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Thuss-Patience P, Högner A, Goekkurt E, Stahl M, Kretzschmar A, Götze T, Stocker G, Reichardt P, Kullmann F, Pink D, Bartels P, Jarosch A, Hinke A, Schultheiß C, Paschold L, Stein A, Binder M. Ramucirumab, Avelumab, and Paclitaxel as Second-Line Treatment in Esophagogastric Adenocarcinoma: The Phase 2 RAP (AIO-STO-0218) Nonrandomized Controlled Trial. JAMA Netw Open 2024; 7:e2352830. [PMID: 38261316 PMCID: PMC10807255 DOI: 10.1001/jamanetworkopen.2023.52830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/30/2023] [Indexed: 01/24/2024] Open
Abstract
Importance Adding immune checkpoint inhibitors to chemotherapy has been associated with improved outcomes in metastatic esophagogastric adenocarcinoma, but treatment combinations and optimal patient selection need to be established. Objective To investigate the efficacy and tolerability of the programmed cell death ligand 1 (PDL-1) inhibitor avelumab with paclitaxel plus ramucirumab. Design, Setting, and Participants This multicenter, single-group, phase 2 nonrandomized controlled trial was conducted among patients with second-line metastatic esophagogastric adenocarcinoma. Patients pretreated with platinum plus fluoropyrimidine between April 2019 and November 2020 across 10 German centers (median follow-up, 27.4 months [95% CI 22.0-32.9 months]) were included. Data analysis was performed from January to December 2022. Interventions Patients received ramucirumab at 8 mg/kg on days 1 and 15, avelumab at 10 mg/kg on days 1 and 15, and paclitaxel at 80 mg/m2 on days 1, 8, and 15 every 4 weeks. Main Outcomes and Measures The prespecified primary end point was overall survival (OS) rate at 6 months, with the experimental therapy considered insufficiently active with an OS rate of 50% or less and a promising candidate with an OS rate of 65% or greater. Results Of 60 enrolled patients, 59 patients (median [range] age, 64 [18-81] years; 47 males [70.7%]) were evaluable, including 30 patients with metastatic adenocarcinoma of the stomach and 29 patients with gastroesophageal junction. All patients were pretreated with platinum plus fluoropyrimidine, and 40 patients (67.8%) had received prior taxanes; 24 of 56 evaluable patients (42.9%) had a PDL-1 combined positive score (CPS) of 5 or greater, centrally assessed. The OS rate at 6 months was 71.2% (95% CI, 61.5%-83.7%). The median OS in the intention-to-treat population (59 patients) was 10.6 months (95% CI, 8.4-12.8 months) overall. Among patients assessable by central pathology, median OS was 9.4 months (95% CI, 7.2-11.7 months) in 32 patients with a PDL-1 CPS less than 5 and 14.0 months (95% CI, 6.0-22.1 months) in 24 patients with a PDL-1 CPS of 5 or greater (P = .25). Treatment was generally well tolerated, without unexpected toxicities. Patients with higher vs lower than median T cell repertoire richness showed an increased median OS of 20.4 months (95% CI, 7.7-33.0 months) compared with 8.3 months (95% CI, 3.7-12.9 months; hazard ratio, 0.43; 95% CI, 0.23-0.81; P = .008). Patients with lower vs higher than median cell-free DNA burden had a median OS of 19.2 months (95% CI, 8.9-29.6 months) compared with 7.3 months (95% CI, 3.2-11.4 months; hazard ratio, 0.30; 95% CI, 0.16-0.59; P < .001). Conclusions and relevance In this study, the combination of avelumab with paclitaxel plus ramucirumab showed favorable efficacy and tolerability in the second-line treatment for metastatic esophagogastric adenocarcinoma. A PDL-1 CPS score of 5 or greater, cell-free DNA level less than the median, and T cell repertoire richness greater than the median were associated with increased median OS. Trial Registration ClinicalTrials.gov Identifier: NCT03966118.
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Affiliation(s)
- Peter Thuss-Patience
- Department of Hematology, Oncology and Cancer Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Anica Högner
- Department of Hematology, Oncology and Cancer Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eray Goekkurt
- Hematology-Oncology Practice Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Stahl
- Department of Medical Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Albrecht Kretzschmar
- Hematology-Oncology Practice Medizinisches Versorgungszentrum Mitte, Leipzig, Germany
| | - Thorsten Götze
- Institute of Clinical Cancer Research at Krankenhaus Nordwest, University Cancer Center, Frankfurt, Germany
| | - Gertraud Stocker
- Leipzig University Cancer Center, Leipzig University Hospital, Leipzig, Germany
| | - Peter Reichardt
- Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Kullmann
- Department of Medicine I, Hospital Weiden, Weiden, Germany
| | - Daniel Pink
- Department of Oncology and Palliative Care, Helios Klinikum Bad Saarow, Germany
- Department of Internal Medicine C, University Hospital Greifswald, Germany
| | - Prisca Bartels
- Department of Hematology, Oncology and Cancer Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Armin Jarosch
- Laboratory of Molecular Tumor Pathology and Systems Biology, Institute of Pathology, Charité-University Medicine Berlin, Berlin, Germany
| | - Axel Hinke
- Clinical Cancer Research Consulting, Düsseldorf, Germany
| | - Christoph Schultheiß
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Germany
| | - Lisa Paschold
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Germany
| | - Alexander Stein
- Hematology-Oncology Practice Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mascha Binder
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Germany
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Alberti A, Stocker G, Lordick F, Hacker UT, Kobitzsch B, Haffner I, Baiocchi GL, Zamparini M, Tiberio GAM, Baronchelli C, Caruso A, Bossi P, Berruti A. Plasma EBV DNA as a prognostic factor in EBV associated gastric cancer: a multicenter, prospective study (EBV PRESAGE study). Front Oncol 2023; 13:1276138. [PMID: 37941551 PMCID: PMC10629611 DOI: 10.3389/fonc.2023.1276138] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose The Cancer Genome Atlas Research Network identified Epstein-Barr-Virus (EBV)-positive gastric cancer as a distinct molecular subtype. The prevalence is 8-9% and the histological examination shows pronounced lymphocytic infiltration, elevated levels of IFN-γ and consequently overexpression of PD-L1. The role of plasma EBV DNA load as a prognostic factor in patients with this cancer subtype is still to be defined. Methods and analysis The present multicenter prospective observational study "EBV PRESAGE", involving German and Italian cancer centers, aims to evaluate the prognostic role of plasma EBV DNA in EBV-related gastric cancer (GC). The objective is to study the association between plasma EBV DNA load at different consecutive time points and the patient's prognosis. Every patient with a new diagnosis of gastric cancer (including gastroesophageal junction adenocarcinoma) will be screened for Epstein-Barr encoded small Region (EBER) on tissue biopsies using in situ hybridization (ISH). If EBER ISH is positive, blood analysis for plasma EBV DNA will be conducted. The plasma EBV quantitative analysis will be centralized, and extraction, detection, and quantification of EBV DNA in plasma samples will be performed using real-time PCR. Discussion We hypothesized that plasma EBV DNA represents a non-invasive tool for monitoring EBV-related GC and might be valuable as a prognostic marker.
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Affiliation(s)
- Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Gertraud Stocker
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Florian Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Ulrich T. Hacker
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Benjamin Kobitzsch
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Ivonne Haffner
- Department of Medicine II (Oncology, Gastroenterology, Hepatology and Pulmonology), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Gian Luca Baiocchi
- Surgical Unit, Department of Clinical and Experimental Sciences, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST), Cremona, Italy
| | - Manuel Zamparini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Guido A. M. Tiberio
- Surgical Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Carla Baronchelli
- Pathology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
| | - Arnaldo Caruso
- Microbiology Unit, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili at the Azienda Socio Sanitaria Territoriale (ASST) – Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology and Hematology Unit, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia, Italy
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Chekerov R, Arndt T, Pietzner K, Canzler U, Wimberger P, Strauß HG, Mahner S, Woelber L, de Gregorio N, Stocker G, von Abel E, Neunhoeffer T, Belau AK, Mustea A, Yalinkaya I, Braicu EI, Richter R, Sehouli J. Pazopanib with Topotecan weekly for patients with platinum-resistant or intermediate-sensitive recurrent ovarian cancer: results of a multicentre, open label phase I/II study (TOPAZ). J Cancer Res Clin Oncol 2023; 149:7637-7649. [PMID: 37000264 PMCID: PMC10374680 DOI: 10.1007/s00432-023-04647-9] [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: 12/23/2022] [Accepted: 02/09/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Pazopanib has promising antiangiogenetic activity in solid cancers. The investigator-initiated phase I/II trial evaluated the combination of Topotecan with Pazopanib in platinum-resistant or intermediate-sensitive recurrent ovarian cancer (ROC). METHODS Patients (≥ 18 years) with first or second recurrence were enrolled in this multicentre open-label trial. Phase I analysed Topotecan 4 mg/m2 (day 1, 8, 15, ever 28 days) for six cycles to identify the maximum tolerated dose (MTD) of Pazopanib added in a dose-escalating scheme with 400 mg starting dose. The phase II analysed safety and efficacy aspects. For all patients with clinical remission a maintenance with Pazopanib until progression was allowed. This trial is registered with ClinicalTrials.gov, number NCT01600573. RESULTS Between June 2012 and February 2017, 11 patients were enrolled in the phase I, and 50 patients in the phase II study. The MTD of Pazopanib was determined by 400 mg/daily. Haematological and liver toxicities determined the dose limiting toxicities (DLT) and the most common grade 3-4 adverse events: leucopenia (25%), neutropenia (22%), thrombocytopenia (19%), accumulation of cholestatic (20%) and hepatocellular damage (15%), which often caused dose modifications, but no new life-threatening events. Overall response was 16% and clinical benefit rate 68%. Median progression-free survival (PFS) was 3.5 months (95% CI 2.0-5.0). Due to early progression only 20% of the patients were able to start with maintenance treatment. CONCLUSION The combination of pazopanib and weekly topotecan is feasible, resulting in a manageable haematological and liver toxicity, but despite its encouraging response rate, was not associated with a significant survival benefit.
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Affiliation(s)
- Radoslav Chekerov
- Department of Gynaecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Tjadina Arndt
- Department of Gynaecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynaecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ulrich Canzler
- Department of Gynaecology and Obstetrics TU Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Pauline Wimberger
- Department of Gynaecology and Obstetrics TU Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Hans-Georg Strauß
- Department of Gynaecology Universitätsklinik und Poliklinik, Martin-Luther University, Halle-Wittenberg, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynaecology, University Hospital, Ludwig-Maximilian-University, Munich, Germany
| | - Linn Woelber
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaus de Gregorio
- Department of Obstetrics and Gynaecology, SLK Klinikum Heilbronn, Heilbronn, Germany
| | - Gertraud Stocker
- Medical Department, University Cancer Center Leipzig (UCCL), University Medical Center, Leipzig, Germany
| | - Ekkehard von Abel
- Department of Obstetrics and Gynaecology, Stauferklinikum Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Tanja Neunhoeffer
- Department of Gynaecology, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | | | - Alexander Mustea
- Department of Gynaecology and Gynaecological Oncology, University of Bonn, Bonn, Germany
| | - Isil Yalinkaya
- Department of Gynaecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Elena Ioana Braicu
- Department of Gynaecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Rolf Richter
- Department of Gynaecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynaecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Topf V, Kheifetz Y, Daum S, Ballhausen A, Schwarzer A, Trung KV, Stocker G, Aigner A, Lordick F, Scholz M, Knödler M. Individual hematotoxicity prediction of further chemotherapy cycles by dynamic mathematical models in patients with gastrointestinal tumors. J Cancer Res Clin Oncol 2023; 149:6989-6998. [PMID: 36854800 PMCID: PMC10374676 DOI: 10.1007/s00432-023-04601-9] [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: 12/22/2022] [Accepted: 01/25/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Hematotoxicity is a common side-effect of cytotoxic gastrointestinal (GI) cancer therapies. An unsolved problem is to predict the individual risk therefore to decide on treatment adaptions. We applied an established biomathematical prediction model and primarily evaluated its predictive value in patients undergoing chemotherapy for GI cancers in curative intent. METHODS In a prospective, observational multicenter study on patients with gastro-esophageal or pancreatic cancer (n = 28) receiving myelosuppressive adjuvant or neoadjuvant chemotherapy (FLO(T) or FOLFIRINOX), individual model parameters were learned based on patients' observed laboratory values during the first chemotherapy cycle and further external data resources. Grades of hematotoxicity of subsequent cycles were predicted by model simulation and compared with observed data. RESULTS The most common high-grade hematological toxicity was neutropenia [19/28 patients (68%)]. For the FLO(T) regimen, individual grades of thrombocytopenia and leukopenia could be well predicted for cycles 2-4, as well as grades of neutropenia for cycle 2. Prediction accuracy for neutropenia in the third and fourth cycle differed by one toxicity grade on average. For the FOLFIRINOX-regimen, thrombocytopenia predictions showed a maximum deviation of one toxicity grade up to the end of therapy (8 cycles). Deviations of predictions were less than one degree on average up to cycle 4 for neutropenia, and up to cycle 6 for leukopenia. CONCLUSION The biomathematical model showed excellent short-term and decent long-term prediction performance for all relevant hematological side effects associated with FLO(T)/FOLFIRINOX. Clinical utility of this precision-medicine approach needs to be further investigated in a larger cohort.
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Affiliation(s)
- Vivien Topf
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Yuri Kheifetz
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Severin Daum
- Medical Department, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité University Medicine Berlin, Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Alexej Ballhausen
- Medical Department, Division of Hematology, Oncology and Tumor Immunology, Charité University Medicine Berlin, Campus Virchow Hospital (CVK), Berlin, Germany
| | | | - Kien Vu Trung
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Gertraud Stocker
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Achim Aigner
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, Clinical Pharmacology, University of Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Maren Knödler
- University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany.
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectiology), Medical Center, University of Leipzig, Leipzig, Germany.
- Charité Comprehensive Cancer Center (CCCC), Charité University Medicine Berlin, Campus Charité Mitte (CCM), Virchowweg 23, 10117, Berlin, Germany.
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Lorenzen S, Schwarz A, Pauligk C, Goekkurt E, Stocker G, Knorrenschild JR, Illerhaus G, Dechow T, Moehler M, Moulin JC, Pink D, Stahl M, Schaaf M, Goetze TO, Al-Batran SE. Ramucirumab plus irinotecan / leucovorin / 5-FU versus ramucirumab plus paclitaxel in patients with advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction, who failed one prior line of palliative chemotherapy: the phase II/III RAMIRIS study (AIO-STO-0415). BMC Cancer 2023; 23:561. [PMID: 37337155 DOI: 10.1186/s12885-023-11004-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Paclitaxel in combination with ramucirumab is the standard of care second-line therapy in gastro-esophageal adenocarcinoma (GEA). As the number of taxane pretreated patients in the perioperative or first-line setting is increasing, it is unknown whether these patients benefit from re-applying a taxane in using the combination of paclitaxel and ramucirumab. Furthermore, the rates of neurotoxicity with first-line FOLFOX or FLOT range from 30%-70%, making second-line taxane-containing therapy less suitable to a meaningful portion of patients. This patient group is likely to benefit from a taxane-free second-line chemotherapy regimen, such as FOLFIRI and ramucirumab (FOLFIRI-Ram). Therefore, the RAMIRIS phase III trial evaluates the effects of the regimen of FOLFIRI-Ram in the second-line treatment after a taxane-based chemotherapy in patients with advanced GEA. METHODS The RAMIRIS trial is a randomized, open-label, multicenter phase II/III study comparing treatment of FOLFIRI-Ram (arm A) with paclitaxel and ramucirumab (arm B). The Phase II is already closed with 111 enrolled patients. In the phase III, 318 taxane-pretreated patients with advanced GEA will be recruited and randomized 1:1 to FOLFIRI (5-FU 2400 mg/m2 over 46 h i.v., irinotecan 180 mg/m2 i.v.; 5-FU 400 mg/m2 bolus; leucovorin 400 mg/m2 i.v.; on day 1 and 15, q28) with ramucirumab 8 mg/kg every two weeks (Arm A) or paclitaxel 80 mg/m2 (days 1, 8, 15, q28) with ramucirumab 8 mg/kg every two weeks (Arm B). The primary endpoints are overall survival (OS) and objective overall response rate (ORR). Secondary endpoints are progression-free survival (PFS), disease control rate and safety and quality of life as assessed by EORTC-QLQ-C30 questionnaire. DISCUSSION The already completed RAMIRIS phase II demonstrated feasibility and efficacy of FOLFIRI-Ram. Especially docetaxel-pretreated patients seemed to markedly benefit from FOLFIRI-Ram, with favorable response- and PFS rates and lower toxicity. This offers a rationale for the phase III trial. If the RAMIRIS III trial transfers and confirms the results, they will affect the current treatment guidelines, recommending the combination therapy of FOLFIRI-Ram for taxane-pretreated patients with advanced GEA. TRIAL REGISTRATION NCT03081143 Date of registration: 13.11.2015.
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Affiliation(s)
- Sylvie Lorenzen
- Klinikum rechts der Isar, Technische Universität München, III. Medizinische Klinik und Poliklinik, München, Germany.
| | - Alix Schwarz
- Klinikum rechts der Isar, Technische Universität München, III. Medizinische Klinik und Poliklinik, München, Germany
| | - Claudia Pauligk
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - Eray Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), und Universitäres Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - Gertraud Stocker
- Universitäres Krebszentrum Leipzig (UCCL), Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie - Bereich Onkologie Leipzig, Leipzig, Germany
| | - Jorge Riera Knorrenschild
- Universitätsklinikum Marburg, Klinik für Innere Medizin, Hämatologie, Onkologie und Immunologie, Marburg, Germany
| | - Gerald Illerhaus
- Klinikum Stuttgart, Klinik für Hämatologie, Onkologie und Palliativmedizin, Stuttgart, Germany
| | - Tobias Dechow
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Markus Moehler
- I. Department of Internal Medicine, University Cancer Center Mainz, Mainz, Germany
| | - Jean-Charles Moulin
- Ortenau Klinikum Lahr, Medizinische Klinik, Sektion Hämatologie/Onkologie, Lahr, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, and Klinik für Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad-Saarow, Bad Saarow, Germany
| | - Michael Stahl
- Evang. Kliniken Essen-Mitte, Klinik für Internistische Onkologie und Hämatologie, Essen, Germany
| | - Marina Schaaf
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - Thorsten Oliver Goetze
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
- University Cancer Center Frankfurt, Krankenhaus Nordwest, Institut für Klinisch-Onkologische Forschung, Frankfurt/Main, Germany
| | - Salah-Eddin Al-Batran
- Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Frankfurt/Main, Germany
- University Cancer Center Frankfurt, Krankenhaus Nordwest, Institut für Klinisch-Onkologische Forschung, Frankfurt/Main, Germany
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Stocker G, Lorenzen S, Ettrich T, Herz AL, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Larcher-Senn J, Keller G, Lordick F, Haag GM. S-1 maintenance therapy in Caucasian patients with metastatic esophagogastric adenocarcinoma-final results of the randomized AIO MATEO phase II trial. ESMO Open 2023; 8:101572. [PMID: 37270871 PMCID: PMC10373924 DOI: 10.1016/j.esmoop.2023.101572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Platinum-fluoropyrimidine combinations are standard of care for treatment of metastatic esophagogastric adenocarcinoma. The optimal duration of first-line chemotherapy is unknown, however, and maintenance strategies have not yet been established. DESIGN MATEO is an international randomized phase II trial exploring efficacy and safety of S-1 maintenance therapy in human epidermal growth factor receptor 2 (HER2)-negative advanced esophagogastric adenocarcinoma. After 3 months of first-line platinum-fluoropyrimidine-based induction therapy, patients without progression were randomized in a 2 : 1 allocation to receive S-1 monotherapy (arm A) or to continue combination chemotherapy (arm B). The primary objective was to show non-inferiority of overall survival in the S-1 maintenance group. Progression-free survival, adverse events, and quality of life were secondary endpoints. RESULTS From 2014 to 2019, 110 and 55 patients were randomized in arm A and arm B, respectively (recruitment closed prematurely). Median overall survival from randomization was 13.4 months for arm A and 11.4 months for arm B [hazard ratio 0.97 (80% confidence interval 0.76-1.23), P = 0.86]. Median progression-free survival from randomization was 4.3 and 6.1 months for arm A versus arm B, respectively [hazard ratio 1.10 (80% confidence interval 0.86-1.39), P = 0.62]. Patients in arm A had numerically fewer treatment-related adverse events (84.9% versus 93.9%) and significantly less peripheral sensory polyneuropathy ≥grade 2 (9.4% versus 36.7%). CONCLUSIONS S-1 maintenance following platinum-based induction therapy leads to non-inferior survival outcomes compared with the continuation of platinum-based combination. Toxicity patterns favor a fluoropyrimidine maintenance strategy. These data challenge the continued use of platinum combination chemotherapy after response to 3 months induction therapy in patients with advanced human epidermal growth factor receptor 2-negative esophagogastric adenocarcinoma.
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Affiliation(s)
- G Stocker
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - S Lorenzen
- Clinic and Policlinic for Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - T Ettrich
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - A-L Herz
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Longo
- Ramon y Cajal University Hospital, IRYCIS, CIBERONC, Madrid, Spain
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - J Trojan
- Medical Clinic 1, Goethe University Hospital, Frankfurt am Main, Germany
| | - R Mahlberg
- Department of Internal Medicine I, Klinikum Mutterhaus der Borromaerinnen, Trier, Germany
| | - N Moosmann
- Department of Hematology and Oncology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - B Chibaudel
- Department of Medical Oncology, Franco-British Hospital, Fondation Cognacq-Jay, Levallois-Perret, France
| | - S Kubicka
- Cancer Center Reutlingen, Reutlingen, Germany
| | - R Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - S Daum
- Department of Gastroenterology, Campus B. Franklin, Charité - Universitätsmedizin, Berlin, Germany
| | | | - J Larcher-Senn
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - G Keller
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Lordick
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - G M Haag
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor-Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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7
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Schröder J, Chegwidden L, Maj C, Gehlen J, Speller J, Böhmer AC, Borisov O, Hess T, Kreuser N, Venerito M, Alakus H, May A, Gerges C, Schmidt T, Thieme R, Heider D, Hillmer AM, Reingruber J, Lyros O, Dietrich A, Hoffmeister A, Mehdorn M, Lordick F, Stocker G, Hohaus M, Reim D, Kandler J, Müller M, Ebigbo A, Fuchs C, Bruns CJ, Hölscher AH, Lang H, Grimminger PP, Dakkak D, Vashist Y, May S, Görg S, Franke A, Ellinghaus D, Galavotti S, Veits L, Weismüller J, Dommermuth J, Benner U, Rösch T, Messmann H, Schumacher B, Neuhaus H, Schmidt C, Wissinowski TT, Nöthen MM, Dong J, Ong JS, Buas MF, Thrift AP, Vaughan TL, Tomlinson I, Whiteman DC, Fitzgerald RC, Jankowski J, Vieth M, Mayr A, Gharahkhani P, MacGregor S, Gockel I, Palles C, Schumacher J. GWAS meta-analysis of 16 790 patients with Barrett's oesophagus and oesophageal adenocarcinoma identifies 16 novel genetic risk loci and provides insights into disease aetiology beyond the single marker level. Gut 2023; 72:612-623. [PMID: 35882562 DOI: 10.1136/gutjnl-2021-326698] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/07/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Oesophageal cancer (EC) is the sixth leading cause of cancer-related deaths. Oesophageal adenocarcinoma (EA), with Barrett's oesophagus (BE) as a precursor lesion, is the most prevalent EC subtype in the Western world. This study aims to contribute to better understand the genetic causes of BE/EA by leveraging genome wide association studies (GWAS), genetic correlation analyses and polygenic risk modelling. DESIGN We combined data from previous GWAS with new cohorts, increasing the sample size to 16 790 BE/EA cases and 32 476 controls. We also carried out a transcriptome wide association study (TWAS) using expression data from disease-relevant tissues to identify BE/EA candidate genes. To investigate the relationship with reported BE/EA risk factors, a linkage disequilibrium score regression (LDSR) analysis was performed. BE/EA risk models were developed combining clinical/lifestyle risk factors with polygenic risk scores (PRS) derived from the GWAS meta-analysis. RESULTS The GWAS meta-analysis identified 27 BE and/or EA risk loci, 11 of which were novel. The TWAS identified promising BE/EA candidate genes at seven GWAS loci and at five additional risk loci. The LDSR analysis led to the identification of novel genetic correlations and pointed to differences in BE and EA aetiology. Gastro-oesophageal reflux disease appeared to contribute stronger to the metaplastic BE transformation than to EA development. Finally, combining PRS with BE/EA risk factors improved the performance of the risk models. CONCLUSION Our findings provide further insights into BE/EA aetiology and its relationship to risk factors. The results lay the foundation for future follow-up studies to identify underlying disease mechanisms and improving risk prediction.
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Affiliation(s)
- Julia Schröder
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Laura Chegwidden
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Carlo Maj
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Jan Gehlen
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Jan Speller
- Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), Medical Faculty, University of Bonn, Bonn, Germany
| | - Anne C Böhmer
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Oleg Borisov
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Timo Hess
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Nicole Kreuser
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Andrea May
- Department of Gastroenterology, Oncology and Pneumology, Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - Christian Gerges
- Department of Internal Medicine II, Evangelisches Krankenhaus Dusseldorf, Dusseldorf, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Rene Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - Axel M Hillmer
- Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Germany
| | - Julian Reingruber
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Arne Dietrich
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Gertraud Stocker
- University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Michael Hohaus
- Department for General and Visceral Surgery, Städt. Klinikum Dresden Friedrichstadt, Dresden, Germany
| | - Daniel Reim
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, München, Germany
| | - Jennis Kandler
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty of Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Michaela Müller
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University, Marburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Claudia Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Arnulf H Hölscher
- Department for General, Visceral and Trauma Surgery, Elisabeth-Krankenhaus-Essen GmbH, Essen, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Dani Dakkak
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | | | - Sandra May
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Siegfried Görg
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck/Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sara Galavotti
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lothar Veits
- Institute of Pathology, Friedrich-Alexander-Universiät Erlangen-Nürnberg, Klinikum Bayreuth, Bayreuth, Germany
| | | | | | - Udo Benner
- Gastroenterologische Gemeinschaftspraxis, Koblenz, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Brigitte Schumacher
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - Horst Neuhaus
- Department of Internal Medicine II, Evangelisches Krankenhaus Dusseldorf, Dusseldorf, Germany
| | - Carsten Schmidt
- Medical Clinic II (Gastroenterology, Hepatology, Endocrinology, Diabetology and Infektiology), Klinikum Fulda, University Medicine Marburg-Campus Fulda, Fulda, Germany
- Medical Faculty, Friedrich Schiller University Jena, Jena, Germany
| | | | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Jing Dong
- Division of Hematology and Oncology, Department of Medicine, Cancer Center, and Genomic Sciences & Precision Medicine Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jue-Sheng Ong
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Matthew F Buas
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas L Vaughan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ian Tomlinson
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, UK
| | - David C Whiteman
- Cancer Control, Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rebecca Claire Fitzgerald
- Medical Research Council (MRC) Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Janusz Jankowski
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-Universiät Erlangen-Nürnberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Andreas Mayr
- Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), Medical Faculty, University of Bonn, Bonn, Germany
| | - Puya Gharahkhani
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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8
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Ebert MP, Meindl-Beinker NM, Gutting T, Maenz M, Betge J, Schulte N, Zhan T, Weidner P, Burgermeister E, Hofheinz R, Vogel A, Angermeier S, Bolling C, de Wit M, Jakobs R, Karthaus M, Stocker G, Thuss-Patience P, Leidig T, Gaiser T, Kather JN, Haertel N. Second-line therapy with nivolumab plus ipilimumab for older patients with oesophageal squamous cell cancer (RAMONA): a multicentre, open-label phase 2 trial. Lancet Healthy Longev 2022; 3:e417-e427. [PMID: 36098320 DOI: 10.1016/s2666-7568(22)00116-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The overall survival of patients with advanced and refractory oesophageal squamous cell carcinoma, mostly aged 65 years and older, is poor. Treatment with PD-1 antibodies showed improved progression-free survival and overall survival. We assessed the safety and efficacy of combined nivolumab and ipilimumab therapy in this population. METHODS This multicentre, open-label, phase 2 trial done in 32 sites in Germany included patients aged 65 years and older with oesophageal squamous cell carcinoma and disease progression or recurrence following first-line therapy. Patients were treated with nivolumab (240 mg fixed dose once every 2 weeks, intravenously) in the safety run-in phase and continued with nivolumab and ipilimumab (nivolumab 240 mg fixed dose once every 2 weeks and ipilimumab 1 mg/kg once every 6 weeks, intravenously). The primary endpoint was overall survival, which was compared with a historical cohort receiving standard chemotherapy in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03416244. FINDINGS Between March 2, 2018, and Aug 20, 2020, we screened 75 patients with advanced oesophageal squamous cell carcinoma. We enrolled 66 patients (50 [76%] men and 16 [24%] women; median age 70·5 years [IQR 67·0-76·0]), 44 (67%) of whom received combined nivolumab and ipilimumab therapy and 22 (33%) received nivolumab alone. Median overall survival time at the prespecified data cutoff was 7·2 months (95% CI 5·7-12·4) and significantly higher than in a historical cohort receiving standard chemotherapy (p=0·0063). The most common treatment-related adverse events were fatigue (12 [29%] of 42), nausea (11 [26%]), and diarrhoea (ten [24%]). Grade 3-5 treatment-related adverse events occurred in 13 (20%) of 66 patients. Treatment-related death occurred in one patient with bronchiolitis obliterans while on nivolumab and ipilimumab treatment. INTERPRETATION Patients aged at least 65 years, with advanced oesophageal squamous cell carcinoma might benefit from combined nivolumab and ipilimumab therapy in second-line treatment. FUNDING Bristol Myers Squibb.
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Affiliation(s)
- Matthias P Ebert
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany.
| | - Nadja M Meindl-Beinker
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Gutting
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Johannes Betge
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany; Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, German Cancer Research Center, Heidelberg, Germany
| | - Nadine Schulte
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tianzuo Zhan
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philip Weidner
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Elke Burgermeister
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf Hofheinz
- Interdisciplinary Tumor Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology und Endocrinology, Hannover Medical School, Hannover, Germany
| | - Stefan Angermeier
- Department of Internal Medicine I, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Claus Bolling
- Department of Internal Medicine, Agaplesion Markus Krankenhaus Frankfurt, Diakonie Kliniken, Frankfurt, Germany
| | - Maike de Wit
- Department of Internal Medicine, Hematology, Oncology and Palliative Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Ralf Jakobs
- Department of Medicine C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology and Palliative Care, Klinikum Neuperlach, Munich, Germany
| | - Gertraud Stocker
- University Cancer Center, University Medicine Leipzig, Leipzig, Germany
| | - Peter Thuss-Patience
- Department of Hematology, Medical Oncology and Tumor Immunology, Charité Universitätsmedizin, Berlin, Germany
| | | | - Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jakob N Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Nicolai Haertel
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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9
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Thuss-Patience PC, Högner A, Goekkurt E, Stahl M, Kretzschmar A, Schädlich B, Goetze TO, Stocker G, Reichardt P, Kullmann F, Pink D, Bartels P, Ballhausen A, Jarosch A, Hinke A, Binder M, Stein A. Ramucirumab, avelumab, and paclitaxel (RAP) as second-line treatment in gastro-esophageal adenocarcinoma, a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie (AIO). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4051] [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
4051 Background: Combination of ramucirumab and paclitaxel is a standard second line therapy in gastro-esophageal adenocarcinoma (GEAC) (RAINBOW trial, Wilke et al., 2014). We integrated the PD-L1 inhibitor avelumab into this regimen aiming for synergistic efficacy. Methods: In a multicenter phase II trial (NCT03966118) pts with metastatic GEAC, after progression on platinum / fluoropyrimidine based palliative 1st-line, ECOG 0 or 1, were treated with ramucirumab 8 mg/kg (d1,15) + avelumab 10 mg/kg (d1,15) + paclitaxel 80 mg/m² (d1,8,15), q4w. Sample size calculation was based on a Simon 2-stage design with overall survival rate at 6 months as the primary endpoint (H0≤50%, H1≥65%). Results: 60 pts were enrolled, 59 were evaluable (ITT), median age 64.0 yrs (range 18-81), male 80%, female 20%, primary gastric 52%, GEJ 48%, histology intestinal 59.6%, diffuse 24.6%, mixed 15.8%. Previous treatment with platin/fluoropyrimidine 100%, previous taxanes 66%. At central pathology MSI-H 7%, PD-L1 CPS < 5: 54%; ≥5: 41%, NA 5%. Response by investigator (%) CR 3.4, PR 27.1, SD 49.2, PD 20.3; DCR 79.7%, independent radiology review will be presented. DOR: 8.2 mo (95%CI 6.7-9.7), PFS 5.4 mo (95%CI 4.2-6.6); 6-mo OS rate 71.2%; 12-mo OS rate 45.8%; med OS (ITT) 10.6 mo (95%CI 8.2-13.1), med OS CPS < 5: 9.4 mo (95%CI 7.2-11.2), CPS ≥5: 14.0 mo (95%CI 12.8-15.3), translational data (ct-DNA) will be analysed. Treatment was generally well tolerated and no unexpected toxicities occurred: Grade 3/4 AE above 5%: anemia 5%, leucopenia 12%, neutropenia 22%, diarrhea 5%, pain 10%, peripheral neuropathy 10%, hypertension 5%, non-neutropenic infection 5% including 1 CTC grade 5 due to an esophago-tracheal fistula. Conclusions: The med OS of 10.6 mo (in a population of 66% pretreated with taxanes) compares very favourably to 8.6 mo in the Western population RAINBOW trial (Shitara et al., 2016) and 7.6 mo in the RAMIRIS trial (Lorenzen et al., 2022). PD-L1 CPS≥ 5 seems to predict for an even better efficacy (med OS 14.0 mo). Second-line RAP is a very efficacious and well tolerated combination. Clinical trial information: NCT03966118.
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Affiliation(s)
- Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Berlin, Germany
| | - Anica Högner
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Berlin, Germany
| | - Eray Goekkurt
- Practice of Hematology and Oncology (HOPE), Hamburg, Germany
| | - Michael Stahl
- Evang. Kliniken Essen-Mitte, Klinik für Internistische Onkologie und Hämatologie, Essen, Germany
| | | | - Bärbel Schädlich
- Practice for Hematology and Oncology, MVZ Mitte, Leipzig, Germany
| | | | | | - Peter Reichardt
- Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Frank Kullmann
- Department of Medicine I, Hospital Weiden, Weiden I.d.O., Germany
| | - Daniel Pink
- Sarcoma Center Berlin-Brandenburg, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - Prisca Bartels
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Berlin, Germany
| | - Alexej Ballhausen
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Berlin, Germany
| | - Armin Jarosch
- Charité - University Medicine Berlin, Institute of Pathology, Berlin, Germany
| | - Axel Hinke
- CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - Mascha Binder
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Alexander Stein
- Hematology Oncology Practice Eppendorf and University Cancer Center Hamburg (UCCH), Hamburg, Germany
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10
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Ebert MP, Meindl-Beinker NM, Gutting T, Maenz M, Betge J, Schulte N, Zhan T, Weidner P, Hofheinz RD, Vogel A, Angermeier S, de Wit M, Jakobs R, Karthaus M, Stocker G, Thuss-Patience PC, Leidig T, Haertel N. Nivolumab plus ipilimumab in second-line combination therapy for older patients with esophageal squamous cell cancer (AIO-STO-0117 trial). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.303] [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
303 Background: Overall survival of patients with advanced and refractory esophageal squamous cell carcinoma (ESCC) is poor. Most patients are 65 years or older, present with advanced and metastatic disease and suffer from extensive co-morbidity and decreased functionality. While approved therapies beyond first-line therapy have not been available for decades, just recently treatment with PD-1 antibodies has shown to improve progression-free and overall survival in this patient cohort. Thus, we assessed the combination of nivolumab and ipilimumab in this vulnerable and older patient population. Methods: In this multi-center, open-label phase II trial older patients with ESCC with progression or recurrence of disease following first-line therapy were treated with nivolumab and ipilimumab. Patients had to pass a brief geriatric assessment using the G8 screening tool in combination with the Deficit Accumulation Frailty Index (DAFI). A safety run–in phase was initiated with nivolumab (240mg fixed dose Q2W). Following a safety assessment, patients then went on to receive the combination therapy of nivolumab/ipilimumab (nivolumab 240 mg fixed dose Q2W; ipilimumab 1 mg/kg Q6W), in case safety was critical patients were allowed to continue with nivolumab monotherapy. The primary outcome was overall survival. Progression-free survival, quality of life and adverse events were also assessed. Results: In total 66 evaluable patients (16 female, 50 male) with ESCC were enrolled in this trial after successful geriatric assessment, median age was 70.5 years (range 55-84 years). 44 patients were treated with the combination therapy of nivolumab and ipilimumab, 22 patients with nivolumab only. The primary endpoint was met with a median OS of 7.2 months (95% CI, 5.7 to 12.4 months) (p < 0.006; versus historical control treated with standard chemotherapy). Median PFS was 2.7 months (95% CI, 2.5 to 2.9 months). ORR was 18.2% (95% CI, 9.8 to 29.6), all cases were partial responses. Grade 3 or more treatment related adverse events were observed in ̃25% of patients. Conclusions: The combination therapy of nivolumab and ipilimumab demonstrates improved overall survival and sustained confirmed responses in the second line therapy of older European patients with ESCC. Geriatric assessment is feasible in the setting of a prospective immune therapy trial. Overall, the RAMONA trial confirmed efficacy and safety of combination checkpoint inhibitor therapy in G8 prescreened older patients with ESCC in Europe beyond first line therapy. Clinical trial information: NCT03416244.
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Affiliation(s)
- Matthias Philip Ebert
- Department of Medicine II, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nadja M Meindl-Beinker
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Gutting
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Johannes Betge
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nadine Schulte
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tianzuo Zhan
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philip Weidner
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf-Dieter Hofheinz
- Interdisciplinary Tumor Center Mannheim, University Medical Centre Mannheim, University Heidelberg, Mannheim, Germany
| | | | | | | | - Ralf Jakobs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Meinolf Karthaus
- Hematology, Oncology, and Palliative Medicine, Klinikum Neuperlach and Harlaching, Munich, Germany
| | | | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Berlin, Germany
| | | | - Nicolai Haertel
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Hartel N, Meindl-Beinker NM, Maenz M, Hiegl W, Betge J, Hofheinz RD, Vogel A, Angermeier S, Bolling C, de Wit M, Jakobs R, Karthaus M, Stocker G, Thuss-Patience PC, Ebert MP. Nivolumab and ipilimumab for second-line therapy in elderly patients with advanced esophageal squamous cell cancer: Safety interim analysis of the RAMONA trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4029] [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
4029 Background: Advanced esophageal squamous cell cancer (ESCC) is frequently diagnosed in elderly patients (pts) with additional comorbidities. Limited treatment options are available. We report the safety interim analysis of a phase II clinical trial evaluating nivolumab and ipilimumab as second-line therapy for advanced ESCC in elderly pts. Methods: RAMONA is a multicenter open-label phase II trial assessing nivolumab/ipilimumab combination therapy in elderly pts (≥65 years). The geriatric status of the pts was assessed using the G8 screening tool and the Deficit Accumulation Frailty Index (DAFI). After a run-in phase of 3 cycles nivolumab (240mg Q2W), cohort assignment was based on a safety assessment. Pts with toxicities grade ≤2 were considered eligible for escalation to nivolumab (240mg Q2W)/ipilimumab (1mg/kg Q6W) combination therapy (cohort B). Other pts remained on nivolumab monotherapy (cohort A). Primary endpoint is overall survival (OS). Key secondary endpoint is time to Quality of Life deterioration defined as a loss of ≥ 10 points in the EORTC QLQ-C30 compared to baseline. Adverse events were assessed according to NCI-CTCAE version 4.03. Results: From February 2018 until February 2020, 69 pts entered the study. 61 pts were eligible for safety interim analysis. Median age of the pts was 71.9 yrs (± 5.4), median KPS score was 80% (50-100%). In 73.8% of the pts, metastases were detected at the time of study inclusion. Most pts received the IO therapy in ≥ 2nd line (91.8%). The mean G8-score at screening was 11.9 points (46 pts ≤ 14 points, 75.4%) (mean DAFI: 0.19). Based on safety assessment, 42 pts were escalated to nivolumab/ipilimumab, while 9 pts remained on nivolumab monotherapy. 10 pts were not allocated at the time of analysis. Median numbers of cumulative doses were 3.0 [1.0 - 3.0] for the run-in phase (nivolumab), 6.0 [1.0 – 48.0] for nivolumab therapy (cohort A/B) and 2.5 [1.0 – 16.0] for ipilimumab (cohort B). Median treatment duration was 144.5 days (56-781 days) in cohort A and 231 days (85-484 days) in cohort B. Frailty indices remained stable after 3 cycles of nivolumab with limited toxicity at the time of the safety assessment. Drug-related treatment emergent adverse events (AEs) were observed in 42 pts (68.9%); 29/42 in cohort A, 8/9 in cohort B, and 5/10 pts not allocated at the time of analysis. Grade ≥3 AEs were detected in 9 pts of 42 in cohort A and 4 of 9 pts in cohort B. Drug-related treatment emergent serious adverse events (SAEs) were detected in 12 pts (19.7%); 8/42 in cohort A, 2/9 pts in cohort B, and 2/10 pts not yet allocated. Conclusions: Combined nivolumab/ipilimumab is a safe and feasible second-line therapy for elderly pts with advanced ESCC. Most pts could be escalated to nivolumab/ipilimumab. Treatment duration was exceptional long for a subset of pts. Clinical trial information: NCT03416244.
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Affiliation(s)
| | | | | | | | - Johannes Betge
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf Dieter Hofheinz
- Department of Medicine III, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | | | | | | | | | - Ralf Jakobs
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Meinolf Karthaus
- Hematology, Oncology, and Palliative Medicine, Klinikum Neuperlach and Harlaching, Munich, Germany
| | | | - Peter C. Thuss-Patience
- Charité–University Medicine Berlin, Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Berlin, Germany
| | - Matthias Philip Ebert
- Department of Medicine II, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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12
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Schaudinn A, Hudak A, Linder N, Reinhardt M, Stocker G, Lordick F, Denecke T, Busse H. Toward a Routine Assessment of Visceral Adipose Tissue Volume from Computed Tomographic Data. Obesity (Silver Spring) 2021; 29:294-301. [PMID: 33369246 DOI: 10.1002/oby.23061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/14/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study's aim was to determine to what extent total visceral adipose tissue (VAT) volume (VVAT-T ) measured from segmented VAT areas (AVAT ) on all axial computed tomography (CT) sections (thickness of 5 mm) between the diaphragm and pelvic floor can be predicted by the AVAT of commonly selected landmark sections in patients with overweight or obesity. METHODS A total of 113 patients (31 females, 82 males) with images of full abdominopelvic coverage and proper image quality were included (BMI = 25.0-64.1 kg/m2 , 29.5 ± 4.9 kg/m2 ). Linear regression between AVAT and VVAT-T (reference) was used to determine approximate equations for VAT volume for all parameters (single sex, different anatomical landmarks or lumbar intervertebral disc spaces, one or five axial sections). Agreement was evaluated by the multivariate coefficient of determination and by the SD of the percentage difference (sd% ) between the estimated VAT volume on one or five sections and VVAT-T . RESULTS The VVAT-T was 0.9 to 8.4 (3.8 ± 2.2) L for females and 2.7 to 11.7 (5.6 ± 2.1) L for males. Best agreement was found at L2-3 (sd% = 14.3%-15.5%) for females and at L1-2 or L2-3 (11.7%-12.4%) for males. Agreement at the umbilicus or the femoral heads was poor (20.2%-57.9%). Segmentation of one or five sections was substantially faster (11/70 seconds) than whole-abdomen processing (15 minutes). CONCLUSIONS VVAT-T can be rapidly estimated by VAT segmentation of axial CT sections at sex-specific lumbar intervertebral disc spaces.
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Affiliation(s)
- Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Andrea Hudak
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Nicolas Linder
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
- Integrated Research and Treatment Center, Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Martin Reinhardt
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Gertraud Stocker
- Leipzig University Cancer Center, Leipzig University Hospital, Leipzig, Germany
| | - Florian Lordick
- Leipzig University Cancer Center, Leipzig University Hospital, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
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Haag G, Stocker G, Lorenzen S, Ettrich T, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Mann J, Lordick F. 1447P S-1 maintenance therapy in non-Asian patients with advanced, Her-2 negative esophagogastric adenocarcinoma – First results of the international MATEO trial initiated by the AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Hacker UT, Hasenclever D, Linder N, Stocker G, Chung HC, Kang YK, Moehler M, Busse H, Lordick F. Prognostic role of body composition parameters in gastric/gastroesophageal junction cancer patients from the EXPAND trial. J Cachexia Sarcopenia Muscle 2020; 11:135-144. [PMID: 31464089 PMCID: PMC7015239 DOI: 10.1002/jcsm.12484] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/29/2019] [Accepted: 07/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Body fat and/or muscle composition influences prognosis in several cancer types. For advanced gastric and gastroesophageal junction cancer, we investigated which body composition parameters carry prognostic information beyond well-established clinical parameters using robust model selection strategy such that parameters identified can be expected to generalize and to be reproducible beyond our particular data set. Then we modelled how differences in these parameters translate into survival outcomes. METHODS Fat and muscle parameters were measured on baseline computed tomography scans in 761 patients with advanced gastric or gastroesophageal junction cancer from the phase III EXPAND trial, undergoing first-line chemotherapy. Cox regression analysis for overall survival (OS) and progression-free survival (PFS) included body composition parameters and clinical prognostic factors. All continuous variables were entered linearly into the model as there was no evidence of non-linear prognostic impact. For transferability, the final model included only parameters that were picked by Bayesian information criterion model selection followed by bootstrap analysis to identify the most robust model. RESULTS Muscle and fat parameters formed correlation clusters without relevant between-cluster correlation. Mean muscle attenuation (MA) clusters with the fat parameters. In multivariate analysis, MA was prognostic for OS (P < 0.0001) but not for PFS, while skeletal muscle index was prognostic for PFS (P = 0.02) but not for OS. Worse performance status Eastern Cooperative Oncology Group (ECOG 1/0), younger age (on a linear scale), and the number of metastatic sites were strong negative clinical prognostic factors for both OS and PFS. MA remained in the model for OS (P = 0.0001) following Bayesian information criterion model selection in contrast to skeletal muscle index that remained prognostic for PFS (P = 0.009). Applying stricter criteria for transferability, MA represented the only prognostic body composition parameter for OS, selected in >80% of bootstrap replicates. Finally, Cox model-derived survival curves indicated that large differences in MA translate into only moderate differences in expected OS in this cohort. CONCLUSIONS Among body composition parameters, only MA has robust prognostic impact for OS. Data suggest that treatment approaches targeting muscle quality are unlikely to prolong OS noticeably on their own in advanced gastric cancer patients, indicating that multimodal approaches should be pursued in the future.
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Affiliation(s)
- Ulrich T Hacker
- 1st Medical Department, University Cancer Center Leipzig (UCCL), University Leipzig Medical Center, Leipzig, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Medical Faculty of the University Leipzig, Leipzig, Germany
| | - Nicolas Linder
- Department of Radiology, University Leipzig Medical Center, Leipzig, Germany
| | - Gertraud Stocker
- 1st Medical Department, University Cancer Center Leipzig (UCCL), University Leipzig Medical Center, Leipzig, Germany
| | - Hyun-Cheol Chung
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon-Koo Kang
- Division Oncology Department, Medical Center, Seoul, South Korea
| | - Markus Moehler
- First Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Harald Busse
- Department of Radiology, University Leipzig Medical Center, Leipzig, Germany
| | - Florian Lordick
- 1st Medical Department, University Cancer Center Leipzig (UCCL), University Leipzig Medical Center, Leipzig, Germany
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15
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Haag GM, Stocker G, Quidde J, Jaeger D, Lordick F. Randomized controlled trial of S-1 maintenance therapy in metastatic esophagogastric cancer - the multinational MATEO study. BMC Cancer 2017; 17:509. [PMID: 28760152 PMCID: PMC5537937 DOI: 10.1186/s12885-017-3497-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The optimal duration of firstline chemotherapy in metastatic esophagogastric cancer is unknown. In most clinical trials therapy was given until tumour progression or limiting toxicity. Maintenance concepts aiming to prolong the duration of response and maintain quality of life have been established in other tumour types but not in esophagogastric cancer. S-1 is an oral fluoropyrimidine with proven efficacy in metastatic esophagogastric cancer. METHODS The Maintenance Teysuno® (S-1) in esophagogastric cancer (MATEO) trial is a multinational, randomized phase II study that explores the role of S-1 maintenance therapy in Her-2 negative, advanced esophagogastric adenocarcinoma. After a 12-week firstline platinum-fluoropyrimidine-based chemotherapy patients without tumour progression are randomized in a 2:1 allocation to receive S-1 alone or continue with the same regimen as during the primary period. The primary endpoint is overall survival. Secondary endpoints include safety and toxicity, progression-free survival and quality of life. Correlative biomarker analyses focus on the identification of a subgroup of patients with a prolonged benefit from S-1 based maintenance therapy. DISCUSSION MATEO will be the first trial to define the role of a S-1 based maintenance therapy in patients having received a platinum-based firstline chemotherapy. TRIAL REGISTRATION NCT02128243 (date of registration: 29-04-2014).
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Affiliation(s)
- Georg-Martin Haag
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany.
| | - Gertraud Stocker
- University Cancer Center Leipzig (UCCL), University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany
| | - Julia Quidde
- II. Department of Internal Medicine (Oncology/Haematology), University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Dirk Jaeger
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany
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16
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Schaudinn A, Linder N, Hudak A, Stange R, Garnov N, Stocker G, Hacker U, Kahn T, Busse H. Semi-automatische Software zur zeiteffizienten CT-basierten Quantifizierung des abdominellen Fettgewebes. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600184] [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: 10/19/2022]
Affiliation(s)
- A Schaudinn
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - N Linder
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - A Hudak
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - R Stange
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - N Garnov
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - G Stocker
- Universitätsklinikum Leipzig, Universitäts Krebszentrum Leipzig, Leipzig
| | - U Hacker
- Universitätsklinikum Leipzig, Universitäts Krebszentrum Leipzig, Leipzig
| | - T Kahn
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - H Busse
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
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17
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Haag G, Stocker G, Quidde J, Jaeger D, Lordick F. Randomized controlled phase II trial of S-1 maintenance therapy in Caucasian population with metastatic esophagogastric cancer– the multinational MATEO study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Lorenzen S, Riera-Knorrenschild J, Haag GM, Pohl M, Thuss-Patience PC, Bassermann F, Helbig U, Weissinger F, Schnoy E, Becker K, Stocker G, Ruschoff J, Eisenmenger A, Karapanagiotou-Schenkel I, Lordick F. Lapatinib versus lapatinib plus capecitabine as second-line treatment in HER-2-overexpressing metastatic gastro-esophageal cancer (GC): A randomized phase II trial of the Arbeitsgemeinschaft Internistische Onkologie (AIO). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.112] [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
112 Background: HER2 amplification is present in a subgroup of gastroesophageal cancers (GCs). HER2 inhibition with trastuzumab has shown to improve outcomes in advanced disease. Lapatinib ditosylate (LAP), a dual anti-EGFR and anti-HER2 tyrosine kinase inhibitor with preclinical activity against GC, has been approved in HER2-positive breast cancer. We aimed to study the activity of LAP in HER2-amplified GC. Methods: Patients (pts) with HER2-positive (gene amplification or increased copy numbers based on predefined criteria) advanced GC were randomly allocated 1:1 to receive LAP 1250 mg per day 1-21 plus capecitabine (CAP) 2000mg/m² on days 1-14 of a 21-day cycle or LAP 1500 mg monotherapy day 1-21 after having failed on a platinum-based first-line therapy. HER2 status was assessed centrally. The primary endpoint was the objective response rate (ORR) as assessed by the investigator using RECIST 1.1 criteria. We aimed to include 38 pts per arm to show a response rate of >20% in either of the two arms. Results: 37 pts were enrolled (18 to LAP+CAP, 19 to LAP). Pts had received a median of three prior treatment lines, however, the treatment was intended to be tested as a second-line treatment. 12 pts in the LAP+CAP group (67%) and 12 pts in the LAP group (63%) had received prior trastuzumab. Only two pts (11.1%; 95% CI: 1.37 – 34.7), both in the LAP+CAP arm, achieved an objective response. The study was closed prematurely for futility. Median time to progression was 42 (95% CI: 38 to 61) days in the LAP group and 83 (95% CI: 42 to 86) days in the LAP+CAP group. Other secondary efficacy endpoints (progression-free and overall survival) were comparable in the two treatment groups. Rates of diarrhea were higher with LAP+CAP (61%; 95% CI: 35 to 83) compared to 26% (95%CI 9 to 51) with LAP mono, whereas other adverse events were mostly similar between the groups (18 [100%] vs. 17 [90%]). Conclusions: Lapatinib showed insufficient activity in HER2-amplified pretreated advanced GC. The safety profile of LAP or LAP+CAP was as expected with some more toxicity in the combination arm. Clinical trial information: NCT01145404.
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Affiliation(s)
- Sylvie Lorenzen
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | - Michael Pohl
- Department of Medicine, Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | | | - Florian Bassermann
- Third Department of Internal Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulrike Helbig
- Klinikum Braunschweig Medizinische Klinik III, Hämatologie und Onkologie, Braunschweig, Germany
| | - Florian Weissinger
- Department of Medicine, Hematology, Oncology and Palliative Care, Evangelisches Krankenhaus, Bielefeld, Germany
| | - Elisabeth Schnoy
- Department of Internal Medicine, University Hospital Regensburg, Germany, Regensburg, Germany
| | - Klaus Becker
- Onkologische Praxis Hamburg-Lerchenfeld, Hamburg, Germany
| | | | - Josef Ruschoff
- Institut für Pathologie Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany
| | | | | | - Florian Lordick
- Universitätsklinikum Leipzig, Universitäres Krebszentrum, Leipzig, Germany
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Cella CA, Arcopinto M, Lordick F, Carlomagno C, Matano E, Muehlberg K, Bruzzese D, Moretto R, Attademo L, Raimondo L, Schloegl H, De Stefano A, Knoedler M, Stocker G, Gabrecht M, De Placido S. Risk factors for cancer-related venous thromboembolism in ambulatory patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20625] [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)
| | - Michele Arcopinto
- Department of Translational Medical Science Federico II University, Naples, Italy
| | - Florian Lordick
- Universitätsklinikum Leipzig, Universitäres Krebszentrum (UCCL), Leipzig, Germany
| | - Chiara Carlomagno
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | - Elide Matano
- Department of Clinical Oncology and Endocrinology and Rare Tumors Reference Center Campania Region, University Federico II, Naples, Italy
| | | | | | | | | | | | | | - Alfonso De Stefano
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
| | - Maren Knoedler
- Comprehensive Cancer Center, University Leipzig, Leipzig, Germany
| | | | | | - Sabino De Placido
- Medical Oncology, Endocrinology and Oncology Department, University Federico II of Napoli, Naples, Italy
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20
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Stocker G, Ott K, Henningsen N, Becker K, Hapfelmeier A, Lordick F, Hois S, Plaschke S, Höfler H, Keller G. CyclinD1 and interleukin-1 receptor antagonist polymorphisms are associated with prognosis in neoadjuvant-treated gastric carcinoma. Eur J Cancer 2009; 45:3326-35. [PMID: 19822419 DOI: 10.1016/j.ejca.2009.09.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/28/2009] [Accepted: 09/17/2009] [Indexed: 12/12/2022]
Abstract
PURPOSE We evaluated DNA polymorphisms in genes related to DNA repair, cell-cycle control and tumour microenvironment to determine possible associations with response and survival in neoadjuvant-treated gastric cancer patients. PATIENTS AND METHODS One hundred and seventy eight patients who received platinum/5FU-based chemotherapy were genotyped for 10 polymorphisms in nine genes (ERCC1: Asn118Asn, C > T; ERCC1: 8092C > A; TP53: Arg72Pro, G < C; cyclinD1: Pro241Pro, G > A; STK15: Phe31Ile, A > T; VEGF: 936C > T; TNF-alpha: -308G > A; interleukin-1b (IL-1B): -511C >T; IL-1 receptor antagonist (IL-1RN): variable tandem repeat; IL-8: -251T>A). Genotypes were correlated with histopathological and clinical response and overall (OS) and progression-free survival (PFS). RESULTS Only the cyclinD1 genotypes were associated with clinical response (P(x)(2)=0.044). Significantly worse survival rates were noted in patients homozygous for the G-allele as compared to patients with the AG or AA genotypes of the cyclinD1 polymorphism (OS: P(log-rank) = 0.024; PFS: P(log-rank)=0.007) and in patients homozygous for the short allele compared to all other genotypes at the IL-1RN polymorphic locus (OS: P(log-rank) = 0.026; PFS: P(log-rank) = 0.013). The combination of both unfavourable genotypes demonstrated strong prognostic relevance (OS: P(log-rank) = 0.006; PFS: P(log-rank) = 0.001). Multivariate analysis for OS in the group of completely resected patients (n = 139) revealed statistical significance for ypM (P < 0.001), histopathological response (P < 0.001) and the combined cyclinD1/IL-1RN genotypes (P = 0.043). CONCLUSION The cyclinD1 and IL-1RN polymorphisms were associated with survival. The combination of specific cyclinD1 and IL-1RN genotypes showed a particular prognostic relevance and should be considered an independent prognostic marker for neoadjuvant-treated gastric cancer patients.
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Affiliation(s)
- Gertraud Stocker
- Institute of Pathology, Technische Universität München, Trogerstr. 18, 81675 München, Germany
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Hilbrig F, Stocker G, Schläppi JM, Kocher H, Freitag R. Utilization of Group Specific Ligands in the Downstream Processing of Proteins by Affinity Precipitation. Food and Bioproducts Processing 2006. [DOI: 10.1205/fbp.05153] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
MOTIVATION With cDNA or oligonucleotide chips, gene-expression levels of essentially all genes in a genome can be simultaneously monitored over a time-course or under different experimental conditions. After proper normalization of the data, genes are often classified into co-expressed classes (clusters) to identify subgroups of genes that share common regulatory elements, a common function or a common cellular origin. With most methods, e.g. k-means, the number of clusters needs to be specified in advance; results depend strongly on this choice. Even with likelihood-based methods, estimation of this number is difficult. Furthermore, missing values often cause problems and lead to the loss of data. RESULTS We propose a fully probabilistic Bayesian model to cluster gene-expression profiles. The number of classes does not need to be specified in advance; instead it is adjusted dynamically using a Reversible Jump Markov Chain Monte Carlo sampler. Imputation of missing values is integrated into the model. With simulations, we determined the speed of convergence of the sampler as well as the accuracy of the inferred variables. Results were compared with the widely used k-means algorithm. With our method, biologically related co-expressed genes could be identified in a yeast transcriptome dataset, even when some values were missing. AVAILABILITY The code is available at http://genome.tugraz.at/BayesianClustering/
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Affiliation(s)
- C Vogl
- Institute of Animal Breeding and Genetics, Veterinärmedizinische Universität Wien, Vienna, Austria.
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Wolff JM, Stocker G, Borchers H, Haubeck H, Greiling H, Jakse G. Critical aspects related to the interpretation of the free-to-total PSA-ratio. Anticancer Res 1999; 19:2633-6. [PMID: 10470208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The number of assays available for the measurement of total and free PSA is increasing. As different methods can determine different PSA concentrations as well as different free-to-total PSA ratios in identical serum samples, the cut-offvalue for the ratio still needs to be determined. METHODS 114 sera from patients with histologically confirmed benign prostatic hyperplasia (BPH; n = 58) and cancer of the prostate (CaP; n = 56) were analyzed with two different assays. Free PSA (free), total PSA (total) and the free-to-total- PSA ratio (ratio) were determined employing Enzym-Test PSA und freies PSA (Boehringer Mannheim, Germany) and Immulite PSA und freies PSA (DPC Biermann, Bad Nauheim, Germany) RESULTS The statistical results are tabulated below: [table: see text] CONCLUSION Direct comparison of the two assays revealed a high statistical correlation (r = 0.94-0.99) for free and total PSA. In contrast, the ratio of the two assays was not as reproducible (r = 0.81-0.83). This result indicates that the reference range for the ratio is dependent on the assay employed and an that uncritical use of an applied reference range can be counter-productive.
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Affiliation(s)
- J M Wolff
- Department of Urology, RWTH Aachen, Germany
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Inauen W, Stocker G, Haeberli A, Straub PW. Effects of low and high dose oral contraceptives on blood coagulation and thrombogenesis induced by vascular subendothelium exposed to flowing human blood. Contraception 1991; 43:435-46. [PMID: 1833126 DOI: 10.1016/0010-7824(91)90134-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We investigated the effect of oral contraceptives with low and high estrogen concentration on blood coagulation and thrombogenesis, induced by vascular subendothelium of rabbit aorta exposed to flowing human blood. Twenty healthy women intending to take oral contraceptives were studied [1] before drug ingestion (control), and subsequently during the intake of oral contraceptives with [2] low estrogen content (20 micrograms ethinyl estradiol and 150 micrograms desogestrel per day) and [3] high estrogen content (50 micrograms ethinyl estradiol and 125 micrograms desogestrel per day). All experiments were performed between day 17 and 21 of the menstrual cycle and drug effects were studied during the third tablet cycle. Deposition of fibrin, platelets and platelet thrombi on vascular subendothelium was tested at a defined blood flow and wall shear rate (10 ml/min, 650 s-1) and was quantified by morphometrical techniques. Treatment with the low and high dose contraceptive increased the plasma levels of ethinyl estradiol (728 +/- 139 and 1438 +/- 212 vs. 0 fmol/l [low and high dose vs. control], means +/- SEM, P less than 0.001) and fibrinogen (2.3 +/- 0.1 and 2.6 +/- 0.1 vs. 2.0 +/- 0.1 g/l, P less than 0.05); and decreased antithrombin III activity (95 +/- 3 and 92 +/- 3 vs. 101 +/- 3 %, P less than 0.05). Fibrin deposition on vascular subendothelium was enhanced by the high dose contraceptive only (47 +/- 4 vs. 35 +/- 4 % coverage of the subendothelial surface with fibrin, high dose vs. control, P less than 0.05). The subendothelial deposition of platelets and platelet thrombi was not changed by contraceptive treatment. These results indicate that treatment with high dose contraceptives leads to an increase of fibrin-subendothelial interactions, whereas low dose contraceptives do not significantly alter the blood-subendothelium interactions. observed in this ex vivo model of thrombogenesis.
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Affiliation(s)
- W Inauen
- Department of Internal Medicine, University Hospital, Inselspital, Bern, Switzerland
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Stocker G, Lüps P. Qualitative und quantitative Angaben zur Nahrungswahl des Dachses Meles meles im Schweizerischen Mittelland. REV SUISSE ZOOL 1984. [DOI: 10.5962/bhl.part.81595] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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