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Ahn DH, Barzi A, Ridinger M, Samuëlsz E, Subramanian RA, Croucher PJP, Smeal T, Kabbinavar FF, Lenz HJ. Onvansertib in Combination with FOLFIRI and Bevacizumab in Second-line Treatment of KRAS-mutant Metastatic Colorectal Cancer: A Phase 1b Clinical Study. Clin Cancer Res 2024:733380. [PMID: 38231047 DOI: 10.1158/1078-0432.ccr-23-3053] [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] [Received: 10/06/2023] [Revised: 12/01/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE Onvansertib is a highly specific inhibitor of Polo-like kinase 1 (PLK1), with demonstrated safety in solid tumors. We evaluated, preclinically and clinically, the potential of onvansertib in combination with chemotherapy as a therapeutic option for KRAS-mutant colorectal cancer (CRC). PATIENTS AND METHODS Preclinical activity of onvansertib was assessed: (1) in vitro in KRAS-wild type and -mutant isogenic CRC cells; and (2) in vivo, in combination with irinotecan, in a KRAS-mutant xenograft model. Clinically, a Phase Ib trial was conducted to investigate onvansertib at doses 12, 15, and 18 mg/m2 (days 1-5 and 14-19 of a 28-day cycle) in combination with FOLFIRI/bevacizumab (days 1 and 15) in KRAS-mutant metastatic CRC patients who had prior oxaliplatin exposure. Safety, efficacy, and changes in circulating tumor DNA (ctDNA) were assessed. RESULTS In preclinical models, onvansertib displayed superior activity in KRAS-mutant than wild-type isogenic CRC cells and demonstrated potent anti-tumor activity in combination with irinotecan in vivo. Eighteen patients enrolled in the Phase Ib study. Onvansertib recommended phase 2 dose was established at 15 mg/m2. Grade 3 and 4 adverse events (AE) represented 15% of all treatment-related AEs, with neutropenia being the most common. Partial responses were observed in 44% of patients with a median duration of response of 9.5 months. Early ctDNA dynamics were predictive of treatment efficacy. CONCLUSIONS Onvansertib combined with FOLIFRI/bevacizumab exhibited manageable safety and promising efficacy in second-line treatment of KRAS-mutant metastatic CRC patients. Further exploration of this combination therapy is ongoing.
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Affiliation(s)
| | - Afsaneh Barzi
- City Of Hope National Medical Center, Duarte, CA, United States
| | | | | | | | | | - Tod Smeal
- Cardiff Oncology, San Diego, CA, United States
| | | | - Heinz-Josef Lenz
- University of Southern California, Los Angeles, CA, United States
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Margalit O, Harmsen WS, Shacham-Shmueli E, Voss MM, Boursi B, Wagner AD, Cohen R, Olswold CL, Saltz LB, Goldstein DA, Hurwitz H, Tebbutt NC, Kabbinavar FF, Adams RA, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, de Gramont A, Shi Q, Lenz HJ. Corrigendum to "Evaluating sex as a predictive marker for response to bevacizumab in metastatic colorectal carcinoma: Pooled analysis of 3369 patients in the ARCAD database" Eur J Cancer. 2023 Jan;178:162-170. Eur J Cancer 2023; 194:113339. [PMID: 37813779 DOI: 10.1016/j.ejca.2023.113339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Ofer Margalit
- Tel-Aviv University, Tel-Aviv, Israel; Sheba Medical Center, Ramat-Gan, Israel.
| | - William S Harmsen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Molly M Voss
- Department of Quantitative Science Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Ben Boursi
- Tel-Aviv University, Tel-Aviv, Israel; Sheba Medical Center, Ramat-Gan, Israel
| | - Anna D Wagner
- Department of Oncology, Division of Medical Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Romain Cohen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA; Sorbonne University, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Curtis L Olswold
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Niall C Tebbutt
- University of Melbourne, Melbourne, Australia; Austin Health, Heidelberg, Victoria, Australia
| | - Fairooz F Kabbinavar
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health and School of Public Health, Monash University, Melbourne, Australia
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
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Ou FS, Ahn DH, Dixon JG, Grothey A, Lou Y, Kasi PM, Hubbard JM, Van Cutsem E, Saltz LB, Schmoll HJ, Goldberg RM, Venook AP, Hoff P, Douillard JY, Hecht JR, Hurwitz H, Punt CJA, Koopman M, Bokemeyer C, Fuchs CS, Diaz-Rubio E, Tebbutt NC, Cremolini C, Kabbinavar FF, Bekaii-Saab T, Chibaudel B, Yoshino T, Zalcberg J, Adams RA, de Gramont A, Shi Q. Evaluation of Intratumoral Response Heterogeneity in Metastatic Colorectal Cancer and Its Impact on Patient Overall Survival: Findings from 10,551 Patients in the ARCAD Database. Cancers (Basel) 2023; 15:4117. [PMID: 37627145 PMCID: PMC10452983 DOI: 10.3390/cancers15164117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Metastatic colorectal cancer (mCRC) is a heterogeneous disease that can evoke discordant responses to therapy among different lesions in individual patients. The Response Evaluation Criteria in Solid Tumors (RECIST) criteria do not take into consideration response heterogeneity. We explored and developed lesion-based measurement response criteria to evaluate their prognostic effect on overall survival (OS). PATIENTS AND METHODS Patients enrolled in 17 first-line clinical trials, who had mCRC with ≥ 2 lesions at baseline, and a restaging scan by 12 weeks were included. For each patient, lesions were categorized as a progressing lesion (PL: > 20% increase in the longest diameter (LD)), responding lesion (RL: > 30% decrease in LD), or stable lesion (SL: neither PL nor RL) based on the 12-week scan. Lesion-based response criteria were defined for each patient as follows: PL only, SL only, RL only, and varied responses (mixture of RL, SL, and PL). Lesion-based response criteria and OS were correlated using stratified multivariable Cox models. The concordance between OS and classifications was measured using the C statistic. RESULTS Among 10,551 patients with mCRC from 17 first-line studies, varied responses were noted in 51.6% of patients, among whom, 3.3% had RL/PL at 12 weeks. Among patients with RL/SL, 52% had stable disease (SD) by RECIST 1.1, and they had a longer OS (median OS (mOS) = 19.9 months) than those with SL only (mOS = 16.8 months, HR (95% CI) = 0.81 (0.76, 0.85), p < 0.001), although a shorter OS than those with RL only (mOS = 25.8 months, HR (95% CI) = 1.42 (1.32, 1.53), p < 0.001). Among patients with SL/PL, 74% had SD by RECIST 1.1, and they had a longer OS (mOS = 9.0 months) than those with PL only (mOS = 8.0 months, HR (95% CI) = 0.75 (0.57, 0.98), p = 0.040), yet a shorter OS than those with SL only (mOS = 16.8 months, HR (95% CI) = 1.98 (1.80, 2.18), p < 0.001). These associations were consistent across treatment regimen subgroups. The lesion-based response criteria showed slightly higher concordance than RECIST 1.1, although it was not statistically significant. CONCLUSION Varied responses at first restaging are common among patients receiving first-line therapy for mCRC. Our lesion-based measurement criteria allowed for better mortality discrimination, which could potentially be informative for treatment decision-making and influence patient outcomes.
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Affiliation(s)
- Fang-Shu Ou
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel H Ahn
- Division of Medical Oncology, Mayo Clinic, Phoenix, AZ 85259, USA
| | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Axel Grothey
- West Cancer Center, University of Tennessee, Memphis, TN 38104, USA
| | - Yiyue Lou
- Vertex Pharmaceuticals, Boston, MA 02210, USA
| | - Pashtoon M Kasi
- Division of Hematology and Oncology, University of Iowa, Iowa City, IA 52242, USA
| | | | - Eric Van Cutsem
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, 3000 Leuven, Belgium
| | - Leonard B Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hans-Joachim Schmoll
- Department of Internal Medicine, Clinic for Internal Medicine IV, Martin-Luther-University Halle/Saale, 06120 Halle, Germany
| | - Richard M Goldberg
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Alan P Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA 94143, USA
| | - Paulo Hoff
- Department of Clinical Oncology, University of Sao Paulo, Sao Paulo 05508-010, Brazil
| | - Jean-Yves Douillard
- Department of Medical Oncology, University of Nantes Medical School, 44035 Nantes, France
| | | | - Herbert Hurwitz
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
| | - Cornelis J A Punt
- Julius Center, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | - Eduardo Diaz-Rubio
- Department of Oncology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Niall C Tebbutt
- Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Richard A Adams
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
- Velindre Cancer Center, Velindre NHS Trust, Cardiff CF14 2TL, UK
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
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Shmueli ES, Raeisi M, Chibaudel B, Hurwitz H, Saltz LB, Kabbinavar FF, Tebbutt NC, Grothey A, Adams R, Zalcberg JR, Yoshino T, Bachet JB, Cohen R, Sharara L, Andre T, Shi Q, De Gramont A. Bevacizumab in first-line therapy in lung metastases of colorectal cancer: An ARCAD pooled analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.118] [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: 01/25/2023] Open
Abstract
118 Background: Anti-VEGF is widely used in the treatment (trt) of metastatic colorectal cancer (mCRC). Only studies with bevacizumab (BEV) have shown survival benefit (bnf) in first line trt. The magnitude of bnf might differ based on the metastatic (met) site and the chemotherapy regimen (CTR) with which BEV is partnered. ARCAD database contains individual patient data (IPD) of randomized trials that evaluated BEV+ CT. In this pooled analysis, we aimed to evaluate BEV bnf in mCRC with lung metastases (mets) either as single or multiple sites. Methods: IPD from four trials (AVF2107g, N016966, AVF2192g, AGITG) comparing CT +/- BEV were pooled. The primary endpoint, overall survival (OS), was estimated using Kaplan-Meier method and prognostic value of lung mets was evaluated by stratified Cox models according to number and type of met sites and CTRs, oxaliplatin or irinotecan (OX/IRI) based. The predictive bnf of BEV was evaluated by interaction test (int) between trt and lung mets status in subgroups and considered as significant (sig) with a P < 0.1. Results: 2728 patients (pts) with known met sites and survival data were pooled. 1020 pts had single met site, 133 had only lung mets. 1708 pts had multiple met sites, 1008 had lung mets. Pts characteristics were well balanced. Sig OS bnf of BEV was observed in the whole population. In pts subgroup according to the presence or absence of lung mets, sig bnf of BEV were observed with a non-sig int ( Pint=.590). Non-sig bnf of BEV was observed in pts with single site regardless of met site (lung or no lung) or CTR. Sig bnf of BEV was observed in pts with multiple sites without lung mets whatever the CTRs. While sig bnf of BEV was observed in pts with multiple sites with lung mets, we found a sig int between BEV and OX/IRI-based regimens ( Pint=.022). The bnf of BEV was observed with IRI-based regimen but not in OX-based regimen. The bnf of BEV appears greater in multiple sites without lung mets than with lung mets with a sig stratified log-rank test ( PLRT<.001). Conclusions: In pts with multiple sites mCRC, a statistically sig OS bnf of BEV added to CT was observed mainly among pts without lung mets. The overall effect of CT partner choice when combined with BEV can be different. In pts with single site, BEV did not seem to improve OS but the evaluation of efficacy of BEV in presence or absence lung mets was based on small number of pts and needs to be evaluated in trials with larger pts sample, especially trials including pts with single site lung mets. [Table: see text]
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Affiliation(s)
- Einat S Shmueli
- Cancer Center, The Chaim Sheba Medical Center, Ramat Gan, Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Morteza Raeisi
- Statistical Unit, Fondation A.R.CA.D - Aide et Recherche en CAncérologie Digestive, Levallois-Perret, France
| | - Benoist Chibaudel
- Hopital Franco-Britannique-Fondation Cognacq-Jay, Levallois-Perret, France
| | | | | | | | - Niall C. Tebbutt
- Department of Medical Oncology, Olivia Newton-John Cancer, Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
| | | | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jean-Baptiste Bachet
- Sorbonne University, Hepatogastroenterology and Digestive Oncology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Romain Cohen
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Lama Sharara
- Fondation A.R.CA.D.-Aide et Recherche en Cancérologie Digestive, Levallois-Perret, France
| | - Thierry Andre
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | | | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Hospital, Levallois-Perret, France
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5
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Margalit O, Harmsen WS, Shacham-Shmueli E, Voss MM, Boursi B, Wagner AD, Cohen R, Olswold CL, Saltz LB, Goldstein DA, Hurwitz H, Tebbutt NC, Kabbinavar FF, Adams RA, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, de Gramont A, Shi Q, Lenz HJ. Evaluating sex as a predictive marker for response to bevacizumab in metastatic colorectal carcinoma: Pooled analysis of 3,369 patients in the ARCAD database. Eur J Cancer 2023; 178:162-170. [PMID: 36446161 DOI: 10.1016/j.ejca.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies suggest a possible sex-specific response to bevacizumab in metastatic colorectal carcinoma (mCRC), showing a benefit in males, while the effect in females is less significant. METHODS Data from 3369 patients with mCRC enrolled on four first-line randomised trials testing chemotherapy with or without bevacizumab (2000-2007) were pooled. Association between sex and progression-free survival and overall survival (OS) was evaluated by stratified Cox regression model, adjusted for potential confounders. Predictive value was evaluated by interaction effect between sex and treatment. In a pre-planned secondary analysis, analyses were stratified using an age cut point of 60 years to evaluate the possible role of menopausal-related effects. RESULTS Bevacizumab was associated with an improved median OS in males and females, with a 2.3- and 0.6-months benefit, respectively. Stratified by age, bevacizumab resulted in improved OS in males at both age categories. In females at or above the age of 60 (n = 731), bevacizumab resulted in improved OS. However, in females below the age of 60 (n = 634), OS benefit did not reach statistical significance (adjusted hazard ratio = 0.94, 95% confidence interval 0.74-1.20). CONCLUSIONS Our results confirmed the OS benefit from the addition of bevacizumab to first-line chemotherapy in mCRC in both sexes. Among females, the benefit was less than 1 month. For females under the age of 60, there was no survival benefit. These findings could be used to relieve financial toxicity or be redistributed within healthcare systems for other health-related purposes.
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Affiliation(s)
- Ofer Margalit
- Sheba Medical Center, Ramat-Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel.
| | - William S Harmsen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Molly M Voss
- Department of Quantitative Science Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Ben Boursi
- Sheba Medical Center, Ramat-Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Anna D Wagner
- Department of Oncology, Division of Medical Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Romain Cohen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, F-75012 Paris, France; Sorbonne University, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, F-75012 Paris, France
| | - Curtis L Olswold
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Niall C Tebbutt
- University of Melbourne, Australia; Austin Health, Heidelberg, Victoria, Australia
| | - Fairooz F Kabbinavar
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health and School of Public Health, Monash University, Melbourne, Australia
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
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Franko J, Yin J, Adams R, Zalcberg JR, Fiskum J, VanCutsem E, Goldberg RM, Hurwitz HI, Bokemeyer C, Kabbinavar FF, Curtis A, Chibaudel B, Yoshino T, De Gramont A, Shi Q. Trajectories of body weight change and survival among mCRC patients treated with systemic therapy: Pooled analysis from the ARCAD database. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.080] [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
80 Background: Higher baseline body mass index is associated with improved survival in metastatic CRC (mCRC). Whether weight gain or loss after mCRC diagnosis is associated with survival remains largely unknown. Methods: We analyzed individual patient data from 3504 patients with previously untreated mCRC enrolled in five phase III randomized trials (AVF2017g, AVF2192g, CRYSTAL, N9741, OPUS) conducted between 2000 and 2006. Weight measurements were prospectively collected at 3 months after diagnosis and then up to 5 years. Patients were categorized into three groups based on the percent weight change at 3 months: stable weight or gain, weight loss up to 5% of baseline weight, and ≥5% weight loss of baseline weight. Cox models were used to assess the prognostic associations of weight change at 3 months with overall survival (OS) and progression-free survival (PFS), adjusting for baseline BMI, age, sex, performance score, chemotherapy backbone (oxaliplatin vs. irinotecan), and biologics type (cetuximab vs. bevacizumab). Sub-analyses included Cox models adjusted for additional clinical-pathological factors (primary tumor sidedness [right colon vs. left colon-rectum], and BRAF status; N=1,511). Results: Median percent weight change at 3 months was -0.5% (IQR -4.0 to+1.6%). OS was better in patients with weight stability or gain than in those with weight loss (up to 5% or ≥5%; (Table). Results were consistent for PFS for patients with ≥5% weight loss of baseline weight, as well as for sub-analyses. Conclusions: Patients losing weight during the first 3 months of systemic therapy for metastatic colorectal cancer have significantly shorter overall survival than those with stable or increasing weight. Degree of weight loss is proportional to the observed increased risk of death and remains evident among underweight, normal weight and obese individuals. Further studies examining possible usefulness of on-treatment early weight loss as a novel intermediary end-point are needed.[Table: see text]
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Affiliation(s)
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
| | | | - Jack Fiskum
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
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7
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Burzykowski T, Coart E, Saad ED, Shi Q, Sommeijer DW, Bokemeyer C, Díaz-Rubio E, Douillard JY, Falcone A, Fuchs CS, Goldberg RM, Hecht JR, Hoff PM, Hurwitz H, Kabbinavar FF, Koopman M, Maughan TS, Punt CJA, Saltz L, Schmoll HJ, Seymour MT, Tebbutt NC, Tournigand C, Van Cutsem E, de Gramont A, Zalcberg JR, Buyse M. Evaluation of Continuous Tumor-Size-Based End Points as Surrogates for Overall Survival in Randomized Clinical Trials in Metastatic Colorectal Cancer. JAMA Netw Open 2019; 2:e1911750. [PMID: 31539075 PMCID: PMC6755539 DOI: 10.1001/jamanetworkopen.2019.11750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Tumor measurements can be used to estimate time to nadir and depth of nadir as potential surrogates for overall survival (OS). OBJECTIVE To assess time to nadir and depth of nadir as surrogates for OS in metastatic colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS Pooled analysis of 20 randomized clinical trials within the Aide et Recherche en Cancerologie Digestive database, which contains academic and industry-sponsored trials, was conducted. Three sets of comparisons were performed: chemotherapy alone, antiangiogenic agents, and anti-epidermal growth factor receptor agents in first-line treatment for patients with metastatic colorectal cancer. MAIN OUTCOMES AND MEASURES Surrogacy of time to nadir and depth of nadir was assessed at the trial level based on joint modeling of relative tumor-size change vs baseline and OS. Treatment effects on time to nadir and on depth of nadir were defined in terms of between-arm differences in time to nadir and in depth of nadir, and both were assessed in linear regressions for their correlation with treatment effects (hazard ratios) on OS within each set. The strengths of association were quantified using sample-size-weighted coefficients of determination (R2), with values closer to 1.00 indicating stronger association. At the patient level, the correlation was assessed between modeled relative tumor-size change and OS. RESULTS For 14 chemotherapy comparisons in 4289 patients, the R2 value was 0.63 (95% CI, 0.30-0.96) for the association between treatment effects on time to nadir and OS and 0.08 (95% CI, 0-0.37) for depth of nadir and OS. For 11 antiangiogenic agent comparisons (4854 patients), corresponding values of R2 were 0.25 (95% CI, 0-0.72) and 0.06 (95% CI, 0-0.35). For 8 anti-epidermal growth factor receptor comparisons (2684 patients), corresponding values of R2 were 0.24 (95% CI, 0-0.83) and 0.21 (95% CI, 0-0.78). CONCLUSIONS AND RELEVANCE In contrast with early reports favoring depth of response as a surrogate, these results suggest that neither time to nadir nor depth of nadir is an acceptable surrogate for OS in the first-line treatment of metastatic colorectal cancer.
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Affiliation(s)
- Tomasz Burzykowski
- International Drug Development Institute, Louvain-la-Neuve, Belgium
- Hasselt University, Diepenbeek, Belgium
| | - Elisabeth Coart
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Everardo D. Saad
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Dirkje W. Sommeijer
- The University of Sydney, Camperdown, New South Wales, Australia
- Academic Medical Centre, Amsterdam, the Netherlands
- Flevohospital, Almere, the Netherlands
| | - Carsten Bokemeyer
- Department of Internal Medicine II and Clinic, University of Hamburg, Hamburg, Germany
| | - Eduardo Díaz-Rubio
- Hospital Clinico San Carlos and Centro de Investigación Biomédica en Red Cáncer, CIBERONC, Madrid, Spain
| | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine, University of California, Los Angeles
| | - Paulo M. Hoff
- Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Timothy S. Maughan
- Cancer Research UK and the Medical Research Council Oxford Institute for Radiation Oncology, Oxford, United Kingdom
| | - Cornelis J. A. Punt
- Amsterdam University Medical Centrum, Department of Medical Oncology, University of Amsterdam, Amsterdam, the Netherlands
| | - Leonard Saltz
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | | | | | - Eric Van Cutsem
- Division of Digestive Oncology, University Hospitals Gasthuisberg Leuven, Leuven, Belgium
| | - Aimery de Gramont
- Katholieke Universiteit, Leuven, Belgium
- Franco-British Institute, Levallois-Perret, France
| | - John R. Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Marc Buyse
- Hasselt University, Diepenbeek, Belgium
- International Drug Development Institute Inc, San Francisco, California
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8
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Margalit O, Harmsen WS, shacham-Shmueli E, Petersen M, Boursi B, Saltz LB, Adams R, Maughan T, Douillard JY, Van Cutsem E, Hurwitz H, Bokemeyer C, Tebbutt NC, Kabbinavar FF, De Gramont A, Shi Q, Lenz HJ. Evaluating gender as a predictive marker for response to bevacizuamb (Bev) in metastatic colorectal carcinoma (mCRC): Pooled analysis of 3369 patients (pts) in the ARCAD database. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3539] [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
3539 Background: Previous studies suggest a possible gender-specific response to Bev in mCRC, showing a benefit in males, while the effect in females is less significant. Therefore, we evaluated response to Bev according to gender. Methods: Data from 3369 mCRC patients enrolled on 4 first-line randomized trials testing Bev (2000-2007) were pooled. Association between gender and progression-free survival (PFS)/overall survival (OS) was evaluated by stratified Cox regression model, adjusted for potential confounders. Predictive value was evaluated by interaction (inter.) effect between gender and treatment. In a pre-planned secondary analysis, analyses were stratified using an age cut-point of 60 years (commonly used in breast cancer trials) to evaluate the possible role of menopausal-related effects. Results: OS was not statistically different between males and females (median OS [mOS], 18.8 vs. 17.6 months [mo], adjusted hazard ratio [HRadj], 0.93, 95% confidence interval [CI], 0.84-1.03, p, 0.15) in the overall population. Bev was associated with an improved mOS in males and females, with a 2.3 and 0.6 mo benefit, respectively, as well as an improved PFS. There was no statistically significant interaction effect between gender and treatment (see table). Further stratified by age (< vs. ≥ 60 years), Bev resulted in improved PFS and OS in both genders, at all ages, except for the effect in young females which did not reach statistical significance (see table). Conclusions: Our results confirmed the mOS benefit from addition of Bev to first-line chemotherapy in mCRC in both genders, although the benefit in females was < 1 month. For females under the age of 60, there are uncertainties for mOS benefit from addition of Bev and further evaluation is needed. [Table: see text]
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Affiliation(s)
| | | | | | | | - Ben Boursi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | | | | | - Niall C. Tebbutt
- Olivia Newton-John Cancer and Wellness Centre, Victoria, Australia
| | | | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN
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9
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Sjoquist KM, Renfro LA, Simes RJ, Tebbutt NC, Clarke S, Seymour MT, Adams R, Maughan TS, Saltz L, Goldberg RM, Schmoll HJ, Van Cutsem E, Douillard JY, Hoff PM, Hecht JR, Tournigand C, Punt CJA, Koopman M, Hurwitz H, Heinemann V, Falcone A, Porschen R, Fuchs C, Diaz-Rubio E, Aranda E, Bokemeyer C, Souglakos I, Kabbinavar FF, Chibaudel B, Meyers JP, Sargent DJ, de Gramont A, Zalcberg JR. Personalizing Survival Predictions in Advanced Colorectal Cancer: The ARCAD Nomogram Project. J Natl Cancer Inst 2018; 110:638-648. [PMID: 29267900 PMCID: PMC6005015 DOI: 10.1093/jnci/djx253] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/09/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
Background Estimating prognosis on the basis of clinicopathologic factors can inform clinical practice and improve risk stratification for clinical trials. We constructed prognostic nomograms for one-year overall survival and six-month progression-free survival in metastatic colorectal carcinoma by using the ARCAD database. Methods Data from 22 674 patients in 26 randomized phase III clinical trials since 1997 were used to construct and validate Cox models, stratified by treatment arm within each study. Candidate variables included baseline age, sex, body mass index, performance status, colon vs rectal cancer, prior chemotherapy, number and location of metastatic sites, tumor mutation status (BRAF, KRAS), bilirubin, albumin, white blood cell count, hemoglobin, platelets, absolute neutrophil count, and derived neutrophil-to-lymphocyte ratio. Missing data (<11%) were imputed, continuous variables modeled with splines, and clinically relevant pairwise interactions tested if P values were less than .001. Final models were internally validated via bootstrapping to obtain optimism-corrected calibration and discrimination C-indices, and externally validated on a 10% holdout sample from each trial (n = 2257). Results In final models, all included variables were associated with overall survival except for lung metastases, and all but total white cell count associated with progression-free survival. No clinically relevant pairwise interactions were identified. Final nomogram calibration was good (C = 0.68 for overall and C = 0.62 for progression-free survival), as was external validity (concordance between predicted >50% vs < 50% probability) and actual (yes/no) survival (72.8% and 68.2% concordance, respectively, for one-year overall and six-month progression-free survival, between predicted [>50% vs < 50% probability] and actual [yes/no] overall and progression-free survival). Median survival predictions fell within the actual 95% Kaplan-Meier confidence intervals. Conclusions The nomograms are well calibrated and internally and externally valid. They have the potential to aid prognostication and patient-physician communication and balance risk in colorectal cancer trials.
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Affiliation(s)
- Katrin M Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | | | - R John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | | | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | | | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Jean-Yves Douillard
- European Society for Medical Oncology (ESMO) Chief Medical Officer (CMO), Institut de Cancérologie de l'Ouest (ICO) René Gauducheau, Saint-Herblain, France
| | - Paulo M Hoff
- Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paolo, Sao Paolo, Brazil
| | - Joel Randolph Hecht
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Christophe Tournigand
- University of Paris Est Creteil, Paris, France
- Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Creteil, France
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Miriam Koopman
- University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Volker Heinemann
- University of Munich, Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | | | - Rainer Porschen
- Klinikum Bremen-Ost Klinik fur Innere Medizin, Bremen, Germany
| | | | - Eduardo Diaz-Rubio
- Department of Oncology, Hospital Clínico San Carlos, CIBERONC Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Aranda
- Department of Medical Oncology IMIBIC, Reina Sofía Hospital, University of Córdoba, CIBERONC Instituto de Salud Carlos III, Córdoba, Spain
| | | | | | - Fairooz F Kabbinavar
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | | | | | | | | | - John R Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
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10
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Ou FS, Lou Y, Van Cutsem E, Saltz L, Schmoll HJ, Goldberg RM, Hoff P, Douillard JY, Hecht JR, Hurwitz H, Punt CJA, Bokemeyer C, Fuchs CS, Diaz-Rubio E, Tebbut N, Falcone A, Kabbinavar FF, De Gramont A, Grothey A, Shi Q. Evaluation of lesion-based response at 12 weeks (LBR12) of treatment (Rx) in metastatic colorectal cancer (mCRC): Findings from 9,092 patients (pts) in the ARCAD database. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
612 Background: mCRC is a heterogeneous disease leading to possible disparate responses among lesions in a single pt. This study assesses the heterogeneity of lesion responses and evaluates the prognostic value of LBR12 and its mortality risk discrimination beyond RECIST responses. Methods: Pts with ≥ 2 lesions and no new lesions at 12 weeks (wks) were eligible. For each pt, after 12 wks of Rx, each lesion was categorized as progressive disease (L-PD: ≥20% increase in the longest diameter [LD]), partial response (L-PR: ≥30% decrease in LD), or stable disease (L-SD: neither L-PD nor L-PR). LBR12 was defined, per patient, by the combination of lesion responses: homogeneous LBR12 (L-PD, L-SD, L-PR only) and heterogeneous LBR12 (mixture of L-PD/L-SD, L-PD/L-PR, L-SD/L-PR). LBR12 and overall survival (OS) were correlated using stratified multivariate Cox models after adjusting for age, gender, and ECOG PS. Results: Among 9,092 mCRCs (Rx: chemo alone 44%; chemo + VEGF inhibitor [VEGFi] 42%; chemo + EGFR inhibitor [EGFRi] 10%) from 16 1st-line studies. Median OS: 2.2 years. Per RECIST at 12 wks, CR 0%; PR 36.1%; SD 60.9%; PD 3.0%. Responses in 52% were heterogeneous (Table). VEGFi and EGFRi treated pts had the highest rate of L-SD/L-PR (45%) and L-PR only (22%) status, respectively. Median OS increased monotonically across pts with more L-PRs and fewer L-PDs (Table). Pts with L-SD/L-PR status, among which 51% had SD per RECIST, had longer OS than those with L-SD only status (HRadj.= .81, padj.< .0001), but shorter OS than those with L-PR only status (HRadj.= 1.46, padj.< .0001). Pts with L-PD/L-SD status, among which 71% were SD per RECIST, had shorter OS than those with L-SD only status (HRadj.= 2.22, padj.< .0001). These associations were consistent across treatment regimens. Conclusions: The lesion-based response captures the heterogeneity of within pt lesion responses and provides refinement in predicting outcome beyond RECIST response at 12 wks. [Table: see text]
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Affiliation(s)
| | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Paulo Hoff
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Niall Tebbut
- University of Sydney Medical School, Sydney, Australia
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11
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Renfro LA, Goldberg RM, Grothey A, Sobrero A, Adams R, Seymour MT, Heinemann V, Schmoll HJ, Douillard JY, Hurwitz H, Fuchs CS, Diaz-Rubio E, Porschen R, Tournigand C, Chibaudel B, Hoff PM, Kabbinavar FF, Falcone A, Tebbutt NC, Punt CJ, Hecht JR, Souglakos J, Bokemeyer C, Van Cutsem E, Saltz L, de Gramont A, Sargent DJ. Clinical Calculator for Early Mortality in Metastatic Colorectal Cancer: An Analysis of Patients From 28 Clinical Trials in the Aide et Recherche en Cancérologie Digestive Database. J Clin Oncol 2017; 35:1929-1937. [PMID: 28414610 PMCID: PMC5466009 DOI: 10.1200/jco.2016.71.5771] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Factors contributing to early mortality after initiation of treatment of metastatic colorectal cancer are poorly understood. Materials and Methods Data from 22,654 patients enrolled in 28 randomized phase III trials contained in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were pooled. Multivariable logistic regression models for 30-, 60-, and 90-day mortality were constructed, including clinically and statistically significant patient and disease factors and interaction terms. A calculator (nomogram) for 90-day mortality was developed and validated internally using bootstrapping methods and externally using a 10% random holdout sample from each trial. The impact of early progression on the likelihood of survival to 90 days was examined with time-dependent Cox proportional hazards models. Results Mortality rates were 1.4% at 30 days, 3.4% at 60 days, and 5.5% at 90 days. Among baseline factors, advanced age, lower body mass index, poorer performance status, increased number of metastatic sites, BRAF mutant status, and several laboratory parameters were associated with increased likelihood of early mortality. A multivariable model for 90-day mortality showed strong internal discrimination (C-index, 0.77) and good calibration across risk groups as well as accurate predictions in the external validation set, both overall and within patient subgroups. Conclusion A validated clinical nomogram has been developed to quantify the risk of early death for individual patients during initial treatment of metastatic colorectal cancer. This tool may be used for patient eligibility assessment or risk stratification in future clinical trials and to identify patients requiring more or less aggressive therapy and additional supportive measures during and after treatment.
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Affiliation(s)
- Lindsay A. Renfro
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard M. Goldberg
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Axel Grothey
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alberto Sobrero
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard Adams
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew T. Seymour
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Volker Heinemann
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hans-Joachim Schmoll
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jean-Yves Douillard
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Herbert Hurwitz
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles S. Fuchs
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eduardo Diaz-Rubio
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rainer Porschen
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christophe Tournigand
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Benoist Chibaudel
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paulo M. Hoff
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fairooz F. Kabbinavar
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alfredo Falcone
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niall C. Tebbutt
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cornelis J.A. Punt
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J. Randolph Hecht
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John Souglakos
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carsten Bokemeyer
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Van Cutsem
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leonard Saltz
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aimery de Gramont
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel J. Sargent
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - on behalf of the ARCAD Clinical Trials Program
- Lindsay A. Renfro, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Richard M. Goldberg, The Ohio State University, Columbus, OH; Alberto Sobrero, Ospedale San Martino, Genoa; Alfredo Falcone, University Hospital of Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James’s Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil; Christophe Tournigand, Assistance Hopitaux Publique de Paris Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs; Dana-Farber Cancer Institute, Boston, MA; Eduardo Diaz-Rubio, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Paulo M. Hoff, Hospital Sírio-Libanês and University of São Paulo, São Paulo, Brazil; Fairooz F. Kabbinavar and J. Randolph Hecht, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, University of Amsterdam, Amsterdam, the Netherlands; John Souglakos, University of Crete, Heraklion, Greece; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; and Leonard Saltz, Memorial Sloan Kettering Cancer Center, New York, NY
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Horn L, Mansfield AS, Reck M, Mok T, Spira AI, Tang X, Lam S, Kabbinavar FF, Lopez-Chavez A, Sandler A, Liu SV. Phase I/III trial of atezolizumab with carboplatin and etoposide in ES-SCLC in first-line setting (IMpower133). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps8584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8584 Background: The first-line standard of care for the majority of patients (pts) with extensive-stage small-cell lung cancer (ES-SCLC) is platinum-based chemotherapy with etoposide, but survival outcomes remain poor (median OS, < 1 year) despite initial response rates ranging from 50-70%. Atezolizumab (atezo), an anti–PD-L1 mAb, prevents the binding of PD-L1 with its receptors PD-1 and B7.1 and restores anticancer T-cell activity. Tolerable safety with promising durability of response has been shown with atezo in pts with ES-SCLC: confirmed ORR was 6% (n = 1/17 [partial response]; DOR of 7 mo) by RECIST v1.1 and 24% by immune-related response criteria (irRC; n = 4/17, with 2 pts on atezo for ≥ 12 mo). Preliminary data also indicate the potential synergy between atezo and platinum-based chemotherapy in NSCLC, whereby durable responses may translate into improved survival over atezo alone. IMpower133 (NCT02763579), a global, Phase I/III, randomized, multicenter, double-blinded, placebo-controlled trial will evaluate the efficacy and safety of 1L atezo + carboplatin + etoposide compared with placebo + carboplatin + etoposide in treatment-naive pts with ES-SCLC. Methods: Pts with measurable (RECIST v1.1) ES-SCLC, who have ECOG PS 0-1 and no prior systemic anticancer treatment, are eligible for the study. Exclusion criteria include untreated CNS metastases and history of autoimmune disease. The study requires submission of tumor tissue, but pts will be enrolled regardless of biomarker status. Pts will be stratified by sex, ECOG PS and presence of treated brain metastases. Eligible pts will be randomized 1:1 to receive four 21-day cycles of atezo (1200 mg IV) or placebo in combination with carboplatin (AUC 5 mg/mL/min IV, d 1) and etoposide (100 mg/m2 IV, d 1-3), followed by maintenance therapy with atezo or placebo until PD per RECIST v1.1. Pts can continue with treatment until persistent radiographic PD, symptomatic deterioration or unacceptable toxicity. Co-primary endpoints are investigator-assessed PFS per RECIST v1.1 and OS. Secondary efficacy endpoints include investigator-assessed ORR and DOR. Safety and tolerability will also be assessed. Approximately 400 pts will be enrolled. Clinical trial information: NCT02763579.
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Affiliation(s)
- Leora Horn
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tony Mok
- Chinese University of Hong Kong, Hong Kong, China
| | - Alexander I. Spira
- Virginia Cancer Specialists Research Institute and Oncology Research, Fairfax, VA
| | | | | | | | | | | | - Stephen V. Liu
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
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Ji Y, Rankin C, Grunberg S, Sherrod AE, Ahmadi J, Townsend JJ, Feun LG, Fredericks RK, Russell CA, Kabbinavar FF, Stelzer KJ, Schott A, Verschraegen C. Double-Blind Phase III Randomized Trial of the Antiprogestin Agent Mifepristone in the Treatment of Unresectable Meningioma: SWOG S9005. J Clin Oncol 2015; 33:4093-8. [PMID: 26527781 DOI: 10.1200/jco.2015.61.6490] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Progesterone receptors are expressed in approximately 70% of meningiomas. Mifepristone is an oral antiprogestational agent reported to have modest activity in a phase II study. This multicenter, prospective, randomized, placebo-controlled phase III trial conducted by SWOG was planned to define the role of mifepristone in the treatment of unresectable meningioma. PATIENTS AND METHODS Eligible patients were randomly assigned to receive either mifepristone or placebo for 2 years unless disease progressed. Patients who were stable or responding to protocol therapy after 2 years had the option to continue with the same blinded therapy. Serial follow-up allowed assessment of efficacy and toxicity. Time to treatment failure and overall survival were ascertained for all randomly assigned patients. On progression, patients receiving placebo could cross over and receive active drug. RESULTS Among 164 eligible patients, 80 were randomly assigned to mifepristone and 84 to placebo. Twenty-four patients (30%) were able to complete 2 years of mifepristone without disease progression, adverse effects, or other reasons for discontinuation. Twenty-eight patients (33%) in the placebo arm completed the 2-year study. There was no statistical difference between the arms in terms of failure-free or overall survival. CONCLUSION Long-term administration of mifepristone was well tolerated but had no impact on patients with unresectable meningioma.
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Affiliation(s)
- Yongli Ji
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Cathryn Rankin
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Steven Grunberg
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Andy E Sherrod
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Jamshid Ahmadi
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Jeannette J Townsend
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Lynn G Feun
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Ruth K Fredericks
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Christy A Russell
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Fairooz F Kabbinavar
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Keith J Stelzer
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Anne Schott
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI
| | - Claire Verschraegen
- Yongli Ji, Steven Grunberg, and Claire Verschraegen, University of Vermont Cancer Center, Burlington, VT; Cathryn Rankin, SWOG Statistical Center, Seattle, WA; Andy E. Sherrod, Jamshid Ahmadi, and Christy A. Russell, University of Southern California; Fairooz F. Kabbinavar, University of California Los Angeles, Los Angeles, CA; Jeannette J. Townsend, University of Utah Medical Center, Salt Lake City, UT; Lynn G. Feun, University of Miami, Miami, FL; Ruth K. Fredericks, University of Mississippi Medical Center, Jackson, MS; Keith J. Stelzer, Celilo Cancer Center, the Dalles, OR; and Anne Schott, University of Michigan, Ann Arbor, MI.
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Ji Y, Rankin CJ, Grunberg SM, Sherrod A, Ahmadi J, Feun LG, Fredericks R, Russell CA, Kabbinavar FF, Stelzer K, Schott AF, Verschraegen CF. SWOG S9005: Double blind phase III randomized trial of the anti-progestin agent mifepristone in the treatment of unresectable meningioma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e17084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yongli Ji
- University of Vermont, Burlington, VT
| | | | | | - Andy Sherrod
- University of Southern California, Los Angeles, CA
| | | | | | | | - Christy Ann Russell
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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Shi Q, de Gramont A, Grothey A, Zalcberg J, Chibaudel B, Schmoll HJ, Seymour MT, Adams R, Saltz L, Goldberg RM, Punt CJA, Douillard JY, Hoff PM, Hecht JR, Hurwitz H, Díaz-Rubio E, Porschen R, Tebbutt NC, Fuchs C, Souglakos J, Falcone A, Tournigand C, Kabbinavar FF, Heinemann V, Van Cutsem E, Bokemeyer C, Buyse M, Sargent DJ. Individual patient data analysis of progression-free survival versus overall survival as a first-line end point for metastatic colorectal cancer in modern randomized trials: findings from the analysis and research in cancers of the digestive system database. J Clin Oncol 2015; 33:22-8. [PMID: 25385741 PMCID: PMC4482837 DOI: 10.1200/jco.2014.56.5887] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Progression-free survival (PFS) has previously been established as a surrogate for overall survival (OS) for first-line metastatic colorectal cancer (mCRC). Because mCRC treatment has advanced in the last decade with extended OS, this surrogacy requires re-examination. METHODS Individual patient data from 16,762 patients were available from 22 first-line mCRC studies conducted from 1997 to 2006; 12 of those studies tested antiangiogenic and/or anti-epidermal growth factor receptor agents. The relationship between PFS (first event of progression or death) and OS was evaluated by using R(2) statistics (the closer the value is to 1, the stronger the correlation) from weighted least squares regression of trial-specific hazard ratios estimated by using Cox and Copula models. RESULTS Forty-four percent of patients received a regimen that included biologic agents. Median first-line PFS was 8.3 months, and median OS was 18.2 months. The correlation between PFS and OS was modest (R(2), 0.45 to 0.69). Analyses limited to trials that tested treatments with biologic agents, nonstrategy trials, or superiority trials did not improve surrogacy. CONCLUSION In modern mCRC trials, in which survival after the first progression exceeds time to first progression, a positive but modest correlation was observed between OS and PFS at both the patient and trial levels. This finding demonstrates the substantial variability in OS introduced by the number of lines of therapy and types of effective subsequent treatments and the associated challenge to the use of OS as an end point to assess the benefit attributable to a single line of therapy. PFS remains an appropriate primary end point for first-line mCRC trials to detect the direct treatment effect of new agents.
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Affiliation(s)
- Qian Shi
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Aimery de Gramont
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Axel Grothey
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - John Zalcberg
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Benoist Chibaudel
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Hans-Joachim Schmoll
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Matthew T Seymour
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Richard Adams
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Leonard Saltz
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Richard M Goldberg
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Cornelis J A Punt
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Jean-Yves Douillard
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Paulo M Hoff
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Joel Randolph Hecht
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Herbert Hurwitz
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Eduardo Díaz-Rubio
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Rainer Porschen
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Niall C Tebbutt
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Charles Fuchs
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - John Souglakos
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Alfredo Falcone
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Christophe Tournigand
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Fairooz F Kabbinavar
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Volker Heinemann
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Eric Van Cutsem
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Carsten Bokemeyer
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Marc Buyse
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Daniel J Sargent
- Qian Shi, Axel Grothey, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Aimery de Gramont and Benoist Chibaudel, Hospital Saint Antoine; Christophe Tournigand, Université Paris Est Créteil, Paris; Jean-Yves Douillard, Institute of Cancer Research in Western, St Herblain, France; John Zalcberg, Monash University; Niall C. Tebbutt, Austin Health, Melbourne, Victoria, Australia; Hans-Joachim Schmoll, Martin-Luther University, Halle; Rainer Porschen, Klinikum Bremen-Ost, Bremen; Volker Heinemann, University of Munich, München; Carsten Bokemeyer, University Hospital, Hamburg-Eppendorf, Germany; Matthew T. Seymour, Cancer Research UK Clincal Center, Leeds; Richard Adams, Cardiff University, Cardiff, United Kingdom; Leonard Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY; Richard M. Goldberg, Ohio State University, Columbus, OH; Cornelis J.A. Punt, Academic Medical Center, Amsterdam, the Netherlands; Paulo M. Hoff, Hospital Sírio-Libanês, Sao Paulo, Brazil; Joel Randolph Hecht and Fairooz F. Kabbinavar, University of California at Los Angeles, Los Angeles, CA; Herbert Hurwitz, Duke University, Durham, NC; Eduardo Díaz-Rubio, Hospital Clinico San Carlos, Madrid, Spain; Charles Fuchs, Dana-Farber Cancer Institute, Boston, MA; John Souglakos, University of Crete, Heraklion, Greece; Alfredo Falcone, University of Pisa, Pisa, Italy; Eric Van Cutsem, University Hospital Gasthuisberg, Leuven; and Marc Buyse, International Drug Development Institute, Louvain-la-Neuve, Belgium.
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McDermott DF, Cheng SC, Signoretti S, Margolin KA, Clark JI, Sosman JA, Dutcher JP, Logan TF, Curti BD, Ernstoff MS, Appleman L, Wong MKK, Khushalani NI, Oleksowicz L, Vaishampayan UN, Mier JW, Panka DJ, Bhatt RS, Bailey AS, Leibovich BC, Kwon ED, Kabbinavar FF, Belldegrun AS, Figlin RA, Pantuck AJ, Regan MM, Atkins MB. The high-dose aldesleukin "select" trial: a trial to prospectively validate predictive models of response to treatment in patients with metastatic renal cell carcinoma. Clin Cancer Res 2014; 21:561-8. [PMID: 25424850 DOI: 10.1158/1078-0432.ccr-14-1520] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE High-dose aldesleukin (HD IL2) received FDA approval for the treatment of metastatic renal cell carcinoma (MRCC) in 1992, producing a 14% objective response rate (ORR) and durable remissions. Retrospective studies suggested that clinical and pathologic features could predict for benefit. The Cytokine Working Group conducted this prospective trial to validate proposed predictive markers of response to HD IL2. EXPERIMENTAL DESIGN Standard HD IL2 was administered to prospectively evaluate whether the ORR of patients with mRCC with "good" predictive pathologic features based on an "integrated selection" model [ISM (e.g., clear-cell histology subclassification and carbonic anhydrase-9 (CA-9) IHC staining] was significantly higher than the ORR of a historical, unselected population. Archived tumor was collected for pathologic analysis including tumor programmed death-ligand 1 (PD-L1) expression. RESULTS One hundred and twenty eligible patients were enrolled between June 11 and September 7; 70% were Memorial Sloan Kettering Cancer Center (New York, NY) intermediate risk, 96% had clear cell RCC, and 99% had prior nephrectomy. The independently assessed ORR was 25% (30/120, 95% CI, 17.5%-33.7%, P = 0.0014; 3 complete responses, 27 partial responses) and was higher than a historical ORR. Thirteen patients (11%) remained progression free at 3 years and the median overall survival was 42.8 months. ORR was not statistically different by ISM classification ("good-risk" 23% vs. "poor-risk" 30%; P = 0.39). ORR was positively associated with tumor PD-L1 expression (P = 0.01) by IHC. CONCLUSIONS In this prospective, biomarker validation study, HD IL2 produced durable remissions and prolonged survival in both "good" and "poor-risk" patients. The proposed ISM was unable to improve the selection criteria. Novel markers (e.g., tumor PD L1 expression) appeared useful, but require independent validation.
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Affiliation(s)
- David F McDermott
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.
| | | | - Sabina Signoretti
- Brigham and Women's Hospital, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | | | - Joseph I Clark
- Loyola University, Stritch School of Medicine, Chicago, Illinois
| | - Jeffrey A Sosman
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | | | | | - Brendan D Curti
- Providence Cancer Center, Earle A. Chiles Research Institute, Portland, Oregon
| | - Marc S Ernstoff
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Dartmouth, New Hampshire
| | - Leonard Appleman
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | | | - James W Mier
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - David J Panka
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Alexandra S Bailey
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | | | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Arie S Belldegrun
- University of California Los Angeles Medical Center, Santa Monica, California
| | - Robert A Figlin
- Cedars-Sinai's Samuel Oschin Comprehensive Cancer Institute, West Hollywood, California
| | - Allan J Pantuck
- University of California Los Angeles Medical Center, Santa Monica, California
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Fishman MN, Srinivas S, Hauke RJ, Amato RJ, Esteves B, Dhillon R, Cotreau M, Al‐Adhami M, Bhargava P, Kabbinavar FF. Abstract B60: Combination of tivozanib (AV‐951) and temsirolimus in patients with renal cell carcinoma (RCC): Preliminary results from a phase 1 trial. Clin Trials 2014. [DOI: 10.1158/1535-7163.targ-09-b60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rampersaud EN, Said JW, Bot A, Birkhäuser FD, Kroeger N, Zeng G, Kabbinavar FF, Ribas A, Pantuck AJ, Belldegrun AS, Riss J. Abstract 2819: Efficacy and safety of the Ad-GM·CAIX dendritic cell-based vaccine in treating in vivo metastatic renal cell carcinoma compared to sunitinib monotherapy and simultaneous vaccine-sunitinib combination therapy. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Metastatic clear cell renal cell carcinoma (ccRCC) disease is responsible for significant morbidity and represents the main cause of death in patients with advanced ccRCC. We have developed a novel dendritic cell based vaccine targeting human carbonic anhydrase IX (hCAIX; DC-Ad-GM·CAIX) and compared it with the ccRCC standard-of-care drug, sunitinib as a monotherapy and in simultaneous vaccine-sunitinib combination therapy.
Immunocompetent mice (Balb/c) were orthotopically-transplanted with syngeneic RCC-hCAIXpositive (NPR-IX) tumor cells, immunized, and/or treated with sunitinib at low-dose (5mg/kg/d), high-dose (40mg/kg/d) or untreated. At termination, primary tumor size (weight), lung metastatic burden, hCAIX and immune-markers expression levels were compared.
Mono-immunotherapy with DC-Ad-GM·CAIX vaccine suppressed metastatic tumor growth: the total number of metastatic heterotypic foci (i.e., hCAIX positive and negative foci) following vaccination decreased 2.5 fold compared with untreated mice (P<0.05). When counting only the hCAIX positive metastatic tumor cells, the decrease in the metastatic tumor burden compared to untreated mice was even more pronounced (>10 fold). Vaccination alone resulted in reduced primary tumor burden of RCC-hCAIXpositive cells to <25% of the tumor cell population, with the remaining cells lacking hCAIX expression (hCAIXnegative); there was no significant overall primary tumor reduction compared to untreated mice. In contrast, sunitinib, whether given as high-dose monotherapy or in combination with the vaccine, inhibited the primary orthotopic tumors, achieving 35% (P=0.0001) and 51% (P=1.7e-7) tumor reduction, respectively. However, sunitinib monotherapy was less effective in reducing the metastatic tumor burden compared with the vaccine.
In fact, simultaneous administration of vaccine and sunitinib increased the metastatic tumor burden in heterotypic tumors composed also of hCAIXnegative cells.
In conclusion, this preclinical study demonstrates that (i) the DC-Ad-GM·CAIX vaccine effectively controls both primary and metastatic hCAIXpositive tumors and forms the basis for a phase I trial in metastatic ccRCC patients, which has been initiated at UCLA (http://clinicaltrials.gov number NCT01826877), (ii) Antigen editing with loss of hCAIX is an important immune escape mechanism, (iii) This in vivo study raises caution regarding the use of DC-Ad-GM·CAIX vaccine in simultaneous combination therapies with sunitinib.
Co-corresponding Authors: ASB and JR
Citation Format: Edward N. Rampersaud, Jonathan W. Said, Adrian Bot, Frédéric D. Birkhäuser, Nils Kroeger, Gang Zeng, Fairooz F. Kabbinavar, Antoni Ribas, Allan J. Pantuck, Arie S. Belldegrun, Joseph Riss. Efficacy and safety of the Ad-GM·CAIX dendritic cell-based vaccine in treating in vivo metastatic renal cell carcinoma compared to sunitinib monotherapy and simultaneous vaccine-sunitinib combination therapy. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2819. doi:10.1158/1538-7445.AM2014-2819
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Affiliation(s)
- Edward N. Rampersaud
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Jonathan W. Said
- 2Department of Pathology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | | | - Frédéric D. Birkhäuser
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Nils Kroeger
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Gang Zeng
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Fairooz F. Kabbinavar
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Antoni Ribas
- 4Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Allan J. Pantuck
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Arie S. Belldegrun
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Joseph Riss
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
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Saad ED, Coart E, Sommeijer DW, Shi Q, Zalcberg JR, Burzykowski T, Meyers JP, Hoff PM, Hecht JR, Hurwitz H, Tol J, Tebbutt NC, Fuchs CS, Diaz-Rubio E, Souglakos J, Falcone A, Kabbinavar FF, Sargent DJ, De Gramont A, Buyse ME. Early predictors of improved long-term outcomes in first-line antiangiogenics plus chemotherapy (anti-ANG/CT) in metastatic colorectal cancer (mCRC): Analysis of individual patient (pt) data from the ARCAD database. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Elisabeth Coart
- International Drug Development Institute, Louvain la Neuve, Belgium
| | - Dirkje Willemien Sommeijer
- NHMRC Clinical Trials Centre, Sydney; Academic Medical Centre, Amsterdam; Flevohospital, Almere, Amsterdam, Netherlands
| | | | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | - Jolien Tol
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | | | | | - John Souglakos
- University General Hospital of Heraklion, Department of Medical Oncology, Heraklion, Greece
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | | | | | - Marc E. Buyse
- International Drug Development Institute (IDDI), Louvain la Neuve, Belgium
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Kabbinavar FF, Zomorodian N, Rettig M, Khan F, Greenwald DR, Davidson SJ, DiCarlo BA, Patel R, Pandit L, Chandraratna R, Sanders M. An open-label phase II clinical trial of the RXR agonist IRX4204 in taxane-resistant, castration-resistant metastatic prostate cancer (CRPC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nazy Zomorodian
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Matthew Rettig
- UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Faraz Khan
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - Ravi Patel
- Translational Oncology Research International, Bakersfield, CA
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21
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Rizvi NA, Chow LQM, Dirix LY, Gettinger SN, Gordon MS, Kabbinavar FF, Von Pawel J, Soria JC, Chappey C, Mokatrin A, Sandler A, Waterkamp D, Spigel DR. Clinical trials of MPDL3280A (anti-PDL1) in patients (pts) with non-small cell lung cancer (NSCLC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps8123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Kabbinavar FF, Zomorodian N, Belldegrun AS, Wong SG, Bot A, Chodon T, Comin-Anduix B, Nguyen P, Khan F, Rettig M, Pantuck AJ. A phase I, open label, dose escalation and cohort expansion study to evaluate the safety and immune response to autologous dendritic cells (DC) transduced with AdGMCA9 (DC-AdGMCAIX) in patients with mRCC. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
490 Background: Carbonic anhydrase IX (CAIX) is an attractive target for the development of a RCC specific vaccine. We developed a fusion gene construct, GM-CSF + CAIX, transduced by a replication deficient adenovirus into autologous dendritic cells (DC) that are injected in patients with mRCC. This is a ph1 study of cancer vaccine against CAIX gene expressed on RCC tumors. Methods: A recombinant adenovirus encoding the GMCSF-CAIX fusion gene (AdGMCAIX) was produced per GMP in collaboration with the NCI RAID program. The final product is produced in an in-house GMP cell processing facility using DCs cultured ex vivo from patients’ PBMC's and engineered with AdGMCAIX prior to intradermal injection. The transduced DCs are expected to stimulate an antigen specific immune response against CAIX expressing RCC, leading to a potential anti-tumor effect. Dose escalation in 3 dose cohorts (5 X 106, 15 X 106, and 50 X 106 cells/administration) follows the std 3+3 ph1 design with an expansion cohort. DC-AdGMCAIX is given intradermally Q 2 weeks X 3 doses. The primary aim is safety of DC-AdGMCAIX injections. Secondary aims are to evaluate immune responses & the antitumor effects per RECIST 1.1. Pts with clear cell mRCC with ECOG 0-1 & measurable disease & adequate organ function were enrolled. Results: Six pts with clear cell mRCC are enrolled. Four pts received all 3 planned vaccine doses and the fifth pt only the 1st dose. No SAE’s were seen to date. One pt had chills that lasted several minutes and transient Gr1 leucopenia. One pt has worsening of pre-existing proteinuria, though unclear if related to the vaccine. One pt has PD & the other two have SD on D85 scans. Tumor bx shows intra-tumoral infiltration by T cells. Conclusions: These early data show that autologous DC transduced by Ad-GMCAIX vector can be safely given to mRCC patients without any acute SAE’s noted at the doses tested so far. The study will complete its 3rd cohort & expansion cohort enrollment. This data support the further development of Ad-GMCAIX vaccine strategies either alone or in combination with approved therapies. Funding: Supported by NCI RAID Initiative NSC 740833 and Kite Pharma.
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Affiliation(s)
- Fairooz F. Kabbinavar
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Nazy Zomorodian
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - Begonya Comin-Anduix
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Phuong Nguyen
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Faraz Khan
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Matthew Rettig
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Allan J. Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Kabbinavar FF, Zomorodian N, Rettig M, Khan F, Greenwald DR, DiCarlo B, Davidson SJ, Patel R, Pandit L, Chandraratna R, Sanders M. An open-label phase II clinical trial of the RXR agonist IRX4204 in taxane-resistant, castration-resistant metastatic prostate cancer (CRPC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
169 Background: IRX4204 is a potent, selective, oral small compound agonist of retinoid X receptor (RXR) nuclear receptor pathways. In preclinical studies IRX4204 synergizes with insulin-like growth factor binding protein-3, to induce apoptosis in human prostate cancer cells and was effective in reducing human prostate tumor burden in a murine xenograft model. The only prostate cancer patient in a phase I trial of IRX4204 trial manifested a sustained greater than 90% prostate-specific antigen (PSA) reduction and a PR lasting over seven months. These findings led to the current open label phase II trial of IRX4204 to evaluate safety and activity or futility, for treatment of advanced castration-resistant metastatic prostate cancer (CRPC). Methods: The trial enrolled 23 men with metastatic CRPC, who had failed a taxane or declined chemotherapy, with ECOG 0-2 with evidence of biochemical or radiographic progression on bone scan, CT and/or MRI. Patients continued with androgen blockade and had to have adequate organ function. Patients were deemed to have demonstrated benefit of IRX4204 treatment if they had PFS greater than 56 days, and/or a 50% PSA decrease, and/or PR or CR by RECIST. Futility defined as four or fewer patients demonstrating benefit in the planned enrollment of 37 patients. Patients received IRX4204 (20 mg/orally daily). PSA was checked Q4 weeks and radiographic assessments Q8 weeks. Radiographic, not PSA progression, was used to determine progression. Results: IRX4204 was well tolerated for up to 11 months. No drug related serious adverse events (SAE) have occurred. Manageable decreases in the thyroid-stimulating hormone (TSH) and increases in triglycerides, both known adverse effects of RXR agonists, have been observed. Protocol defined patient benefit was observed in 13 out of 23 (57%) patients. Progression-free survival (PFS) more than 56 days observed in 13 out of 23 (57%). PFS more than 112 days observed in 9 out of 23 (39%), range 113 to 330 days. PSA 50% response occurred in 3 out of 23 (13%), including one additional PSA 90% response. No objective responses have occurred. Conclusions: This study demonstrates that IRX4204 treatment of taxane-resistant CRPC is well tolerated, and provides an activity signal warranting further evaluation of IRX4204 as a treatment for chemo-refractory CRPC. Funding: Supported by Io Therapeutics, Inc. 1805 East Garry Ave., Suite 110, Santa Ana, 92705. Clinical trial information: NCT01540071.
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Affiliation(s)
- Fairooz F. Kabbinavar
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Nazy Zomorodian
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Matthew Rettig
- Department of Medicine, VA Greater Los Angeles Healthcare System,, West Los Angeles,, CA
| | - Faraz Khan
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | - Brian DiCarlo
- Translational Oncology Research International, Santa Maria, CA
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Logan JE, Mostofizadeh N, Desai AJ, VON Euw E, Conklin D, Konkankit V, Hamidi H, Eckardt M, Anderson L, Chen HW, Ginther C, Taschereau E, Bui PH, Christensen JG, Belldegrun AS, Slamon DJ, Kabbinavar FF. PD-0332991, a potent and selective inhibitor of cyclin-dependent kinase 4/6, demonstrates inhibition of proliferation in renal cell carcinoma at nanomolar concentrations and molecular markers predict for sensitivity. Anticancer Res 2013; 33:2997-3004. [PMID: 23898052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND PD-0332991 is an inhibitor of cyclin-dependent kinases (CDK) 4 and 6, and was evaluated to determine its anti-proliferative effects in 25 renal cell carcinoma (RCC) cell lines. MATERIALS AND METHODS Half-maximal inhibitory concentrations (IC50) of PD-0332991 were determined with cell line proliferation assays, as were its effects on the cell cycle, apoptosis, and retinoblastoma (RB) phosphorylation. Molecular markers for response prediction, including p16, p15, cyclin D1 (CCND1), cyclin E1 (CCNE1), E2F transcription factor 1 (E2F1), RB, CDK4 and CDK6, were studied using array comparative genomic hybridization (CGH) and gene expression. RESULTS IC50 values for PD-0332991 ranged from 25.0 nM to 700 nM, and the agent demonstrated G0/G1 cell-cycle arrest, induction of late apoptosis, and blockade of RB phosphorylation. Through genotype and expression data p16, p15 and E2F1 were identified as having significant association between loss and sensitivity to PD-0332991: p16 (p=0.021), p15 (p=0.047), and E2F1 (p=0.041). CONCLUSION PD-0332991 has antiproliferative activity in RCC cell lines, and molecular markers predict for sensitivity to this agent.
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Affiliation(s)
- Joshua E Logan
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Blvd., Suite 1050, Los Angeles, CA 90095, USA.
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25
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Fishman MN, Srinivas S, Hauke RJ, Amato RJ, Esteves B, Cotreau MM, Strahs AL, Slichenmyer WJ, Bhargava P, Kabbinavar FF. Phase Ib study of tivozanib (AV-951) in combination with temsirolimus in patients with renal cell carcinoma. Eur J Cancer 2013; 49:2841-50. [PMID: 23726267 DOI: 10.1016/j.ejca.2013.04.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 04/17/2013] [Accepted: 04/25/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Tivozanib is a potent and selective tyrosine kinase inhibitor of vascular endothelial growth factor receptors (VEGFR)-1, -2 and -3, with a long half-life. Tivozanib has demonstrated clinical activity and acceptable tolerability in renal cell carcinoma (RCC). This phase Ib study determined the recommended phase II dose (RP2D) and evaluated the safety and clinical activity of tivozanib plus temsirolimus, a mammalian target of rapamycin inhibitor. PATIENTS AND METHODS Patients with advanced RCC were administered open-label tivozanib 0.5, 1.0 or 1.5mg/d orally (3 weeks on/1 week off) and temsirolimus 15 or 25 mg/week intravenously in a 3+3 dose-escalation design and subsequent expansion cohort. RESULTS Of 27 patients treated, 20 patients had received ≥ 1 prior VEGF-targeted therapy. No dose-limiting toxicities occurred; the RP2D was determined to be tivozanib 1.5mg/d plus temsirolimus 25mg/week. Combination of tivozanib plus temsirolimus demonstrated acceptable tolerability and suggested no synergistic toxicity. The most common grade ≤ 3 adverse events were fatigue and thrombocytopenia (15% each). One patient each required dose reduction of tivozanib or temsirolimus due to an adverse event. Confirmed partial responses and stable disease were achieved at 23% and 68%, respectively. Pharmacokinetic analyses may suggest lack of an interaction between tivozanib and temsirolimus. CONCLUSIONS In this small phase Ib study, tivozanib and temsirolimus were safely combined at the fully recommended dose and schedule of both agents. The observed clinical activity and manageable toxicity profile of this combination warrant further exploration in patients with RCC.
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Affiliation(s)
- M N Fishman
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Sommeijer DW, Shi Q, Meyers JP, Sjoquist KM, Hoff PM, Seymour MT, Cassidy J, Goldberg RM, Douillard JY, Hecht JR, Hurwitz H, Tournigand C, Tebbutt NC, Aranda E, Souglakos J, Kabbinavar FF, Chibaudel B, De Gramont A, Sargent DJ, Zalcberg JR. Prognostic value of early objective tumor response (EOTR) to first-line systemic therapy in metastatic colorectal cancer (mCRC): Individual patient data (IPD) meta-analysis of randomized trials from the ARCAD database. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3520 Background: EOTR has been suggested as a potential surrogate for overall survival (OS) in patients (pts) with mCRC and allows early assessment of treatment efficacy, facilitating adaptive trial design. We assessed at the individual patient level, the correlation between EOTR (complete or partial response) at 6, 8 and 12 weeks (wk), OS and progression free survival (PFS) in pts with mCRC treated with 1stline chemotherapy with or without a targeted agent as a first step in a surrogacy demonstration. Methods: IPD from 13,949 pts enrolled on 15 randomized Phase III trials in 1st line mCRC were used; 8 trials included targeted (anti-angiogenic and anti-EGFR) agents. EOTR prognostic value was assessed by landmark analyses using Cox models stratified by treatment assignment. P-values <0.01 were considered statistically significant to account for multiple comparisons. Results: Of 13,949 pts, 11,987 had sufficient response data to be included in the analysis. Median OS was 21.7 months (mo) in pts with an EOTR vs. 16.5 mo without EOTR at 6 wk (p<.0001, Hazard Ratio [HR] 0.64, 95% confidence interval [CI] 0.58-0.70, c statistic [c] 0.55). HRs were similar whether pts were treated with targeted therapies (p<.0001, HR 0.68, 95% CI 0.58-0.80, x 0.54) or non-targeted therapies (p<.0001, HR 0.61, 95% CI 0.55-0.69, x 0.55). Median PFS was 8.4 mo in pts with EOTR at 6 wk vs. 7.0 mo in pts without EOTR (p<.0001, HR 0.79, 95% CI 0.73-0.85). EOTR at 8 and 12 wks were also significantly associated with longer OS and PFS. The prognostic value of EOTR at 6, 8 and 12 wks remained significant (p<0.0001) after adjusting for age, gender, performance statusand location of metastatic disease (lung or liver). Overall tumor response (to 26 wk) however provided superior OS prediction (p<.0001, HR 0.51, 95% CI, 0.47-0.56, CS 0.61) vs. EOTR. Conclusions: Early response measured at 6, 8 or 12 wk after starting 1st line treatment was a strong and independent predictor of both OS and PFS in patient with mCRC and warrants further consideration as a potential endpoint for future trials, particularly randomized phase II trials.
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Affiliation(s)
| | | | | | | | - Paulo Marcelo Hoff
- Centro de Oncologia, Hospital Sírio Libanes, e Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | | | - J. Randolph Hecht
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | | | - Niall C. Tebbutt
- Austin Health and University of Melbourne, Heidelberg, Australia
| | | | - John Souglakos
- University of Crete, School of Medicine, Heraklion, Greece
| | - Fairooz F. Kabbinavar
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
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Kroeger N, Seligson DB, Signoretti S, Yu H, Birkhaeuser FD, Magyar C, Huang J, Riss J, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Investigating the association of cytoplasmic and nuclear HIF-2 expression with cancer specific survival (CSS) in clear cell renal cell carcinoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.387] [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
387 Background: Studies support the prognostic importance of HIF-2α for ccRCC. Interestingly, a recent study has implicated HIF-2α as part of a protein translational initiation complex, a cytoplasmic function that goes far beyond its role as a nuclear transcription factor. We hypothesized that both the absolute expression as well as the subcellular localization of HIF-2α would predict clinicopathological features and CSS in ccRCC. Methods: A tissue microarray (TMA) study was conducted on 308 ccRCC patients. Survival differences were investigated with the log rank test and associations with CSS with uni- and multivariate Cox regression analyses. Recursive partition tree analysis was used to identify relevant cutoff values. Results: The median follow-up was 2.29 years (IQR 11.82). The mean percentage of positive cells was 22.45±18.00 and 0.12 ± 0.29 for HIF-2α nuclear (N) and cytoplasmic (C), respectively. High HIF-2α N (cutoff>32%) expression was associated with smaller tumor sizes (p = 0.002) and less advanced Fuhrman grades (p = 0.044). To the contrary, tumors with high HIF-2α C (>0%) more often had lymph node (p = 0.004), distant metastases (p = 0.021), and higher Fuhrman grades (p<0.0001). Univariate analyses showed an association of high HIF-2α N (p = 0.035) with better CSS. This was not found when HIF-2α N was used as a continuous variable (p = 0.067). In contrast, HIF-2α C demonstrated an association with CSS when examined as both a continuous (p < 0.0001) and as a dichotomized variable (p < 0.0001). After adjustment for TNM stage, ECOG PS, and Fuhrman grade, both continuous (p < 0.0001) and dichotomized (p < 0.0001) HIF-2α C variables remained significant predictors of CSS, while neither HIF-2α N variable was retained. The ratio of HIF-2α C/N was the strongest predictor of CSS in multivariate analysis (p = 0.001; HR 4.83 [95% CI: 1.99 – 11.76]). Conclusions: Our investigation suggests an important role for HIF-2α as a cytoplasmic protein translational initiation complex in ccRCC. This novel observation warrants further molecular and genetic studies examining biological pathways that are involved in the tumor promotive properties of HIF-2α in the cytoplasm.
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Affiliation(s)
- Nils Kroeger
- Institute of Urologic Oncology, Department of Urology, UCLA, Los Angeles, CA
| | - David B. Seligson
- Institute of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA
| | | | - Hong Yu
- Institute of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA
| | | | - Clara Magyar
- Institute of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA
| | - Jiaoti Huang
- Institute of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA
| | - Joseph Riss
- Institute of Urologic Oncology, Department of Urology, UCLA, Los Angeles, CA
| | | | - Arie S. Belldegrun
- Institute of Urologic Oncology, Department of Urology, UCLA, Los Angeles, CA
| | - Allan J. Pantuck
- Institute of Urologic Oncology, Department of Urology, UCLA, Los Angeles, CA
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Logan JE, Mostofizadeh N, Desai AJ, Von Euw EM, Conklin D, Konkatkit V, Hamidi H, Eckardt MA, Anderson L, Cheng HW, Ginther C, Taschereau E, Christensen JG, Belldegrun AS, Slamon DJ, Kabbinavar FF. Effect of PD-0332991, a potent and selective inhibitor of cyclin-dependent kinase 4/6, on proliferation in renal cell carcinoma at nanomolar concentrations and prediction of sensitivity by molecular markers. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.413] [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
413 Background: Cell cycle dysregulation is prevalent in renal cell carcinoma (RCC). PD-0332991 is an orally active, potent, and selective inhibitor of cyclin-dependent kinases (CDK) 4 and 6, blocking retinoblastoma (Rb) phosphorylation at nanomolar concentrations. Methods: 28 RCC and immortalized kidney cell lines were used to examine the effects of PD-0332991 on proliferation to determine the half maximal inhibitory concentration (IC50). Effects of PD-0332991 on cell-cycle, apoptosis, and Rb phosphorylation were assessed with flow cytometry and western blot analysis for five of the cell lines: RCC-HB and SW 156 (sensitive/malignant), R444 and Hs 891.T (resistant/malignant), and CCD 1103 (resistant/immortalized non-malignant). Molecular markers for response prediction were studied using array CGH and gene expression profiling. Results: Concentration-dependent inhibition of proliferation was identified in response to PD-0332991, with IC50values ranging from 25.0nM up to 700nM; five cell lines were identified as completely resistant at 1000nM. PD-0332991 induced G0/G1 cell cycle arrest, as well as induction of late apoptosis in SW 156, and Rb phosphorylation was blocked in a time-dependent fashion in both sensitive cell lines, while resistant lines were unaffected. Genotype and expression data of CDKN2A and CDKN2B were combined and a consensus was made regarding p16 and p15 status; significant association between loss and sensitivity to PD-0332991 was identified for p16 (p = 0.027). For CCND1, CCNE1, E2F1, Rb, CDK4, and CDK6 no amplifications or homozygous deletions were identified by array CGH; cell lines were then classified as having high or low expression for each of these markers. E2F1 had low expression levels significantly associated with response to PD-0332991 (p = 0.041). Conclusions: PD-0332991 shows anti-proliferative activity in RCC through blockade of the cell cycle. The decreased expression of molecular markers p16 and E2F1 predict for sensitivity to PD-0332991 in RCC.
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Affiliation(s)
- Joshua E. Logan
- Institute of Urologic Oncology, Department of Urology, UCLA, Los Angeles, CA
| | - Nikayeh Mostofizadeh
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Amrita J. Desai
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Erika Maria Von Euw
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Dylan Conklin
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Veerauo Konkatkit
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Habib Hamidi
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Mark A. Eckardt
- University of California, Los Angeles Translational Oncology Research Laboratory, Santa Monica, CA
| | - Lee Anderson
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Hsiao-Wang Cheng
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Charles Ginther
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - Eileen Taschereau
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
| | - James G. Christensen
- Department of Cancer Research, Pfizer Global Research and Development, La Jolla, CA
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, Department of Urology, UCLA, Los Angeles, CA
| | - Dennis J. Slamon
- University of California, Los Angeles School of Medicine/Translational Oncology Research Laboratory, Los Angeles, CA
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Kroeger N, Klatte T, Chamie K, Rao PN, Birkhäuser FD, Sonn GA, Riss J, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Deletions of chromosomes 3p and 14q molecularly subclassify clear cell renal cell carcinoma. Cancer 2013; 119:1547-54. [PMID: 23335244 DOI: 10.1002/cncr.27947] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/05/2012] [Accepted: 12/10/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND The short arm of chromosome 3 (3p) harbors the von Hippel-Lindau (VHL) tumor suppressor gene, and the long arm of chromosome 14 (14q) harbors the hypoxia-inducible factor 1α (HIF-1α) gene. The objective of this study was to evaluate the significance of 3p loss (loss VHL gene) and 14q loss (loss HIF-1α gene) in clear cell renal cell carcinoma (ccRCC). METHODS In total, 288 ccRCC tumors underwent a prospective cytogenetic analysis for alterations in chromosomes 3p and 14q. Tumors were assigned to 1 of 4 possible chromosomal alterations: VHL +3p/+14q (VHL wild type [VHL-WT]), VHL +3p/-14q (VHL-WT plus HIF2α [WT/H2]), -3p/+14q (HIF1α and HIF2α [H1H2]), and -3p/-14q (HIF2α [H2]). RESULTS Among patients who had loss of 3p, tumors with -3p/-14q (H2) alterations were larger (P = .002), had higher grade (P = .002) and stage (P = .001), and more often were metastatic (P = .029) than tumors that retained 14q (H1H2). All patients who had tumors with -3p/-14q (H2) had worse cancer-specific survival (P = .014), and patients who had localized disease (P = .012) and primary T1 (pT1) tumors (P = .008) had worse recurrence-free survival. In patients who had pT1 tumors, combined 3p/14q loss was an independent predictor of recurrence-free survival (hazard ratio, 11.19; 95% confidence interval, 1.91-65.63) and cancer-specific survival (hazard ratio, 15.93; 95% confidence interval, 3.09-82.16). The current investigation was limited by its retrospective design, single-center experience, and a lack of confirmatory protein analyses. CONCLUSIONS Loss of chromosome 3p (the VHL gene) was associated with improved survival in patients with ccRCC, whereas loss of chromosome 14q (the HIF-1α gene) was associated with worse outcomes. The results of the current study support the hypothesis that HIF-1α functions as an important tumor suppressor gene in ccRCC.
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Affiliation(s)
- Nils Kroeger
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
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Birkhäuser FD, Koya RC, Neufeld C, Lu X, Micewicz ED, Chodon T, Atefi M, Kroeger N, Rampersaud EN, Chandramouli GV, Li G, Said JW, Ribas A, McBride WH, Kabbinavar FF, Pantuck AJ, Belldegrun AS, Riss J. Safety and efficacy of dendritic cell immunotherapy with ad-GMCAIX in an immunocompetent preclinical tumor model of renal cell carcinoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13045] [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
e13045 Background: We have previously reported the successful ex vivo generation of hCAIX-specific cytotoxic T lymphocytes (CTLs) by adenoviral (Ad) transduction of the GMCAIX fusion protein in dendritic cells (DC). We then produced GMP-grade material (NIH-RAID program, NSC 740833). Now we test, for the first time, the in vivo anti-tumor activity of DC-Ad-GMCAIX against renal cell carcinoma (RCC) in a unique immunocompetent mouse tumor model. Methods: Tumor growth inhibition and specificity were studied in BALB/c mice s.c. transplanted with either syngeneic RENCA cells transduced with hCAIX (URCAIX) or with non-hCAIX-expressing RENCA cells (RENCA). In a tumor prevention model, cohorts of mice were first immunized s.c. twice with DC-Ad-GMCAIX, DC-Ad-null, or no DCs, followed by tumor challenge with s.c. transplantation of URCAIX or RENCA cells. In an intervention model, tumors were first established and then immunotherapy was employed. Tumor volume and body weight were regularly assessed. Partial necropsy, immunohistochemistry of harvested tumors, and complete blood count were performed at termination of each study. Results: In the prevention model, URCAIX tumor growth was specifically and significantly inhibited for 15 days (p<0.0001). At termination, median growth inhibition reached 79% (113 vs. 531 mm3) and half of the mice remained tumor-free. In the intervention model, DC-Ad-GMCAIX-treated mice showed specific and significant growth inhibition of URCAIX tumors for 8 days (p<0.0018) with a median growth inhibition reaching 60% (487 vs. 1,205 mm3). The threshold of 15% weight loss was delayed in the therapeutic groups of both models (p<0.0167). No treatment-related weight loss or organ toxicity was observed. hCAIX staining was absent or minimally present in URCAIX-tumors that evaded DC-Ad-GMCAIX therapy. Conclusions: DC-Ad-GMCAIX therapy in a novel immunocompetent mouse model demonstrated, for the first time, both tumor prevention and growth inhibition of established RCC tumors without evidence of systemic toxicity. These studies form the basis for first-in-human clinical trial in patients with advanced RCC.
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Affiliation(s)
- Frédéric D. Birkhäuser
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Richard C. Koya
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Caleb Neufeld
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Xuyang Lu
- Department of Biostatistics, School of Public Health at the University of California, Los Angeles, Los Angeles, CA
| | - Ewa D. Micewicz
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Thinle Chodon
- Division Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Mohammad Atefi
- Division Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Nils Kroeger
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Edward N. Rampersaud
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | - Gang Li
- Department of Biostatistics, School of Public Health at the University of California, Los Angeles, Los Angeles, CA
| | - Jonathan W. Said
- Department of Pathology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Antoni Ribas
- Division Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - William H. McBride
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Fairooz F. Kabbinavar
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Allan J. Pantuck
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Joseph Riss
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Klatte T, Kroeger N, Rampersaud EN, Birkhäuser FD, Logan JE, Sonn G, Riss J, Rao PN, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Gain of chromosome 8q is associated with metastases and poor survival of patients with clear cell renal cell carcinoma. Cancer 2012; 118:5777-82. [PMID: 22605478 DOI: 10.1002/cncr.27607] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/01/2012] [Accepted: 03/20/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the prevalence of chromosome 8q gain in clear cell renal cell carcinoma (CCRCC) and to correlate the findings with tumor phenotype and disease-specific survival (DSS). METHODS The tumor karyotypes of 336 consecutive patients with CCRCC were prospectively evaluated with classical cytogenetic analysis. Chromosome 8q status was correlated with clinicopathological variables, and its impact on DSS was evaluated. RESULTS Gain of 8q occurred in 28 tumors (8.3%). Gain of 8q was associated with a higher risk of regional lymph node (21.4% vs 6.2%, P = .011) and distant metastases (50.0% vs 24.4%, P = .006), and greater tumor sizes (P = .030). Patients with gain of 8q had a 3.22-fold increased risk of death from CCRCC (P < .001). In multivariable analysis, gain of 8q was identified as an independent prognostic factor (hazard ratio, 2.37; P = .006). The concordance index of a multivariable base model increased significantly following inclusion of 8q gain (P = .0015). CONCLUSIONS Gain of chromosome 8q occurs in a subset of CCRCCs and is associated with an increased risk of metastases and death from CCRCC. Because the proto-oncogene c-MYC is among the list of candidate genes located on 8q, our data suggest that these tumors may have unique pathways activated, which are associated with an aggressive tumor phenotype. If confirmed, defining tumors with gain of 8q may assist in identifying patients who would benefit for specific c-MYC inhibitors or agents that target the MAPK/ERK (mitogen-activated protein kinase) pathway.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095-7384, USA
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Birkhäuser FD, Koya RC, Neufeld C, Lu X, Micewicz ED, Chodon T, Atefi M, Kroeger N, Rampersaud EN, Chandramouli GVR, Li G, Said JW, Ribas A, McBride WH, Kabbinavar FF, Pantuck AJ, Belldegrun AS, Riss J. Abstract 1563: In vivo safety and efficacy of a novel dendritic cell based Ad-GMCAIX vaccine with activity against renal cell carcinoma. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Carbonic anhydrase IX (CAIX) expression is constitutively up-regulated in clear cell renal cell carcinoma (ccRCC) due to loss of the VHL gene. Its up-regulation in ccRCC and low expression levels in normal tissues led us to develop an immunotherapeutic approach targeting the CAIX tumor antigen. We previously reported the successful generation and ex vivo priming of CAIX-specific, MHC restricted cytotoxic T lymphocytes (CTLs) by adenoviral (Ad) transduction of the GM-CAIX fusion protein in dendritic cells (DCs). Our current study tests, for the first time, the in vivo anti-tumor activity of DC-Ad-GMCAIX in preventing and intervening in the growth of RCC in immunocompetent mouse models. Tumor growth was studied in BALB/c mice transplanted s.c. with either the syngeneic CAIX-expressing RCC cell line RENCA-CAIX (PRCAIX) or the non-CAIX-expressing parental RENCA line. In the preventative model, cohorts of mice were s.c. immunized twice 6 days apart with either DC-Ad-GMCAIX, DC-Ad-null, or no DC transplantation, followed by s.c. challenge with PRCAIX or RENCA lines 12 days later. In the interventional model, tumors were first established and then immunotherapy was employed. At the end of each study, tumors were harvested, and partial necropsy, immunohistochemistry, and complete blood count were performed. DC-Ad-GMCAIX expressed in vivo the hCAIX protein that primed CTLs to specifically target hCAIX expressed by the PRCAIX line. In the preventative model, PRCAIX tumor growth was specifically and significantly inhibited by DC-Ad-GMCAIX for 15 days (all p<0.0001), reaching 79% median growth inhibition at termination (113 vs. 531 mm3). In the therapeutic cohort, time to 15% weight loss was significantly delayed (log-rank test p<0.001). Half of the mice in the treatment cohort did not develop tumors. The results were confirmed by a repeated study (inhibition for 15 days; all p<0.0001; 7/8 mice without tumor). In the interventional model, DC-Ad-GMCAIX-vaccinated mice demonstrated a specific and significant growth inhibition of PRCAIX-tumors for 8 days, with 60% median growth inhibition at termination (all p<0.0018; 487 vs. 1,205 mm3). In the therapeutic cohort, time to 15% weight loss was significantly delayed (log-rank test p<0.0167). No vaccine-related weight loss or organ toxicity was observed. hCAIX staining was absent or only minimally present in PRCAIX-tumors that grew despite therapy with DC-Ad-GMCAIX, compared to strong staining in the negative control groups. In conclusion, DC-Ad-GMCAIX therapy is capable of in vivo generation of CAIX specific CTLs in immunocompetent mice, leading to a significant inhibition of RCC tumor growth without systemic toxicity. Additional studies are being done to analyze the immune response, and the differential global gene and miRNA expression of tumor cells resistant to CAIX-based therapy. NCI RAID Initiative NSC 740833. § co-corresponding.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1563. doi:1538-7445.AM2012-1563
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Affiliation(s)
- Frédéric D. Birkhäuser
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Richard C. Koya
- 2Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Caleb Neufeld
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Xuyang Lu
- 3Department of Biostatistics, School of Public Health at the University of California, Los Angeles, CA
| | - Ewa D. Micewicz
- 4Department of Radiation Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Thinle Chodon
- 5Division Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Mohammad Atefi
- 5Division Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Nils Kroeger
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Edward N. Rampersaud
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | | | - Gang Li
- 3Department of Biostatistics, School of Public Health at the University of California, Los Angeles, CA
| | - Jonathan W. Said
- 7Department of Pathology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Antoni Ribas
- 5Division Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - William H. McBride
- 4Department of Radiation Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Fairooz F. Kabbinavar
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Allan J. Pantuck
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Arie S. Belldegrun
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Joseph Riss
- 1Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, CA
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Birkhäuser FD, Koya RC, Neufeld C, Lu X, Micewicz ED, Chodon T, Atefi M, Kroeger N, Rampersaud EN, Chandramouli GV, Li G, Said JW, Ribas A, McBride WH, Kabbinavar FF, Pantuck AJ, Belldegrun§ AS, Riss§ J. 304 DC-AD-GMCAIX BASED VACCINE THERAPY IS SAFE AND EFFECTIVE IN IMMUNOCOMPETENT MURINE KIDNEY CANCER TUMOR MODELS. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kabbinavar FF, Flynn PJ, Kozloff M, Ashby MA, Sing A, Barr CE, Grothey A. Gastrointestinal perforation associated with bevacizumab use in metastatic colorectal cancer: results from a large treatment observational cohort study. Eur J Cancer 2012; 48:1126-32. [PMID: 22424880 DOI: 10.1016/j.ejca.2012.02.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 01/05/2012] [Accepted: 02/19/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bevacizumab prolongs overall and progression-free survival when added to fluorouracil-based chemotherapy in patients with metastatic colorectal cancer in randomised controlled trials (RCTs). However, gastrointestinal perforation (GIP) occurs in 1-2% of treated patients. We sought to describe the incidence, temporal pattern, outcomes and potential risk factors for GIP in a large, community-based observational cohort study of patients treated with bevacizumab. PATIENTS AND METHODS Baseline patient and tumour characteristics, including potential GIP risk factors, were collected at study entry. Treatment, targeted adverse events, progression events and survival data were recorded every 3 months. Detailed clinical information was collected for all patients experiencing a GIP event. Effects of baseline risk factors on GIP risk were investigated using Cox proportional hazards regression. RESULTS Of 1953 evaluable patients followed for a median of 20.1 months, 37 (1.9%) experienced GIP. Most GIP events were surgically managed with successful outcomes; four events were fatal. The majority of GIP events (26/37) occurred ≤6 months after starting bevacizumab (median, 3.35 months). Univariate and multivariate analyses showed that age ≥65 years was significantly associated with lower GIP risk. In multivariate analyses, intact primary tumour and prior adjuvant radiotherapy were significantly associated with increased risk of GIP within 6 months after starting bevacizumab. A regression analysis that assessed the risk of GIP over time showed no cumulative risk associated with bevacizumab exposure. CONCLUSION The observed rate of GIP in this large, community-based experience was consistent with rates reported in RCTs. Most events were successfully managed with surgical intervention.
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Affiliation(s)
- Fairooz F Kabbinavar
- Department of Medicine, Division of Hematology & Oncology, University of California at Los Angeles, 924 Westwood Blvd, Los Angeles, CA 90095-7207, USA
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Rampersaud EN, Birkhauser F, Logan JE, Sonn G, Chan Y, Anterasian C, Li D, Pouliot F, Kabbinavar FF, Pantuck AJ, Belldegrun AS. Non–clear cell histology in patients with metastatic RCC as a prognostic indicator in the targeted therapy era. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
454 Background: The role of targeted therapy (TT) in metastatic renal cell carcinoma (mRCC) having non-clear cell histology (non-ccRCC) is still being defined. We sought to examine the factors associated with survival outcomes in patients presenting with various histological subtypes in the TT era. Methods: The UCLA Kidney Cancer Program database containing records of over 2000 patients was queried. The clinicopathologic factors between patients with clear cell subtype (ccRCC) and those with non-clear cell histology were compared using the Student’s T-test and the chi-square test for continuous and categorical variables, where appropriate. Survival outcomes were estimated using Kaplan-Meier (log rank). Univariate and multivariate Cox regression models were used to identify independent associations with survival. Results: Of 157 patients treated with FDA-approved TT, 132 (84%) had ccRCC while 25 (16%) had non-ccRCC. The two groups were balanced for baseline demographic variables, including gender, race, BMI, pack-years of smoking, T-stage, Fuhrman grade, performance status and UCLA Integrated Staging System (UISS) risk category. Median survival of patients with ccRCC and non-ccRCC was 41.6 and 18.1 months (p<0.001). In univariate analysis, non-ccRCC was associated with a 2.7-fold risk of cancer specific death compared to ccRCC patients. Among patients receiving TT-only, median survival of patients with ccRCC and non-ccRCC was 35 and 15.4 months (p=0.007). A subset of ccRCC patients treated sequentially with IMT followed by TT had a median survival of 73 months. Worsening UISS risk class and non-ccRCC histology, but not age, gender, race, tobacco exposure history, or tumor size, were independently associated with the risk of cancer death. Conclusions: Non-clear cell histology remains a significant and independent risk factor for cancer specific death for mRCC patients treated by TT even after controlling for UISS risk category. [Table: see text]
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Affiliation(s)
- Edward N. Rampersaud
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Frederic Birkhauser
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Joshua E Logan
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Geoffrey Sonn
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Yvonne Chan
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Christine Anterasian
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - David Li
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Frederic Pouliot
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Fairooz F. Kabbinavar
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Allan J. Pantuck
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Arie S. Belldegrun
- Institute of Urologic Oncology, University of California, Los Angeles, Los Angeles, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; University of California, Los Angeles School of Medicine, Los Angeles, CA
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Logan JE, Rampersaud EN, Sonn GA, Chamie K, Belldegrun AS, Pantuck AJ, Slamon DJ, Kabbinavar FF. Systemic therapy for metastatic renal cell carcinoma: a review and update. Rev Urol 2012; 14:65-78. [PMID: 23526579 PMCID: PMC3602729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
An in-depth understanding of metastatic renal cell carcinoma (mRCC) is important so that practitioners can make informed evidenced-based decisions with patients to optimize not only quantity of life but quality of life as well. Therefore, this review focuses on the biology of mRCC as it relates to targets for therapy, as well as on the small molecules rationally designed with these targets in mind. In addition, anticipated emerging therapies are highlighted, including the new tyrosine kinase inhibitors axitinib and tivozanib, as well as new immune-based therapies such as dendritic cell-based vaccines and antibodies. We also briefly review recent reports from the emerging field of predicting drug response based on molecular markers. And finally, management of metastatic non-clear cell RCC histologies are discussed focusing on available evidence to direct decision making when assessing therapeutic options.
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Affiliation(s)
- Joshua E Logan
- Institute of Urologic Oncology, Department of Urology, The David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Kroeger N, Klatte T, Birkhäuser FD, Rampersaud EN, Seligson DB, Zomorodian N, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Smoking negatively impacts renal cell carcinoma overall and cancer-specific survival. Cancer 2011; 118:1795-802. [DOI: 10.1002/cncr.26453] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/22/2011] [Accepted: 06/27/2011] [Indexed: 12/16/2022]
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Klatte T, Remzi M, Zigeuner RE, Mannweiler S, Said JW, Kabbinavar FF, Haitel A, Waldert M, de Martino M, Marberger M, Belldegrun AS, Pantuck AJ. Development and External Validation of a Nomogram Predicting Disease Specific Survival After Nephrectomy for Papillary Renal Cell Carcinoma. J Urol 2010; 184:53-8. [DOI: 10.1016/j.juro.2010.03.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Indexed: 01/20/2023]
Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | | | - Jonathan W. Said
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
| | - Fairooz F. Kabbinavar
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Andrea Haitel
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Matthias Waldert
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Marberger
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Arie S. Belldegrun
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Allan J. Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
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Shuch B, Said J, LaRochelle JC, Zhou Y, Li G, Klatte T, Pouliot F, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Histologic evaluation of metastases in renal cell carcinoma with sarcomatoid transformation and its implications for systemic therapy. Cancer 2010; 116:616-24. [PMID: 19998348 DOI: 10.1002/cncr.24768] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sarcomatoid features in renal cell carcinoma may represent an aggressive subclone arising from the primary tumor. The patterns of metastases for these tumors were evaluated to determine if sarcomatoid features were retained at metastasis and whether the percentage of sarcomatoid features in the primary tumor influenced spread. METHODS All patients with sarcomatoid features found at nephrectomy with synchronous or metachronous resection of metastases were evaluated. The histology, grade, and percentage of sarcomatoid features in the primary and metastatic site were recorded. The association between percentage of sarcomatoid features, grade, histology, and pattern of metastases was evaluated. RESULTS Thirty-two patients were identified with sarcomatoid features and resected metastases. Fifty-two metastatic sites were evaluated. A single histologic appearance (sarcomatoid or carcinomatoid) was present in 50 of 52 sites (96%). Thirty sites (58%) demonstrated only a sarcomatoid pattern, whereas 20 (38%) contained only a carcinoma pattern. Histology and carcinoma grade did not influence metastatic pattern; however, greater percentage of sarcomatoid features was associated with the presence of distant sarcomatoid histology. A cutoff of 30% sarcomatoid features in the primary tumor was useful in predicting systemic sarcomatoid histology. CONCLUSIONS Sarcomatoid elements are frequently observed in the metastases of primary tumors with sarcomatoid features, and these metastases generally contain a solitary pattern supporting the subclone hypothesis. However, both components can metastasize in the same patient. The percentage of sarcomatoid features influences the pattern of spread, and patients with >30% sarcomatoid features in the primary tumor frequently have distant sarcomatoid histology. This cutpoint may be helpful for inclusion criteria for future clinical trials.
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Affiliation(s)
- Brian Shuch
- Department of Urology, David Geffen School of Medicine at University of California-Los Angles, Los Angeles, California 90095-1738, USA
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Cassidy J, Saltz LB, Giantonio BJ, Kabbinavar FF, Hurwitz HI, Rohr UP. Effect of bevacizumab in older patients with metastatic colorectal cancer: pooled analysis of four randomized studies. J Cancer Res Clin Oncol 2009; 136:737-43. [PMID: 19904559 PMCID: PMC2841755 DOI: 10.1007/s00432-009-0712-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 10/19/2009] [Indexed: 02/07/2023]
Abstract
Background Bevacizumab is frequently combined with 5-fluorouracil-based chemotherapy for patients with metastatic colorectal cancer (mCRC). The relative benefit of bevacizumab in older patients has not been widely studied and is of interest. Patients and methods This retrospective analysis used data from three first-line randomized controlled studies and one second-line randomized controlled study of bevacizumab plus chemotherapy in medically fit (Eastern Cooperative Oncology Group performance status 0 or 1) patients with mCRC. Overall survival (OS) and on-treatment progression-free survival (PFS) were assessed in patients aged <65, ≥65, and ≥70 years. Results were compared using unstratified hazard ratios (HRs). Grade 3–5 adverse events were also assessed. Results Bevacizumab statistically significantly improved PFS [HR 0.58; 95% confidence interval (CI) 0.49–0.68] and OS (HR 0.85; 95% CI 0.74–0.97) in patients aged ≥65 years; patients aged ≥70 years had similar improvements. Benefits were consistent across the studies, irrespective of setting, bevacizumab dose, or chemotherapy regimen. Increases in thromboembolic events were observed in patients aged ≥65 and ≥70 years in the bevacizumab group compared with the control group, mainly as a result of increases in arterial thromboembolic events. No other substantial age-related increases in grade 3–5 adverse events were observed. Conclusions In medically fit older patients, bevacizumab provides similar PFS and OS benefits as in younger patients.
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Kozloff M, Yood MU, Berlin J, Flynn PJ, Kabbinavar FF, Purdie DM, Ashby MA, Dong W, Sugrue MM, Grothey A. Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer: the BRiTE observational cohort study. Oncologist 2009; 14:862-70. [PMID: 19726453 DOI: 10.1634/theoncologist.2009-0071] [Citation(s) in RCA: 256] [Impact Index Per Article: 17.1] [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: 12/13/2022] Open
Abstract
BACKGROUND The Bevacizumab Regimens' Investigation of Treatment Effects (BRiTE) study is a prospective, observational cohort study designed to elucidate safety and effectiveness outcomes associated with bevacizumab combined with chemotherapy as used in clinical practice for first-line treatment of metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Baseline characteristics, prespecified bevacizumab-related adverse events, and effectiveness data were collected from 1,953 mCRC patients who were receiving first-line treatment including bevacizumab at 248 U.S. sites. RESULTS At database lock, the median follow-up was 20.1 months. At baseline, 46% of patients were aged >or=65 years and 49% had an Eastern Cooperative Oncology Group performance status score >or=1. Fluorouracil, leucovorin, and oxaliplatin was the most common first-line chemotherapy regimen (56%). Overall rates of bevacizumab-related adverse events in the BRiTE study, such as gastrointestinal perforation (1.9%), arterial thromboembolic events (2%), grade 3-4 bleeding (2.2%), and de novo hypertension requiring medication (22%), were consistent with those reported in randomized clinical trials (RCTs) of bevacizumab in first-line mCRC treatment. The median progression-free survival (PFS) and overall survival (OS) times were 9.9 (95% confidence interval [CI], 9.5-10.3) months and 22.9 (95% CI, 21.9-24.4) months, respectively. CONCLUSION The median PFS and OS durations and safety profile of bevacizumab in the BRiTE study were similar to those in RCTs of bevacizumab plus chemotherapy in first-line mCRC patients. The observations from the BRiTE study complement and expand upon RCT data, providing clinical information in a large cohort of bevacizumab-treated patients and subgroups such as the elderly.
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Affiliation(s)
- Mark Kozloff
- Ingalls Hospital, Suite 401, Harvey, Illinois 60426, USA.
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de Martino M, Klatte T, Seligson DB, LaRochelle J, Shuch B, Caliliw R, Li Z, Kabbinavar FF, Pantuck AJ, Belldegrun AS. CA9 Gene: Single Nucleotide Polymorphism Predicts Metastatic Renal Cell Carcinoma Prognosis. J Urol 2009; 182:728-34. [DOI: 10.1016/j.juro.2009.03.077] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Indexed: 10/20/2022]
Affiliation(s)
- Michela de Martino
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Tobias Klatte
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - David B. Seligson
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
| | - Jeffrey LaRochelle
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Brian Shuch
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Randy Caliliw
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Zhenhua Li
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Fairooz F. Kabbinavar
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Allan J. Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Arie S. Belldegrun
- Department of Urology, University of California-Los Angeles, Los Angeles, California
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Klatte T, Said JW, de Martino M, LaRochelle J, Shuch B, Rao JY, Thomas GV, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Presence of Tumor Necrosis is Not a Significant Predictor of Survival in Clear Cell Renal Cell Carcinoma: Higher Prognostic Accuracy of Extent Based Rather Than Presence/Absence Classification. J Urol 2009; 181:1558-64; discussion 1563-4. [DOI: 10.1016/j.juro.2008.11.098] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Tobias Klatte
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Jonathan W. Said
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
| | - Michela de Martino
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Jeffrey LaRochelle
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Brian Shuch
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Jian Yu Rao
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
| | - George V. Thomas
- Department of Pathology and Laboratory Medicine, University of California-Los Angeles, Los Angeles, California
| | - Fairooz F. Kabbinavar
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Arie S. Belldegrun
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Allan J. Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
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Klatte T, Pantuck AJ, Said JW, Seligson DB, Rao NP, LaRochelle JC, Shuch B, Zisman A, Kabbinavar FF, Belldegrun AS. Cytogenetic and molecular tumor profiling for type 1 and type 2 papillary renal cell carcinoma. Clin Cancer Res 2009; 15:1162-9. [PMID: 19228721 DOI: 10.1158/1078-0432.ccr-08-1229] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The goal of this study was to evaluate immunohistochemical and cytogenetic features and their prognostic value in papillary renal cell carcinoma (PRCC) subtypes. EXPERIMENTAL DESIGN One hundred fifty-eight cases of PRCC were identified and reclassified by subtype. Tumoral expression of 29 molecular markers was determined by immunohistochemistry. Cytogenetic analyses were done on a prospective series of 65 patients. Associations with clinicopathologic information and disease-specific survival were assessed. RESULTS Fifty-one patients (32%) had type 1 and 107 (68%) type 2 PRCC. Type 2 patients had worse Eastern Cooperative Oncology Group performance status, higher T stages, nodal and distant metastases, higher grades, and a higher frequency of necrosis, collecting system invasion and sarcomatoid features. Type 2 showed greater expression of vascular endothelial growth factor (VEGF)-R2 in the tumor epithelium, and of VEGF-R3 in both tumor epithelium and endothelium. Loss of chromosome 1p, loss of 3p, and gain of 5q were exclusively observed in type 2, whereas type 1 more frequently had trisomy 17. Type 2 PRCC was associated with worse survival than type 1, but type was not retained as an independent prognostic factor. Lower PTEN, lower EpCAM, lower gelsolin, higher CAIX, and higher VEGF-R2 and VEGF-R3 expression, loss of 1p, 3p, or 9p, and absence trisomy 17 were all associated with poorer prognosis. CONCLUSIONS Type 2 PRCC is associated with more aggressive clinicopathologic features and worse outcome. Molecular and chromosomal alterations can distinguish between PRCC subtypes and influence their prognosis. The effect of 3p loss on survival in PRCC is opposite to the relationship seen in clear cell RCC.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles, California 90095-1738, USA
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Klatte T, Seligson DB, LaRochelle J, Shuch B, Said JW, Riggs SB, Zomorodian N, Kabbinavar FF, Pantuck AJ, Belldegrun AS. Molecular signatures of localized clear cell renal cell carcinoma to predict disease-free survival after nephrectomy. Cancer Epidemiol Biomarkers Prev 2009; 18:894-900. [PMID: 19240241 DOI: 10.1158/1055-9965.epi-08-0786] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To identify the molecular signature of localized (N0M0) clear cell renal cell carcinoma (RCC) and assess its ability to predict outcome. METHODS Clinical characteristics and pathologic records of 170 patients with localized clear cell RCC who underwent nephrectomy were reviewed. Immunohistochemical analysis was done on a tissue microarray of all primary tumors using a kidney cancer-related panel of protein markers, which included CAIX, CAXII, CXCR3, gelsolin, Ki-67, vimentin, EpCAM, p21, p27, p53, pS6, PTEN, HIF-1alpha, pAkt, VEGF-A, VEGF-C, VEGF-D, VEGFR-1, VEGFR-2, and VEGFR-3. Associations with disease-free survival (DFS) were evaluated with Cox models, and a concordance index assessed prognostic accuracy. RESULTS Median follow-up was 7.1 years. The final multivariate Cox model determined T classification, Eastern Cooperative Oncology Group performance status, and five molecular markers (Ki-67, p53, endothelial VEGFR-1, epithelial VEGFR-1, and epithelial VEGF-D) to be independent prognostic indicators of DFS. The molecular signature based on these markers predicted DFS with an accuracy of 0.838, an improvement over T classification of 0.746, and the University of California-Los Angeles Integrated Staging System of 0.780. A constructed nomogram combined the molecular, clinical, and pathologic factors and approached a concordance index of 0.904. CONCLUSIONS A molecular signature consisting of five molecular markers (Ki-67, p53, endothelial VEGFR-1, epithelial VEGFR-1, and epithelial VEGF-D) can predict DFS for localized clear cell RCC. The prognostic ability of the signature and nomogram may be superior to clinical and pathologic factors alone and may identify a subset of localized patients with aggressive clinical behavior. Independent, external validation of the nomogram is required.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, 10833 Le Conte Avenue, 66-118 CHS, Box 951738, Los Angeles, CA 90095-1738, USA
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Klatte T, Rao PN, de Martino M, LaRochelle J, Shuch B, Zomorodian N, Said J, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Cytogenetic profile predicts prognosis of patients with clear cell renal cell carcinoma. J Clin Oncol 2009; 27:746-53. [PMID: 19124809 DOI: 10.1200/jco.2007.15.8345] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The majority of cytogenetic studies in renal cell carcinoma (RCC) have been impaired by small sample size, retrospective character, and lack of a survival end point. We prospectively studied the prognostic impact of cytogenetic abnormalities on a larger cohort of patients having up to 108 months of follow-up. PATIENTS AND METHODS Tumors of 282 patients who underwent nephrectomy for clear cell RCC were cytogenetically analyzed. Results were correlated with pathological factors and disease-specific survival. RESULTS The most frequently observed cytogenetic abnormalities were loss of 3p (60%), gain of 5q (33%), loss of 14q (28%), trisomy 7 (26%), loss of 8p (20%), loss of 6q (17%), loss of 9p (16%), loss of 4p (13%), and loss of chromosome Y in men (55%). Tumors with loss of 3p presented at lower TNM stages. Loss of 4p, 9p, and 14q were all associated with higher TNM stages, higher grade, and greater tumor size. A deletion of 3p was associated with better prognosis (P = .03), while loss of 4p (P < .001), loss of 9p (P < .01), and loss of 14q (P < .01) were each associated with worse prognosis. Loss of the Y chromosome led to improved progression-free survival in metastatic patients (P = .02). In multivariate analysis, loss of 9p was retained as an independent prognostic factor. CONCLUSION This cytogenetic study serves as a proof of principal that genetic information, such as loss of chromosome 9, can be obtained from widely available technology, and can provide additional prognostic information to standard clinicopathologic variables.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA 90025-1738, USA
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Kabbinavar FF, Hurwitz HI, Yi J, Sarkar S, Rosen O. Addition of bevacizumab to fluorouracil-based first-line treatment of metastatic colorectal cancer: pooled analysis of cohorts of older patients from two randomized clinical trials. J Clin Oncol 2008; 27:199-205. [PMID: 19064978 DOI: 10.1200/jco.2008.17.7931] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) occurs predominantly in older persons. To provide more statistical power to assess risk/benefit in older patients, we examined the clinical benefit of bevacizumab (BV) plus fluorouracil-based chemotherapy in first-line metastatic CRC (mCRC) treatment in patients aged > or = 65 years, using data pooled from two placebo-controlled studies. PATIENTS AND METHODS Pooled efficacy data for 439 patients > or = 65 years old randomized to BV plus chemotherapy (n = 218) or placebo plus chemotherapy (n = 221) in study 1 and study 2 were retrospectively analyzed on an intent-to-treat basis for overall survival (OS), progression-free survival (PFS), and objective response. Safety analysis was based on reports of targeted adverse events in treated patients. RESULTS Median OS with BV plus chemotherapy was 19.3 v 14.3 months with placebo plus chemotherapy (hazard ratio [HR] = 0.70; 95% CI, 0.55 to 0.90; P = .006). Patients treated with BV plus chemotherapy had a median PFS of 9.2 v 6.2 months for placebo plus chemotherapy patients (HR = 0.52; 95% CI, 0.40 to 0.67; P < .0001). The objective response rate was 34.4% with BV plus chemotherapy versus 29.0% with placebo plus chemotherapy (difference not statistically significant). Rates of BV-associated adverse events in the pooled BV plus chemotherapy group were consistent with those reported in the overall populations for the two studies. CONCLUSION Analysis of pooled patient cohorts age >/= 65 years from two similar trials in mCRC indicates that adding bevacizumab to fluorouracil-based chemotherapy improved OS and PFS, similar to the benefits in younger patients. Also, the risks of treatment do not seem to exceed those in younger patients with mCRC.
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Affiliation(s)
- Fairooz F Kabbinavar
- Department of Medicine, Division of Hematology & Oncology, University of California at Los Angeles, 2333D PVUB MC 705907, 10945 Le Conte Ave, Los Angeles, CA 90095-7059, USA.
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Belldegrun AS, Klatte T, Shuch B, LaRochelle JC, Miller DC, Said JW, Riggs SB, Zomorodian N, Kabbinavar FF, Dekernion JB, Pantuck AJ. Cancer-specific survival outcomes among patients treated during the cytokine era of kidney cancer (1989-2005): a benchmark for emerging targeted cancer therapies. Cancer 2008; 113:2457-63. [PMID: 18823034 DOI: 10.1002/cncr.23851] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The management of renal cell carcinoma (RCC) is evolving toward less extirpative surgery and the use of targeted therapy. The authors set out to provide a benchmark against which emerging therapies should be measured. METHODS A prospective database including clinical and pathological variables for 1632 patients with RCC treated between 1989 and 2005 was queried. Patients were stratified using the University of California-Los Angeles Integrated Staging System (UISS) into low-, intermediate-, and high-risk groups. Disease-specific survival (DSS) was measured. Response to systemic therapy for patients with advanced disease was assessed. RESULTS Nephrectomy was performed in 1492 patients. Overall 5-, 10-, and 15-year DSS was 55%, 40%, and 29%. For localized disease, 5- and 10-year DSS for UISS low-, intermediate-, and high-risk groups was 97% and 92%, 81% and 61%, and 62% and 41%, respectively. For metastatic disease, 5- and 10-year DSS for UISS low-, intermediate-, and high-risk groups was 41% and 31%, 18% and 7%, and 8% and 0%, respectively. Patients with metastatic disease receiving immunotherapy (n=453) had complete response in 7% (median survival [MS], 120+ months), partial response in 15% (MS, 42.8 months), stable disease in 33% (MS, 38.6 months), and progressive disease in 45% (MS, 11.6 months). CONCLUSIONS Most patients with localized RCC do well with surgery alone, but effective adjuvant therapy is needed for patients identified as at high risk for recurrence. For advanced disease, newer targeted and potentially less toxic treatments should be at least as effective as those achieved with aggressive surgical resection and immunotherapy.
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Affiliation(s)
- Arie S Belldegrun
- Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90095-1738, USA.
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Klatte T, Han KR, Said JW, Böhm M, Allhoff EP, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Pathobiology and prognosis of chromophobe renal cell carcinoma. Urol Oncol 2008; 26:604-9. [DOI: 10.1016/j.urolonc.2007.07.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Revised: 07/20/2007] [Accepted: 07/23/2007] [Indexed: 11/27/2022]
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Shuch B, La Rochelle JC, Klatte T, Riggs SB, Liu W, Kabbinavar FF, Pantuck AJ, Belldegrun AS. Brain metastasis from renal cell carcinoma. Cancer 2008; 113:1641-8. [DOI: 10.1002/cncr.23769] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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