Feelings Related to the COVID-19 Pandemic Among Patients Treated in the Oncology Clinics (Poland)

Background: The number of cancer patients is constantly growing. Both WHO and IARC report that this number may reach up to 24 million new diagnosed cases in the next two decades. The proposed treatment and especially the diagnosis can have a significant impact on an individual's approach to the disease, as well as on the patient's quality of life. Objectives: The study aimed to assess the quality of life, feelings, and fear of cancer-treating oncological patients, before and during the COVID-19 pandemic. Material and Methods: The study used the standardized WHOQOL quality of life questionnaire in a shortened version, the COVID-19 fear scale (FCV-19S), and the AIS disease acceptance scale (in terms of cancer-related sensations). The questionnaire survey was conducted among patients of cancer clinics (Poland). The study was conducted in two stages-before the COVID-19 pandemic (May 2019) and during the COVID-19 pandemic (May 2020). Data from 450 correctly completed questionnaires were analyzed statistically. The obtained data were statistically processed using the Kruskal-Wallis and Mann-Whitney U test (p = 0.05). Results: Among the surveyed patients of the cancer clinic, the quality of life during the COVID-19 pandemic decreased by 2%, compared to the period before the pandemic. The frequency of negative feelings associated with cancer increased during the COVID-19 pandemic-by 11% more men, and 4.4% of women determined the frequency of negative feelings to be 2-3 times a week. The level of fear associated with COVID-19 was moderate (57.1%), with women having a higher level of fear (12.5% higher than men). Conclusion: The development of the epidemic is very important in terms of public health. COVID-19 should be considered as one of the factors that bring about sudden changes in the mental health of the population, which may result from the dynamic development of this disease, dramatic media coverage, and own experiences. It has been shown that the sudden appearance of such a large stressor causes a decrease in patients' quality of life and an increase in negative feelings associated with chronic disease.

CHEK2 mutation in renal cell carcinoma (RCC): Single center experience

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Background: Renal cell cancer (RCC) accounts for about 4% of all the adult malignancies. RCC occurs in both sporadic and heritable forms. Genetic mutations have been identified as the cause of inherited cancer risk in 1% to 2% of RCC cases overall. In some studies, variant I157T of CHEK2 gene were found to be associated with increased risk of clear cell renal cancer. The aim of this study was to evaluate the association between CHEK2 mutation and RCC in our centre. Methods: We reviewed the medical records of 43 clear cell renal cancer patients (pts) who were diagnosed and treated in COI in Gliwice. Mutation profile was assessed by RFLP-PCR technique. In Poland, there are three polymorphic variants of CHEK2 1100delC, IVS2+1G →A (premature protein truncation), and a common missense variant (I157T) (substitution of an isoleucine for a threonine). We evaluated the presence of CHEK2 mutation in clear cell carcinoma. Results: In our study CHEK2 mutation (variant I157T) was detected in 7% pts. The median age of pts was 57 years (range from 34 to 74). Most of the patients were women (87%). All CHEK2 mutation carriers were women and were >65 years old. Cancer in family history were reported in 80% pts. Most frequently were: breast cancer (33%), gynecological cancers (33%), gastrointestinal cancers (27%), and renal cell carcinoma (20%). There was also described lung cancer in family history (7%). The most frequent cancers in family history in CHEK2 mutation carriers were: breast cancer and gynecological cancers. 20% of pts had other cancers in their history (breast cancer, ovarian cancer, and contralateral renal cell carcinoma). Contralateral renal cell carcinoma was reported in CHEK2 mutation carrier. All pts had nephrectomy due to RCC and all had clear cell renal cancer in histopathologic examination. All CHEK2 mutation carriers had higher grade (grade 3) and capsular invasion. 5% of CHEK2 mutation carriers had TP53 (c.[215G>C])polymorphism. Conclusions: Variant I157T of CHEK2 gene were found to be associated with increased risk of cancer in family history (breast cancer, gynecological cancer), and renal cancer of contralateral kidney. Factors associated with CHEK2 mutation carriers were higher histologic grade (G3) and elderly age.

Abstract P2-07-13: TP53 gene polymorphisms (c.[215G>C]) in breast cancer patients and predisposition to family cancers- Single center experience

Introduction: Somatic mutations in the TP53 gene are one of the most frequent alterations in human cancers, and germline mutations are the underlying cause of Li-Fraumeni syndrome, which predisposes to a wide spectrum of early-onset cancers. The aim of this study was to evaluate the association between TP53 gene polymorphisms (c.[215G>C]) and predisposition to family cancers. Methods: We reviewed the medical records of 89 (21% TP53 gene homozygotes and 79% heterozygotes) breast cancer patients who were diagnosed and treated in COI in Gliwice. The history of family cancers was colected from medical history. Mutation profile was assessed by RFLP-PCR technique. We evaluatedthe presence ofpolymorphism TP53 (c.[215G>C]). Statistical analysis was carried out using STATISTICA 7 software. Results: Cancers in family history were detected in 72% of pts with TP53 polymorphisms and they were observed insignificantly more often in heterozygotes than in homozygotes (76% vs. 58%, p=0.153). The most frequently reported cancers were: breast cancer (33%), lymphoma (17%), colorectal cancer (9%), OUN cancer (8%), gastric cancer (8%), pancreatic cancer (7%), ovarian cancer (6%) and renal cancer (3%). In analyzed group, renal cancers in family were detected more frequently in TP53 homozygotes than in heterozygotes (16% vs. 0, p=0.008). Similarly, there was also observed tendency to the presence of colorectal cancer in TP53 homozygotes (11% vs. 0, p=0.193). Ovarian cancers and cholangiocarcinomas in family were also observed insignificantly more often in homozygotes than in heterozygotes (7% vs. 0, p=0.580) and (5% vs. 1%, p=0.383). There was no association between number of cancers in family and TP53 polymorphisms (47% vs. 43%, p=0.797). Conclusion: TP53 polymorphism (c.[215G>C]) predisposed to development renal and colorectal cancers (TP53 homozygotes) and ovarian cancer or cholangiocarcinoma (TP53 heterozygotes) in family.

Citation Format: Huszno J, Grzybowska E, Nycz Bochenek M, Pamula Pilat J, Tecza K, Nowara E. TP53 gene polymorphisms (c.[215G>C]) in breast cancer patients and predisposition to family cancers- Single center experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-07-13.

Randomized clinical trial on 7-days-a-week post-operative radiotherapy vs concurrent post-operative radiochemotherapy in locally advanced cancer of the oral cavity/oropharynx: a report on acute normal tissue reactions

OBJECTIVE

The purpose of the study was to evaluate acute normal tissue reactions and treatment compliance in a randomized clinical trial on 7-days-a-week post-operative radiotherapy (p-CAIR) vs post-operative concurrent radiochemotherapy (p-RTCT) in locally advanced cancer of the oral cavity/oropharynx. The sample analyzed at present represents approximately 30% of the intended future trial size.

METHODS

The patients were randomly assigned to receive 63 Gy in 1.8-Gy fractions 7 days a week (n = 44) or 63 Gy in 1.8-Gy fractions 5 days a week with concurrent cisplatin 80-100 mg per square metre of body surface area on Days 1, 22 and 43 of the course of radiotherapy (n = 40). Acute mucosal reactions were scored using the modified Dische system.

RESULTS

15 (17.9%) patients, including 5 patients in p-CAIR and 10 patients in p-RTCT, did not comply with the assigned radiation treatment, mostly because of rapid tumour progression or deteriorating general performance. In p-RTCT, 22 (55%) patients received less than the intended three courses of chemotherapy mostly owing to haematological toxicity. The average maximum mucosal severity score was 14.2 in p-CAIR compared with 13.4 in p-RTCT; the difference was not statistically significant (p = 0.31).

CONCLUSION

The schedules compared (p-CAIR and p-RTCT) did not differ considerably with respect to acute mucosal reactions. Haematological toxicity in p-RTCT was elevated compared with p-CAIR. Both schedules were considered tolerable with respect to acute toxicity, which justifies further recruitment to the trial.

ADVANCES IN KNOWLEDGE

The results show that early mucosal reactions are comparable in both trial arms but haematological toxicity is more pronounced during radiochemotherapy.

A randomized, placebo-controlled phase III trial of masitinib plus gemcitabine in the treatment of advanced pancreatic cancer

BACKGROUND

Masitinib is a selective oral tyrosine-kinase inhibitor. The efficacy and safety of masitinib combined with gemcitabine was compared against single-agent gemcitabine in patients with advanced pancreatic ductal adenocarcinoma (PDAC).

PATIENTS AND METHODS

Patients with inoperable, chemotherapy-naïve, PDAC were randomized (1 : 1) to receive gemcitabine (1000 mg/m(2)) in combination with either masitinib (9 mg/kg/day) or a placebo. The primary endpoint was overall survival (OS) in the modified intent-to-treat population. Secondary OS analyses aimed to characterize subgroups with poor survival while receiving single-agent gemcitabine with subsequent evaluation of masitinib therapeutic benefit. These prospectively declared subgroups were based on pharmacogenomic data or a baseline characteristic.

RESULTS

Three hundred and fifty-three patients were randomly assigned to receive either masitinib plus gemcitabine (N = 175) or placebo plus gemcitabine (N = 178). Median OS was similar between treatment-arms for the overall population, at respectively, 7.7 and 7.1 months, with a hazard ratio (HR) of 0.89 (95% CI [0.70; 1.13]. Secondary analyses identified two subgroups having a significantly poor survival rate when receiving single-agent gemcitabine; one defined by an overexpression of acyl-CoA oxidase-1 (ACOX1) in blood, and another via a baseline pain intensity threshold (VAS > 20 mm). These subgroups represent a critical unmet medical need as evidenced from median OS of 5.5 months in patients receiving single-agent gemcitabine, and comprise an estimated 63% of patients. A significant treatment effect was observed in these subgroups for masitinib with median OS of 11.7 months in the 'ACOX1' subgroup [HR = 0.23 (0.10; 0.51), P = 0.001], and 8.0 months in the 'pain' subgroup [HR = 0.62 (0.43; 0.89), P = 0.012]. Despite an increased toxicity of the combination as compared with single-agent gemcitabine, side-effects remained manageable.

CONCLUSIONS

The present data warrant initiation of a confirmatory study that may support the use of masitinib plus gemcitabine for treatment of PDAC patients with overexpression of ACOX1 or baseline pain (VAS > 20mm). Masitinib's effect in these subgroups is also supported by biological plausibility and evidence of internal clinical validation.

TRIAL REGISTRATION

ClinicalTrials.gov:NCT00789633.

Exploratory RAS analysis of the phase Ib/II 20060447 trial of rilotumumab (R) or ganitumab (G) plus panitumumab (pmab) versus pmab alone in patients (pts) with previously treated metastatic colorectal cancer (mCRC)

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Background: Pmab, R, and G are fully human monoclonal antibodies that target EGFR, HGF, and IGF-1R, respectively. In part 2 of this 3-part study in previously treated pts with wild-type (WT) KRAS mCRC, pmab+R met the pre-specified criterion for improvement in objective response rate (ORR) whereas pmab+G did not. We report an exploratory analysis of the treatment effect of pmab, R, and G in pts with activating RAS mutations beyond KRAS exon 2. Methods: Part 2 was a phase II, randomized, double-blinded trial of pmab+R or pmab+G vs. pmab+placebo, administered Q2W until disease progression or intolerance. The primary endpoint was ORR. Secondary endpoints included overall survival (OS), progression-free survival (PFS), and safety. Mutations in KRAS exon 3 (codons 59/61) and exon 4 (codons 117/146); NRAS exon 2 (codons 12/13), exon 3 (codons 59/61), and exon 4 (codons 117/146); and BRAF exon 15 (codon 600) were detected by bidirectional Sanger sequencing. Results: Of 142 pts randomized, 92 (65%) were evaluable for RAS. Of 92 evaluable pts, 79 (86%) were WT RAS (WT in KRAS and NRAS exons 2, 3, and 4) and 13 (14%) had RAS mutations beyond KRAS exon 2 (mutant in any KRAS exon 3 or 4 or NRAS exon 2, 3, or 4). None of the pts with RAS mutations had an objective response (Table). Of 93 pts evaluable for BRAF, 7 (8%) had V600E mutations (all 7 were WT RAS). Two pts with BRAF V600E tumors had a partial response and were in the pmab+R arm (n=3). No new safety signals were identified. Conclusions: In this small, retrospective study, ORR, PFS and OS were similar between the arms of R or G plus pmab vs pmab alone in pts with WT RAS mCRC tumors. Our findings indicate that RAS mutations beyond KRAS exon 2 impact ORR, PFS, and OS. Clinical trial information: NCT00788957. [Table: see text]

Randomized phase Ib/II trial of rilotumumab or ganitumab with panitumumab versus panitumumab alone in patients with wild-type KRAS metastatic colorectal cancer

PURPOSE

Panitumumab, a fully human anti-epidermal growth factor receptor monoclonal antibody (mAb), has demonstrated efficacy in patients with wild-type KRAS metastatic colorectal cancer (mCRC). Rilotumumab and ganitumab are investigational, fully human mAbs against hepatocyte growth factor (HGF)/scatter factor and IGF1R, respectively. Here we evaluate combining rilotumumab or ganitumab with panitumumab in previously treated patients with wild-type KRAS mCRC.

EXPERIMENTAL DESIGN

Part 1 was a phase Ib dose-finding study of panitumumab plus rilotumumab. The primary endpoint was the incidence of dose-limiting toxicities (DLT). Part 2 was a randomized phase II trial of panitumumab in combination with rilotumumab, ganitumab, or placebo. The primary endpoint was objective response rate (ORR); safety, progression-free survival (PFS), and overall survival (OS) were secondary endpoints. Archival tissue specimens were collected for exploratory correlative work.

RESULTS

In part 1, no DLTs were reported. A recommended phase II dose of 10 mg/kg rilotumumab was selected. In part 2, for the panitumumab plus rilotumumab (n = 48), panitumumab plus ganitumab (n = 46), and panitumumab plus placebo arms (n = 48), the ORRs were 31%, 22%, and 21%, respectively. The median PFS was 5.2, 5.3, and 3.7 months and median OS 13.8, 10.6, and 11.6 months, respectively. Adverse events were tolerable. Exploratory biomarker analyses, including MET and IGF-related protein expression, failed to indicate conclusive predictive evidence on efficacy endpoints.

CONCLUSIONS

Panitumumab plus rilotumumab met the prespecified criterion for improvement in ORR whereas ganitumab did not. This is the first study to suggest a benefit for combining an HGF inhibitor (rilotumumab) with panitumumab in previously treated patients with wild-type KRAS mCRC.

A randomized controlled phase II trial of a novel composition of paclitaxel embedded into neutral and cationic lipids targeting tumor endothelial cells in advanced triple-negative breast cancer (TNBC)

BACKGROUND

EndoTAG-1, composed of paclitaxel embedded in liposomal membranes targeting tumor endothelial cells, was evaluated for safety and efficacy in advanced triple-negative breast cancer (TNBC).

PATIENTS AND METHODS

One hundred and forty patients were treated with weekly EndoTAG-1 (22 mg/m(2)) plus paclitaxel (70 mg/m(2)), twice weekly EndoTAG-1 (2× 44 mg/m(2)), or weekly paclitaxel (90 mg/m(2)) for greater than or equal to four cycles (3-week treatment + 1-week rest) or until progression/toxicity. Primary end point was progression-free survival (PFS) rate evaluated centrally after four cycles of therapy (week 16). The study was not powered for intergroup comparisons.

RESULTS

The PFS rate at week 16 was 59.1% [one-sided 95% CI: 45.6, ∞] on combination treatment, 34.2% [21.6, ∞] on EndoTAG-1, and 48.0% [30.5, ∞] on paclitaxel. Median PFS reached 4.2, 3.4, and 3.7 months, respectively. After complete treatment (week 41 analysis), median overall survival (OS) was 13.0, 11.9, and 13.1 months for the modified Intention-to-Treat (ITT) population and 15.1, 12.5, and 8.9 months for the per-protocol population, respectively. The clinical benefit rate was 53%, 31%, and 36% for the treatment groups. Safety analysis revealed known toxicities of the drugs with slight increases of grade 3/4 neutropenia on combination therapy.

CONCLUSION

Treatment of advanced TNBC with a combination of EndoTAG-1 and standard paclitaxel [Taxol® (Bristol-Myers Squibb GmbH), or equivalent generic formulation] was well tolerated and showed antitumor efficacy. The positive trend needs to be confirmed in a randomized phase III trial.

STUDY REGISTRATION

European Clinical Trials Database: EudraCT number 2006-002221-23. ClinicalTrials.gov identifier: NCT00448305.

PRECEDENT: a randomized phase II trial comparing vintafolide (EC145) and pegylated liposomal doxorubicin (PLD) in combination versus PLD alone in patients with platinum-resistant ovarian cancer

PURPOSE

Vintafolide (EC145) is a folic acid-desacetylvinblastine conjugate that binds to the folate receptor (FR), which is expressed on the majority of epithelial ovarian cancers. This randomized phase II trial evaluated vintafolide combined with pegylated liposomal doxorubicin (PLD) compared with PLD alone. The utility of an FR-targeted imaging agent, (99m)Tc-etarfolatide (EC20), in selecting patients likely to benefit from vintafolide was also examined.

PATIENTS AND METHODS

Women with recurrent platinum-resistant ovarian cancer who had undergone ≤ two prior cytotoxic regimens were randomly assigned at a 2:1 ratio to PLD (50 mg/m(2) intravenously [IV] once every 28 days) with or without vintafolide (2.5 mg IV three times per week during weeks 1 and 3). Etarfolatide scanning was optional. The primary objective was to compare progression-free survival (PFS) between the groups.

RESULTS

The intent-to-treat population comprised 149 patients. Median PFS was 5.0 and 2.7 months for the vintafolide plus PLD and PLD-alone arms, respectively (hazard ratio [HR], 0.63; 95% CI, 0.41 to 0.96; P = .031). The greatest benefit was observed in patients with 100% of lesions positive for FR, with median PFS of 5.5 compared with 1.5 months for PLD alone (HR, 0.38; 95% CI, 0.17 to 0.85; P = .013). The group of patients with FR-positive disease (10% to 90%) experienced some PFS improvement (HR, 0.873), whereas patients with disease that did not express FR experienced no PFS benefit (HR, 1.806).

CONCLUSION

Vintafolide plus PLD is the first combination to demonstrate an improvement over standard therapy in a randomized trial of patients with platinum-resistant ovarian cancer. Etarfolatide can identify patients likely to benefit from vintafolide.

PRECEDENT: A Randomized Phase II Trial Comparing Vintafolide (EC145) and Pegylated Liposomal Doxorubicin (PLD) in Combination Versus PLD Alone in Patients With Platinum-Resistant Ovarian Cancer

Purpose

Vintafolide (EC145) is a folic acid–desacetylvinblastine conjugate that binds to the folate receptor (FR), which is expressed on the majority of epithelial ovarian cancers. This randomized phase II trial evaluated vintafolide combined with pegylated liposomal doxorubicin (PLD) compared with PLD alone. The utility of an FR-targeted imaging agent, 99mTc-etarfolatide (EC20), in selecting patients likely to benefit from vintafolide was also examined.

Patients and Methods

Women with recurrent platinum-resistant ovarian cancer who had undergone ≤ two prior cytotoxic regimens were randomly assigned at a 2:1 ratio to PLD (50 mg/m2 intravenously [IV] once every 28 days) with or without vintafolide (2.5 mg IV three times per week during weeks 1 and 3). Etarfolatide scanning was optional. The primary objective was to compare progression-free survival (PFS) between the groups.

Results

The intent-to-treat population comprised 149 patients. Median PFS was 5.0 and 2.7 months for the vintafolide plus PLD and PLD-alone arms, respectively (hazard ratio [HR], 0.63; 95% CI, 0.41 to 0.96; P = .031). The greatest benefit was observed in patients with 100% of lesions positive for FR, with median PFS of 5.5 compared with 1.5 months for PLD alone (HR, 0.38; 95% CI, 0.17 to 0.85; P = .013). The group of patients with FR-positive disease (10% to 90%) experienced some PFS improvement (HR, 0.873), whereas patients with disease that did not express FR experienced no PFS benefit (HR, 1.806).

Conclusion

Vintafolide plus PLD is the first combination to demonstrate an improvement over standard therapy in a randomized trial of patients with platinum-resistant ovarian cancer. Etarfolatide can identify patients likely to benefit from vintafolide.

[Multiple primary malignancies in BRCA1 mutation carriers--two clinical cases]

Mutations of BRCA1 and BRCA2 genes account for the majority of hereditary breast and ovarian cancers. So far; risk-reducing salpingo-oophorectomy has been the most effective strategy for gynecological cancer prevention in susceptibility gene mutation carriers. It does not prevent, however from the occurrence of primary peritoneal cancer We present two clinical cases of patients with the BRCA1 gene mutation. Both patients had a family history of cancer and both were presenting with metachronic malignances. The first patient, whose mother suffered from breast and ovarian cancer, was diagnosed with left breast cancer in 2004. The patient was 44 years old at diagnosis. Genetic testing revealed the BRCA1 gene mutation. A breast conserving therapy (BCT) was conducted, followed by chemotherapy, radiotherapy and immunotherapy with trastuzumab due to HER2 overexpression. Due to BRCA1 mutation, in November 2005, prophylactic hysterectomy with appendages was performed. Histological examination revealed bilateral ovarian cancer (adenocarcinoma G3) with metastasis to the paraaortal lymph node. The patient received six cycles of chemotherapy: paclitaxel and carboplatin. Ovarian cancer relapsed 3 years later After that the patient received 5 lines of chemotherapy and finally died due to disease progression in September 2011. The second patient, a 49-year-old woman, was diagnosed with breast cancer in July 2003 and subsequently treated with neoadjuvant chemotherapy breast conserving surgery and radiotherapy Genetic testing was also performed and revealed the BRCA1 gene mutation. A year earlier the patient had undergone hysterectomy with appendages due to uterine myomas. Three of her five sisters suffered from breast and ovarian cancer The patients father died of colorectal cancer The patient remained under surveillance. Because of the increasing level of Ca-125 (since October 2004), PET-CT was performed and revealed a tumor lesion of the peritoneum. Histological examination from the biopsy confirmed primary peritoneal cancer (papillary serous adenocarcinoma--primary peritoneal carcinoma). Reexamination of the tissues from hysterectomy with appendages was also performed and revealed an adenocarcinoma in the right ovary Pathologic examination excluded metastasis of a breast cancer Pathomorphology of the ovarian lesion was also different than in the lesions of the peritoneum. Thus, three different tumor types (breast, ovarian and peritoneal cancer) coexisted independently The patient received chemotherapy: paclitaxel and cisplatin. Later on, due to disease progression she was treated with five consecutive chemotherapy regimens and hormonal therapy The patient died in January 2008. These case illustrate that genetic diagnosis may be critical for the overall treatment plan.

Does routine clinical practice reproduce the outcome of large prospective trials? The analysis of institutional database on patients with limited-disease small-cell lung cancer

We performed the analysis of database on 409 patients with LD-SCLC to evaluate as to what extent the clinical outcome of large prospective trials was reproduced in routine practice. The analysis has shown that the hazard rate of death in the absence of prophylactic cranial irradiation (PCI) adjusted for the effects of confounding factors, appeared larger than that reported in the trials on PCI in LD-SCLC, and was comparable to that estimated for extensive disease. Less intense routine staging procedures, compared to the trial settings, contributed for such outcome. Hyperfractionated thoracic radiotherapy provided survival advantage similar to that reported in the literature.

The prospective estimation of blood serum free IGF-1, insulin concentration, and body mass index as a prognostic factor for breast cancer patients

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Background: Numerous epidemiologic findings suggest that an increase in IGF-1, insulin concentration and body mass index correlates with the risk of developing certain types of malignant tumors, including breast cancer. They may also have an influence on the cancer stage. The purpose of this study was to prospectively evaluate the correlation of body mass index (BMI), insulin, and free IGF-1 concentration with cancer stage. Methods: Prospective analysis has been conducted in 2011 in Cancer Center and Institute of Oncology in Gliwice, Poland. This study has been approved by Bioethics Committee according to national regulations. The pilot group included 138 patients with breast cancer treated with chemotherapy, 76% in adjuvant setting and 24% due to cancer dissemination. Results: Patients’ median weight was 70kg (range 52-106kg) and median BMI was 27 (range 18.8-40.8). Patients with HER2 overexpression had diabetes more frequently (8% vs. 0%), p=0.06. Patients with higher BMI more frequently had negative steroid receptor status (42% vs. 25%) p=0.06, and significantly more often were in postmenopausal period (81% vs. 52%), p=0.00029. Tumor stage was significantly more advanced in patients with lower physical activity, p=0.04. Tumor stage was insignificantly more advanced in patients with higher plasma insulin level, p=0.09. Multivariate analysis had shown that overweight patients with more advanced stage of breast cancer had negative steroid receptors more often, p=0.033. Patients with metastatic breast cancer often had higher insulin plasma levels in comparison to patients with early breast cancer (7% vs. 1%), p=0.09. The multivariate analysis also showed that patients with diabetes had more frequently more often overexpression of HER2 and were in a more advanced cancer stage, p=0.03. Conclusions: Hyperinsulinemia may be a risk factor for more advanced stage of disease. There is a possibility that the effect of being overweight on breast cancer stage is mediated by estrogen metabolism. This analysis is scheduled to be performed later in the project.

A randomized, placebo-controlled phase 2 study of ganitumab or conatumumab in combination with FOLFIRI for second-line treatment of mutant KRAS metastatic colorectal cancer

BACKGROUND

Targeted agents presently available for mutant KRAS metastatic colorectal cancer (mCRC) are bevacizumab and aflibercept. We evaluated the efficacy and safety of conatumumab (an agonistic monoclonal antibody against human death receptor 5) and ganitumab (a monoclonal antibody against the type 1 insulin-like growth factor receptor) combined with standard FOLFIRI chemotherapy as a second-line treatment in patients with mutant KRAS mCRC.

PATIENTS AND METHODS

Patients with mutant KRAS metastatic adenocarcinoma of the colon or rectum refractory to fluoropyrimidine- and oxaliplatin-based chemotherapy were randomized 1 : 1 : 1 to receive intravenous FOLFIRI plus conatumumab 10 mg/kg (Arm A), ganitumab 12 mg/kg (Arm B), or placebo (Arm C) Q2W. The primary end point was progression-free survival (PFS).

RESULTS

In total, 155 patients were randomized. Median PFS in Arms A, B, and C was 6.5 months (HR, 0.69; P = 0.147), 4.5 months (HR, 1.01; P = 0.998), and 4.6 months, respectively; median overall survival was 12.3 months (HR, 0.89; P = 0.650), 12.4 months (HR, 1.27; P = 0.357), and 12.0 months; and objective response rate was 14%, 8%, and 2%. The most common grade ≥3 adverse events in Arms A/B/C included neutropenia (30%/25%/18%) and diarrhea (18%/2%/10%).

CONCLUSIONS

Conatumumab, but not ganitumab, plus FOLFIRI was associated with a trend toward improved PFS. Both combinations had acceptable toxicity.

Skin toxicity after palliative chemotherapy containing pegylated liposomal doxorubicin for ovarian cancer patients

BACKGROUND

Skin toxicity in the course of anticancer treatment occurs in majority of patients and may substantially reduce quality of life. Pegylated liposomal doxorubicin (PLD) is an anthracyclines' derivative with reducing severity of cardiotoxicity and myelosuppression but with localized skin lesions on the palms and the soles (PPE).

MATERIAL AND METHODS

The retrospective analysis included medical records of ovarian cancer patients who were treated with PLD due to disease progression after prior therapy. The impact of several factors on the risk and severity of PPE was analyzed.

RESULTS

In analyzed group of ovarian cancer PPE occurred more often in patients who have previously received more than two chemotherapy lines, P=0.09. The risk of PPE increased with the number of chemotherapy cycles, P<0.001 and anemia, P=0.038. In 5% of pts dose reduction was necessary due to PPE.

CONCLUSIONS

Skin toxicity may significantly limit the possibility to continue the treatment. Good communication with patients and their families, close cooperation with family doctors, palliative care and dermatologists is essential for prompt and effective treatment of skin toxicity. Early preventive actions make to alleviate the discomfort associated with skin complications.

Immune responses and association with clinical outcome of advanced colorectal cancer patients treated with the multi-peptide vaccine IMA910

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Background: IMA910 is a novel multi-peptide cancer vaccine consisting of 10 HLA class I and 3class II tumor-associated peptides (TUMAPs), which were selected based on natural presentation on colorectal tumors by the XPRESIDENT antigen discovery platform. Methods: 92 HLA-A*02+ advanced colorectal cancer (aCRC) patients (pts) with stable or responding disease after 12 weeks of first-line oxaliplatin-based therapy were enrolled in this phase I/II trial. After pre-treatment with cyclophosphamide (300 mg/m2), patients were immunized intradermally with IMA910 plus the immune modulator GM-CSF without (cohort 1; n=66) or with (cohort 2; n=26) topically applied imiquimod, another immune modulator acting via toll-like receptor 7 on antigen presenting cells. T-cell responses to individual IMA910 peptides were analyzed by HLA multimer and intracellular cytokine staining (ICS) assays. Results: IMA910 elicited immune responses towards multiple class I (43%) and class II TUMAPs (65%). 34% of pts responded to multiple class I and class II TUMAPs. Pts that received imiquimod were more often multi-peptide class I responders in the ICS assay (p=0.016) and showed an approx. 2x higher frequency of T-cell response (p=0.12). Responses to multiple class I and class II TUMAPs were associated with higher disease control rate at all time points (all p<0.02), increased time to progression (p=0.006), progression-free survival (p=0.009) and OS (p=0.088, HR=0.53). Baseline characteristics of multi vs. non-multi responders were overall well comparable. In a prospectively defined, blinded matched-pair analysis with patients in arm C of the COIN trial, multi-peptide responder patients showed a prolonged survival vs. corresponding COIN patients (p=0.04), while the non-multi responder patients had comparable survival. Conclusions: IMA910 is immunogenic. Imiquimod increases the quality of immune responses. Responses to multiple TUMAPs are associated with better clinical outcome. Several observations indicate that this association is not a reflection of better prognosis of the immunologically responding subset of patients. These results suggest further development of IMA910.

Overall survival (OS) of advanced colorectal cancer (aCRC) patients (pts) treated with the multipeptide vaccine IMA910: Results of a matched-pair analysis with arm C pts from COIN

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Background: IMA910 is a novel cancer vaccine consisting of 10 class I and 3 class II tumor-associated peptides (TUMAPs), naturally presented on HLA molecules of CRC. Vaccine-induced immune responses are associated with prolonged OS of renal cell carcinoma pts treated with IMA901, a multi-peptide vaccine identified by the same antigen discovery platform. Methods: 92 HLA-A*02+ aCRC pts with stable or responding disease after 12 weeks of first-line oxaliplatin-based therapy were enrolled in this phase I/II trial. After immunomodulation with cyclophosphamide (300 mg/m2) to reduce regulatory T cells, pts were immunized intradermally (up to 16 vaccinations) with IMA910 in combination with GM-CSF without (cohort 1; n=66) or with (cohort 2; n=26) topically applied imiquimod. Safety and PFS data was recently presented [Mayer et al., ASCO-GI 2012]. OS of IMA910 pts was compared to matched pts from arm C (intermittent chemotherapy) of the COIN trial [Adams et al., Lancet Oncology 2011]. Matching was performed in a prospectively defined, fully blinded fashion based on a propensity score involving all available prognostic factors. T-cell responses to individual IMA910 peptides were analyzed by HLA multimer and intracellular cytokine assays. Results: At a median follow up of 1.7 yrs, OS of IMA910 vaccinated pts was significantly longer in comparison to 1:1 matched HLA-A*02+ COIN pts (HR 0.675, 95% CI 0.458-0.995, p=0.047; 1 yr OS: 69% vs 55%; 2 yr OS: 40% vs 24%). Multi-TUMAP responders (≥2 CD8+ and ≥2 CD4+ vaccine-induced T cells) had a significantly longer OS (HR 0.45, p=0.04) compared to matched COIN pts while non-multi-TUMAP responders showed similar OS compared to matched COIN pts (HR 0.76, p=0.22). Conclusions: OS of IMA910 pts was significantly longer in comparison to matched COIN pts with separation of survival curves at ~9 months and increasing OS difference over time. Multi-TUMAP immune responders had a significantly longer OS compared to non-multi-TUMAP responders and compared to matched COIN pts. These clinical and immune response data strongly suggest clinical activity of IMA910 in 1st line CRC pts and warrant further development.

Clinical and biologic factors associated with time to progression in patients treated by first-line palliative FOLFOX chemotherapy in metastatic colorectal cancer

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Background: Chemotherapy is the mainstay of treatment patients with metastatic colorectal cancer. The choice of first-line treatment is difficult, especially when cost-effectiveness is the primary constraint. Thus, the optimal use of the clinical and biological factors influencing prognosis would be beneficial. The aim of our study was to identify factors affecting the time to progression (TTP) after first-line FOLFOX chemotherapy in palliative setting. Methods: The study is a retrospective analysis of the series of consecutive patients from large cancer center in south of Poland. The analysis was carried out in the group of 180 patients (37.2% of women), treated between 2007-2010 by FOLFOX-4 regimen and followed-up with the median time of observation 16.3 month. Patients received chemotherapy with median time of 5.0 months, median 10 cycles. Progression was defined as PD by RECIST criteria, death due to disease or sympomatic deterioration. 94 paraffin blocks were available for KRAS testing and gene expression analysis by real-time PCR. Results: The median TTP (counted from beginning of chemotherapy) was 8.6 month, the median TTP from the end of treatment was 3.4 month. We tested the wide range of clinical variables associated with both disease and and patient status by multivariate Cox regression analysis. Two most potent independent negative predictors were identified: the presence of massive lymph node involvement as assessed in CT scan before palliative treatment (>10 nodes enlarged) – hazard ratio 2.82, p<0.001; and tumor grade in histopathological assessment (grade 3 vs. grade 1-2) – hazard ratio 2.76, p=0.003. KRAS status was not prognostic for the TTP; Ki67 gene expression measurement by quantitative RT-PCR did not predict better that the routine assessment of grade. Patients with either grade 3 or lymph node involvement showed significantly shorter TTP (median 5.7 months vs 9.7 months in patients with none of these factors). Conclusions: High tumor grade and the massive involvement of lymph nodes worsen prognosis and shorten time to progression in patients treated with first line palliative FOLFOX chemotherapy.

PTEN as a prognostic and predictive marker in postoperative radiotherapy for squamous cell cancer of the head and neck

Background

Tumor suppressor PTEN is known to control a variety of processes related to cell survival, proliferation, and growth. PTEN expression is considered as a prognostic factor in some human neoplasms like breast, prostate, and thyroid cancer.

Methodology/Principal Findings

In this study we analyzed the influence of PTEN expression on the outcome of a randomized clinical trial of conventional versus 7-days-a-week postoperative radiotherapy for squamous cell cancer of the head and neck. The patients with cancer of the oral cavity, oropharynx, and larynx were randomized to receive 63 Gy in fractions of 1.8 Gy given 5 days a week (CF) or 7 days a week (p-CAIR). Out of 279 patients enrolled in the study, 147 paraffin blocks were available for an immunohistochemical assessment of PTEN. To evaluate the prognostic value of PTEN expression and the effect of fractionation relative to PTEN, the data on the outcome of a randomized clinical trial were analyzed. Tumors with a high intensity of PTEN staining had significant gain in the loco-regional control (LRC) from p-CAIR (5-year LRC 92.7% vs. 70.8%, for p-CAIR vs. CF, p = 0.016, RR = 0.26). By contrast, tumors with low intensity of PTEN did not gain from p-CAIR (5-year LRC 56.2% vs. 47.2%, p = 0.49, RR = 0.94). The intensity of PTEN highly affected the LRC in a whole group of 147 patients (5-year LRC 80.9% vs. 52.3% for high vs. low PTEN, p = 0.0007, RR = 0.32). In multivariate Cox analysis, including neck node involvement, EGFR, nm23, Ki-67, p53, cyclin D1, tumor site and margins, PTEN remained an independent predictor of LRC (RR = 2.8 p = 0.004).

Conclusions/Significance

These results suggest that PTEN may serve as a potent prognostic and predictive marker in postoperative radiotherapy for high-risk squamous cell cancer of the head and neck.

Conatumumab (CON) plus FOLFIRI (F) or ganitumab (GAN) plus F for second-line treatment of mutant (MT) KRAS metastatic colorectal cancer (mCRC)

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Background: EGFR inhibitors are not an option for patients (pts) with MT KRAS mCRC; therefore, there is an unmet medical need for novel agents to treat this pt population. CON (agonist) and GAN (antagonist) are investigational, fully human monoclonal antibodies to death receptor 5 and type 1 insulin-like growth factor receptor, respectively. In colorectal xenografts, CON enhanced the activity of 5FU, and both agents enhanced the activity of irinotecan. A 3-arm, placebo (pbo)-controlled, double-blind, double dummy, randomized phase 2 study evaluated both agents in MT KRAS mCRC.

Methods: Planned sample size = 150. Eligibility: MT KRAS mCRC; disease progression on 1 prior oxaliplatin and fluoropyrimidine therapy. Randomization was 1:1:1 to Arm 1: CON 10 mg/kg + GAN pbo + F Q2W; Arm 2: CON pbo + GAN 12 mg/kg + F Q2W; Arm 3: CON pbo + GAN pbo + F Q2W. Randomization was stratified by PS (0 vs 1) and prior anti-VEGF therapy (yes vs no). Pts received CON, GAN, or pbo IV day (D)1 and 15; irinotecan 180 mg/m2 D1; leucovorin 400 mg/m2 over 2 h D1; 5FU bolus 400 mg/m2 over 2-4 min D1 then 5FU 2400 mg/m2 over 46-48 h. Primary endpoint: PFS by investigator assessment.

Results: 155 pts (Arms 1/2/3: 51/52/52 pts) were randomized between 3/09 and 2/11; 50/50/52 received ≥ 1 dose of study drug. Median age, 59/58/59 years; women, 47/54/56%; colon cancer, 75/65/83%; PS 1, 37/42/40%; prior anti-VEGF therapy, 43/40/42%. See table for efficacy. % pts with grade 3-5 adverse events (Arms 1/2/3) included: neutropenia 30/25/18%; diarrhea 18/2/10%; intestinal obstruction 4/6/8%. There was 1 treatment-related death of unknown cause on Arm 1.

Conclusions: CON + F and GAN + F were tolerable in this pt population. CON + F, but not GAN + F, improved PFS. ORR was increased vs pbo. OS data are immature. Further study of CON may be warranted in mCRC.

[Table: see text]

A phase I/II trial of the multipeptide cancer vaccine IMA910 in patients with advanced colorectal cancer (CRC)

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Background: Treatment interruption after 12 weeks of oxaliplatin-based therapy followed by re-introduction upon signs of progression results in better overall tolerability and quality of life compared to continuous therapy while survival rates are only modestly impaired. Specific immunotherapy may provide a safe and tolerable intervention to prolong time to re-introduction and eventually overall survival. IMA910 is a novel peptide-based cancer vaccine consisting of 13 tumor-associated peptides (TUMAPs), which are naturally presented on MHC molecules of colorectal tumors.

Methods: HLA-A*02+ advanced CRC patients being at least clinically stable after 12 weeks of first-line oxaliplatin-based therapy were enrolled. After immunomodulation with a single low dose of cyclophosphamide (300 mg/m2), patients were immunized intradermally (up to 16 vaccinations) with IMA910 in combination with GM-CSF (cohort 1; n=66) or IMA910 with GM-CSF plus topically applied imiquimod (cohort 2; n=26). T-cell responses to individual IMA910 peptides were analyzed by HLA-multimer and intra-cellular cytokine assay. Analysis of disease control rates (DCR) and progression-free survival (PFS) was based on RECIST-centrally reviewed CT/ MRI scans.

Results: IMA910 was overall well tolerated with most AEs being mild and transient local site reactions. Three patients presented with systemic hypersensitivity reactions, all of which were observed after ≥10 vaccinations and were confirmed to have an in vitro reaction against GM-CSF in all cases. IMA910 induced immune responses in 71% and 72% of patients in the two cohorts, respectively. Interestingly, patients developing CD8 T-cell responses against multiple TUMAPs had a better clinical outcome compared to others, in terms of DCR (18% vs. 2% at 6 months; p=0.012) and PFS (HR: 0.652; p=0.039). OS data will be shown at the meeting.

Conclusions: Vaccination with IMA910 is safe, well tolerated, and immunogenic. Significantly better clinical outcome of multi-TUMAP responders in comparison to patients with one/no TUMAP response indicates clinical activity of IMA910 in 1st line advanced CRC patients.

[Usefulness of osteopontin (OPN) determinations in ovarian cancer patients who underwent first-line chemotherapy]

INTRODUCTION

Currently CA 125 is a marker of choice for monitoring ovarian cancer Nonetheless, scientists are still searching for new markers, which could provide additional information for the evaluation of treatment, especially in patients with normal CA 125 levels, despite the progression of the disease. According to the latest reports, OPN can be a potential new marker:

AIM

Estimation of usefulness of OPN determinations in the monitoring of ovarian cancer patients.

MATERIAL AND METHODS

The study included 54 ovarian cancer patients, undergoing chemotherapy Markers were measured before, during and after treatment. The dynamics of the change of OPN levels was shown on line graphs, using Microsoft Excel programme. Statistical analysis was performed by Kaplan-Meier method and log-rank test.

RESULTS

44% of patients from the study group were found to have low CA 125 levels. In these cases only the increase of OPN concentration indicated recurrence of the disease. In 43% of patients the high initial CA 125 and OPN levels decreased during chemotherapy and complete regression was stated in these patients. Nevertheless, in 13/17 patients a repeated increase of OPN concentration signalling the recurrence, earlier than CA 125 and clinical recurrence manifestation, was observed. In 13% of patients high initial levels of markers did not decrease during chemotherapy which correlated with the progression of the disease. Our study showed that only the CA 125 levels had a significant influence (p=0.00063) on the disease-free survival time.

CONCLUSIONS

Our data suggest a potential usefulness of the OPN determinations in estimating ovarian cancer recurrence. Nonetheless, there was no correlation between the initial OPN concentration and the disease-free survival time.

A randomized, phase I/II trial of AMG 102 or AMG 479 in combination with panitumumab (pmab) compared with pmab alone in patients (pts) with wild-type (WT) KRAS metastatic colorectal cancer (mCRC): Safety and efficacy results

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Background: Pmab is a fully human anti-epidermal growth factor receptor monoclonal antibody (mAb) approved as monotherapy for pts with mCRC. AMG 102 and AMG 479 are investigational, fully human mAbs against hepatocyte growth factor (HGF) and insulin-like growth factor receptor 1 (IGF1R), respectively. This 3-part study evaluated the safety and efficacy of AMG 102 or AMG 479 in combination with pmab.

Methods: Part 1 was a phase 1b, open-label, dose-finding study to determine a tolerable dose of AMG 102 in combination with pmab. Part 2 was a phase II, randomized, blinded, placebo-controlled trial that explored pmab + the dose of AMG 102 selected in Part 1 vs pmab + AMG 479 vs pmab + placebo. Part 3 is a 2-arm randomized extension study for pts who developed disease progression (PD) or intolerability to pmab + placebo in part 2. Eligible pts were ≥ 18 years old with WT KRAS mCRC and ECOG PS 0/1. In part 1, all pts received 6 mg/kg pmab + 10 mg/kg AMG 102 Q2W IV until PD or intolerability. The primary endpoint of part 1 was the incidence of dose-limiting toxicities (DLTs). The primary endpoint for part 2 is objective response rate (ORR).

Results: In part 1, no DLTs were reported for the first 6 DLT-evaluable pts. A total of 11 pts were enrolled in part 1 prior to the decision to use the 10 mg/kg Q2W AMG 102 dose in part 2; 5 pts were men; mean (range) age was 56 (37-75) yrs; ECOG 0/1 was 55%/45%. Grade 3 treatment-related adverse events (AEs) were acneiform dermatitis or rash (55%), paronychia (18%), infection (9%), capillary leak syndrome (9%), erythema (9%), nail disorder (9%), and pruritus (9%). There were no grade 4 or 5 treatment-related AEs. Serious AEs included acneiform dermatitis (n = 1), intestinal obstruction (n = 1), cerebrovascular accident (n = 1), capillary leak syndrome (n = 1), and anemia/general health deterioration (n = 1). One pt died on study from PD. In part 2, 142 pts received at least one dose of study drug; enrollment is complete, and data analyses are ongoing.

Conclusions: In part 1, 6 mg/kg pmab + 10 mg/kg AMG 102 Q2W was well tolerated. Primary efficacy results from part 2, including ORR and progression-free survival, will be presented.

[Table: see text]

Time Factor in Radiotherapy and Chemotherapy for Limited Disease Small-Cell Lung Cancer

The prognostic significance of planned and unplanned gaps in radiotherapy and chemotherapy for limited-disease small-cell lung cancer (LD-SCLC) has been retrospectively evaluated in a series of 245 patients. All of them had cisplatine-based chemotherapy and fractionated radiotherapy. There was substantial heterogeneity in overall radiation treatment time and dose-intensity of chemotherapy attributable mostly to planned and unplanned gaps in therapy. Several variables that potentially may influence survival of the patients after treatment, including duration of treatment gaps, and dose-intensity of chemotherapy and radiotherapy were analyzed using univariate and multivariate Cox regression model. The following variables had significant and independent negative influence on survival in a multivariate model: performance status ZUBROD > 0 (p < 0.0001), metastases to supraclavicular nodes (p = 0.001), dyspnoea according to Borg scale > 2 (p = 0.004) and the average dose intensity of radiotherapy < 80 percent (p = 0.02). An independent association between total dose and survival also has been found. The dose-intensity of chemotherapy did not appear to significantly influence survival. While due to the retrospective character of the present research, this conclusion must be regarded as hypothesis-generating only, we assume that within the range of doses and dose-intensitites used in the present group the preventable gaps in radiotherapy and undue reduction of total radiation dose should be promptly avoided, while gaps in chemotherapy can be deemed acceptable if crucially demanded by the tolerance of treatment.