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Koumarianou A, Pectasides D, Koliou GA, Dionysopoulos D, Kolomodi D, Poulios C, Skondra M, Sgouros J, Pentheroudakis G, Kaltsas G, Fountzilas G. Efficacy and Safety of First-Line Everolimus Therapy Alone or in Combination with Octreotide in Gastroenteropancreatic Neuroendocrine Tumors. A Hellenic Cooperative Oncology Group (HeCOG) Study. Biology (Basel) 2020; 9:biology9030051. [PMID: 32182791 PMCID: PMC7150771 DOI: 10.3390/biology9030051] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 01/17/2023]
Abstract
The purpose of this study was to explore the efficacy and safety of everolimus administered as a first-line treatment in newly diagnosed patients with metastatic or inoperable gastroenteropancreatic neuroendocrine tumors (GEP NETs). This phase II, multicenter, single-arm study included patients with well-differentiated GEP NETs and a Ki67 < 20%. Everolimus, at 10 mg/day, was administered until disease progression; 18 patients (72%) concomitantly received octreotide long-acting release (LAR), at 30 mg/month. The primary endpoint was the 15-month progression-free survival (PFS) rate. Twenty-five patients (grade 1: 11 patients, grade 2: 14 patients) were enrolled between August 2012 and October 2015. At a median follow-up of 58.1 months, the median PFS was 14.6 months, while the 15-month PFS rate was 48%; median overall survival had not been reached yet. Normal baseline chromogranin A (<4 nmol/l) confirmed a longer PFS (HR = 0.25, 95% CI 0.08–0.77, p = 0.016). Seven patients (28%) achieved an objective response (one complete response and six partial responses) in a median of 2.6 months. Twenty-three grade 3–4 events were recorded (14 patients). No fatal reactions occurred. This prospective phase II study unravels the notable activity of everolimus as a first-line treatment in patients with GEP NETS and contributes valuable information about the high activity of the combination of everolimus and octreotide LAR in this setting. Clinical trial information: NCT01648465.
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Affiliation(s)
- Anna Koumarianou
- Hematology Oncology Unit Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462 Athens, Greece
- Correspondence: ; Tel.: +30-210-583-1687; Fax: +30-210-583-6446
| | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527 Athens, Greece; (D.P.); (M.S.)
| | - Georgia-Angeliki Koliou
- Section of Biostatistics, Hellenic Cooperative Oncology Group, Data Office, 11526 Athens, Greece;
| | - Dimitrios Dionysopoulos
- Department of Medical Oncology, Papageorgiou Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, 56403 Thessaloniki, Greece;
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko University Hospital, 11527 Athens, Greece; (D.K.); (G.K.)
| | - Christos Poulios
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, 54006 Thessaloniki, Greece;
| | - Maria Skondra
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, 11527 Athens, Greece; (D.P.); (M.S.)
| | - Joseph Sgouros
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, 14564 Athens, Greece;
| | - George Pentheroudakis
- Department of Medical Oncology, Medical School, University of Ioannina, 45110 Ioannina, Greece;
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), 45110 Ioannina, Greece
| | - Gregory Kaltsas
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laiko University Hospital, 11527 Athens, Greece; (D.K.); (G.K.)
| | - George Fountzilas
- Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece;
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece
- Department of Medical Oncology, German Oncology Center, Limassol 4108, Cyprus
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Abstract
CONTEXT Although most sellar lesions are related to pituitary adenomas, the region gives rise to a variety of neoplasms that can be associated with substantial morbidity and/or mortality. DESIGN Information from reviews and guidelines of relevant societies dealing with such neoplasms, as well as articles that have provided new developments that made important contributions to their pathogenesis and treatment up to 2018, were obtained: public indexes such as PubMed/MEDLINE were used with the relevant search items. RESULTS Sellar neoplasms have a worse outcome than pituitary adenomas that is related not only to their natural history but also to side effects of therapies and evolving endocrine and/or hypothalamic deficiencies. Recent imaging advances have established the radiological fingerprint of some of these neoplasms, and several chromosomal aberrations have also been identified. Although established approaches along with new surgical and radiotherapeutic approaches remain the main treatment modalities, recent evidence has provided insight into their molecular pathogenesis involving, other than chemotherapy, treatments with targeted agents as in gliomas and craniopharyngiomas bearing BRAF mutations. Development of predictive markers of recurrences may also identify high-risk patients, including proliferative markers and expression of the progesterone receptor in meningiomas, and lead to less aggressive surgery. Owing to the rarity and complexity of these neoplasms, patients should be managed in dedicated centers. CONCLUSIONS The diagnosis and management of sellar neoplasms necessitate a multidisciplinary approach. Following evolving recent advances in their diagnosis and therapy, such a multidisciplinary approach needs to be extended to establish evidence-based diagnostic and management plans.
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Affiliation(s)
- Gregory A Kaltsas
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Harpal Randeva
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Ashley Grossman
- Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
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Tsoli M, Chatzellis E, Koumarianou A, Kolomodi D, Kaltsas G. Current best practice in the management of neuroendocrine tumors. Ther Adv Endocrinol Metab 2019; 10:2042018818804698. [PMID: 30800264 PMCID: PMC6378464 DOI: 10.1177/2042018818804698] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 12/13/2022] Open
Abstract
Neuroendocrine neoplasms are rare tumors that display marked heterogeneity with varying natural history, biological behavior, response to therapy and prognosis. Their management is complex, particularly as a number of them may be associated with a secretory syndrome and involve a variety of options. A number of factors such as proliferation rate, degree of differentiation, functionality and extent of the disease are mostly utilized to tailor treatment accordingly, ideally in the context of a multidisciplinary team. In addition, a number of relevant scientific societies have published therapeutic guidelines in an attempt to direct and promote evidence-based treatment. Surgery remains the treatment of choice with an intention to cure while it may also be recommended in some cases of metastatic disease and difficult to control secretory syndromes. Long-acting somatostatin analogs constitute the main treatment for the majority of functioning tumors, whereas specific evolving agents such as telotristat may be used for the control of carcinoid syndrome and related sequelae. In patients with advanced disease not amenable to surgical resection, treatment options include locoregional therapies, long-acting somatostatin analogs, molecular targeted agents, radionuclides, chemotherapy and recently immunotherapy, alone or in combination. However, the ideal time of treatment initiation, sequence of administration of different therapies and identification of robust prognostic markers to select the most appropriate treatment for each individual patient still need to be defined.
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Affiliation(s)
| | - Eleftherios Chatzellis
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
| | - Anna Koumarianou
- Fourth Department of Internal Medicine, Attikon
University General Hospital, Athens, Greece
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
| | - Gregory Kaltsas
- First Department of Propaedeutic Internal
Medicine, Laiko General Hospital, National and Kapodistrian University of
Athens, Athens, Greece
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Koumarianou A, Pectasides D, Manousou K, Dionysopoulos D, Kaltsas G, Kolomodi D, Poulios C, Skondra M, Samantas E, Pentheroudakis G, Fountzilas G. Evaluation of the efficacy and safety of everolimus as a first-line treatment in newly diagnosed patients with advanced gastroenteropancreatic neuroendocrine tumors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.019] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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Komninaka V, Kolomodi D, Christoulas D, Marinakis T, Papatheodorou A, Repa K, Voskaridou E, Revenas K, Terpos E. Evaluation of bone involvement in patients with Gaucher disease: a semi-quantitative magnetic resonance imaging method (using ROI estimation of bone lesion) as an alternative method to semi-quantitative methods used so far. Eur J Haematol 2015; 95:342-51. [PMID: 25645321 DOI: 10.1111/ejh.12504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate bone involvement in patients with Gaucher disease (GD) and to propose a novel semi-quantitative magnetic resonance imaging (MRI) staging. METHODS MRI of the lumbar spine, femur, and tibia was performed in 24 patients with GD and 24 healthy controls. We also measured circulating levels of C-C motif ligand-3 (CCL-3) chemokine, C-telopeptide of collagen type-1 (CTX), and tartrate-resistant acid phosphatase isoform type-b (TRACP-5b). RESULTS We used the following staging based on MRI data: stage I: region of interest (ROI) 1/2 of normal values and bone infiltration up to 30%; stage II: ROI 1/3 of normal values and bone infiltration from 30 to 60%; stage III: ROI 1/4 of normal values and bone infiltration from 60% to 80%; and stage IV: detection of epiphyseal infiltration, osteonecrosis and deformity regardless of the ROI's values. All but two patients had abnormal MRI findings: 9 (37.5%), 6 (25%), 3 (12.5%), and 4 (16.7%) had stages I-IV, respectively. Patients with GD had elevated chitotriosidase, serum TRACP-5b, and CCL-3 levels (P < 0.001). CONCLUSIONS We propose an easily reproducible semi-quantitative scoring system and confirm that patients with GD have abnormal MRI bone findings and enhanced osteoclast activity possibly due to elevated CCL-3.
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Affiliation(s)
| | | | | | - Theodoros Marinakis
- Department of Haematology, "Georgios Gennimatas" General Hospital, Athens, Greece
| | | | | | - Ersi Voskaridou
- Thalassaemia Centre, Laikon General Hospital, Athens, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Tzortzis G, Kolomodi D, Stathopoulou S, Kostakis A, Michail S, Pappas P, Revenas K. Hyperselective renal artery embolisation in the treatment of post-traumatic iatrogenic haematuria: report of two cases. INT ANGIOL 1998; 17:58-61. [PMID: 9657250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Angiography and selective renal artery embolisation were performed in two patients with post-traumatic iatrogenic kidney lesions and intractable haematuria. One patient presented after a nephrolithotomy with rupture of a segmental branch of the renal artery well demonstrated on selective angiography which showed intraparenchymal extravasion of contrast medium. The other presented after a renal biopsy with severe haematuria. Angiography performed 10 days later demonstrated an arteriovenous fistula at the site of the puncture. Hyperselective embolisation achieved immediate control of the haematuria in both patients, with maximal preservation of the renal parenchyma and maintenance of good renal function. At follow-up 12 months later, there had been no recurrence of the haematuria. These results suggest that transcatheter embolisation should be considered the method of first choice in renal trauma accompanied by intractable haematuria before any surgery is attempted.
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Affiliation(s)
- G Tzortzis
- Department of Radiology, Laikon General Hospital of Athens, Greece
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