heart rate and prognosis in treatment-naïve unselected cancer patients: results from a prospective observational study. Eur J Heart Fail 2020; 22:1230-1238. [PMID: 32202022 PMCID: PMC7540544 DOI: 10.1002/ejhf.1782] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/21/2020] [Accepted: 02/16/2020] [Indexed: 12/19/2022] Open
Abstract
Aims Cancer patients suffer from impaired cardiovascular function. Elevated resting heart rate (RHR) has been identified as a marker for increased long‐term mortality in cancer patients prior to the receipt of anticancer treatment. We aimed to establish whether RHR is associated with survival in treatment‐naïve cancer patients. Methods and results This prospective study enrolled 548 unselected treatment‐naïve cancer patients between 2011 and 2013. The median age of the cohort was 62 years; 40.9% were male and 32.7% had metastatic disease. Median RHR was 72 b.p.m. Most patients were in sinus rhythm (n = 507, 92.5%). Clinical heart failure was noted in 37 (6.8%) patients. RHR was not related to cancer stage (P = 0.504). Patients in the highest RHR tertile had higher levels of high‐sensitivity troponin (P = 0.003) and N‐terminal pro‐B‐type natriuretic peptide (P = 0.039). During a median follow‐up of 25 months (interquartile range: 16–32 months; range: 0–40 months), 185 (33.8%) patients died from any cause [1‐year‐mortality: 17%, 95% confidence interval (CI) 13–20%]. In univariate survival analysis, RHR predicted all‐cause mortality [crude hazard ratio (HR) for a 5 b.p.m. increase in RHR: 1.09, 95% CI 1.04–1.15; P < 0.001], and remained significantly associated with outcome after adjustment for age, gender, tumour entity, tumour stage, cardiac status and haemoglobin (adjusted HR for a 5 b.p.m. increase in RHR: 1.10, 95% CI 1.04–1.16; P < 0.001). There was no significant impact of metastatic/non‐metastatic disease state on the predictive value of RHR (P = 0.433 for interaction). In subgroup analyses, the strongest associations for RHR with mortality were observed in lung (crude HR 1.14; P = 0.007) and gastrointestinal (crude HR 1.31; P < 0.001) cancer. Conclusions Treatment‐naïve cancer patients with higher RHRs display higher levels of cardiovascular biomarkers. RHR was independently associated with all‐cause mortality, especially in lung and gastrointestinal cancers. Elevated RHR and cardiovascular biomarkers may represent early signs of incipient cardiac dysfunction.
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Affiliation(s)
- Markus S Anker
- Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (Campus CVK), Berlin, Germany.,Department of Cardiology, Charité Universitätsmedizin Berlin (Campus CBF), Berlin, Germany
| | - Maria K Frey
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Suriya Prausmüller
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Gabriela Kornek
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Guido Strunk
- Department of Complexity Research, Complexity Science Hub, Vienna, Austria.,Department of Integrated Safety and Security, University of Applied Sciences, FH Campus Vienna, Vienna, Austria.,Department of Entrepreneurship and Economic Education, Faculty of Business and Economics, Technical University Dortmund, Dortmund, Germany
| | - Markus Raderer
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
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36
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Guzek A, Berghoff A, Jasinska J, Garner-Spitzer E, Wagner A, Stiasny K, Holzmann H, Kundi M, Zielinski C, Wiedermann U. Reduced seroprevalence against vaccine preventable diseases (VPDs) in adult patients with cancer: necessity of routine vaccination as part of the therapeutic concept. Ann Oncol 2020; 31:319-321. [DOI: 10.1016/j.annonc.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/17/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022] Open
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Dediu M, Zielinski C. A Proposal to Redefine Pathologic Complete Remission as Endpoint following Neoadjuvant Chemotherapy in Early Breast Cancer. Breast Care (Basel) 2020; 15:67-71. [PMID: 32231500 PMCID: PMC7098275 DOI: 10.1159/000500620] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/20/2018] [Indexed: 12/24/2022] Open
Abstract
Many analyses of the efficacy of neoadjuvant treatment (NAT) for early breast cancer including a meta-analysis derived from 10 randomized trials came to the conclusion that patients who would achieve pathologic complete response (pCR) following NAT would experience significant improvement in disease-free and overall survival (OS). Thus, pCR was proposed as a surrogate endpoint for OS, with pCR representing a robust prognostic marker for survival at an individual level. In the current analysis, we argue that OS following NAT-induced pCR might have reflected the initial prognosis of patients mainly defined - among other factors - by the initial pathological lymph node status while being largely independent on the type of administrated treatment, thus pleading against the pCR surrogacy hypothesis. We therefore propose to redefine pCR as a surrogate endpoint of NAT trials by the involvement of additional biologic parameters.
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Affiliation(s)
| | - Christoph Zielinski
- Comprehensive Cancer Center, General Hospital, Medical University Vienna, Vienna, Austria
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38
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Cufer T, Ciuleanu TE, Berzinec P, Galffy G, Jakopovic M, Jassem J, Jovanovic D, Mihaylova Z, Ostoros G, Thallinger C, Zemanova M, Zielinski C. Access to Novel Drugs for Non-Small Cell Lung Cancer in Central and Southeastern Europe: A Central European Cooperative Oncology Group Analysis. Oncologist 2019; 25:e598-e601. [PMID: 32162818 PMCID: PMC7066717 DOI: 10.1634/theoncologist.2019-0523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background Treatment of non‐small cell lung cancer (NSCLC) improved substantially in the last decades. Novel targeted and immune‐oncologic drugs were introduced into routine treatment. Despite accelerated development and subsequent drug registrations by the European Medicinal Agency (EMA), novel drugs for NSCLC are poorly accessible in Central and Eastern European (CEE) countries. Material and Methods The Central European Cooperative Oncology Group conducted a survey among experts from 10 CEE countries to provide an overview on the availability of novel drugs for NSCLC and time from registration to reimbursement decision in their countries. Results Although first‐generation epidermal growth factor receptor tyrosine kinase inhibitors were reimbursed and available in all countries, for other registered therapies—even for ALK inhibitors and checkpoint inhibitors in first‐line—there were apparent gaps in availability and/or reimbursement. There was a trend for better availability of drugs with longer time from EMA marketing authorization. Substantial differences in access to novel drugs among CEE countries were observed. In general, the availability of drugs is not in accordance with the Magnitude of Clinical Benefit Scale (MCBS), as defined by the European Society for Medical Oncology (ESMO). Time spans between drug registrations and national decisions on reimbursement vary greatly, from less than 3 months in one country to more than 1 year in the majority of countries. Conclusion The access to novel drugs for NSCLC in CEE countries is suboptimal. To enable access to the most effective compounds within the shortest possible time, reimbursement decisions should be faster and ESMO MCBS should be incorporated into decision making. Access to novel therapies is a factor contributing to disparities in cancer care. Limited drug availability is a challenge in Central and Eastern European countries, where financial and organizational shortages exist. This article reports a survey that investigated access to novel anti‐cancer drugs for non‐small cell lung cancer.
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Affiliation(s)
- Tanja Cufer
- Medical Faculty Ljubljana, University Clinic GolnikLjubljanaSlovenia
| | - Tudor E. Ciuleanu
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuta" Institute of OncologyCluj‐NapocaRomania
| | - Peter Berzinec
- Department of Oncology, Hospital of St Zoerardus ZoborNitraSlovakia
| | - Gabriela Galffy
- Department of Chest Surgery, Pest County Pulmonology HospitalTörökbálintHungary
| | - Marko Jakopovic
- Department for Respiratory Disease Jordanovic, University Hospital Centre ZagrebZagrebCroatia
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of GdanskGdanskPoland
| | - Dragana Jovanovic
- Department of Palliative Medicine, University Hospital of Pulmonology, Clinical Center of SerbiaBelgradeSerbia
| | | | - Gyula Ostoros
- Department of Pulmunology, National Koranyi Institute of PulmunologyBudapestHungary
| | - Christiane Thallinger
- Department of Medicine I, Medical University of Vienna – General HospitalViennaAustria and Central European Cooperative Oncology Group (CECOG)
| | - Milada Zemanova
- Department of Oncology, University HospitalPragueCzech Republic
| | - Christoph Zielinski
- Vienna Cancer Center, Medical University of Vienna – General HospitalViennaAustria and Central European Cooperative Oncology Group (CECOG)
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Richtig G, Richtig E, Böhm A, Oing C, Bozorgmehr F, Kruger S, Kiesewetter B, Zielinski C, Berghoff AS. Awareness of predatory journals and open access among medical oncologists: results of an online survey. ESMO Open 2019; 4:e000580. [PMID: 31803502 PMCID: PMC6890386 DOI: 10.1136/esmoopen-2019-000580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Predatory journals harm the integrity of science as principles of 'good scientific practice' are bypassed by omitting a proper peer-review process. Therefore, we aimed to explore the awareness of predatory journals among oncologists. Methods An online survey among oncologists working in Germany or Austria of various professional surroundings was conducted between October 2018 and April 2019. Results One hundred and eighty-eight participants (55 women (29.2%), 128 men (68.1%)) completed the questionnaire. 41 (21.8%) participants indicated to work in a hospital, 24 (12.8%) in private practice and 112 (59.6%) in a university hospital. 98.9% of participants indicated to actively read scientific articles and consider them in clinical decision-making (96.3%). 90.4% of participants indicated to have scientific experience by publishing papers in journals with peer-review system. The open-access system was known by 170 (90.4%), predatory journals by 131 (69.7%) and Beall's list by 52 participants (27.7%). Predatory journals were more likely to be known by participants with a higher number of publications (p<0.001), with more high-impact publications (p=0.005) and with recent publications (p<0.001). Awareness of predatory journals did not correlate with gender (p=0.515) or translation of scientific literature into clinical practice (p=0.543). Conclusions The problematic topic of 'predatory journals' is still unknown by a considerable amount of oncologist, although the survey was taken in a cohort of oncologists with scientific experience. Dedicated educational initiatives are needed to raise awareness of this problem and to aid in the identification of predatory journals for the scientific oncology community.
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Affiliation(s)
- Georg Richtig
- Otto-Loewi Research Center, Pharmacology Section, Medical University of Graz, Graz, Austria
- Divison of Oncology, Medical University of Graz, Graz, Austria
| | - Erika Richtig
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Alexandra Böhm
- 3rd Medical Department, Division of Hematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Divison of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- The Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, School of Medical Sciences, Manchester, UK
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Centre Heidelberg (TLRC-H), Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Stephan Kruger
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Barbara Kiesewetter
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Vienna Cancer Center, Central European Cooperative Oncology Group (CECOG), Vienna, Austria
| | - Anna S Berghoff
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
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40
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Awada A, Gligorov J, Jerusalem G, Preusser M, Singer C, Zielinski C. CDK4/6 inhibition in low burden and extensive metastatic breast cancer: summary of an ESMO Open-Cancer Horizons pro and con discussion. ESMO Open 2019; 4:e000565. [PMID: 31798979 PMCID: PMC6863664 DOI: 10.1136/esmoopen-2019-000565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/11/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 12/31/2022] Open
Abstract
In December 2017, ESMO Open-Cancer Horizons convened a round-table discussion on the background and latest data regarding cyclin-dependent kinase (CDK)4/6 inhibitors with endocrine therapy (ET) in the treatment of endocrine-sensitive breast cancer (BC). A review on this discussion was published in summer 2018 (https://esmoopen.bmj.com/content/3/5/e000368).Endocrine-sensitive BC with non-visceral disease and limited spread of the metastases.Endocrine-sensitive BC with non-life-threatening visceral involvement. Several open questions were identified, which led to a second ESMO Open discussion on CDK4/6 inhibitors, taking place in December 2018 and covered in this article. The panel discussed two important clinical scenarios and the pro and cons of a treatment approach with CDK4/6 inhibitors for each scenario:Endocrine-sensitive BC with non-visceral disease and limited spread of the metastases.Endocrine-sensitive BC with non-life-threatening visceral involvement. Regarding scenario 1, the panel agreed that CDK4/6 inhibitors should be recommended in first-line therapy for most patients if cost and practicality allow. However, the use of single-agent ET with an aromatase inhibitor in the first-line treatment of these patients is still a possibility for a small group of patients with very limited disease, such as one or two bone lesions or limited lymph node involvement. Regarding scenario 2, chemotherapy is the first approach for patients with endocrine-sensitive metastatic BC with life-threatening visceral involvement because of the need for a faster response. The therapeutic approaches for patients with non-life-threatening visceral involvement are still under debate. Nevertheless, CDK4/6 inhibitors are currently the treatment of choice for most patients with a close follow-up of tumour response. A treatment algorithm has been suggested at the round table.
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Affiliation(s)
- Ahmad Awada
- Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie, APHP-Sorbonne Université, Hôpital Tenon, Paris, France
| | - Guy Jerusalem
- CHU Liege and Liege University, Domaine Universitaire du Sart Tilman, Liege, Belgium
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christian Singer
- Center for Breast Health, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Vienna Cancer Center, Medical University of Vienna and Vienna Hospital Association, Vienna, Austria.,Central European Cooperative Oncology Group (CECOG), Vienna, Austria
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Wilking N, Bucsics A, Kandolf Sekulovic L, Kobelt G, Laslop A, Makaroff L, Roediger A, Zielinski C. Achieving equal and timely access to innovative anticancer drugs in the European Union (EU): summary of a multidisciplinary CECOG-driven roundtable discussion with a focus on Eastern and South-Eastern EU countries. ESMO Open 2019; 4:e000550. [PMID: 31798977 PMCID: PMC6863652 DOI: 10.1136/esmoopen-2019-000550] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 06/13/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022] Open
Abstract
The Central European Cooperative Oncology Group (CECOG) and ‘ESMO Open—Cancer Horizons’ roundtable discussion brought together stakeholders from several European Union (EU) countries involved in drug development, drug authorisation and reimbursement or otherwise affected by delayed and unequal access to innovative anticancer drugs. The approval process of drugs is well established and access delays can be caused directly or indirectly by national or regional decision-making processes on reimbursement. The two key aspects for those involved in reimbursement decisions are first the level of evidence required to decide and second pricing, which can be challenging for some innovative oncology compounds, especially in Eastern and South-Eastern European countries. Other important factors include: available healthcare budget; the structure and sophistication of healthcare authorities and health technology assessment processes; societal context and political will. From the point of view of the pharmaceutical industry, better alignment between stakeholders in the process and adaptive pathway initiatives is desirable. Key aspects for patients are improved access to clinical trials, preapproval availability and reports on real-world evidence. Restricted access limits oncologists’ daily work in Eastern and South-Eastern EU countries. The roundtable discussion suggested considering the sequencing of regulatory approval and reimbursement decisions together with more flexible contracting as a possible way forward. The panel concluded that early and regular dialogue between all stakeholders including regulators, payers, patient stakeholders and industry is required to improve the situation.
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Affiliation(s)
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products, Vienna, Austria
| | | | | | - Andrea Laslop
- Scientific Office, Austrian Federal Office for Safety in Health Care, Vienna, Austria
| | - Lydia Makaroff
- Fight Bladder Cancer, Chinnor, United Kingdom and World Bladder Cancer Patient Coalition, Brussels, Belgium
| | - Alexander Roediger
- EFPIA Oncology Platform, Brussels, Belgium and Oncology Policy Europe, Middle East, Africa and Canada, MSD, Kriens, Switzerland
| | - Christoph Zielinski
- Central European Cooperative Oncology Group (CECOG) and Vienna Cancer Center, Vienna Hospital Association, Vienna, Austria
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42
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Arfsten H, Cho A, Freitag C, Raderer M, Goliasch G, Bartko PE, Wurm R, Strunk G, Gisslinger H, Marosi C, Kornek G, Zielinski C, Hülsmann M, Pavo N. GDF-15 in solid vs non-solid treatment-naïve malignancies. Eur J Clin Invest 2019; 49:e13168. [PMID: 31463975 PMCID: PMC6899906 DOI: 10.1111/eci.13168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 07/30/2019] [Accepted: 08/25/2019] [Indexed: 12/12/2022]
Abstract
AIM GDF-15 is an established cardiovascular risk marker but is equally implicated in tumour biology. Elevated levels of GDF-15 have indeed been observed in distinct tumour entities. This study aimed to explore the relation of GDF-15 to other cardiac biomarkers and the general association of GDF-15 on prognosis in an unselected cohort of treatment-naïve cancer patients. METHODS We prospectively enrolled 555 consecutive patients at time of diagnosis of malignant disease prior receiving anticancer therapy. Plasma GDF-15 concentrations were determined alongside other cardiac and routine laboratory markers. All-cause mortality was defined as primary endpoint. RESULTS GDF-15 levels were 338 ng/L (IQR:205-534) for the total cohort, and values were comparable for different tumour entities except breast cancer. Metastatic disease was characterized by higher plasma GDF-15 [435 ng/L (IQR:279-614) vs 266 ng/L (IQR:175-427), P < .001]. GDF-15 correlated positively with inflammatory status reflected by CRP, SAA and IL-6 [r = .31, P < .001, r = .23, P < .001 and r = .14, P = .002] and cardiac biomarkers as NT-proBNP, hsTnT, MR-proADM and CT-proET-1 [r = .46; r = .46; r = .59 and r = .50; P < .001 for all]. GDF-15 was significantly associated with all-cause mortality after multivariate adjustment [adj.HR for ln(GDF-15) 1.78, 95%CI:1.47-2.16, P < .001]. There was a significant interaction between solid and haematological malignancies with loss of association of GDF-15 with outcome in myelodysplastic and myeloproliferative disease. CONCLUSIONS Elevated plasma GDF-15 is associated with progressing disease severity and poor prognosis in solid tumours of treatment-naïve cancer patients. GDF-15 increase is accompanied by worsening systemic inflammation and a subclinical functional impairment of different organs including the heart. GDF-15 represents a promising target for our pathophysiologic understanding in cardio-oncology linking conditions of both cardiac and neoplastic disease.
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Affiliation(s)
- Henrike Arfsten
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Anna Cho
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Claudia Freitag
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Markus Raderer
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Georg Goliasch
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Philipp E. Bartko
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Raphael Wurm
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Guido Strunk
- Complexity ResearchViennaAustria
- FH Campus ViennaViennaAustria
- Technical University DortmundDortmundGermany
| | - Heinz Gisslinger
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Christine Marosi
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Gabriela Kornek
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Christoph Zielinski
- Department of Internal Medicine IDivision of Oncology and HematologyMedical University of ViennaViennaAustria
| | - Martin Hülsmann
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
| | - Noemi Pavo
- Department of Internal Medicine IIDivision of CardiologyMedical University of ViennaViennaAustria
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Unseld M, Filip M, Seirl S, Gleiss A, Bianconi D, Kieler M, Demyanets S, Scheithauer W, Zielinski C, Prager G. Regorafenib therapy in metastatic colorectal cancer patients: markers and outcome in an actual clinical setting. Neoplasma 2019; 65:599-603. [PMID: 29940763 DOI: 10.4149/neo_2018_170727n506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The oral multikinase inhibitor regorafenib had beneficial effects in randomized clinical phase III trials compared to the placebo in patients with metastatic colorectal cancer (mCRC) who progressed on standard therapies. The factors which influence regorafenib response and therapy sequence during treatment history are still highly discussed, and herein we analyzed the therapy algorithm, outcome and clinical markers following regorafenib application in a single center register study. Clinical data for 48 metastatic colorectal cancer patients were collected from 01.01.2013 to 31.12.2016. Treatment effects according to various patient and tumor characteristics were evaluated using univariate and multivariate Cox proportional hazard regression models. The 48 patients comprised 14 (29%) females and 34 (71%) males, with mean age 64.2±9 and ECOG 0-1. Progression free survival under regorafenib therapy was 2.9 months (quartiles 2.2; 4.4) and the overall response rate was 2 (4%) and disease control rate was 19 (40%). Overall survival (OS) and progression free survival (PFS) were investigated under regorafenib in the chemotherapy regimen given immediately before and afterthis treatment. Variables including tumor localization, Ras status, CEA and CA 19-9 plasma levels were analyzed for their impact on PFS, and the regorafenib-related adverse events were also observed. Our study confirms the efficacy of regorafenib in a real-life setting. We established that response rate and PFS in regorafenib treatment are independent of tumor localization, Ras status or biomarkers such as CEA and CA 19-9. Trifluridin/tripacil application or re-induction of chemotherapy +/- target therapy was effective following regorafenib therapy.
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Affiliation(s)
- M Unseld
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Filip
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - S Seirl
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - A Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - D Bianconi
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Kieler
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - S Demyanets
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - W Scheithauer
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C Zielinski
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - G Prager
- Department of Medicine I, Clin. Div. of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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44
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Minichsdorfer C, Pauzenberger B, Laggner A, Zielinski C, Fuereder T. Characterization of oncologic patient visits at the emergency department (ED) at an Austrian tertiary care center. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6609] [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
6609 Background: Oncologic patients frequently seek out the ED as first contact point. Besides the rare classic oncologic emergencies other causes are supposed to be more frequent. However, little is known about reasons of patients with active malignancies to consult the ED. Methods: Retrospective data regarding emergency visits of patients with a medical history of active cancer or adjuvant therapy, who were taken by ambulance to the ED in the time period from 01.01.2017 – 31.07.2017, was collected. For OS Kaplan-Meier curves were created and univariate COX proportional hazards model analysis was used and log rank tests were performed. For statistical analysis the chi2-test was used to investigate significant relations between the three months mortality (3MM) and patient characteristics. 3MM was defined as death within 3 month of the first ED consultation. Results: From a total of 1029 patient contacts 743 met the inclusion criteria. In total 552 patients were included. The median age was 67 years (Minimum: 18y; Maximum: 95y). The vast majority of patients (480, 87%) were in a palliative setting. 243 patients (44%) were under active treatment. The biggest group of patients suffered from lung cancer (18%) followed by hematologic malignancies (14%), pancreaticobiliary tumours (11%), breast cancer (8%) and colorectal cancer (7%). In total 111 patient contacts (15%) were treatment associated, 384 patient contacts (52%) were tumor related, the remaining (248, 33%) were unrelated to either. In 533 cases (72%) inpatient treatment was necessary. The average length of stay was 9, 36 days. Furthermore the 3MM was significantly higher in elderly patients > 65y (p = 0,001), palliative patients not undergoing active treatment (p = 0,003) and patients with elevated CRP levels ( > 0,5mg/dl) (p = 0,001) at time of ED contact. In addition in our univariate analysis factors that significantly decreased the OS were age > 65, visceral metastasis and palliative patients without active treatment. Conclusions: The majority of cancer patients in this study were in a palliative setting. Moreover, cancer associated complications posed the most frequent cause for ED consultation. We could identify a higher risk for mortality for elderly patients, patients with visceral metastasis and patients undergoing best supportive care. The results may help to inform both cancer patients and primary care units about frequent complications.
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Affiliation(s)
- Christoph Minichsdorfer
- Department of Medicine 1 and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | | | - Anton Laggner
- Medical University Vienna, Dep. of Emergency Medicine, Vienna, Austria
| | | | - Thorsten Fuereder
- Medical University Vienna, Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Vienna, Austria
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45
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Paz-Ares LG, Spigel DR, Zielinski C, Chen Y, Jove M, Juan Vidal O, Chu D, Rich P, Hayes TM, Gutierrez Calderon MV, Bernabe Caro R, Navarro A, Dowlati A, Zhang B, Moore Y, Wang HT, Nazarenko N, Ponce Aix S, Bunn PA. RESILIENT: Study of irinotecan liposome injection (nal-IRI) in patients with small cell lung cancer—Preliminary findings from part 1 dose-defining phase. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
8562 Background: Nal-IRI is investigated as monotherapy in patients with SCLC who progressed on or after platinum regimen. The RESILIENT study is a Part 1 study of a Phase 2/3 trial to assess safety, tolerability, and efficacy of Irinotecan Liposome Injection in patients with SCLC. Methods: Nal-IRI is evaluated in patients ≥18 yrs with advanced SCLC with an ECOG performance status ≤1 and adequate organ function; prior exposure to immunotherapy is allowed. Safety and tolerability at dose levels of 85 mg/m2 and 70 mg/m2 are the primary endpoints, with assessment of exploratory efficacy signal. Results: At 24 Dec 2018 safety cutoff 12 patients in Part 1 received ≥1 dose of nal-IRI (Cohort 1 [C-1] at 85 mg/m2 dose n=4; Cohort 2 [C-2] at 70 mg/m2 dose n=8; median age 60.0 yrs; range 49–73 yrs). Three patients experienced ≥1 DLT (Cohort 1 n=3/4; Cohort 2 n=0/8). Most frequent treatment-emergent adverse events (TEAE) were gastrointestinal (GI) disorders (any grade): diarrhea (91.7%), nausea (58.3%), vomiting (41.7%), decreased appetite (58%), abdominal pain (33%) manageable by antidiarrheal regimen and antiemetics; as well as fatigue (50%) and asthenia (37.5%). Overall, hematologic toxicity was neutropenia (any grade) at 16.7% and anemia (any grade) at 16.7%. At 11 Dec 2018 efficacy cutoff the best objective response was partial response (PR) at 33.3% in 4/12 patients (C-1 n=1/4; C-2 n=3/8), median time to response was 6 wks. Overall disease control rate (DCR) was 58.3%; progressive disease (PD) was observed in 2 patients (16.7%), and 3 patients were non-evaluable (25%). Conclusions: Initial assessment suggests that nal-IRI at 70 mg/m2 dose given bi-weekly is well-tolerated and has promising antitumor activity in patients with SCLC who progressed on or after platinum regimen. Part 1 dose expansion is ongoing. Clinical trial information: NCTN03088813. [Table: see text]
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Affiliation(s)
- Luis G. Paz-Ares
- Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and CNIO, Madrid, Spain
| | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | - Christoph Zielinski
- Vienne Cancer Center and Central European Cooperative Oncology Group, Vienna, Austria
| | | | - Maria Jove
- Institut Català d’Oncologia, L’Hospitalet, Barcelona, Spain
| | | | - David Chu
- North Shore Hematology Oncology Associates, East Setauket, NY
| | - Patricia Rich
- Cancer Treatment Centers of America, Southeastern Regional Medical Center, Newnan, GA
| | | | | | | | | | - Afshin Dowlati
- Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH
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46
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Schreiber S, Honz M, Schiemann M, Zielinski C, Protzer U, Wisskirchen K. Characterization of MHC class II-restricted T-cell receptors for T-cell therapy of HBV infection. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.567] [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: 10/26/2022]
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47
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Pavo N, Arfsten H, Cho A, Goliasch G, Bartko PE, Wurm R, Freitag C, Gisslinger H, Kornek G, Strunk G, Raderer M, Zielinski C, Hülsmann M. The circulating form of neprilysin is not a general biomarker for overall survival in treatment-naïve cancer patients. Sci Rep 2019; 9:2554. [PMID: 30796257 PMCID: PMC6385211 DOI: 10.1038/s41598-019-38867-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/07/2019] [Indexed: 12/11/2022] Open
Abstract
The transmembrane zink-metalloendopeptidase neprilysin (NEP) is implicated in cardiovascular disease but also tumor biology. The aim of the study was to investigate the relationship of circulating NEP (cNEP) levels with established cardiovascular biomarkers and its effect on overall survival in an unselected cohort of treatment-naïve cancer patients. 555 consecutive cancer patients prior anticancer therapy were enrolled prospectively. NEP levels were determined alongside routine laboratory parameters, established cardiac biomarkers, i.e. NT-proBNP, hsTnT, MR-proANP, MR-proADM, CT-proET-1 and Copeptin, and inflammatory parameters, i.e. CRP, IL-6 and SAA, in venous plasma samples. All-cause mortality was the primary endpoint. cNEP levels of 276 pg/ml (IQR: 0–5981) displayed a weak inverse correlation with age [r = −0.12, p = 0.023] and inflammatory status [r = −0.14, p = 0.007 CRP; r = −0.20, p < 0.001 IL-6 and r = −0.18, p < 0.001 SAA]. cNEP was comparable between different tumor entities and stages and not related to functional parameters of other organ systems as kidney, liver or especially the heart. Moreover, cNEP was not associated with overall survival in the total cohort [adj.HR for ln (cNEP) 1.00, 95% CI: 0.94–1.06, p = 0.887] but in myelodysplatic malignancies [adj.HR for ln (cNEP) 1.27, 95% CI: 1.01–1.61, p = 0.044]. In conclusion, cNEP lacks association with outcome but for myelodysplastic disease. cNEP shows no correlation with established cardiovascular biomarkers related to prognosis, thereby holding a limited potential as a biomarker in cardio-oncology.
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Affiliation(s)
- Noemi Pavo
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Anna Cho
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Raphael Wurm
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Claudia Freitag
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Gabriela Kornek
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Guido Strunk
- Complexity Research, Vienna, Austria.,FH Campus Vienna, Vienna, Austria.,Technical University Dortmund, Dortmund, Germany
| | - Markus Raderer
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria.
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48
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Prager GW, Unseld M, Waneck F, Mader R, Wrba F, Raderer M, Fuereder T, Staber P, Jäger U, Kieler M, Bianconi D, Hoda MA, Baumann L, Reinthaller A, Berger W, Grimm C, Kölbl H, Sibilia M, Müllauer L, Zielinski C. Results of the extended analysis for cancer treatment (EXACT) trial: a prospective translational study evaluating individualized treatment regimens in oncology. Oncotarget 2019; 10:942-952. [PMID: 30847023 PMCID: PMC6398177 DOI: 10.18632/oncotarget.26604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/28/2018] [Accepted: 01/02/2019] [Indexed: 01/09/2023] Open
Abstract
Background The concept of personalized medicine defines a promising approach in cancer care. High-throughput genomic profiling of tumor specimens allows the identification of actionable mutations that potentially lead to tailored treatment for individuals' benefit. The aim of this study was to prove efficacy of a personalized treatment option in solid tumor patients after failure of standard treatment concepts. Results Final analysis demonstrates that 34 patients (62%) had a longer PFS upon experimental treatment (PFS1) when compared to previous therapy (PFS0); PFS ratio > 1.0 (p = 0.002). The median PFS under targeted therapy based on molecular profiling (PFS1) was 112 days (quartiles 66/201) and PFS0 = 61 days (quartiles 51/92; p = 0.002). Of the 55 patients, 31 (56%) showed disease control (DCR), consisting of 2 (4%) patients which achieved a complete remission, 14 (25%) patients with a partial remission and 15 (27%) patients who had a stabilization of disease. Median OS from start of experimental therapy was 348 days (quartiles 177/664). Conclusion The prospective trial EXACT suggests that treatment based on real-time molecular tumor profiling leads to superior clinical benefit. Materials and Methods In this prospective clinical phase II trial, 55 cancer patients, after failure of standard treatment options, aimed to achieve a longer progression-free survival on the experimental treatment based on the individual's molecular profile (PFS1) when compared to the last treatment given before (PFS0). The personalized medicine approach was conceived to be clinical beneficial for patients who show a PFS ratio (PFS 1/PFS0) of > 1.0.
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Affiliation(s)
- Gerald W Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Fredrik Waneck
- Department of Interventional Radiology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Robert Mader
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Fritz Wrba
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Thorsten Fuereder
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Phillip Staber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Markus Kieler
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Daniela Bianconi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Surgery, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Lukas Baumann
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Alexander Reinthaller
- Department of General Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Walter Berger
- Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Christoph Grimm
- Department of General Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Heinz Kölbl
- Department of General Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Maria Sibilia
- Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Leonhard Müllauer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
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Cherny NI, de Vries EGE, Dafni U, Garrett-Mayer E, McKernin SE, Piccart M, Latino NJ, Douillard JY, Schnipper LE, Somerfield MR, Bogaerts J, Karlis D, Zygoura P, Vervita K, Pentheroudakis G, Tabernero J, Zielinski C, Wollins DS, Schilsky RL. Comparative Assessment of Clinical Benefit Using the ESMO-Magnitude of Clinical Benefit Scale Version 1.1 and the ASCO Value Framework Net Health Benefit Score. J Clin Oncol 2018; 37:336-349. [PMID: 30707056 DOI: 10.1200/jco.18.00729] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [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
PURPOSE To better understand the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS v1.1) and the ASCO Value Framework Net Health Benefit score version 2 (ASCO-NHB v2), ESMO and ASCO collaborated to evaluate the concordance between the frameworks when used to assess clinical benefit attributable to new therapies. METHODS The 102 randomized controlled trials in the noncurative setting already evaluated in the field testing of ESMO-MCBS v1.1 were scored using ASCO-NHB v2 by its developers. Measures of agreement between the frameworks were calculated and receiver operating characteristic curves used to define thresholds for the ASCO-NHB v2 corresponding to ESMO-MCBS v1.1 categories. Studies with discordant scoring were identified and evaluated to understand the reasons for discordance. RESULTS The correlation of the 102 pairs of scores for studies in the noncurative setting is estimated to be 0.68 (Spearman's rank correlation coefficient; overall survival, 0.71; progression-free survival, 0.67). Receiver operating characteristic curves identified thresholds for ASCO-NHB v2 for facilitating comparisons with ESMO-MCBS v1.1 categories. After applying pragmatic threshold scores of 40 or less (ASCO-NHB v2) and 2 or less (ESMO-MCBS v1.1) for low benefit and 45 or greater (ASCO-NHB v2) and 4 to 5 (ESMO-MCBS v1.1) for substantial benefit, 37 discordant studies were identified. Major factors that contributed to discordance were different approaches to evaluation of relative and absolute gain for overall survival and progression-free survival, crediting tail of the curve gains, and assessing toxicity. CONCLUSION The agreement between the frameworks was higher than observed in other studies that sought to compare them. The factors that contributed to discordant scores suggest potential approaches to improve convergence between the scales.
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Affiliation(s)
| | | | - Urania Dafni
- National and Kapodistrian University of Athens, Athens, Greece.,Frontier Science Foundation-Hellas, Hellas, Greece
| | | | | | - Martine Piccart
- Jules Bordet Institute Université Libre de Bruxelles, Brussels, Belgium
| | - Nicola J Latino
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Lowell E Schnipper
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Jan Bogaerts
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | | | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology, Barcelona, Spain
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50
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Unseld M, Mader R, Baumann L, Veraar C, Wrba F, Waneck F, Kieler M, Bianconi D, Berger W, Sibilia M, Müllauer L, Zielinski C, Prager GW. Feasibility of personalized treatment concepts in gastrointestinal malignancies: Sub-group results of prospective clinical phase II trial EXACT. Chin J Cancer Res 2018; 30:508-515. [PMID: 30510362 PMCID: PMC6232366 DOI: 10.21147/j.issn.1000-9604.2018.05.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/14/2022] Open
Abstract
Objective Advances in high-throughput genomic profiling and the development of new targeted therapies improve patient’s survival. In gastrointestinal (GI) malignancies, the concept of personalized medicine (PM) was not investigated so far. The aim of this prospective study was to evaluate the efficacy of a personalized treatment in GI patients who failed standard treatment. Methods Out of the original prospective clinical phase II EXACT trial, 21 (38%) GI cancer patients who had no further treatment options were identified. A molecular profile (MP) via a 50 gene next generation sequencing (NGS) panel in combination with immunohistochemistry (IHC) was conducted using real-time biopsy tumor material. Results were discussed by a multidisciplinary team (MDT) to translate the individual MP in an experimental treatment. Results Of the 55 patients originally included in the EXACT trial, 21 (38%) suffered from GI malignancies. The final analysis showed that 15 (71%) patients had experienced a longer progression-free survival (PFS) upon experimental targeted treatment (124 d, quartiles 70/193 d), when compared with the PFS achieved by the previous conventional therapy (62 d, quartiles 55/83 d) (P=0.014). Thirteen (62%) patients receiving targeted treatment experienced a disease control according to Response Evaluation Criteria in Solid Tumors (RECIST). Median overall survival (OS) from the start of experimental therapy to time of censoring or death was 193 d (quartiles 115/374 d). Conclusions PM was not investigated in GI malignancies so far in a prospective trial. This study shows that treatment based on real-time molecular tumor profiling led to a superior clinical benefit, and survival as well as response was significantly improved when compared with previous standard medications.
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Affiliation(s)
- Matthias Unseld
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna 1090, Austria.,Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria
| | - Robert Mader
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna 1090, Austria.,Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria
| | - Lukas Baumann
- Department of Medical Statistics, Medical University of Vienna, Vienna 1090, Austria
| | - Clarence Veraar
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna 1090, Austria.,Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria
| | - Fritz Wrba
- Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria.,Clinical Institute of Pathology, Medical University of Vienna, Vienna 1090, Austria
| | - Fredrik Waneck
- Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria.,Department of Interventional Radiology, Medical University of Vienna, Vienna 1090, Austria
| | - Markus Kieler
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna 1090, Austria.,Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria
| | - Daniela Bianconi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna 1090, Austria.,Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria
| | - Walter Berger
- Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria.,Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna 1090, Austria
| | - Maria Sibilia
- Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria.,Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna 1090, Austria
| | - Leonhard Müllauer
- Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria.,Clinical Institute of Pathology, Medical University of Vienna, Vienna 1090, Austria
| | - Christoph Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna 1090, Austria.,Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria
| | - Gerald W Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna 1090, Austria.,Comprehensive Cancer Center, Medical University Vienna - General Hospital, Vienna 1090, Austria
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