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Joga S, Goyal S, Mehta A, Sharma M, Koyyala V, Doval D, Goyal P, Aggarwal C, M. swamy, Patel A, Nathani S, Suryavanshi M, Narayan S, Soni S, Jain A, Redhu P. P-21 Molecular subtypes (profile) of colorectal cancer and their correlation with clinical and pathological profile in a tertiary care centre in India. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.112] [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: 11/01/2022] Open
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Parikh PM, Bhattacharyya GS, Biswas G, Krishnamurty A, Doval D, Heroor A, Sharma S, Deshpande R, Chaturvedi H, Somashekhar SP, Babu G, Reddy GK, Sarkar D, Desai C, Malhotra H, Rohagi N, Bapna A, Alurkar SS, Krishna P, Deo SV, Shrivastava A, Chitalkar P, Majumdar SK, Vijay D, Thoke A, Udupa KS, Bajpai J, Rath GK, Dattatreya PS, Bondarde S, Patil S. Practical Consensus Recommendations for Optimizing Risk versus Benefit of Chemotherapy in Patients with HR Positive Her2 Negative Early Breast Cancer in India. South Asian J Cancer 2021; 10:213-219. [PMID: 34984198 PMCID: PMC8719963 DOI: 10.1055/s-0041-1742080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Breast cancer is a public health challenge globally as well as in India. Improving outcome and cure requires appropriate biomarker testing to assign risk and plan treatment. Because it is documented that significant ethnic and geographical variations in biological and genetic features exist worldwide, such biomarkers need to be validated and approved by authorities in the region where these are intended to be used. The use of western guidelines, appropriate for the Caucasian population, can lead to inappropriate overtreatment or undertreatment in Asia and India. A virtual meeting of domain experts discussed the published literature, real-world practical experience, and results of opinion poll involving 185 oncologists treating breast cancer across 58 cities of India. They arrived at a practical consensus recommendation statement to guide community oncologists in the management of hormone positive (HR-positive) Her2-negative early breast cancer (EBC). India has a majority (about 50%) of breast cancer patients who are diagnosed in the premenopausal stage (less than 50 years of age). The only currently available predictive test for HR-positive Her2-negative EBC that has been validated in Indian patients is CanAssist Breast. If this test gives a score indicative of low risk (< 15.5), adjuvant chemotherapy will not increase the chance of metastasis-free survival and should not be given. This is applicable even during the ongoing COVID-19 pandemic.
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Affiliation(s)
| | | | - Ghanshyam Biswas
- Medical Oncology, Sparsh Hospital & Critical Care, Bhubaneswar, India
| | | | - Dinesh Doval
- Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Anil Heroor
- Surgical Oncology, Fortis Hospital, Mumbai, India
| | - Sanjay Sharma
- Surgical Oncology, Asian Cancer Institute, Mumbai, India
| | | | | | - S. P. Somashekhar
- Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore, India
| | - Govind Babu
- Medical Oncology, HCG Cancer Hospital, Bengaluru, India
| | | | - Diptendra Sarkar
- Surgical Oncology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Chirag Desai
- Medical Oncology, Vedanta Institute of Medical Sciences, Ahmedabad, India
| | | | - Nitesh Rohagi
- Medical Oncology, Max Institute of Cancer Care, Delhi, India
| | - Ajay Bapna
- Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, India
| | | | - Prasad Krishna
- Medical Oncology, Mangalore Institute of Oncology, Mangalore, India
| | - S. V.S. Deo
- Surgical Oncology, All India Institute of Medical Sciences, Delhi, India
| | | | - Prakash Chitalkar
- Medical Oncology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, India
| | | | | | - Aniket Thoke
- Radiation Oncology, Sanjeevani CBCC USA Cancer Hospital, Raipur, India
| | - K. S. Udupa
- Medical Oncology, Kasturba Medical College, Manipal, India
| | - Jyoti Bajpai
- Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - G. K. Rath
- Radiation Oncology, DR. B.R.A. Institute Rotary Cancer Hospital, Delhi, India
| | | | | | - Shekhar Patil
- Medical Oncology, HCG Cancer Hospital, Bengaluru, India
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Aggarwal S, Vaid A, Ramesh A, Parikh PM, Purohit S, Avasthi B, Gupta S, Ranjan S, Kaushal V, Salim S, Singh R, Minhas S, Doval D. Practical consensus recommendations on management of HR + ve early breast cancer with specific reference to genomic profiling. South Asian J Cancer 2020; 7:96-101. [PMID: 29721472 PMCID: PMC5909304 DOI: 10.4103/sajc.sajc_110_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is a heterogeneous disease and patients are managed clinically based on ER, PR, HER2 expression, and key risk factors. The use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. Most guidelines for hormone receptor (HR)–positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. Expert oncologist discussed about strategies of gene expression assays and aid in chemotherapy recommendations for treatment of HR + ve EBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- S Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - A Vaid
- Department of Medical Oncology, Medanata Hospital, Gurugram, Haryana, India
| | - A Ramesh
- Department of Medical Oncology, HCG Cancer Center, Chennai, Tamil Nadu, India.,Department of Medical Oncology, SMH Curie Cancer Center, New Delhi, India
| | - Purvish M Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S Purohit
- Department of Medical Oncology, Artemis Hospital, Gurugram, Haryana, India
| | - B Avasthi
- Department or Radiation Oncology, Fortis Hospital, New Delhi, India
| | - S Gupta
- Department of Medical Oncology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - S Ranjan
- Department of Medicine, INHS Sanjivani, Kochi, Kerala, India
| | - V Kaushal
- Department of Radiation Oncology, RCC, Rohtak, Haryana, India
| | - S Salim
- Department of Oncology, Hakim Sanaullah Cancer Center, Baramulla, Jammu and Kashmir, India
| | - R Singh
- Department of Medical Oncology, Army Hospital R and R, New Delhi, India
| | - S Minhas
- Department of Medical Oncology, Medanata Hospital, Gurugram, Haryana, India
| | - D Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
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Agrawal C, Doval D, Agarwal A, Goyal P, Baghmar S, Talwar V, Batra U, Goyal S, Sinha R, Archana S, Jain P. Real world evidence of palbociclib use in metastatic hormone positive HER negative metastatic breast cancer in Indian population. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30812-1] [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] [Indexed: 11/28/2022]
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Bajaj R, Doval D, Tripathi R, Sridhar T, Korlimarla A, Choudhury K, Suryavanshi M, Mehta A. Prognostic role of microRNA 182 and microRNA 18a in locally advanced triple negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nair R, Kakroo A, Bapna A, Gogia A, Vora A, Pathak A, Korula A, Chakrapani A, Doval D, Prakash G, Biswas G, Menon H, Bhattacharya M, Chandy M, Parihar M, Vamshi Krishna M, Arora N, Gadhyalpatil N, Malhotra P, Narayanan P, Nair R, Basu R, Shah S, Bhave S, Bondarde S, Bhartiya S, Nityanand S, Gujral S, Tilak TVS, Radhakrishnan V. Management of Lymphomas: Consensus Document 2018 by an Indian Expert Group. Indian J Hematol Blood Transfus 2018; 34:398-421. [PMID: 30127547 PMCID: PMC6081314 DOI: 10.1007/s12288-018-0991-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022] Open
Abstract
The clinical course of lymphoma depends on the indolent or aggressive nature of the disease. Hence, the optimal management of lymphoma needs a correct diagnosis and classification as B cell, T-cell or natural killer (NK)/T-cell as well as indolent or high-grade type lymphoma. The current consensus statement, developed by experts in the field across India, is intended to help healthcare professionals manage lymphomas in adults over 18 years of age. However, it should be noted that the information provided may not be appropriate to all patients and individual patient circumstances may dictate alternative approaches. The consensus statement discusses the diagnosis, staging and prognosis applicable to all subtypes of lymphoma, and detailed treatment regimens for specific entities of lymphoma including diffuse large B-cell lymphoma, Hodgkin's lymphoma, follicular lymphoma, T-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Burkitt's lymphoma, and anaplastic large cell lymphoma.
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Affiliation(s)
- Reena Nair
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Ajay Bapna
- Bhagwan Mahavir Cancer Hospital Research Center (BMCHRC), Jaipur, India
| | - Ajay Gogia
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Anu Korula
- Christian Medical College (CMC), Vellore, India
| | | | - Dinesh Doval
- Rajiv Gandhi Cancer Institute and Research Centre (RGCI), New Delhi, Delhi India
| | - Gaurav Prakash
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ghanashyam Biswas
- Sparsh Hospital American Oncology Institute (AOI), Bhubaneswar, India
| | - Hari Menon
- Cytecare Cancer Hospitals, Bangalore, India
| | | | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Mayur Parihar
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Neeraj Arora
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Pankaj Malhotra
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Rekha Nair
- Regional Cancer Centre (RCC), Thiruvananthapuram, India
| | - Rimpa Basu
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Sandip Shah
- Vedant Institute of Medical Sciences, Ahmedabad, India
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | | | - Soniya Nityanand
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | | | | | - Vivek Radhakrishnan
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
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Gupta S, Babu GK, Chacko RT, Doval D, Desai C, Kilara N, Nag SM, Shah CA, Deo SVS, Koppikar SB, Swarup B, Kukreja AA, Raina V. An open label, single arm, prospective phase II study to evaluate the efficacy and safety of bevacizumab with gemcitabine and carboplatin as first-line treatment for metastatic triple negative breast cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sudeep Gupta
- Department of Medical Oncology, Breast Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India
| | | | | | | | - Chirag Desai
- Vedanta Institute of Medical Science, Ahmedabad, India
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Prabhash K, Parikh PM, Rajappa SJ, Noronha V, Joshi A, Aggarwal S, Bondarde SA, Patil S, Desai CJ, Naik R, Anand S, Chacko RT, Biswas G, Sahoo TP, Dabkara D, Patil VM, MV C, Das PK, Vaid AK, Doval D. EGFR testing scenario across 111 centres in India: A questionnaire-based survey. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13111 Background: Lung cancer diagnosis now involves routine use of biomarker testing to identify the driver mutations. We conducted a survey of 111 medical oncologists across India to understand the current pattern of EGFR mutation testing at their respective centres. Methods: Medical oncologists from 111 institutes across India were interviewed face to face using a structured questionnaire. They were divided into two groups - Group 1 with in-house EGFR testing and Group 2 who send samples to central/commercial labs. Answers of the two groups were analysed to see the prevailing patterns of EGFR mutation testing and differences between the groups if any. Results: In India, 95% of medical oncologists recommend testing for EGFR mutations in patients with adenocarcinoma histology. 40% would also recommend testing in squamous histology. 80% of medical oncologists request for biomarker testing at the time of primary biopsy. From the time of biopsy, the average time duration to get EGFR test results is 18 days. In centres with in-house testing (Group 1), results are available in 10 days. 96% of the medical oncologists from Group 1 centres request for factoring additional sample for biomarker testing compared to only 69% from Group 2. 69% of medical oncologists in Group 1 centres would prefer to wait for the test results before initiating treatment compared to 46% in Group 2. EGFR TKIs are used in 60% of patients with diagnosed EGFR mutation in the first line. For patients in whom chemotherapy is initiated while waiting for test results, 50% of medical oncologists prefer completing 4-6 cycles before switching to targeted therapy. At the time of progression, rebiopsy is possible in 25% of the patients. Rapid disease progression and poor PS were the two most common reasons given for the low rebiopsy rates. Conclusions: Application of molecular testing is improving. Yield can be improved by training of multidisciplinary team involved in tumor biopsy. There is scope and need to reduce the turnaround time. This will reduce the current scenario of commencing chemotherapy while waiting for test results. Increasing application of liquid biopsy will help in initial diagnosis as well as at relapse, especially for patients with poor PS or difficult access to tumor site.
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Affiliation(s)
| | | | | | | | | | | | | | - Shekar Patil
- HCG Bangalore Institute of Oncology, Bangalore, India
| | | | - Rajesh Naik
- Boehringer Ingelheim India Pvt Ltd, Mumbai, India
| | - Sohit Anand
- Boehringer Ingelheim India Pvt Ltd, Mumbai, IA, India
| | | | | | | | | | | | | | | | - Ashok K. Vaid
- Medanta Cancer Institute Medanta The Medicity, Gurgaon Haryana, India
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Abstract
<span>Breast cancer is a heterogeneous disease. Liquid biopsy is a novel diagnostic tool and may provide answers to many questions related to unevenness in prognosis and ultimate outcome. Different technologies for CTC isolation, enrichment, detection, and characterization are under evaluation. Various clinical trials and meta-analysis have been conducted to define the role of CTC in early and metastatic breast cancer. CTCs are superior to other serum markers for prognostication. Their role as predictive marker remains elusive.</span>
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Goel V, DASH P, Talwar V, Singh S, Doval D, Patnaik N. Efficacy and safety of adjuvant intraperitoneal chemotherapy in carcinoma ovary: A prospective observational study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Varun Goel
- Department of Medical Oncology, Rajiv gandhi cancer Institute and Research center, New Delhi, India
| | - Prasanta DASH
- Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | | | - Sajjan Singh
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | - Nivedita Patnaik
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Doval D. Breast cancer: Are we in the best era? Asian Journal of Oncology 2015. [DOI: 10.4103/2454-6798.173281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- D. Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India
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Prabhash K, Parikh PM, Noronha V, Joshi A, Rajappa SJ, Bondarde SA, Patil S, Desai CJ, Naik R, Anand S, Chacko RT, Biswas G, Sahoo TP, Das PK, Vaid AK, Aggarwal S, Doval D. Patterns of EGFR testing for lung cancer among tertiary care centers in India. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e19114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Shekar Patil
- HCG Bangalore Institute of Oncology, Bangalore, India
| | | | - Rajesh Naik
- Boehringer Ingelheim India Pvt Ltd, Mumbai, India
| | - Sohit Anand
- Boehringer Ingelheim India Pvt Ltd, Mumbai, India
| | | | | | | | | | - Ashok K. Vaid
- Medanta Cancer Institute Medanta The Medicity, Gurgaon Haryana, India
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Doval D, Cinieri S, Bozcuk H, Pierga JY, Altundag K, Wang X, Gupta S, Lopez Vivanco G, Gupta V, Chmielowska E, Bines J, Montcuquet P, Namour A, Alba E, Mustacchi G, Cortes P, de Ducla S, Freudensprung U, Fallowfield L, Gligorov J. Abstract P2-12-16: Exploratory post hoc analyses of patient-reported outcomes (PROs) in the IMELDA randomized phase III trial: Maintenance bevacizumab (BEV) ± capecitabine (CAP) after initial first-line BEV plus docetaxel (DOC) for HER2-negative metastatic breast can. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p2-12-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND The addition of CAP to maintenance BEV demonstrated statistically significant and clinically relevant improvements in progression-free survival (PFS [primary endpoint]; HR 0.38 [95% CI 0.27–0.55]; log-rank p<0.001) and overall survival (OS [secondary endpoint]; HR 0.43 [95% CI 0.26–0.69]; log-rank p<0.001) in patients (pts) without disease progression (PD) on initial first-line BEV–DOC for HER2-negative mBC in the IMELDA trial. This benefit was achieved despite the smaller than planned sample size due to premature recruitment discontinuation because of regulatory withdrawal of BEV–DOC.
METHODS Pts with HER2-negative measurable mBC, ECOG PS <2, and no prior chemotherapy for mBC were eligible. After 3–6 cycles of BEV–DOC, pts without PD were randomized to either BEV alone or BEV–CAP (BEV 15 mg/kg q3w; CAP 1000 mg/m2 bid d1–14 q3w) until PD. PROs (secondary endpoint) were assessed using the EORTC QLQ-C30 completed at screening (before BEV–DOC), at randomization to CAP vs no CAP, then every 3 cycles until PD, and at (but not beyond) PD. Analyses of mean change from randomization were prespecified. A 28-day window around the scheduled timepoints from randomization was applied to maximize the number of questionnaires available for analysis. Exploratory post hoc analyses included mixed-model repeated measures (MMRM; modeling weighted treatment effect from randomization across all available timepoints) and responder analyses using the global health status/QoL subscale. Pts were categorized as having improved (≥10-point increase), stable (change of <10 points), or worsened (≥10-point decrease) scores from randomization [Osoba, 2005].
RESULTS Adherence with questionnaire completion was 65–85% for all assessment timepoints during the first year of maintenance therapy. MMRM analysis of the global health status/QoL subscale showed no difference between the treatment arms in change from randomization (least squares mean estimate 0.40 [95% CI –6.07 to 6.87]). Similar results were observed for other subscales, including the diarrhea symptom subscale.
No. of pts (%)BEV (N=94)BEV–CAP (N=91)Week 9aN=51N=59Improved15 (29.4)17 (28.8)Stable26 (51.0)34 (57.6)Week 18aN=29N=57Improved11 (37.9)12 (21.1)Stable12 (41.4)30 (52.6)Week 27aN=23N=43Improved7 (30.4)16 (37.2)Stable12 (52.2)20 (46.5)Week 36aN=15N=35Improved4 (26.7)14 (40.0)Stable9 (60.0)17 (48.6)aNo. of patients with completed questionnaires at both randomization and the respective week. Only weeks with ≥10 pts in both arms shown.
CONCLUSIONS The IMELDA sample size was smaller than planned but protocol adherence with PRO completion was relatively high. Prespecified change from randomization and exploratory post hoc MMRM analyses of PROs suggest that the clinically meaningful PFS and OS benefit from adding CAP to BEV is achieved while maintaining QoL, with no difference between BEV and BEV–CAP treatments. Responder analyses over time showed improved or stable global health status/QoL scores in the majority of pts at each timepoint in both treatment arms.
Citation Format: Dinesh Doval, Saverio Cinieri, Hakan Bozcuk, Jean-Yves Pierga, Kadri Altundag, Xiaojia Wang, Sudeep Gupta, Guillermo Lopez Vivanco, Vineet Gupta, Ewa Chmielowska, Jose Bines, Philippe Montcuquet, Alfred Namour, Emilio Alba, Giorgio Mustacchi, Paulo Cortes, Sabine de Ducla, Ulrich Freudensprung, Lesley Fallowfield, Joseph Gligorov. Exploratory post hoc analyses of patient-reported outcomes (PROs) in the IMELDA randomized phase III trial: Maintenance bevacizumab (BEV) ± capecitabine (CAP) after initial first-line BEV plus docetaxel (DOC) for HER2-negative metastatic breast can [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-16.
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Affiliation(s)
- Dinesh Doval
- 1Rajiv Gandhi Cancer Institute & Research Center
| | | | | | | | | | | | | | | | | | | | | | | | | | - Emilio Alba
- 14Hospital University Clinic Virgen de la Victoria
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Gligorov J, Bines J, Alba E, Mustacchi G, Cinieri S, Gupta V, Pierga JY, Bozcuk H, Gaafar R, Gupta S, Lopez Vivanco G, Wang X, Costa R, Altundag K, Chmielowska E, de Ducla S, Freudensprung U, Cortes P, Doval D. Abstract P2-17-01: Overall survival (OS) in the IMELDA randomized phase III trial of maintenance bevacizumab (BEV) with or without capecitabine (CAP) for HER2-negative metastatic breast cancer (mBC). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p2-17-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND The open-label randomized phase III IMELDA trial demonstrated that adding CAP to maintenance BEV until disease progression (PD) after initial BEV–docetaxel (DOC) provides statistically significant and clinically meaningful improvements in both progression-free survival (PFS [primary endpoint]; hazard ratio [HR] 0.38 [95% CI 0.27–0.55]; log-rank p<0.001) and OS. We present OS in subgroups representing stratification factors and clinically important populations.
METHODS Patients (pts) with HER2-negative measurable mBC, ECOG PS <2, and no prior chemotherapy for mBC were eligible. After 3–6 cycles of BEV–DOC, pts without PD were randomized to BEV alone or BEV–CAP (BEV 15 mg/kg q3w; CAP 1000 mg/m2 bid d1–14 q3w) until PD. Stratification factors were estrogen receptor (ER) status, visceral metastases, response status, and lactate dehydrogenase (LDH) concentration. OS from randomization was a secondary endpoint. The planned sample size of 360 enrolled pts (290 randomized) was calculated assuming a PFS HR of 0.70 (median PFS 5.8→8.3 months) with 80% power at 2-sided α=0.05 after 244 PFS events. Recruitment was stopped prematurely after regulatory withdrawal of the BEV–DOC combination but pts who had already been enrolled and randomized were followed as originally planned.
RESULTS Between Jun 2009 and Mar 2011, 284 pts were enrolled and treated. Of these, 99 were not eligible for randomization (most commonly due to PD [41%] or AEs/toxicity [31%]) and 185 (65%) were randomized. At the time of the primary PFS analysis, representing study closure, median follow-up (from randomization) was 31.6 months. Median OS from randomization was 23.7 months in the BEV arm and 39.0 months in the BEV–CAP arm (events in 36% of pts). The HR for OS in the two randomized arms showed consistency between subgroups, favoring the BEV–CAP arm in all subgroups analyzed.
SubgroupNo. of events/No. of pts (%)Unstratified HR (95% CI)1-y OS rate (%) BEVBEV–CAP BEVBEV–CAPAll53/94 (56)33/91 (36)0.43 (0.26-0.69)a7290<65 y46/81 (57)27/77 (35)0.51 (0.32-0.82)7293≥65 y7/13 (54)6/14 (43)0.50 (0.16-1.60)6879Triple negative16/21 (76)10/25 (40)0.44 (0.19-0.99)6290Hormone receptor positive37/73 (51)23/66 (35)0.53 (0.31-0.89)7591ER positiveb36/69 (52)23/64 (364)0.53 (0.32-0.90)7590ER negativeb17/25 (68)10/27 (37)0.44 (0.20-0.99)6491<3 metastatic organ sites17/40 (43)17/48 (35)0.75 (0.38-1.49)8193≥3 metastatic organ sites36/54 (67)16/43 (37)0.39 (0.22-0.71)6588Visceral metastasesb38/65 (58)23/62 (37)0.43 (0.26-0.73)7092No visceral metastasesb15/29 (52)10/29 (34)0.76 (0.34-1.70)7688Complete or partial responseb36/68 (53)24/68 (35)0.61 (0.37-1.03)7389Stable diseaseb14/22 (64)6/20 (30)0.22 (0.08-0.63)68100Non-measurableb3/4 (75)3/3 (100)0.30 (0.03-2.98)6767LDH ≤1.5×ULNb50/89 (56)30/85 (35)0.49 (0.31-0.76)7294LDH >1.5×ULNb3/5 (60)3/6 (50)1.01 (0.20-5.00)6044aStratified analysis. bStratification factor.
CONCLUSIONS. Combining maintenance BEV with CAP until PD after initial BEV–DOC for mBC provides a statistically significant and clinically meaningful improvement in OS (secondary endpoint), seen consistently irrespective of baseline characteristics.
Citation Format: Joseph Gligorov, Jose Bines, Emilio Alba, Giorgio Mustacchi, Saverio Cinieri, Vineet Gupta, Jean-Yves Pierga, Hakan Bozcuk, Rabab Gaafar, Sudeep Gupta, Guillermo Lopez Vivanco, Xiaojia Wang, Romulo Costa, Kadri Altundag, Ewa Chmielowska, Sabine de Ducla, Ulrich Freudensprung, Paulo Cortes, Dinesh Doval. Overall survival (OS) in the IMELDA randomized phase III trial of maintenance bevacizumab (BEV) with or without capecitabine (CAP) for HER2-negative metastatic breast cancer (mBC) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-17-01.
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Affiliation(s)
| | | | - Emilio Alba
- 3Hospital University Clinic Virgen de la Victoria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dinesh Doval
- 18Rajiv Gandhi Cancer Institute & Research Center
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Gligorov J, Doval D, Bines J, Alba E, Cortes P, Pierga JY, Gupta V, Costa R, Srock S, de Ducla S, Freudensprung U, Mustacchi G. Maintenance capecitabine and bevacizumab versus bevacizumab alone after initial first-line bevacizumab and docetaxel for patients with HER2-negative metastatic breast cancer (IMELDA): a randomised, open-label, phase 3 trial. Lancet Oncol 2014; 15:1351-60. [PMID: 25273343 DOI: 10.1016/s1470-2045(14)70444-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Longer duration of first-line chemotherapy for patients with metastatic breast cancer is associated with prolonged overall survival and improved progression-free survival. We investigated capecitabine added to maintenance bevacizumab after initial treatment with bevacizumab and docetaxel in this setting. METHODS We did this open-label randomised phase 3 trial at 54 hospitals in Brazil, China, Egypt, France, Hong Kong, India, Italy, Poland, Spain, and Turkey. We enrolled patients with HER2-negative measurable metastatic breast cancer; each received three to six cycles of first-line bevacizumab (15 mg/kg) and docetaxel (75-100 mg/m(2)) every 3 weeks. Progression-free patients were randomly assigned with an interactive voice-response system by block (size four) randomisation (1:1) to receive either bevacizumab and capecitabine or bevacizumab only (bevacizumab 15 mg/kg on day 1; capecitabine 1000 mg/m(2) twice per day on days 1-14, every 3 weeks) until progression, stratified by oestrogen receptor status (positive vs negative), visceral metastases (present vs absent), response status (stable disease vs response vs non-measurable), and lactate dehydrogenase concentration (≤1·5 vs >1·5 × upper limit of normal). Neither patients nor investigators were masked to allocation. The primary endpoint was progression-free survival (from randomisation) in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT00929240. FINDINGS Between July 16, 2009, and March 7, 2011 (when enrolment was prematurely terminated), 284 patients received initial bevacizumab and docetaxel; 185 (65%) were randomly assigned (91 to bevacizumab and capecitabine versus 94 to bevacizumab only). Progression-free survival was significantly longer in the bevacizumab and capecitabine group than in the bevacizumab only group (median 11·9 months [95% CI 9·8-15·4] vs 4·3 months [3·9-6·8]; stratified hazard ratio 0·38 [95% CI 0·27-0·55]; two-sided log-rank p<0·0001), as was overall survival (median 39·0 months [95% CI 32·3-not reached] vs 23·7 months [18·5-31·7]; stratified HR 0·43 [95% CI 0·26-0·69]; two-sided log-rank p=0·0003). Results for time to progression were consistent with those for progression-free survival. 78 (86%) patients in the bevacizumab and capecitabine group and 72 (77%) in the bevacizumab only group had an objective response. Clinical benefit was recorded in 92 (98%) patients in the bevacizumab alone group and 90 (99%) in the bevacizumab and capecitabine group. Mean change from baseline in global health score did not differ significantly between groups. Grade 3 or worse adverse events during the maintenance phase were more common with bevacizumab and capecitabine than with bevacizumab only (45 [49%] of 91 patients vs 25 [27%] of 92 patients). The most common grade 3 or worse events were hand-foot syndrome (28 [31%] in the bevacizumab and capecitabine group vs none in the bevacizumab alone group), hypertension (eight [9%] vs three [3%]), and proteinuria (three [3%] vs four [4%]). Serious adverse events were reported by ten (11%) patients in the bevacizumab and capecitabine group and seven (8%) patients in the bevacizumab only group. INTERPRETATION Despite prematurely terminated accrual and the lack of information about post-progression treatment, both progression-free survival and overall survival were significantly improved with bevacizumab and capecitabine compared with bevacizumab alone as maintenance treatment. These results might inform future maintenance trials and current first-line treatment strategies for HER2-negative metastatic breast cancer. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Joseph Gligorov
- Assistance-Publique Hôpitaux de Paris-Tenon, Institut Universitaire de Cancerologie Université Pierre et Marie Curie, Sorbonne Université, Paris, France.
| | - Dinesh Doval
- Rajiv Gandhi Cancer Institute & Research Center, Delhi, India
| | - José Bines
- Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - Emilio Alba
- Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Paulo Cortes
- University Hospital of Santa Maria, Lisbon, Portugal
| | | | | | - Rômulo Costa
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
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Gligorov J, Doval D, Bines J, Jiang Z, Alba E, Cortes P, Srock S, de Ducla S, Freudensprung U, Mustacchi G. Efficacy and Safety of Maintenance Bevacizumab (Bev) with or Without Capecitabine (Cap) After Initial First-Line Bev Plus Docetaxel (Doc) for Her2-Negative Metastatic Breast Cancer (Mbc): Imelda Randomised Phase III Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parikh PM, Prabhash K, Govind KB, Digumarti R, Pandit S, Banerjee I, Biyani R, Deshmukh A, Doval D, Bhattacharyya GS, Gupta S. Standard operating procedure for audio visual recording of informed consent: an initiative to facilitate regulatory compliance. Indian J Cancer 2014; 51:113-6. [PMID: 25104190 DOI: 10.4103/0019-509x.138158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The office of the Drugs Controller General (India) vide order dated 19 th November 2013 has made audio visual (AV) recording of the informed consent mandatory for the conduct of all clinical trials in India. We therefore developed a standard operating procedure (SOP) to ensure that this is performed in compliance with the regulatory requirements, internationally accepted ethical standards and that the recording is stored as well as archived in an appropriate manner. The SOP was developed keeping in mind all relevant orders, regulations, laws and guidelines and have been made available online. Since, we are faced with unique legal and regulatory requirements that are unprecedented globally, this SOP will allow the AV recording of the informed consent to be performed, archived and retrieved to demonstrate ethical, legal and regulatory compliance. We also compared this to the draft guidelines for AV recording dated 9 th January 2014 developed by Central Drugs Standard Control Organization. Our future efforts will include regular testing, feedback and update of the SOP.
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Affiliation(s)
- P M Parikh
- SAARC Federation of Oncology, Mumbai, India
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Gooptu M, Doval D, Kumar K, Dewan A, Mehta A, Batra U, Dutta K, Avery TP, Jaslow RJ, Mitchell EP, Naiyer A, Manavalan J, Cristofanilli M. Breast cancer in low-income countries: India as a model. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Dinesh Doval
- Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Kapil Kumar
- Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Ajay Dewan
- Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Anurag Mehta
- Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv gandhi cancer Institute and Research center, Delhi, India
| | - Kumardeep Dutta
- Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | | | | | - Edith P. Mitchell
- Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
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Parikh PM, Gupta S, Dawood S, Rugo H, Bhattacharyya GS, Agarwal A, Chacko R, Sahoo TP, Babu G, Agarwal S, Munshi A, Goswami C, Smruti BK, Bondarde S, Desai C, Rajappa S, Somani N, Singh M, Nimmagadda R, Pavitran K, Mehta A, Parmar V, Desai S, Nair R, Doval D. ICON 2013: Practical consensus recommendations for hormone receptor-positive Her2-negative advanced or metastatic breastcancer. Indian J Cancer 2014; 51:73-9. [DOI: 10.4103/0019-509x.134650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Choudhury PS, Savio E, Solanki KK, Alonso O, Gupta A, Gambini JP, Doval D, Sharma P, Dondi M. (99m)Tc glucarate as a potential radiopharmaceutical agent for assessment of tumor viability: from bench to the bed side. World J Nucl Med 2013; 11:47-56. [PMID: 23372437 PMCID: PMC3555394 DOI: 10.4103/1450-1147.103405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Several radiotracers have been used for assessing cell death, whether by necrosis or apoptosis. 99mTc glucarate, which has initially been reported to be concentrating/accumulating in myocardial infarction or zones of cerebral injury, has also shown some tumor-seeking properties in a few preliminary studies. Under International Atomic Energy Agency (IAEA)'s coordinated research program, we report here the standardization, quality control, and clinical evaluation (detection, evaluation of response, and comparison with 18F Fluorodeoxyglucose) of this tracer in well-characterized lung cancer and head neck malignancies in a single-arm prospective observational study. Forty-seven patients (29 inoperable lung carcinoma and 18 head and neck malignancies) were prospectively enrolled and underwent 99mTc glucarate imaging [whole body planar and single-photon emission computed tomography of the region of interest] 4-5 hours after injection of 20 mCi of the radiopharmaceutical. Excellent 99mTc glucarate concentration was noted in the target lesion in lung cancer and head and neck malignancies. The sensitivity was found to be better in lung cancer. Avid concentration of tracer was seen in the metastatic sites. During response evaluation, the glucarate concentration correlated well with the clinical and other radiological findings. 99mTc glucarate showed avid concentration of tracer in the tumor, suggesting it to be a potential tumor imaging agent which can be used for detection and assessment of therapeutic response in malignancy.
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Affiliation(s)
- Partha S Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
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Bansal V, Bhutani R, Doval D, Kumar K, Pande P, Kumar G. Neo adjuvant chemo-radiotherapy and rectal cancer: can India follow the West? J Cancer Res Ther 2012; 8:209-14. [PMID: 22842363 DOI: 10.4103/0973-1482.98972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS The management of locally advanced rectal cancer has changed over the years with an emphasis on neoadjuvant chemo radiation therapy (CT-RT) followed by surgery. This study is undertaken to evaluate the efficacy of this treatment in our set of patients with a special focus on the outcome in large circumferential tumors. MATERIALS AND METHODS The study included patients who underwent neo adjuvant CT-RT between Jan 2006 and Oct 2009 in our institution. They received radical radiotherapy with conventional fractionation to a dose of 45-50 Gy along with continuous two cycles of 5-FU infusion. All patients were assessed at four weeks clinically and by CT scan and underwent surgery if the tumor was resectable followed by adjuvant chemotherapy. RESULTS A total of 52 patients received the neoadjuvant treatment in form of CT-RT out of which 13 patients had undergone defunctioning colostomy before commencing treatment for severe obstructive symptoms. Only 73% patients underwent surgery in form of AR (anterior resection) or APR (abdominoperineal resection) and adjuvant chemotherapy was delivered in 28 (53.8%) patients only. The patients who underwent diversion colostomy had worse disease-free survival (DFS) as compared to those who received definitive treatment (33% vs. 74.9%, P<0.009). CONCLUSIONS This study represents Indian experience with standard neoadjuvant chemo radiotherapy followed by surgery in rectal cancer. Large circumferential tumors in our set of patients lead to poor outcome leading to more APR. Also this study supported the need for an abbreviated protocol which can be economically suited and organ preservation protocols have a long way to go.
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Affiliation(s)
- Vivek Bansal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector V, Rohini, Delhi-110 085, India
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Nosov D, Bhargava P, Esteves WB, Strahs AL, Lipatov ON, Lyulko OO, Anischenko AO, Chacko RT, Doval D, Slichenmyer WJ. Final analysis of the phase II randomized discontinuation trial (RDT) of tivozanib (AV-951) versus placebo in patients with renal cell carcinoma (RCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4550] [Citation(s) in RCA: 7] [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] [Indexed: 11/20/2022] Open
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Yi J, Thongprasert S, Doval D, Lee J, Cho MN, Park SH, Park JO, Park YS, Kang WK, Lim HY. Phase II study of sunitinib as second-line treatment in advanced biliary tract carcinoma: Multicenter, multinational study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bhargava P, Esteves B, Al-Adhami M, Nosov D, Lipatov ON, Lyulko AA, Anischenko AA, Chacko RT, Doval D, Slichenmyer W. Activity of tivozanib (AV-951) in patients (Pts) with different histologic subtypes of renal cell carcinoma (RCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
327 Background: This phase 2 randomized discontinuation trial evaluated tivozanib, a potent and selective vascular endothelial growth factor receptor (VEGFR)-1, -2, and -3 kinase inhibitor. Median progression-free survival (PFS) in all pts was 11.8 mo, and the objective response rate (ORR) was 27%. Methods: Pts received 1.5 mg/d tivozanib (3 wk on, 1 wk off = 1 cycle). A retrospective analysis evaluated efficacy and safety by histologic subtype. Response was evaluated by independent radiology review using standard RECIST criteria. Results: 272 pts were enrolled: 70% were male; median age was 56 y (range, 26–79). 226 (83%) pts had clear cell (CC) RCC; 46 had non–clear cell (NCC) RCC, including 11 with papillary RCC. Of pts with CC RCC, 176 (78%) had undergone nephrectomy; of pts with NCC RCC, 23 (50%) had undergone nephrectomy. Median treatment duration was 8.5 mo (range, 0.03– 23.8) as of the data cutoff. Median PFS was 12.5 mo (range, 9.9–17.7) for pts with CC RCC, not yet reached for pts with papillary RCC, and 5.4 mo (range, 3.7–12.0) for pts with other NCC subtypes. ORR and disease control rate (DCR; ORR + stable disease), respectively, were 29% and 85% for pts with CC RCC, 18% and 100% for pts with papillary RCC, and 17% and 74% for pts with other NCC subtypes. For pts with CC RCC, median PFS, ORR, and DCR, respectively, were 14.8 mo, 32%, and 88% for those who had undergone nephrectomy and 8.9 mo, 18%, and 76% for those who had not. Among pts with NCC RCC, median PFS was 6.6 mo for pts who had undergone nephrectomy and 7.2 mo for pts without nephrectomy; ORR was 17% for both NCC subgroups, with a DCR of 78% for pts who had undergone nephrectomy and 83% for pts who had not. Common drug- related adverse events (AEs) for pts with CC and NCC RCC, respectively, included hypertension (49% and 48%), dysphonia (22% and 22%), asthenia (12% and 13%), and diarrhea (13% and 9%). The most common grade ≥3 drug-related AE was hypertension (CC, 8%; NCC, 4%). Conclusions: Disease control was observed for pts with all RCC histologic subtypes. The rate of AEs was similar among patients with CC and NCC RCC and consistent with that of a selective VEGFR inhibitor with minimal off-target toxicities. Tivozanib is currently being tested in a phase 3 trial in pts with CC RCC. [Table: see text]
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Affiliation(s)
- P. Bhargava
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - B. Esteves
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - M. Al-Adhami
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - D. Nosov
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - O. N. Lipatov
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - A. A. Lyulko
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - A. A. Anischenko
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - R. T. Chacko
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - D. Doval
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
| | - W. Slichenmyer
- AVEO Pharmaceuticals, Inc., Cambridge, MA; Blokhin Oncology Research Center, Moscow, Russia; Bashkortostan Clinical Oncology Center, Ufa, Russia; Zaporizhya Medical Academy of Postgraduate Education, Zaporizhya, Ukraine; Donetsk Regional Antitumor Center, Donetsk, Ukraine; Christian Medical College, Vellore, India; Rajiv Gandhi Cancer Institute, New Delhi, India
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Batra U, Doval D. To analyze the safety, efficacy, and toxicity profile of ixabepilone and capecitabine combination in metastatic breast cancer patients in Indian population. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11513] [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: 11/20/2022] Open
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Bhargava P, Esteves B, Al-Adhami M, Nosov D, Lipatov ON, Lyulko AA, Anischenko AA, Chacko RT, Doval D, Slichenmyer WJ. Activity of tivozanib (AV-951) in patients with renal cell carcinoma (RCC): Subgroup analysis from a phase II randomized discontinuation trial (RDT). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4599] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Newton RC, Bradley EC, Levy RS, Doval D, Bondarde S, Sahoo TP, Lokanatha D, Julka PK, Nagarkar R, Friedman SM. Clinical benefit of INCB7839, a potent and selective ADAM inhibitor, in combination with trastuzumab in patients with metastatic HER2+ breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Maniar M, Mani S, Ghalib MH, Roboz J, Ohnuma T, Advani S, Rao R, Doval D, Acharya M, O'Rourke E, Wilhelm F, Holland JF, Taft D. Abstract 2766: Multicenter pharmacokinetic evaluation of ON 01910. Na, a novel broad-spectrum anticancer agent, in Phase I single agent clinical trials in patients with solid tumors. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-2766] [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
Introduction: ON 01910. Na is an anti-cancer agent with demonstrated activity against both solid tumors and hematological cancers. The purpose of this research was to evaluate the effect of dose and administration schedule on ON 01910. Na pharmacokinetics (PK) in advanced, heavily pre-treated solid tumor patients. Methods: Data was collected in three Phase I protcols conducted in the US and in India covering a wide range of doses and intraveous infusion schedules: Protocol 1 (50-1375 mg/m2/day over 72 h); Protocol 2 (250 – 4450 mg/m2/day over 24 h) and Protocol 3 (2400-3200 mg over 2, 4 or 8 h). In several patients, pharmacokinetics were evaluated for more than 1 dosing cycle. Plasma samples were collected pre-dose and up to 72 hours post-infusion. ON 01910. Na plasma levels were determined by a validated LC/MS/MS method. Results: Ninety-five data sets from 81 patients were evaluated in this study. ON 01910. Na showed biphasic elimination from the plasma, regardless of dose and administration schedule. The functional half-life of ON 01910. Na, estimated from the initial decline of plasma levels following infusion termination, was less than 2 hours. This was confirmed in data from patients receiving prolonged infusions as ON. 01910. Na approached steady state levels within several hours after dose initiation. As noted in the table below, ON. 01910. Na clearance was lower at higher drug dosing rates. There were no differences in drug pharmacokinetics among the infusion schedules. Conclusion: The pharmacokinetics of ON 01910. Na is dose dependent. A continuous IV infusion would be recommended to treat patients because of its short plasma half-life and rapid clearance. Systemic drug exposure is not affected by type of dosing (flat dosing vs. BSA adjusted). No significant differences were noted between the PK profiles of patients in the US centers and the patients in the India centers.Effect of Dosing Rate on Clearance of ON 01910. NaDosing Rate (mg/m2/hr)NClearance (L/hr/m2)0-25189.3 ± 4.725-501610.0 ± 5.050-75209.2 ± 3.175-10065.5 ± 2.6100-200126.2 ± 3.8200-40083.3 ± 1.6400-800112.5 ± 1.8800-125041.9 +/− 0.47
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2766.
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Affiliation(s)
| | | | | | | | | | | | - Raghunadh Rao
- 5Nizam Institute of Medical Sciences, Hyderabad, India
| | - D Doval
- 6Rajiv Gandhi Cancer Institute, New Delhi, India
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Wang Y, Raghunadharao D, Raman G, Doval D, Advani S, Julka P, Parikh P, Patil S, Nag S, Madhavan J, Varadhachary A. Adding oral talactoferrin to first-line NSCLC chemotherapy safely enhanced efficacy in a randomized trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7095 Background: Talactoferrin alfa (TLF) is an oral immunomodulatory protein with a novel mechanism. TLF showed preclinical anti-cancer activity alone and in combination with chemotherapy. In Phase I/II trials, TLF was safe with apparent single-agent anti-cancer activity in non-small cell lung cancer (NSCLC). Methods: 110 chemo-naive patients with advanced or metastatic NSCLC were randomized (1:1) in a multi-center trial to carboplatin/paclitaxel (C/P) therapy plus either TLF or placebo. Starting the day after C/P (C:AUC 5 mg/mL/min; P:175 mg/m2) in chemo-cycles 1, 3 and 5, oral TLF (1.5 g BID) or placebo was administered in 35-day cycles for up to three cycles or until progression. Primary endpoint was Confirmed Response Rate (RR; PR+CR) by CT using RECIST. Secondary endpoints included Progression Free Survival (PFS) and Overall Survival (OS). Results: Baseline patient and disease characteristics were comparable in both groups. All 110 patients were included in the Intent To Treat (ITT) population. 100 patients with at least one CT scan after starting treatment were prospectively defined as the Evaluable population. Adding oral TLF to C/P enhanced efficacy on all endpoints examined including RR, PFS and OS. Confirmed RR in the 100 evaluable patients significantly increased from 29% to 47% (P = 0.05). Confirmed RR in the 110 ITT patients improved from 27% to 42% (P = 0.08). Median PFS in both evaluable and ITT patients improved by 2.8 months (67%). Median OS improved by 31% and 18% in evaluable and ITT patients, respectively. A landmark analysis comparing survival in patients with and without a PR showed a significant difference (P < 0.01), suggesting a strong association between RR and survival. TLF appeared to be very safe and well tolerated with no drug-related SAEs. Fewer AEs were observed in the TLF arm than in the placebo arm, 346 and 432 AEs, respectively (P = 0.0023). The number of Grade 3/4 AEs was also lower in the TLF arm, 60 versus 91 (P = 0.0144). Conclusions: Adding oral TLF to standard C/P chemotherapy in NSCLC was safe and increased efficacy in a randomized, multi-center, double-blind, placebo-controlled trial, with apparent improvements in RR, PFS and OS. Results with TLF compare favorably to other anti-cancer agents. Oral TLF will be further evaluated in a Phase III trial. [Table: see text]
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Affiliation(s)
- Y. Wang
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - D. Raghunadharao
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - G. Raman
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - D. Doval
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - S. Advani
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - P. Julka
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - P. Parikh
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - S. Patil
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - S. Nag
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - J. Madhavan
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
| | - A. Varadhachary
- Agennix, Houston, TX; Nizam’s Institute of Medical Sciences, Hyderabad, India; Cancer Institute, Chennai, India; Rajiv Gandhi Cancer Institute, New Delhi, India; Jaslok Hospital and Research Centre, Mumbai, India; All India Institute of Medical Sciences, New Delhi, India; Tata Memorial Hospital, Mumbai, India; Bangalore Institute of Oncology, Bangalore, India; Jehangir Hospital, Pune, India; Regional Cancer Centre, Trivandrum, India
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Ibrahim NK, Samuels B, Page R, Doval D, Patel KM, Rao SC, Nair MK, Bhar P, Desai N, Hortobagyi GN. Multicenter Phase II Trial of ABI-007, an Albumin-Bound Paclitaxel, in Women With Metastatic Breast Cancer. J Clin Oncol 2005; 23:6019-26. [PMID: 16135470 DOI: 10.1200/jco.2005.11.013] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose ABI-007 is a novel nanoparticle, albumin-bound paclitaxel that is free of solvents. This multicenter phase II study was designed to evaluate the efficacy and safety of ABI-007 for the treatment of metastatic breast cancer (MBC). Patients and Methods Sixty-three women with histologically confirmed and measurable MBC received 300 mg/m2 ABI-007 by intravenous infusion over 30 minutes every 3 weeks without premedication. Forty-eight patients received prior chemotherapy; 39 patients received no prior treatment for metastatic disease. Results Overall response rates (complete or partial responses) were 48% (95% CI, 35.3% to 60.0%) for all patients. For patients who received ABI-007 as first-line and greater than first-line therapy for their metastatic disease, the respective response rates were 64% (95% CI, 49.0% to 79.2%) and 21% (95% CI, 7.1% to 42.1%). Median time to disease progression was 26.6 weeks, and median survival was 63.6 weeks. No severe hypersensitivity reactions were reported despite the lack of premedication. Toxicities observed were typical of paclitaxel and included grade 4 neutropenia (24%), grade 3 sensory neuropathy (11%), and grade 4 febrile neutropenia (5%). Patients received a median of six treatment cycles; 16 patients had 25% dose reductions because of toxicities, and two of these patients had subsequent dose reductions. Conclusion ABI-007, the first biologically interactive albumin-bound form of paclitaxel in the nanoparticle state, uses the natural carrier albumin rather than synthetic solvents to deliver paclitaxel and allows for safe administration of high paclitaxel doses without premedication, resulting in significant antitumor activity in patients with MBC, including those receiving the drug as first-line therapy.
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Affiliation(s)
- Nuhad K Ibrahim
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 424, Houston, TX 77030-4009, USA.
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Vaid AK, Gupta S, Doval D, Talwar V, Shrestha S, Pavithran K, Sharma JB, Lokanathan D. Capecitabine: Single institution experience from North India in metastatic breast cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. K. Vaid
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
| | - S. Gupta
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
| | - D. Doval
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
| | - V. Talwar
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
| | - S. Shrestha
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
| | - K. Pavithran
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
| | - J. B. Sharma
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
| | - D. Lokanathan
- Rajiv Gandhi Cancer Institute and Research Centre, New-Delhi, India
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Malik I, Roth A, Ghilezan N, Cufer T, Lazarev A, Doval D, Ionescu-Goga S, Chernozemsky I, Quinaux E, Chirina N. A phase II trial of taxotere (TXT) 100 or 75 mg/m2 as 2nd line chemotherapy (CT) in patients (PTS) with metastatic breast cancer (mbc) with stratification according to prognosis factors. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81701-8] [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: 10/27/2022]
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Nandakumar A, Anantha N, Venugopal T, Reddy S, Padmanabhan B, Swamy K, Doval D, Ramarao C. Descriptive epidemiology of lymphoid and haemopoietic malignancies in Bangalore, India. Int J Cancer 1995; 63:37-42. [PMID: 7558449 DOI: 10.1002/ijc.2910630108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lymphoid and haemopoietic malignancies as a group constitute one of the important cancers in India, as elsewhere in the world. While information on incidence and mortality of these cancers, and that on survival, are available from most developed countries, there are very few reports describing this experience in developing ones. Population-based cancer registration commenced in Bangalore, India, in January 1982, under the auspices of the Indian Council of Medical Research. This source provides fairly complete and reliable incidence data, but, in order to obtain mortality and survival information, active follow-up involving visits of homes of patients was undertaken. Between 1982 and 1989, 1397 cases of lymphoid and haemopoietic malignancies were registered in the Bangalore cancer registry, giving an age-adjusted incidence rate of 7.7 and 4.8 per 100,000 in males and females respectively. Active follow-up provided mortality/survival information in 1267 or 90.7% of these cases. The overall observed 5-year survival for these cancers combined (both sexes) was 26%, and relative survival 28.4%. The 5-year survival rate was lower in all the individual lymphomas and leukaemias as compared with similar reports from the developed countries. Survival in Hodgkin's disease was influenced by clinical stage and age at presentation.
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Affiliation(s)
- A Nandakumar
- Coordinating Unit, National Cancer Registry Programme of India (Indian Council of Medical Research), Bangalore
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