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Cohen EEW, Licitra LF, Burtness B, Fayette J, Gauler T, Clement PM, Grau JJ, Del Campo JM, Mailliez A, Haddad RI, Vermorken JB, Tahara M, Guigay J, Geoffrois L, Merlano MC, Dupuis N, Krämer N, Cong XJ, Gibson N, Solca F, Ehrnrooth E, Machiels JPH. Biomarkers predict enhanced clinical outcomes with afatinib versus methotrexate in patients with second-line recurrent and/or metastatic head and neck cancer. Ann Oncol 2018; 28:2526-2532. [PMID: 28961833 PMCID: PMC5834024 DOI: 10.1093/annonc/mdx344] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background In the phase III LUX-Head & Neck 1 (LUX-H&N1) trial, second-line afatinib significantly improved progression-free survival (PFS) versus methotrexate in patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Here, we evaluated association of prespecified biomarkers with efficacy outcomes in LUX-H&N1. Patients and methods Randomized patients with R/M HNSCC and progression following ≥2 cycles of platinum therapy received afatinib (40 mg/day) or methotrexate (40 mg/m2/week). Tumor/serum samples were collected at study entry for patients who volunteered for inclusion in biomarker analyses. Tumor biomarkers, including p16 (prespecified subgroup; all tumor subsites), EGFR, HER2, HER3, c-MET and PTEN, were assessed using tissue microarray cores and slides; serum protein was evaluated using the VeriStrat® test. Biomarkers were correlated with efficacy outcomes. Results Of 483 randomized patients, 326 (67%) were included in the biomarker analyses; baseline characteristics were consistent with the overall study population. Median PFS favored afatinib over methotrexate in patients with p16-negative [2.7 versus 1.6 months; HR 0.70 (95% CI 0.50-0.97)], EGFR-amplified [2.8 versus 1.5 months; HR 0.53 (0.33-0.85)], HER3-low [2.8 versus 1.8 months; HR 0.57 (0.37-0.88)], and PTEN-high [1.6 versus 1.4 months; HR 0.55 (0.29-1.05)] tumors. Afatinib also improved PFS in combined subsets of patients with p16-negative and EGFR-amplified tumors [2.7 versus 1.5 months; HR 0.47 (0.28-0.80)], and patients with p16-negative tumors who were EGFR therapy-naïve [4.0 versus 2.4 months; HR 0.55 (0.31-0.98)]. PFS was improved in afatinib-treated patients who were VeriStrat 'Good' versus 'Poor' [2.7 versus 1.5 months; HR 0.71 (0.49-0.94)], but no treatment interaction was observed. Afatinib improved tumor response versus methotrexate in all subsets analyzed except for those with p16-positive disease (n = 35). Conclusions Subgroups of HNSCC patients who may achieve increased benefit from afatinib were identified based on prespecified tumor biomarkers (p16-negative, EGFR-amplified, HER3-low, PTEN-high). Future studies are warranted to validate these findings. Clinical trial registration NCT01345682.
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Affiliation(s)
- E E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, USA;.
| | - L F Licitra
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan;; Department of Medical Oncology, University of Milan, Milan, Italy
| | - B Burtness
- Department of Medical Oncology, Yale University School of Medicine, New Haven, USA
| | - J Fayette
- Department of Medicine, Léon Bérard Center, Lyon;; Department of Medicine, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - T Gauler
- Department of Medicine, West German Cancer Center, University Hospital Essen of the University Duisburg-Essen, Essen, Germany
| | - P M Clement
- Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - J J Grau
- Department of Medical Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona
| | - J M Del Campo
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Mailliez
- Oncology Department Mastology, Centre Oscar Lambret, Lille, France
| | - R I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston;; Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - J B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - M Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - J Guigay
- Department of Medical Oncology, Centre Antoine Lacassagne, FHU OncoAge, Nice
| | - L Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - M C Merlano
- Department of Medical Oncology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | - N Krämer
- Staburo GmbH, Munich, Germany on behalf of Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - X J Cong
- Biometrics and Data Management, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, USA
| | - N Gibson
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - F Solca
- Pharmacology and Translational Research, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | - E Ehrnrooth
- TA Oncology, Boehringer Ingelheim, Danmark A/S, Denmark
| | - J-P H Machiels
- Institut Roi Albert II, Service d'Oncologie Médicale, Cliniques Universitaires Saint-Luc, Brussels;; Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
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Mathé YG, Fogel P, Martin-Lannerée S, Marcaillou C, Lallet E, Krämer N, Gibson N, Solca F, Ehrnrooth E, Cadranel J. 60P Circulating miR-31 as a predictive marker of EGFR TKI treatment efficacy in squamous cell lung cancer (SCC): A sub-analysis of the LUX-Lung 8 trial. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30336-8] [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: 10/17/2022]
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Park K, Tan E, O’Byrne K, Zhang L, Boyer M, Mok T, Hirsh V, Yang J, Schuler M, Yamamoto N, Sequist L, Wu Y, Zhou C, Ehrnrooth E, Märten A, Tang W, Paz-Ares L. P3.01-039 Sequential Afatinib-Osimertinib Therapy in EGFR Mutation-Positive (EGFRm+) NSCLC: Analysis of Time on Treatment and OS. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1480] [Citation(s) in RCA: 2] [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: 10/18/2022]
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Goss G, Felip E, Cobo M, Lu S, Syrigos K, Lee K, Göker E, Georgoulias V, Li W, Guclu S, Isla D, Min YJ, Morabito A, Ardizzoni A, Gadgeel S, Gibson N, Krämer N, Solca F, Cseh A, Ehrnrooth E, Soria J. P3.01-043 Impact of ErbB Mutations on Clinical Outcomes in Afatinib- or Erlotinib-Treated Patients with SCC of the Lung. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1484] [Citation(s) in RCA: 2] [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: 12/01/2022]
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Sequist L, Wu Y, Schuler M, Kato T, Yang J, Tanaka H, Hida T, Lu S, Park K, Paz-Ares L, Laurie S, Bennouna J, Moro Sibilot D, Märten A, Tang W, Ehrnrooth E, Yamamoto N, Nakagawa K. PS02.20 Subsequent Therapies Post-Afatinib Among Patients with EGFR Mutation-Positive (EGFRm+) NSCLC in LUX-Lung 3, 6 and 7. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Machiels JP, de Castro G, de Souza Viana L, Galiulin R, Tahara M, Nicolau U, Le Tourneau C, Okami K, Vladimirov V, Izmailov A, Hoermann K, Licitra L, Haddad R, Cohen E, Dupuis N, Love J, Zografos E, Ehrnrooth E, Fayette J. Long-term response to second-line afatinib in patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC): Analysis of the LUX-Head & Neck 1 (LHN1) trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Font A, Real F, Puente J, Vazquez Mazon F, Sala N, Virizuela J, Rodriguez-Vida A, Grande Pulido E, Castellano D, Climent M, Gallardo E, González del Alba A, Fernandez P, Jares P, Aldecoa I, Gibson N, Serra J, Imedio E, Ehrnrooth E, Mellado B. Afatinib in patients with advanced or metastatic urothelial carcinoma (UC) with genetic alterations in ErbB receptors 1–3 who failed on platinum-based chemotherapy: The Phase II LUX-Bladder 1 trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sequist L, Wu YL, Schuler M, Kato T, Yang JH, Tanaka H, Hida T, Lu S, Park K, Laurie S, Bennouna J, Moro Sibilot D, Märten A, Peil B, Ehrnrooth E, Yamamoto N, Nakagawa K. Subsequent therapies post-afatinib among patients (pts) with EGFR mutation-positive (EGFRm+) NSCLC in LUX-Lung (LL) 3, 6 and 7. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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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Yang JH, Goss G, Felip E, Lu S, Ardizzoni A, Gadgeel S, Georgoulias V, Dupuis N, Ehrnrooth E, Soria JC. LUX-Lung 8 phase III trial: Analysis of long-term response to second-line afatinib in patients with advanced squamous cell carcinoma (SCC) of the lung. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx091.022] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Gadgeel S, Soria J, Felip E, Cobo M, Lu S, Syrigos K, Lee K, Göker E, Georgoulias V, Li W, Guclu S, Isla D, Ardizzoni A, Dupuis N, Gibson N, Krämer N, Bühnemann C, Solca F, Ehrnrooth E, Goss G. Second-line afatinib vs erlotinib for patients with squamous cell carcinoma (SCC) of the lung (LUX-Lung 8 [LL8]): analysis of tumour and serum biomarkers and long-term responders. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30671-8] [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: 10/20/2022]
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Schuler M, Paz-Ares L, Sequist L, Tan E, Mok T, Hirsh V, O’Byrne K, Zhang L, Yamamoto N, Boyer M, Shah R, Bennouna J, Dickgreber N, De Grève J, Love J, Märten A, Fan J, Ehrnrooth E, Park K, Yang J. First-line afatinib for advanced EGFR mutation-positive (EGFRm+) NSCLC: analysis of long-term responders in the Phase III LUX-Lung 3, 6 and 7 trials. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30648-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee K, Soria JC, Felip E, Cobo M, Lu S, Syrigos K, Goker E, Georgoulias V, Li W, Guclu S, Isla D, Ardizzoni A, Gadgeel S, Dupuis N, Gibson N, Krämer N, Bühnemann C, Solca F, Ehrnrooth E, Goss G. 446PD Second-line afatinib vs erlotinib for patients with squamous cell carcinoma of the lung in LUX-Lung 8: analysis of tumor and serum biomarkers. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw594.010] [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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Goss G, Lee K, Felip E, Cobo M, Syrigos K, Goker E, Georgioulias V, Guclu S, Isla D, Min Y, Morabito A, Dupuis N, Chand V, Solca F, Krämer N, Gibson N, Ehrnrooth E, Soria J. Evaluation of VeriStrat, a serum proteomic test, in the randomized, open-label, Phase 3 LUX-Lung 8 trial of afatinib versus erlotinib for the second-line treatment of advanced squamous cell carcinoma of the lung. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.38] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Clement PM, Gauler T, Machiels JP, Haddad RI, Fayette J, Licitra LF, Tahara M, Cohen EEW, Cupissol D, Grau JJ, Guigay J, Caponigro F, de Castro G, de Souza Viana L, Keilholz U, Del Campo JM, Cong XJ, Ehrnrooth E, Vermorken JB. Afatinib versus methotrexate in older patients with second-line recurrent and/or metastatic head and neck squamous cell carcinoma: subgroup analysis of the LUX-Head & Neck 1 trial. Ann Oncol 2016; 27:1585-93. [PMID: 27084954 PMCID: PMC4959921 DOI: 10.1093/annonc/mdw151] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the phase III LUX-Head & Neck 1 (LHN1) trial, afatinib significantly improved progression-free survival (PFS) versus methotrexate in recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients progressing on/after platinum-based therapy. This report evaluates afatinib efficacy and safety in prespecified subgroups of patients aged ≥65 and <65 years. PATIENTS AND METHODS Patients were randomized (2:1) to 40 mg/day oral afatinib or 40 mg/m(2)/week intravenous methotrexate. PFS was the primary end point; overall survival (OS) was the key secondary end point. Other end points included: objective response rate (ORR), patient-reported outcomes, tumor shrinkage, and safety. Disease control rate (DCR) was also assessed. RESULTS Of 483 randomized patients, 27% (83 afatinib; 45 methotrexate) were aged ≥65 years (older) and 73% (239 afatinib; 116 methotrexate) <65 years (younger) at study entry. Similar PFS benefit with afatinib versus methotrexate was observed in older {median 2.8 versus 2.3 months, hazard ratio (HR) = 0.68 [95% confidence interval (CI) 0.45-1.03], P = 0.061} and younger patients [2.6 versus 1.6 months, HR = 0.79 (0.62-1.01), P = 0.052]. In older and younger patients, the median OS with afatinib versus methotrexate was 7.3 versus 6.4 months [HR = 0.84 (0.54-1.31)] and 6.7 versus 6.2 months [HR = 0.98 (0.76-1.28)]. ORRs with afatinib versus methotrexate were 10.8% versus 6.7% and 10.0% versus 5.2%; DCRs were 53.0% versus 37.8% and 47.7% versus 38.8% in older and younger patients, respectively. In both subgroups, the most frequent treatment-related adverse events were rash/acne (73%-77%) and diarrhea (70%-80%) with afatinib, and stomatitis (43%) and fatigue (31%-34%) with methotrexate. Fewer treatment-related discontinuations were observed with afatinib (each subgroup 7% versus 16%). A trend toward improved time to deterioration of global health status, pain, and swallowing with afatinib was observed in both subgroups. CONCLUSIONS Advancing age (≥65 years) did not adversely affect clinical outcomes or safety with afatinib versus methotrexate in second-line R/M HNSCC patients. CLINICAL TRIAL REGISTRATION NCT01345682 (ClinicalTrials.gov).
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Affiliation(s)
- P M Clement
- Department of Oncology, KU Leuven, Leuven Department of General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - T Gauler
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, Essen, Germany
| | - J P Machiels
- Institut Roi Albert II, Service d'Oncologie Médicale, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - R I Haddad
- Departmant of Medical Oncology, Dana-Farber Cancer Institute/Harvard Medical School, Boston, USA
| | - J Fayette
- Departmant of Medical Oncology, Léon Bérard Center, University of Lyon, Lyon, France
| | - L F Licitra
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Tahara
- Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - E E W Cohen
- Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, USA
| | - D Cupissol
- Service d'Oncologie Médicale, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - J J Grau
- Department of Medical Oncology, Hospital Clínic and University of Barcelona, Barcelona, Spain
| | - J Guigay
- Department of Medical Oncology, Gustave Roussy, Villejuif Centre Antoine Lacassagne, Nice, France
| | - F Caponigro
- Department of Melanoma, Soft Tissues, Muscolo Scheletal, Head and Neck, Head and Neck Medical Oncology, National Tumor Institute of Naples, Naples, Italy
| | - G de Castro
- Oncologia Clinica, Instituto do Câncer do Estado de São Paulo, São Paulo
| | - L de Souza Viana
- Department of Medical Oncology, Hospital de Câncer de Barretos, São Paulo, Brazil
| | - U Keilholz
- Charité Comprehensive Cancer Center, Berlin, Germany
| | - J M Del Campo
- Department of Medical Oncology, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - X J Cong
- Biometrics and Data Management, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, USA
| | - E Ehrnrooth
- Division of Oncology, Boehringer Ingelheim Danmark A/S, Copenhagen, Denmark
| | - J B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
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Tahara M, Cohen E, Haddad R, Fayette J, Licitra L, Clement P, Vermorken J, Gauler T, Cupissol D, Grau J, Guigay J, del Campo J, Okami K, Takahashi S, Burtness B, Cong X, Gibson N, Solca F, Ehrnrooth E, Machiels JP. 314O_PR Second-line afatinib vs methotrexate (MTX) in patients (pts) with recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC): subgroup/biomarker analysis of LUX-head and neck 1 (LUX-H&N1). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv527.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hu C, Chan A, Gao L, Ahn MJ, Cohen E, Ang MK, Cheng Y, Hu Q, Kim SB, Li P, Sun Y, Fan B, Cheng G, Ehrnrooth E, Wang CH. 339TiP Phase III study of afatinib vs placebo as adjuvant therapy after chemo-radiotherapy (CRT) in primary unresected patients with locoregionally advanced (LA) head and neck squamous cell carcinoma (HNSCC) in Asia: LUX-Head & Neck 4 (LUX-H&N4). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv527.26] [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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Tang P, Ahn MJ, Zhang Q, Chan A, Kim SB, Wang CH, He X, Guo W, Kang J, Dechaphunkul A, Li P, Kandil A, Cohen E, Hu GQ, Geng Y, Ehrnrooth E, Guo Y. 340TiP Phase III study of afatinib vs methotrexate (MTX) for second-line recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients after platinum-based chemotherapy (CT) in Asia/Middle East/North Africa: LUX-Head & Neck 3 (LUX-H&N3). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv527.27] [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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Machiels JP, Haddad R, Fayette J, Licitra L, Tahara M, Vermorken J, Clement P, Gauler T, Cupissol D, Grau J, Guigay J, Caponigro F, De Castro G, De Souza Viana L, Keilholz U, Del Campo J, Cong X, Svensson L, Ehrnrooth E, Cohen E. Afatinib Versus Methotrexate (Mtx) As Second-Line Treatment for Patients with Recurrent and/or Metastatic (R/M) Head and Neck Squamous Cell Carcinoma (Hnscc) Who Progressed After Platinum-Based Therapy: Primary Efficacy Results of Lux-Head & Neck 1, a Phase III Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Seiwert TY, Fayette J, Cupissol D, Del Campo JM, Clement PM, Hitt R, Degardin M, Zhang W, Blackman A, Ehrnrooth E, Cohen EEW. A randomized, phase II study of afatinib versus cetuximab in metastatic or recurrent squamous cell carcinoma of the head and neck. Ann Oncol 2014; 25:1813-1820. [PMID: 24928832 PMCID: PMC4143093 DOI: 10.1093/annonc/mdu216] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/01/2014] [Accepted: 06/04/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Afatinib is an oral, irreversible ErbB family blocker that has shown activity in epidermal growth factor receptor (EGFR)-mutated lung cancer. We hypothesized that the agent would have greater antitumor activity compared with cetuximab in recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients, whose disease has progressed after platinum-containing therapy. PATIENTS AND METHODS An open-label, randomized, phase II trial was conducted in 43 centers; 124 patients were randomized (1 : 1) to either afatinib (50 mg/day) or cetuximab (250 mg/m(2)/week) until disease progression or intolerable adverse events (AEs) (stage I), with optional crossover (stage II). The primary end point was tumor shrinkage before crossover assessed by investigator (IR) and independent central review (ICR). RESULTS A total of 121 patients were treated (61 afatinib, 60 cetuximab) and 68 crossed over to stage II (32 and 36 respectively). In stage I, mean tumor shrinkage by IR/ICR was 10.4%/16.6% with afatinib and 5.4%/10.1% with cetuximab (P = 0.46/0.30). Objective response rate was 16.1%/8.1% with afatinib and 6.5%/9.7% with cetuximab (IR/ICR). Comparable disease control rates were observed with afatinib (50%) and cetuximab (56.5%) by IR; similar results were seen by ICR. Most common grade ≥3 drug-related AEs (DRAEs) were rash/acne (18% versus 8.3%), diarrhea (14.8% versus 0%), and stomatitis/mucositis (11.5% versus 0%) with afatinib and cetuximab, respectively. Patients with DRAEs leading to treatment discontinuation were 23% with afatinib and 5% with cetuximab. In stage II, disease control rate (IR/ICR) was 38.9%/33.3% with afatinib and 18.8%/18.8% with cetuximab. CONCLUSION Afatinib showed antitumor activity comparable to cetuximab in R/M HNSCC in this exploratory phase II trial, although more patients on afatinib discontinued treatment due to AEs. Sequential EGFR/ErbB treatment with afatinib and cetuximab provided sustained clinical benefit in patients after crossover, suggesting a lack of cross-resistance.
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Affiliation(s)
- T Y Seiwert
- Department of Medicine, University of Chicago Medical Centre, Chicago, USA.
| | - J Fayette
- Department of Medicine, Université de Lyon, Lyon
| | - D Cupissol
- Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - J M Del Campo
- Department of Medical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P M Clement
- Division of Oncology, KU Leuven, Leuven, Belgium
| | - R Hitt
- Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain
| | | | - W Zhang
- Boehringer Ingelheim Shanghai Pharmaceuticals Co., Ltd, Shanghai, China
| | - A Blackman
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, USA
| | - E Ehrnrooth
- Boehringer Ingelheim Danmark A/S, Copenhagen, Denmark
| | - E E W Cohen
- Department of Medicine, University of California San Diego Moores Cancer Center, La Jolla, USA
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Brixen LM, Bernstein IT, Bülow S, Ehrnrooth E. Survival of patients with Stage III colon cancer is improved in hereditary non-polyposis colorectal cancer compared with sporadic cases. A Danish registry based study. Colorectal Dis 2013; 15:816-23. [PMID: 23350633 DOI: 10.1111/codi.12150] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/11/2012] [Indexed: 01/01/2023]
Abstract
AIM Patients with hereditary non-polyposis colorectal cancer (HNPCC) seem to have a better prognosis than those with sporadic colorectal cancer (CRC). The aim was to compare survival after Stage III CC in patients with HNPCC with those having sporadic CC. METHOD A total of 230 patients with hereditary cancer from the Danish HNPCC Register and 3557 patients with sporadic CC from the Danish Colorectal Cancer Database, diagnosed during May 2001-December 2008, were included. HNPCC patients were classified according to mismatch repair mutation status and family pedigree. Sporadic cases had no known family history of cancer. Patient characteristics, geographical differences and survival data were analysed. RESULTS The overall survival (OS) was better in HNPCC patients compared with sporadic CC after stratification for sex and age (P = 0.02; CI 1.04-1.7). The 5-year survival was 70% in HNPCC patients compared with 56% in sporadic CC (P < 0.001). No survival difference was found between HNPCC subgroups but a tendency to better OS was seen in patients with Lynch syndrome. No geographical differences in OS were found. The median follow-up was 3.9 (0-9.5) years for HNPCC vs 3.2 (0-9.6) years for sporadic CC. CONCLUSION HNPCC patients with Stage III CC have a better OS compared with sporadic CC. No significant difference in OS was found within HNPCC subgroups.
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Affiliation(s)
- L M Brixen
- Danish HNPCC Register and Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark.
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21
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Vermorken JB, Rottey S, Ehrnrooth E, Pelling K, Lahogue A, Wind S, Machiels JP. A phase Ib, open-label study to assess the safety of continuous oral treatment with afatinib in combination with two chemotherapy regimens: cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil, in patients with advanced solid tumors. Ann Oncol 2013; 24:1392-400. [PMID: 23293114 DOI: 10.1093/annonc/mds633] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In this phase Ib, dose-escalation study, the oral irreversible ErbB family blocker afatinib (BIBW 2992) was combined with cisplatin (Cadila Healthcare Ltd, Ahmedabad, India) 50 or 75 mg/m(2)/paclitaxel (Bristol-Myers Squibb Pharmaceuticals Ltd, New York, USA) (Taxol)175 mg/m(2) (regimen A) or cisplatin 75-100 mg/m(2)/5-fluorouracil 750-1000 mg/m(2) (regimen B) in patients with advanced solid tumors. PATIENTS AND METHODS The primary objective was to assess dose-limiting toxicities (DLTs) during cycle 1 for each regimen, from which the maximum tolerated dose (MTD) was determined. Patients received once daily oral afatinib 20, 30, 40 or 50 mg in 21-day cycles (3 + 3 design). RESULTS The MTD for afatinib in regimens A (n = 26) and B (n = 21) was determined as 20 mg and 30 mg following DLTs in five and four patients in cycle 1, respectively. Most frequent adverse events (AEs, any grade) were diarrhea and nausea. Disease control was observed in 54% and 29% of patients in regimens A and B, respectively. Plasma sampling suggested no relevant pharmacokinetic interaction between afatinib and the chemotherapeutic agents. CONCLUSIONS The MTD of afatinib was 20 mg with cisplatin-paclitaxel and 30 mg with cisplatin-5-fluorouracil. Pre-emptive management of side-effects is important to maintain adequate safety and tolerability. Both combinations showed antitumor activity across tumor types and lines of prior treatment.
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Affiliation(s)
- J B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem.
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Seiwert T, Fayette J, Cupissol D, DelCampo J, Clement P, Tourani J, Degardin M, Blackman A, Cong J, Solca F, Ehrnrooth E, Cohen E. A Randomized, Open-Label, Phase II Study of Afatinib Versus Cetuximab in Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32015-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Steele N, Anthony A, Saunders M, Esmarck B, Ehrnrooth E, Kristjansen PEG, Nihlén A, Hansen LT, Cassidy J. A phase 1 trial of recombinant human IL-21 in combination with cetuximab in patients with metastatic colorectal cancer. Br J Cancer 2012; 106:793-8. [PMID: 22315057 PMCID: PMC3305963 DOI: 10.1038/bjc.2011.599] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [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: 11/09/2022] Open
Abstract
BACKGROUND Pre-clinical data indicate enhanced anti-tumour activity when combining recombinant human interleukin-21 (rIL-21), a class 1 cytokine, with cetuximab, a monoclonal antibody, targeting the epidermal growth factor receptor. This phase 1 trial assessed the safety and tolerability of escalating doses of rIL-21 in combination with cetuximab in chemo-naïve patients with stage IV colorectal cancer. PATIENTS AND METHODS Sequential cohorts of PS 0-1, asymptomatic patients, were treated weekly with cetuximab 250 mg m(-2) intravenously (i.v.) plus escalating i.v. doses of rIL-21 following an initial loading dose of cetuximab 400 mg m(-2). Initial treatment period was 8 weeks, with extension permitted in patients without disease progression. RESULTS In all, 15 patients were included in this study. Adverse events related to rIL-21 or rIL-21 plus cetuximab included lethargy, nausea/vomiting, stomatitis, lymphopenia and pyrexia and were mainly ≤ grade 2. One dose limiting toxicity occurred (grade 3 diarrhoea). Maximum tolerated dose was not determined because of the premature study closure. Maximum administered dose was 100 μg kg(-1) rIL-21 weekly. In all, 60% of the patients had stable disease. Immune activation was confirmed by various T- and NK-cell activation biomarkers, including dose-dependent increases in serum sCD25. CONCLUSION rIL-21 weekly combined with cetuximab is well tolerated at doses up to 100 μg kg(-1) and results in activation of immune response biomarkers.
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Affiliation(s)
- N Steele
- CRUK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK.
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Machiels JH, Subramanian S, Ruzsa A, Repassy G, Lifrenko I, Flygare A, Sorensen P, Ehrnrooth E, Baadsgaard O, Clement PM. An open-label, randomized, phase III trial of zalutumumab, a human monoclonal EGF receptor (EGFr) antibody, versus best supportive care, in patients with noncurable squamous cell carcinoma (SCCHN) of the head and neck who have failed standard platinum-based chemotherapy (ZALUTE). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.18_suppl.lba5506] [Citation(s) in RCA: 3] [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
LBA5506 Background: Zalutumumab is a novel, fully human IgG1 mAb targeting the EGFr that has shown encouraging activity in SCCHN. Methods: Patients with noncurable SCCHN with an ECOG PS of 0-2 and centrally documented radiographic progressive disease (PD) within 6 months after platinum-therapy were randomized between zalutumumab monotherapy and best supportive care (BSC) in a 2:1 ratio. Stratification parameter was ECOG PS. Methotrexate (MTX) was allowed in the BSC arm only. Individual dose-titration of zalutumumab was applied (max. exposure 16 mg/kg). The primary endpoint was overall survival (OS), with progression free survival (PFS) as the only secondary endpoint to be compared between groups, using log-rank test. 231 deaths were required to statistically differentiate OS between groups with 80% power. Results: 286 patients (34F, 252M) were randomized. The median age was 57 years (range 18-78), 65% had distant metastasis and 17% were ECOG PS 2, all similar between groups. 78% of patients in BSC arm received MTX. Although a median OS of 6.7 months was observed in the zalutumumab group compared to 5.2 in the BSC group, this was not statistically significant (p=0.065). A clear improvement in PFS (P=0.001) was demonstrated. Zalutumumab showed a safety profile as expected within this drug class. Conclusions: This is the first controlled study to demonstrate that an EGFr-targeted antibody given as monotherapy induces a clinically meaningful improvement in PFS in patients with SSCHN who have failed platinum-based chemotherapy. [Table: see text] [Table: see text]
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Affiliation(s)
- J. H. Machiels
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - S. Subramanian
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - A. Ruzsa
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - G. Repassy
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - I. Lifrenko
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - A. Flygare
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - P. Sorensen
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - E. Ehrnrooth
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - O. Baadsgaard
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
| | - P. M. Clement
- Cliniques Universitaires Saint-Luc, Universitá Catholique de Louvain, Brussels, Belgium; N. N. Blokhin Russian Cancer Research Center, Moscow, Russia; Zala Megyei Korhaz, Onkologia Osztaly, Zalaegerszeg-Pozva, Hungary; Semmelweis University, Budapest, Hungary; Kursk Regional Oncology Dispencary, Kursk, Russia; Genmab, Copenhagen, Denmark; Department of General Medical Oncology, University Hospitals Leuven and Catholic University of Leuven, Leuven, Belgium
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Mano M, Hendlisz A, Machiels J, Ehrnrooth E, Aladdin H, Van Laethem J. Phase I trial of zalutumumab and irinotecan in metastatic colorectal cancer patients who have failed irinotecan- and cetuximab-based therapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15028] [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
e15028 Background: Zalutumumab is a novel human IgG1 anti-EGFR mAb. We investigated the safety of zalutumumab and irinotecan in heavily pretreated mCRC patients. Methods: Metastatic CRC patients with documented progression (PD) during or within 6 months of stopping cetuximab and irinotecan based therapy were eligible. No prior treatment with anti-EGFR antibodies other than cetuximab was allowed. Patients received weekly doses of zalutumumab 8mg/kg and 16 mg/kg respectively in combination with irinotecan (180 mg/m2) every second week until PD or unacceptable toxicity. Results: The maximum tolerated dose was not reached and no patients experienced any dose limiting toxicity. At data cut-off (18-Dec-08) 4 patients had died (no cases of death were considered related to zalutumumab), 4 were off study due to PD and 1 was still ongoing ( Table 1 ). In total, 6 patients experienced one or more grade 3/4 toxicities (diarrhea 2; neutropenia 2; leucopenia 1; abdominal pain 1; pulmonary embolism 1; alopecia 1). Conclusions: Zalutumumab can be safely administrated in doses up to 16mg/kg in combination with irinotecan in mCRC patients failing cetuximab and irinotecan based therapy. Zalutumumab and irinotecan resulted in durable stable disease warranting further investigation of this regimen. [Table: see text] [Table: see text]
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Affiliation(s)
- M. Mano
- Cliniques Universitaires Saint-Luc, Brussels, Belgium; Jules Bordet Institue, Brussels, Belgium; Genmab A/S, Copenhagen, Denmark; Erasme Hospital, Brussels, Belgium
| | - A. Hendlisz
- Cliniques Universitaires Saint-Luc, Brussels, Belgium; Jules Bordet Institue, Brussels, Belgium; Genmab A/S, Copenhagen, Denmark; Erasme Hospital, Brussels, Belgium
| | - J. Machiels
- Cliniques Universitaires Saint-Luc, Brussels, Belgium; Jules Bordet Institue, Brussels, Belgium; Genmab A/S, Copenhagen, Denmark; Erasme Hospital, Brussels, Belgium
| | - E. Ehrnrooth
- Cliniques Universitaires Saint-Luc, Brussels, Belgium; Jules Bordet Institue, Brussels, Belgium; Genmab A/S, Copenhagen, Denmark; Erasme Hospital, Brussels, Belgium
| | - H. Aladdin
- Cliniques Universitaires Saint-Luc, Brussels, Belgium; Jules Bordet Institue, Brussels, Belgium; Genmab A/S, Copenhagen, Denmark; Erasme Hospital, Brussels, Belgium
| | - J. Van Laethem
- Cliniques Universitaires Saint-Luc, Brussels, Belgium; Jules Bordet Institue, Brussels, Belgium; Genmab A/S, Copenhagen, Denmark; Erasme Hospital, Brussels, Belgium
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Cassidy J, Anthony A, Esmarck B, Ehrnrooth E, Kristjansen P, Nihlen A, Hansen L, Saunders M. 370 POSTER Once weekly rIL-21 in combination with cetuximab as 1st line therpay in CRC. A dose finding safety trial. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72304-8] [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: 11/27/2022] Open
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Ujmajuridze Z, Ehrnrooth E, Lassen E, Hansen HH. Efficacy of carboplatin, docetaxel, and capecitabine (CTX) in the treatment of patients with advanced or metastatic upper gastrointestinal tract carcinomas. A retrospective analysis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Gundgaard MG, Soerensen JB, Ehrnrooth E. Third-line therapy for metastatic colorectal cancer. Cancer Chemother Pharmacol 2007; 61:1-13. [PMID: 17786445 DOI: 10.1007/s00280-007-0573-x] [Citation(s) in RCA: 6] [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] [Received: 05/10/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The past years' therapy for colorectal cancer has evolved rapidly with the introduction of novel cytotoxic agents such as irinotecan, capecitabine and oxaliplatin. Further advances have been achieved with the integration of targeted agents such as bevacizumab, cetuximab and recently, panitumumab. As a result, third-line treatment is now a necessary step in the optimal treatment of patients with metastatic colorectal cancer (MCRC). MATERIALS AND METHODS We conducted a literature review of English language publications on third-line therapy for MCRC from January 2000 to April 2007. Data on median overall survival (mOS), median time to progression (mTTP) and response rate were recorded. RESULTS We found 27 articles and 22 abstracts to fulfil the criteria. Patients who received regimens containing oxaliplatin and infusional 5-fluorouracil (5-FU) demonstrated mTTP up to 7 months and a mOS of 16 months. With irinotecan and 5-FU, mOS around 8 months were reported and with cetuximab combined with irinotecan, the highest mOS was 9.8 months. CONCLUSION Third-line therapy in advanced colorectal cancer may improve mOS for patients with MCRC. Therefore, randomized studies should be conducted in the future.
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Affiliation(s)
- M G Gundgaard
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, von der Maase H. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer 2003; 88:658-65. [PMID: 12618870 PMCID: PMC2376357 DOI: 10.1038/sj.bjc.6600798] [Citation(s) in RCA: 367] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of the study was to investigate the association of physician communication behaviours as perceived by the patient with patient reported satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease in cancer patients. Questionnaires measuring distress, self-efficacy, and perceived control were completed prior to and after the consultation by 454 patients attending an oncology outpatient clinic. After the consultation, the patients also rated the physicians' communicative behaviours by completing a patient-physician relationship inventory (PPRI), and the physicians were asked to estimate patient satisfaction. The overall results showed that higher PPRI scores of physician attentiveness and empathy were associated with greater patient satisfaction, increased self-efficacy, and reduced emotional distress following the consultation. In contrast, lower PPRI scores were associated with reduced ability of the physician to estimate patient satisfaction. The results confirm and expand previous findings, suggesting that communication is a core clinical skill in oncology.
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Affiliation(s)
- R Zachariae
- Psychooncology Research Unit, Aarhus University Hospital, Denmark.
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Ehrnrooth E, Grau C, Zachariae R, Andersen J. Randomized trial of opioids versus tricyclic antidepressants for radiation-induced mucositis pain in head and neck cancer. Acta Oncol 2002; 40:745-50. [PMID: 11765070 DOI: 10.1080/02841860152619179] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [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: 10/17/2022]
Abstract
Patients who receive radiotherapy for head and neck cancer are likely to develop painful mucositis. The pain is characterized by a burning or stinging sensation similar to neuropathic pain sensations. The purpose of the present study was to compare the analgesic effect of a tricyclic antidepressant (TC), commonly used in the treatment of neuropathic pain, with the effect of opioids on radiation-induced mucositis pain. Forty-three patients receiving 66-68 Gy external radiation according to the DAHANCA guidelines (the Danish Head and Neck Cancer Study Group) were randomized to either morphine or TC when mucositis pain was insufficiently managed with weak analgesics. Patients with insufficient pain control in either treatment arm received supplementary medication from the opposite treatment arm. Pain was evaluated weekly using a VAS scale and the McGill Pain Questionnaire. The degree of mucositis and the degree of depression were measured at the same time intervals. Twenty-two patients entered the opioid arm and 21 the TC arm. Two patients in each arm were non-evaluable. VAS pain scores were significantly reduced in the opioid treatment arm one week after randomization (p = 0.01). Eight patients in the TC arm were managed with TC alone, but for 11 patients it was necessary to add morphine. The 20 evaluable patients in the morphine arm required no additional treatment. There were no significant differences in side effects between the two groups. Higher pain scores in the TC arm, but not in the opioid arm, were significantly correlated with higher BDI scores. Some head and neck cancer patients with radiation-induced nucositis pain may have sufficient pain control on TC alone. This might be useful in patients with relative counter-indications to opioid treatment.
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Affiliation(s)
- E Ehrnrooth
- Department of Oncology, Aarhus University Hospital, Denmark.
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31
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Ehrnrooth E, Sørensen B, Poulsen JH, Sørensen BS, von der Maase H. Changes in thymidylate synthase mRNA in blood leukocytes from patients with colorectal cancer after bolus administration of 5-fluorouracil. Acta Oncol 2001; 39:53-7. [PMID: 10752654 DOI: 10.1080/028418600430978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
5-fluorouracil (5-FU) is considered the standard antineoplastic drug of choice for metastatic colorectal cancer. It has been suggested that 5-FU administered as bolus infusion is cytotoxic mainly through an RNA damaging effect. We investigated the effect of i.v. bolus 5-FU 500-600 mg/m2 on the 5-FU target enzyme, thymidylate synthase (TS) mRNA, in blood leukocytes before and after courses 1 and 3 in 21 patients with colorectal cancer. TS mRNA expression was quantified using an RT-PCR assay with an internal RNA standard. Median TS mRNA expression decreased significantly 30 min after course no. 1 (p = 0.004), and both 15 min and 30 min after course 3 (p = 0.01). After course 1, the median TS mRNA expression decreased by 31% and after course 3 by 24%. Pharmacokinetic parameters were similar for individual patients during the two courses but did not correlate with the degree of TS mRNA inhibition. The present results indicate that TS mRNA in blood leukocytes may be an early indicator of an RNA damaging effect after i.v. bolus infusion of 5-FU.
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Affiliation(s)
- E Ehrnrooth
- Department of Oncology, Aarhus University Hospital, Denmark.
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Grau C, Hansen H, Overgaard M, Specht L, Bastholt L, Andersen L, Evensen J, Sapru W, Ehrnrooth E, Hansen O, Andersen E, Jorgensen K, Overqaard J. 12 Morbidity recording in the DAHANCA 6 and 7 trials with accelerated radiotherapy. Radiother Oncol 2000. [DOI: 10.1016/s0167-8140(00)80011-0] [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: 11/24/2022]
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Hornung N, Stengaard-Pedersen K, Ehrnrooth E, Ellingsen T, Poulsen JH. The effects of low-dose methotrexate on thymidylate synthetase activity in human peripheral blood mononuclear cells. Clin Exp Rheumatol 2000; 18:691-8. [PMID: 11138330] [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: 02/18/2023]
Abstract
OBJECTIVE Methotrexate (MTX) in low doses is widely used in the treatment of rheumatoid arthritis (RA) and it is not known whether its effects are due to immunosuppressive and/or anti-inflammatory actions. High concentrations of MTX inhibit the activity of thymidylate synthetase (TS) and dihydrofolate reductase essential for DNA synthesis. This study investigated the effects of low-dose MTX on TS activity and proliferation in human peripheral blood mononuclear cells (PBMC). METHODS The MTX concentrations in our experiments were chosen according to the plasma concentrations measured in 8 RA patients treated with MTX. The effect of MTX on TS activity and DNA synthesis were measured in stimulated normal PBMC and in PBMC obtained from 6 RA patients treated with oral MTX before and 2 hours after intake of their weekly MTX dose. The effect of MTX on the TS mRNA concentration was also investigated in order to elucidate its effect on TS production. RESULTS Low-dose MTX significantly inhibited TS activity and the proliferation of stimulated PBMC independent of the mode of activation. Interestingly, the concentration of TS mRNA in normal PBMC was upregulated by the presence of MTX. Finally, there was no difference between TS activity measured before and after MTX intake in 6 RA patients on long-term MTX treatment. CONCLUSION We show that low concentrations of MTX inhibit TS activity in vitro. An in vivo effect cannot, however, be proven given our study design. The role of these in vitro findings is discussed, particularly in relation to the in vivo effects of MTX.
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Affiliation(s)
- N Hornung
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
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Ehrnrooth E, Sørensen BS, Meldgaard P, Hornung N, Poulsen JH, von der Maase H. A new quantitative RT-PCR assay for thymidylate synthase mRNA in blood leukocytes applied to cancer patients and healthy controls. Clin Chim Acta 2000; 290:129-44. [PMID: 10660804 DOI: 10.1016/s0009-8981(99)00171-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thymidylate synthase (TS) is the target enzyme for 5-fluorouracil (5-FU). TS mRNA and protein levels in colorectal tumours are among the most important determinants for tumour response to 5-FU. TS mRNA levels in blood leukocytes may give information on pharmacokinetic and pharmacodynamic actions of 5-FU on TS as it has previously been shown that inhibition of TS levels by 5-FU in bone marrow leukocytes resembles the degree of TS inhibition in colorectal tumours. The aim of this study was to develop a quantitative high-throughput RT-PCR assay for TS mRNA expression in blood leukocytes (CURT-PCR). Furthermore the TS mRNA levels in blood of patients with colorectal cancer and healthy controls was compared. TS mRNA levels in 17 patients with colorectal cancer did not differ from 20 matched controls whereas a group of 14 younger controls had significantly lower TS mRNA expression than patients and matched controls. In order to investigate the sensitivity of the assay towards cellular reactions such as proliferative stimuli, isolated blood leukocytes were stimulated with phytohemagglutinin both in mitogenic and non-mitogenic concentrations and an induction of TS mRNA expression was measured in both cases. TS activity and cellular proliferation also increased but only at mitogenic concentrations, suggesting that TS mRNA expression is an early leukocyte activation marker. This new CURT-PCR assay may allow improved studies of functional kinetics of drugs with impact upon TS. Further studies are required to establish the possible clinical benefit of TS mRNA measurements in blood leukocytes.
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Affiliation(s)
- E Ehrnrooth
- Department of Oncology, Aarhus University Hospital, Denmark.
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Ehrnrooth E, von der Maase H, Sørensen BS, Poulsen JH, Horsman MR. The ability of hypoxia to modify the gene expression of thymidylate synthase in tumour cells in vivo. Int J Radiat Biol 1999; 75:885-91. [PMID: 10489900 DOI: 10.1080/095530099139944] [Citation(s) in RCA: 9] [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: 10/16/2022]
Abstract
PURPOSE Hypoxic cells in tumours are resistant to 5-fluorouracil (5-FU). This in vivo study investigated the ability of hypoxia to regulate the gene expression of thymidylate synthase (TS), the target enzyme of 5-FU. MATERIALS AND METHODS C3H mammary carcinomas, grown in the feet of female CDF1 mice, were used for all experiments. Mice were placed in a 10% oxygen environment for various time periods and the tumour oxygen status was determined with an Eppendorf oxygen electrode. The animals were then injected with BrdU (100 mg/kg, i.p.). Tumours were excised and immediately frozen (-80 degrees C) until isolation of total RNA. The mRNA was reversibly transcribed to complementary DNA and the resulting cDNA amplified in a multiplex PCR reaction, with beta-actin as the internal reference gene. RESULTS One hour of low oxygen breathing made tumours significantly more hypoxic. This increase was maintained for a maximum incubation period of 48 h. In the same tumours, no change in TS gene expression was seen with up to 3 h of low oxygen breathing. At longer times it decreased, reaching significance at 12-24 h and remaining at this lower level for up to 48 h. BrdU labelling was significantly reduced after breathing low O2 for 24 h (p = 0.001). CONCLUSION Hypoxia-induced down-regulation of TS gene expression was observed. This would be expected to make hypoxic tumour cells more sensitive to 5-FU. Other mechanisms must be responsible for the previously reported resistance to this drug.
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Affiliation(s)
- E Ehrnrooth
- Department of Oncology, Aarhus University Hospital, Denmark.
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Horsman MR, Ehrnrooth E, Ladekarl M, Overgaard J. The effect of combretastatin A-4 disodium phosphate in a C3H mouse mammary carcinoma and a variety of murine spontaneous tumors. Int J Radiat Oncol Biol Phys 1998; 42:895-8. [PMID: 9845117 DOI: 10.1016/s0360-3016(98)00299-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the activity of combretastatin A-4 disodium phosphate in a transplanted C3H mouse mammary carcinoma and several murine spontaneous tumors. METHODS AND MATERIALS The C3H mammary carcinoma was grown in the right rear foot of female CDF1 mice and treated when 200 mm3 in size. Spontaneous tumors (341-1437 mm3 in size) arose at different sites in female CDF1 mice that, 19-21 months earlier, had been irradiated. Oxygen partial pressure (pO2) distributions in the C3H tumors were measured with an Eppendorf oxygen electrode at various times after injecting combretastatin (100 mg/kg, i.p.) in restrained, nonanesthetized mice. Immediately after measurement, tumors were excised and necrotic fraction determined from histological sections. In the spontaneous tumors, pO2 was measured before and 3 h after giving combretastatin. The location of these spontaneous tumors required that measurements be made in anesthetised animals, achieved by injecting a mixture of hypnorm and diazepam. RESULTS In untreated C3H tumors, the mean (+/- 1 SE) percentage of pO2 values < or = 2.5 mmHg was 32% (+/- 11). This was significantly (Student's t-test; p < 0.05) increased to 74% (+/- 4) within 1 h after injecting combretastatin, and remained at this level for at least 6 h, although some recovery was seen at 12 and 24 h. The necrotic fraction in control tumors was 1.9% (+/- 0.4) and this was significantly increased to 16.1% (+/- 3.7) 24 h after drug administration. In spontaneous tumors, the pO2 measurements indicated that 5 of 6 showed some response to combretastatin, although the degree of change was variable. CONCLUSIONS Combretastatin increased tumor hypoxia and necrosis in the C3H mammary carcinoma, consistent with the induction of vascular damage. Drug-induced changes in pO2 were also found in spontaneous tumors, suggesting that the activity of this drug is not restricted to transplanted tumors alone.
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Affiliation(s)
- M R Horsman
- Danish Cancer Society, Department of Experimental Clinical Oncology, Aarhus University Hospital
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Simonsen U, Prieto D, Mulvany MJ, Ehrnrooth E, Korsgaard N, Nyborg NC. Effect of induced hypercholesterolemia in rabbits on functional responses of isolated large proximal and small distal coronary arteries. Arterioscler Thromb 1992; 12:380-92. [PMID: 1547195 DOI: 10.1161/01.atv.12.3.380] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We studied the effects of hypercholesterolemia on the vascular responses of proximal and distal parts of the rabbit coronary circulation in two consecutive studies. For 12 weeks, New Zealand White rabbits were fed a control diet or a diet with 1% cholesterol dissolved in either 3% coconut oil (study A) or ether (study B). Isolated proximal epicardial and distal intramyocardial coronary arteries from control and hypercholesterolemic rabbits were mounted for isometric tension recording in a double myograph. In study A for hypercholesterolemic rabbits (n = 12), the maximal relaxation and sensitivity to acetylcholine (ACh) were significantly decreased in proximal coronary segments contracted with 30 mmol/l potassium solution compared with segments from control rabbits (n = 13). The only change observed in distal coronary segments was a slight decrease in relaxation in response to low ACh concentrations (10(-8) and 3 x 10(-8) mol/l). However, in study B for proximal coronary and distal coronary segments from hypercholesterolemic rabbits (n = 13), the area under the ACh relaxation curve was increased compared with that of control rabbits (n = 12). Other parameters that were similarly affected in studies A and B include the following: 1) proximal coronary segments from hypercholesterolemic rabbits were more sensitive to sodium nitroprusside (SNP) than were those from control rabbits, but this was not true for distal coronary segments; 2) endothelial removal from arterial segments of control rabbits induced a significant increase in sensitivity and maximal relaxation to SNP of proximal coronary and distal coronary arteries; 3) in segments from hypercholesterolemic rabbits, the absence of endothelium did not alter the response of proximal coronary segments to SNP but did augment the relaxation of distal coronary segments to SNP; 4) the maximal response to 5-hydroxytryptamine in proximal coronary arteries from hypercholesterolemic rabbits was increased compared with those from control rabbits, whereas such changes were not observed in distal coronary arteries; and 5) histological examination showed the presence of atheromatous plaques in proximal coronary but not in distal coronary segments from treated animals. In conclusion, the present investigation demonstrates that induced hypercholesterolemia alters both the structure and function of proximal parts of the coronary circulation. In distal coronary arteries of hypercholesterolemic rabbits, the only change observed was an impaired endothelium-dependent cholinergic relaxation, but even this change appeared to be dependent on the manner in which cholesterol was added to the diet, although parallel studies are required to confirm this.
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Affiliation(s)
- U Simonsen
- Department of Pharmacology, University of Aarhus, Denmark
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Simonsen U, Ehrnrooth E, Gerdes LU, Faergemann O, Buch J, Andreasen F, Mulvany MJ. Functional properties in vitro of systemic small arteries from rabbits fed a cholesterol-rich diet for 12 weeks. Clin Sci (Lond) 1991; 80:119-29. [PMID: 1848163 DOI: 10.1042/cs0800119] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [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: 12/29/2022]
Abstract
1. Recent evidence has suggested that the impairment of endothelium-dependent cholinergic relaxation in vitro, which is seen in atherosclerotic large arteries of animals and man, could be part of a general deleterious effect to the endothelium of hypercholesterolaemia. 2. This possibility has been investigated in vitro by measuring the response to acetylcholine, sodium nitroprusside, 5-hydroxytryptamine and noradrenaline in segments of aorta and of femoral, mesenteric and cerebral small arteries (internal diameter approximately 200 microns) from control rabbits (n = 12) and from rabbits fed a 1% (w/w) cholesterol and 3% (w/w) coconut oil diet (n = 12) for 12 weeks. 3. Thoracic aorta segments from the control rabbits exhibited a maximal relaxation in response to acetylcholine of 64 +/- 11% compared with 10 +/- 5% (P less than 0.01) for thoracic segments from cholesterol-fed animals. Cerebral, femoral and mesenteric small arteries exposed to acetylcholine (10(-9)-10(-4) mol/l) relaxed to the same degree as arteries from control rabbits. The responses to sodium nitroprusside and bradykinin of the small arteries from the cholesterol-fed rabbits remained unaffected. 5-Hydroxytryptamine evoked comparable contractions in the small arteries, while the sensitivity to noradrenaline of the femoral small arteries was significantly decreased and the response of cerebral small arteries to noradrenaline in cholesterol-fed rabbits slightly increased compared with control rabbits. 4. Aorta from the cholesterol-fed rabbits had extensive atheromatous lesions. Morphological measurements and histological examination showed unchanged thickness and light microscopic appearance of intima and media of small arteries from cholesterol-fed animals compared with control animals. 5. The present study indicates that hypercholesterolaemia in this rabbit model is followed by atherosclerotic lesions and changed function of large arteries, but that both function and structure of systemic small arteries are largely unaffected.
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Affiliation(s)
- U Simonsen
- Department of Pharmacology, University of Aarhus, Denmark
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Simonsen U, Ehrnrooth E, Prieto D, Gerdes U, Nyborg N, Mulvany M. Vascular responses of rabbit small arteries either exposed to 12 weeks high plasma cholesterol in vivo or low density lipoprotein in vitro are unchanged. Eur J Pharmacol 1990. [DOI: 10.1016/0014-2999(90)94448-7] [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: 11/26/2022]
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