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Maráz A, Nagyiványi K, Balogh I, Bodoky G, Mangel L, Küronya Z, Géczi L, Torday L, Dudás S, Szűcs M, Nagy Z, Hornyák L, Zolcsák Z, Bassam A, Kocsis J, Keresztes T, Kullmann T, Máhr K, Solymosi T, Papdán T, Szabó I, Varga Z, Biró K. [Multicentric Hungarian results of cabozantinib therapy in patients with metastatic kidney cancer based on real-world data]. Magy Onkol 2023; 67:73-83. [PMID: 37086460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 04/24/2023]
Abstract
The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztián Nagyiványi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Ingrid Balogh
- Onkológiai Klinika, Debreceni Egyetem Klinikai Központ, Debrecen, Hungary
| | - György Bodoky
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - László Mangel
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - László Torday
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Szilvia Dudás
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - Miklós Szűcs
- Urológiai Klinika, Semmelweis Egyetem, Budapest, Hungary
| | - Zsófia Nagy
- Onkológiai Osztály, Észak-pesti Centrumkórház, Budapest, Hungary
| | - Lajos Hornyák
- Közép-dunántúli Regionális Onkológiai Centrum, Veszprém Megyei Csolnoky Ferenc Kórház, Veszprém, Hungary
| | - Zita Zolcsák
- Onkoradiológiai Osztály, Uzsoki Utcai Kórház, Budapest, Hungary
| | - Ali Bassam
- Megyei Onkológiai Központ, Békés Megyei Központi Kórház Pándy Kálmán Tagkórház, Gyula, Hungary
| | - Judit Kocsis
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Keresztes
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Kullmann
- Onkoradiológiai Osztály, Petz Aladár Egyetemi Oktató Kórház, Győr, Hungary
| | - Károly Máhr
- Onkológiai Osztály, Zala Megyei Szent Rafael Kórház, Zalaegerszeg, Hungary
| | - Tibor Solymosi
- Klinikai Onkológiai és Sugárterápiás Centrum, Borsod-Abaúj-Zemplén Megyei Központi Kórház, Miskolc, Hungary
| | - Tímea Papdán
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Imre Szabó
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zoltán Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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Punt C, Heinemann V, Maughan T, Cremolini C, Van Cutsem E, McDermott R, Bodoky G, André T, Osterlund P, Teske A, Pfeiffer P. Fluoropyrimidine-induced hand-foot syndrome and cardiotoxicity: recommendations for the use of the oral fluoropyrimidine S-1 in metastatic colorectal cancer. ESMO Open 2023; 8:101199. [PMID: 37018874 PMCID: PMC10163153 DOI: 10.1016/j.esmoop.2023.101199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Fluoropyrimidines (FPs) are an essential part of the majority of systemic regimens in the treatment of metastatic colorectal cancer (CRC). The use of the oral FP S-1 has been approved by the European Medicines Agency as monotherapy or in combination with oxaliplatin or irinotecan, with or without bevacizumab, for the treatment of patients with metastatic CRC in whom it is not possible to continue treatment with another FP due to hand-foot syndrome (HFS) or cardiovascular toxicity (CVT). Subsequently, this indication has been included in the 2022 ESMO guidelines for metastatic CRC. Recommendations for use in daily practice are not available. PATIENTS AND METHODS Based on peer-reviewed published data on the use of S-1 in Western patients with metastatic CRC who switched from infusional 5-fluorouracil (5-FU) or capecitabine to S-1 for reasons of HFS or CVT, recommendations for its use were formulated by an international group of medical oncologists with expertise in the treatment of metastatic CRC and a cardio-oncologist. RESULTS In patients who experience pain and/or functional impairment due to HFS during treatment with capecitabine or infusional 5-FU, a switch to S-1 is recommended without prior dose reduction of capecitabine/5-FU. S-1 should preferably be initiated at full dose when HFS has decreased to grade ≤1. In patients with cardiac complaints, in whom an association with capecitabine or infusional 5-FU treatment cannot be excluded, capecitabine/5-FU should be discontinued and a switch to S-1 is recommended. CONCLUSIONS These recommendations should guide clinicians in daily practice in the treatment of patients with metastatic CRC with FP-containing regimens.
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Maráz A, Nagyiványi K, Balogh I, Bodoky G, Mangel L, Küronya Z, Géczi L, Torday L, Dudás S, Szűcs M, Nagy Z, Hornyák L, Zolcsák Z, Bassam A, Kocsis J, Keresztes T, Kullmann T, Máhr K, Solymosi T, Papdán T, Szabó I, Varga Z, Biró K. [Multicentric Hungarian results of cabozantinib therapy in patients with metastatic kidney cancer based on real-world data]. Magy Onkol 2023; 67:1-10. [PMID: 36989491] [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] [Received: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 03/31/2023]
Abstract
The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztián Nagyiványi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Ingrid Balogh
- Onkológiai Klinika, Debreceni Egyetem Klinikai Központ, Debrecen, Hungary
| | - György Bodoky
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - László Mangel
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - László Torday
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Szilvia Dudás
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - Miklós Szűcs
- Urológiai Klinika, Semmelweis Egyetem, Budapest, Hungary
| | - Zsófia Nagy
- Onkológiai Osztály, Észak-pesti Centrumkórház, Budapest, Hungary
| | - Lajos Hornyák
- Közép-dunántúli Regionális Onkológiai Centrum, Veszprém Megyei Csolnoky Ferenc Kórház, Veszprém, Hungary
| | - Zita Zolcsák
- Onkoradiológiai Osztály, Uzsoki Utcai Kórház, Budapest, Hungary
| | - Ali Bassam
- Megyei Onkológiai Központ, Békés Megyei Központi Kórház Pándy Kálmán Tagkórház, Gyula, Hungary
| | - Judit Kocsis
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Keresztes
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Kullmann
- Onkoradiológiai Osztály, Petz Aladár Egyetemi Oktató Kórház, Győr, Hungary
| | - Károly Máhr
- Onkológiai Osztály, Zala Megyei Szent Rafael Kórház, Zalaegerszeg, Hungary
| | - Tibor Solymosi
- Klinikai Onkológiai és Sugárterápiás Centrum, Borsod-Abaúj-Zemplén Megyei Központi Kórház, Miskolc, Hungary
| | - Tímea Papdán
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Imre Szabó
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zoltán Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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Perez-Gracia JL, Penel N, Calvo E, Awada A, Arkenau HT, Amaral T, Grünwald V, Sanmamed MF, Castelo-Branco L, Bodoky G, Lolkema MP, Di Nicola M, Casali P, Giuliani R, Pentheroudakis G. Streamlining clinical research: an ESMO awareness call to improve sponsoring and monitoring of clinical trials. Ann Oncol 2023; 34:70-77. [PMID: 36209982 DOI: 10.1016/j.annonc.2022.09.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 07/08/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND During recent years, the burden of bureaucracy in clinical research has increased dramatically, adversely impacting the activity of investigators and clinical research teams. Although compliance with the Declaration of Helsinki, the guidelines for Good Clinical Practice (GCP), and other applicable regulations remains unquestionable, their overinterpretation and substitution by the internal operating procedures of sponsors and Contract Research Organizations (CROs) have increased the administrative burden. A survey conducted by the European Society for Medical Oncology (ESMO) Clinical Research Observatory (ECRO) among 940 investigators confirmed that they considered that the administrative burden in clinical research is excessive; that administrative procedures could be reduced without affecting the safety and the rights of the patients and the quality of the data; and that bureaucracy represents an obstacle for clinical research. METHODS A panel of physicians with extensive experience in clinical research, composed by members of the ECRO and the ESMO Scientific Medical and Public Policy divisions, analyzed clinical trial procedures related to administrative workflow, pharmacovigilance, and medical care. RESULTS The panel identified situations that generate debate between investigators and sponsors/CROs and selected real clinical scenarios that exemplify such situations. The panel discussed and proposed specific recommendations for those situations, based on GCP. CONCLUSIONS This initiative aspires to streamline clinical research procedures and to become a platform for discussion among all clinical trial stakeholders, with the aim of promoting the sustainability of clinical research and the care of cancer patients.
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Affiliation(s)
- J L Perez-Gracia
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain.
| | - N Penel
- Centre Oscar Lambret and Lille University, Lille, France
| | - E Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - A Awada
- Institut Jules Bordet, Université Libre de Bruxelles (Head of the Oncology Medicine Department), Brussels, Belgium
| | | | - T Amaral
- Division of Dermato-Oncology, Department of Dermatology, University of Tuebingen, Tuebingen, Germany; Cluster of Excellence iFIT (EXC 2180) 'Image Guided and Functionally Instructed Tumor Therapies', Tuebingen, Germany
| | - V Grünwald
- University Hospital Essen, Clinic for Medical Oncology and Clinic for Urology, Essen, Germany
| | - M F Sanmamed
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | - L Castelo-Branco
- Scientific and Medical Division, ESMO - European Society for Medical Oncology, 6900 - Lugano, Switzerland; NOVA National School of Public Health, NOVA University, Lisbon, Portugal
| | | | - M P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Di Nicola
- Immunotherapy and Innovative Therapeutics Unit, Oncology and Hematology Department Fondazione, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - P Casali
- Fondazione IRCCS Istituto Nazionale Tumori and University of Milan, Milan, Italy
| | - R Giuliani
- The Clatterbridge Cancer Centre, Liverpool, UK
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
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Drozgyik A, Molnár FT, Tokodi Z, Bodoky G, Kollár D, Oláh A. Emlőrák hasüregi áttétei - Egy szokatlan entitás klinikopatológiai jellemzői. Magy Seb 2022; 75:265-269. [PMID: 36515915 DOI: 10.1556/1046.2022.40003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 06/17/2023]
Abstract
CASE REPORT A sixty-five-year-old female patient underwent surgery for severe gastrointestinal symptoms, following an alarming CT image. Laparotomy revealed irresectable gastric cancer and peritoneal carcinosis. Palliative gastro-jejunostomy and ileo-descendostomy were performed. The endoscopic diagnosis - linitis plastica - and the intraoperative macroscopic appearance matched and agreed on the histologically presumed shigillocellular carcinoma. Three years following the initial abdominal symptoms, histological samples taken from newly detected cutaneous metastases which developed during oncological palliative treatment verified occult lobular breast carcinoma. Histological revision of the sample taken from abdominal exploration confirmed the latter diagnosis. The hormone receptor positive, human epidermal growth factor receptor-2 negative malignancy showed very good regression for the palliative hormone treatment. DISCUSSION About ten percent of breast cancer cases are lobular carcinomas, which are more often multicentric, bilateral, occult and have a propensity to metastasize to serous membranes, abdominal and pelvic viscera. Due to the increasing survival of breast cancer patients, the number of abdominal metastases of breast cancer is expected to increase. Histological confirmation is indispensable even in case of advanced abdominal malignancies, especially in the case of an unusual medical history. The currently rare case demonstrates the need for multidisciplinary cooperation in all diagnostic and therapeutic fields of breast cancer.
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Affiliation(s)
- András Drozgyik
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
| | - F Tamás Molnár
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
- 2Pécsi Tudományegyetem, Általános Orvosi Kar, Orvosi Készségfejlesztő és Innovációs Központ, Műveleti Medicina Tanszék, Pécs, Magyarország
| | - Zsófia Tokodi
- 3Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Onkológiai Osztály, Budapest, Magyarország
| | - György Bodoky
- 3Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Onkológiai Osztály, Budapest, Magyarország
| | - Dániel Kollár
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
| | - Attila Oláh
- 1Petz Aladár Egyetemi Oktató Kórház, Sebészeti Osztály, Győr, Magyarország
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Landherr L, Pintér T, Hornyák L, Révész J, Máhr K, Torday L, András C, Erfán J, Árkosy P, Bodoky G. [Not Available]. Magy Onkol 2022; 66:11-19. [PMID: 35343970] [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] [Received: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
The primary aim of AVACONT was to collect data in the course of routine oncological care from patients with metastatic colorectal cancer (mCRC) treated with bevacizumab supplemented fluoropyrimidine-based chemotherapy doublet in an open, multicentre, observational study in Hungary. Primary endpoint of the study was to determine progression-free survival (PFS). The Full Analysis Set (FAS) comprised 280 patients. Median PFS calculated from enrolment was 270 days in the FAS population. The metastatic involvement of the liver or more than one organ significantly decreased (250 and 245 days), while a clinical response achieved significantly increased (partial response: 404, complete response: 623 days) the mPFS calculated from enrolment. PFS calculated from the start of the first-line treatment was significantly decreased by the presence of mutant RAS gene (481 vs. 395 days). The results confirm the efficacy, known prognostic factors and safety profile of bevacizumab in combination with chemotherapy dosed during standard oncology care in Hungarian centres.
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Affiliation(s)
| | - Tamás Pintér
- Petz Aladár Egyetemi Oktató Kórház, Győr, Hungary
| | | | - János Révész
- Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktató Kórház, Miskolc, Hungary
| | - Károly Máhr
- Zala Megyei Szent Rafael Kórház, Zalaegerszeg, Hungary
| | - László Torday
- Szent-Györgyi Albert Klinikai Központ, Szegedi Tudományegyetem, Onkoterápiás Klinika, Szeged, Hungary
| | - Csilla András
- Klinikai Központ, Debreceni Egyetem, Debrecen, Hungary
| | - József Erfán
- Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Debrecen, Hungary
| | - Péter Árkosy
- Klinikai Központ, Debreceni Egyetem, Kenézy Gyula Campus, Debrecen, Hungary
| | - György Bodoky
- Dél-pesti Centrumkórház Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
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Koopman M, Pinto C, Bodoky G, Garcia-Carbonero R, Marti F, Bachet JB. Rationale and design of the PROMETCO study: a real-world, prospective, longitudinal cohort on the continuum of care of metastatic colorectal cancer from a clinical and patient perspective. Future Oncol 2022; 18:1313-1320. [DOI: 10.2217/fon-2021-1333] [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: 11/21/2022] Open
Abstract
The PROMETCO study is collecting real-world data on metastatic colorectal cancer (mCRC) patients with two progressions. This international, prospective, longitudinal, observational cohort study is collecting data on mCRC patients with two disease progressions since diagnosis and receiving subsequent treatment. Objectives include overall survival, treatment patterns, effectiveness and safety and patient-reported outcomes using the EuroQol 5-level, 5-dimensional questionnaire, the Brief Fatigue Inventory and a modified version of the ACCEPTance by the Patients of their Treatment (ACCEPT©) questionnaire. Data are collected retrospectively and prospectively up to 18 months. As of 13 October 2021, 544 patients from 18 countries had been enrolled. To the authors' knowledge, PROMETCO is the first international, real-world study of the continuum of care of mCRC patients in this setting. Trial registration number: NCT03935763 ( ClinicalTrials.gov )
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Affiliation(s)
- Miriam Koopman
- Medical Oncology, University Medical Centre Utrecht, Utrecht University Heidelberglaan 100 3584 CX Utrecht, The Netherlands
| | - Carmine Pinto
- Medical Oncology, Clinical Cancer Centre Azienda USL – IRCCS di Reggio Emilia – Viale Risorgimento, 80 42123 Reggio Emilia, Italy
| | - György Bodoky
- Dél-Pesti Centrumkórház Szent László Telephely Albert Flórián út 5-7 1097 Budapest, Hungary
| | - Rocio Garcia-Carbonero
- Hospital Universitario Doce de Octubre, Imas12, UCM, Av. De Córdoba s/n, 28041 Madrid, Spain
| | | | - Jean-Baptiste Bachet
- Sorbonne Université, Service d'hépato-Gastro-Entérologie, Groupe Hospitalier Pitié Salpêtrière, APHP, Paris, France
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Abstract
Colorectal cancer is a clinically and molecularly heterogeneous disease. Currently, extended RAS and BRAF mutation testing is obligatory in routine clinical practice before starting any treatment in the metastatic setting. Treatment decision making also includes assessment of the clinical condition of the patient, definition of the treatment goal, and consideration of the primary tumor site. Biological treatment is part of the first-line drug combination unless contraindicated. Mutational status is significantly associated with the outcome of patients and is strongly predictive for anti-EGFR-targeted therapy. The prognosis of RAS mutant CRC is clearly inferior to wild-type cases. RAS remains an elusive target, and specific treatment options are not yet available. Recently, promising results of a direct KRAS G12C inhibitor have been reported; however, further confirmation is needed. The biomarker landscape in mCRC is evolving; new promising markers are awaited with the chance of more precise targeted treatment.
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Affiliation(s)
- Gábor Lakatos
- Department of Oncology, South-Pest Hospital Centre - National Institute for Infectology and Haematology, Budapest, Hungary.
| | - Claus-Henning Köhne
- Klinikum Oldenburg, University Clinic of Oncology and Haematology, Oldenburg, Germany
| | - György Bodoky
- Department of Oncology, South-Pest Hospital Centre - National Institute for Infectology and Haematology, Budapest, Hungary
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Koopman M, Pinto C, Bodoky G, Marti Marti F, Chrostek H, Raimond-Thibaut A, Fougeray R, Garcia-Carbonero R, Bachet J. P-137 Patient baseline characteristics in the PROMETCO study: A real-world, prospective longitudinal cohort on the continuum of care of metastatic colorectal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Cascinu S, Bodoky G, Muro K, Van Cutsem E, Oh SC, Folprecht G, Ananda S, Girotto G, Wainberg ZA, Miron MLL, Ajani J, Wei R, Liepa AM, Carlesi R, Emig M, Ohtsu A. Tumor Response and Symptom Palliation from RAINBOW, a Phase III Trial of Ramucirumab Plus Paclitaxel in Previously Treated Advanced Gastric Cancer. Oncologist 2021; 26:e414-e424. [PMID: 33274542 PMCID: PMC7930430 DOI: 10.1002/onco.13623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 04/28/2020] [Accepted: 10/28/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the intent-to-treat (ITT) population of the RAINBOW study, objective response rate (ORR) was 28% and 16% in the ramucirumab and control arms, respectively. To further characterize tumor response, we present details on timing and extent of tumor shrinkage, as well as associations with symptom palliation. MATERIALS AND METHODS Tumor response was assessed with RECIST v1.1, and quality of life (QoL) was assessed with the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (EORTC QLQ-C30) v3.0. Prespecified and post hoc analyses were conducted in the ITT population, patients with measurable disease, or responders, and included best overall response (BOR), ORR, disease control rate (DCR), duration of response, time to response (TtR), change in tumor size, and associations of QoL with tumor shrinkage and BOR. RESULTS In both treatment arms, median TtR was 1.5 months. Responses were more durable in the ramucirumab versus control arm (median 4.4 vs. 2.8 months). In patients with measurable disease (78% of ITT), ORR was 36% versus 20%; DCR was 81% versus 61% in the ramucirumab versus control arms. Waterfall plots demonstrated more tumor shrinkage in the ramucirumab versus control arm. Regardless of treatment, tumor response and stable disease were associated with improved or stable QoL, with more tumor shrinkage associated with greater symptom palliation. CONCLUSION Treatment with ramucirumab plus paclitaxel yielded the highest ORR reported to date for patients with previously treated advanced gastric or gastroesophageal junction adenocarcinoma. Additional details demonstrate robustness of tumor response results. The extent of tumor shrinkage is directly associated with symptom palliation and should be considered when evaluating patient needs and treatment selection. Clinical trial identification number. NCT01170663. IMPLICATIONS FOR PRACTICE Ramucirumab plus paclitaxel is a recognized standard of care as it improves survival for patients with advanced gastric or gastroesophageal junction adenocarcinoma who have been previously treated with recommended first-line therapy. These additional data on tumor response demonstrate a positive association between tumor shrinkage and symptom palliation in a patient population that is often symptomatic. These observations included patients with nonmeasurable disease, a group of patients often underrepresented in clinical trials. This knowledge can inform treatment decisions, which align individual patient characteristics and needs with demonstrated benefits.
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Affiliation(s)
- Stefano Cascinu
- Department of Oncology and Hematology, Modena University Hospital, University of Modena and Reggio EmiliaModenaItaly
| | - György Bodoky
- Department of Oncology, St. Laszlo HospitalBudapestHungary
| | - Kei Muro
- Aichi Cancer Center HospitalAichiJapan
| | - Eric Van Cutsem
- Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg Leuven and KULeuvenLeuvenBelgium
| | - Sang Cheul Oh
- Korea University Guro HospitalSeoulRepublic Of Korea
| | | | | | | | | | | | - Jaffer Ajani
- University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ran Wei
- Statistics, Eli Lilly and CompanyIndianapolis, IndianaUSA
| | | | | | - Michael Emig
- Oncology, Eli Lilly and CompanyIndianapolis, IndianaUSA
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Géczi L, Bodoky G, Rokszin G, Fábián I, Torday L. Survival Benefits of Second-line Axitinib Versus Everolimus After First Line Sunitinib Treatment in Metastatic Renal Cell Carcinoma. Pathol Oncol Res 2020; 26:2201-2207. [PMID: 32291570 PMCID: PMC7471136 DOI: 10.1007/s12253-020-00809-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/24/2020] [Indexed: 12/25/2022]
Abstract
Background Targeted therapies significantly improve clinical outcomes among patients with metastatic renal cell carcinoma (mRCC). Several new agents have been approved for first- and second-line use. However, there is a lack of compelling evidence comparing sequencing strategies, and available comparative data regarding the real-world effectiveness of different therapeutic sequences are limited. Materials and Methods We identified mRCC patients who initiated targeted therapy between January 1, 2008 and May 31, 2017 from the National Health Insurance Fund (NHIF) database of Hungary. Overall survival (OS) and duration of first-line treatment (DFT) were obtained for patients receiving sunitinib-everolimus, sunitinib-axitinib, or pazopanib-everolimus treatment sequences. OS of sunitinib-everolimus and sunitinib-axitinib sequences was also determined for patients having better or worse response to sunitinib first-line therapy. Results Median OS was significantly longer among patients treated with sunitinib-axitinib compared to those receiving sunitinib-everolimus. Median DFT was also significantly longer in the sunitinib-axitinib vs. sunitinib-everolimus group. Sunitinib-axitinib was associated with significantly longer median OS compared to sunitinib-everolimus in patients with better response to first-line sunitinib in the pooled sunitinib population. In patients with worse response to sunitinib, sunitinib-axitinib was associated with a trend towards greater OS compared to sunitinib-everolimus, but the difference did not reach statistical significance. Conclusions In this nationwide database analysis, mRCC patients treated with the sunitinib-axitinib sequence had significantly longer OS compared to those receiving sunitinib-everolimus therapy. The OS benefits of second-line axitinib were consistent among patients with better response to sunitinib defined by DFT values.
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Affiliation(s)
- Lajos Géczi
- Urogenital Tumors and Clinical Pharmacology Department, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary.
| | - György Bodoky
- Department of Oncology, Szent László Hospital, Albert Flórián út 5, 1097, Budapest, Hungary
| | - György Rokszin
- RxTarget Ltd, Bacsó Nándor út 10, 5000, Szolnok, Hungary
| | - Ibolya Fábián
- RxTarget Ltd, Bacsó Nándor út 10, 5000, Szolnok, Hungary.,University of Veterinary Medicine, István út 2, 1078, Budapest, Hungary
| | - László Torday
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
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12
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Van Cutsem E, Muro K, Cunningham D, Bodoky G, Sobrero A, Cascinu S, Ajani J, Oh SC, Al-Batran SE, Wainberg ZA, Wijayawardana SR, Melemed S, Ferry D, Hozak RR, Ohtsu A. Biomarker analyses of second-line ramucirumab in patients with advanced gastric cancer from RAINBOW, a global, randomized, double-blind, phase 3 study. Eur J Cancer 2020; 127:150-157. [PMID: 32014812 DOI: 10.1016/j.ejca.2019.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 05/30/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The RAINBOW trial showed that second-line ramucirumab with paclitaxel prolongs overall survival (OS) and progression-free survival (PFS) compared with placebo plus paclitaxel for treatment of advanced gastric/gastroesophageal junction cancer. Plasma samples were collected from patients during the trial and tested to identify predictive and prognostic biomarkers. PATIENTS AND METHODS Circulating factors in plasma samples from mutually exclusive subsets of RAINBOW patients were assayed using: Intertek assays (24 markers, 380 samples, 57% of patients) and Lilly-developed assay (LDA) platform (5 markers, 257 samples, 39% of patients). Time-trend plots were generated for each marker from the Intertek assays. Baseline patient data were dichotomized into low- and high-marker subgroups. Markers were analyzed for predictive effects using interaction models and for prognostic effects using main-effects models. RESULTS The Intertek and LDA populations were representative of the full trial population. Plasma levels of VEGF-D and PlGF increased from baseline levels during treatment, then declined after treatment discontinued. Angiopoietin-2 exhibited a decrease during treatment, then increased after treatment discontinuation. No clear time trend was evident with the other markers. Analyses of baseline biomarker expression and its relationship with efficacy variables found no biomarker was predictive for efficacy outcomes, including VEGF-D. However, CRP, HGF, ICAM-3, IL-8, SAA, and VCAM-1 were identified as potential prognostic markers with low baseline levels corresponding to longer OS and PFS. CONCLUSIONS Pharmacodynamic and prognostic relationships were found from the exploratory biomarker analyses in RAINBOW; however, no predictive markers for ramucirumab in gastric cancer were identified in this trial.
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Affiliation(s)
- E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, Belgium.
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - G Bodoky
- Department of Oncology, St. László Hospital, Budapest, Hungary
| | - A Sobrero
- Medical Oncology, IRCCS Ospedale San Martino IST, Genova, Italy
| | - S Cascinu
- Department of Medical Oncology, Università Politecnica Delle Marche, Ancona, Italy
| | - J Ajani
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - S C Oh
- Korea University Guro Hospital, Seoul, South Korea
| | - S E Al-Batran
- Institute of Clinical Cancer Research (IKF), UCT- University Cancer Center, Frankfurt, Germany
| | - Z A Wainberg
- Medical Hematology and Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - S Melemed
- Eli Lilly and Company, Indianapolis, IN, USA
| | - D Ferry
- Eli Lilly and Company, Bridgewater, NJ, USA
| | - R R Hozak
- Eli Lilly and Company, Indianapolis, IN, USA
| | - A Ohtsu
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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13
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Macarulla Mercadé T, Chen LT, Li CP, Siveke JT, Cunningham D, Bodoky G, Blanc JF, Lee KH, Dean A, Belanger B, Wang-Gillam A. Liposomal Irinotecan + 5-FU/LV in Metastatic Pancreatic Cancer: Subgroup Analyses of Patient, Tumor, and Previous Treatment Characteristics in the Pivotal NAPOLI-1 Trial. Pancreas 2020; 49:62-75. [PMID: 31856081 PMCID: PMC6946097 DOI: 10.1097/mpa.0000000000001455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/04/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The NAnoliPOsomaL Irinotecan (NAPOLI-1) study (NCT01494506) was the largest global phase 3 study in a post-gemcitabine metastatic pancreatic adenocarcinoma (mPAC) population (N = 417). The subanalyses reported here investigated the prognostic effect of tumor characteristics and disease stage, prior treatment characteristics, baseline patient characteristics on survival outcomes in NAPOLI-1, and whether liposomal irinotecan (nal-IRI) + 5-fluorouracil/leucovorin (5-FU/LV) benefited patients with mPAC across subgroups. METHODS Post hoc analyses were performed in the NAPOLI-1 population (4 across tumor characteristics and disease stage, 6 across prior treatment characteristics, and 4 across patient baseline characteristics). Survival outcomes were estimated by Kaplan-Meier analysis and patient safety data were evaluated. RESULTS Mortality and morbidity risk was lower on nal-IRI+5-FU/LV treatment across subgroups. Exceptions were patients who had received prior nonliposomal irinotecan and those who had undergone prior Whipple procedure (overall survival hazard ratio = 1.25 and 1.23, respectively). Decreased appetite, liver metastases, and number of measurable metastatic lesions seemed to be prognostic of survival in this population. Subgroup safety data were generally comparable with those in the overall NAPOLI-1 safety population. CONCLUSIONS A diverse population of patients with mPAC that progressed on gemcitabine-based therapy benefited from nal-IRI+5-FU/LV versus 5-FU/LV, potentially helping guide treatment decisions for challenging cases.
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Affiliation(s)
- Teresa Macarulla Mercadé
- From the Vall d'Hebron University Hospital (HUVH) and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes
- Department of Internal Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jens T. Siveke
- Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen
- German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - David Cunningham
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - György Bodoky
- Department of Oncology, Szent László Hospital, Budapest, Hungary
| | | | - Kyung-Hun Lee
- Department of Internal Medicine and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Andrew Dean
- St. John of God Hospital, Subiaco, Western Australia, Australia
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14
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Seruga B, Sullivan R, Fundytus A, Hopman W, Ocana A, Joffe J, Bodoky G, Le Tourneau C, Vanderpuye V, Lopes G, Hammad N, Sengar M, Brundage M, Booth C. Medical Oncology Workload in Europe: One Continent, Several Worlds. Clin Oncol (R Coll Radiol) 2020; 32:e19-e26. [DOI: 10.1016/j.clon.2019.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 01/30/2023]
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15
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André T, Vernerey D, Im SA, Bodoky G, Buzzoni R, Reingold S, Rivera F, McKendrick J, Scheithauer W, Ravit G, Fountzilas G, Yong WP, Isaacs R, Österlund P, Liang JT, Creemers GJ, Rakez M, Van Cutsem E, Cunningham D, Tabernero J, de Gramont A. Bevacizumab as adjuvant treatment of colon cancer: updated results from the S-AVANT phase III study by the GERCOR Group. Ann Oncol 2019; 31:246-256. [PMID: 31959341 DOI: 10.1016/j.annonc.2019.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/30/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The bevacizumab-Avastin® adjuVANT (AVANT) study did not meet its primary end point of improving disease-free survival (DFS) with the addition of bevacizumab to oxaliplatin-based chemotherapy in stage III colon cancer (CC). We report here the long-term survival results (S-AVANT). PATIENTS AND METHODS Patients with curatively resected stage III CC were randomly assigned to FOLFOX4, FOLFOX4-bevacizumab, or XELOX-bevacizumab. RESULTS A total of 2867 patients were randomized: FOLFOX4: n = 955, FOLFOX4-bevacizumab: n = 960, XELOX-bevacizumab: n = 952. With a median of 6.73 years follow-up (interquartile range 5.51-10.54), 672 patients died, of whom 198 (20.7%), 250 (26.0%), and 224 (23.5%) were in the FOLFOX4, FOLFOX4-bevacizumab, and XELOX-bevacizumab arms, respectively. The 10-year overall survival (OS) rates were 74.6%, 67.2%, and 69.9%, (P = 0.003) and 5-year disease-free survival (DFS) rates were 73.2%, 68.5%, and 71.0% (P = 0.174), respectively. OS and DFS hazard ratios were 1.29 [95% confidence interval (CI) 1.07-1.55; P = 0.008] and 1.16 (95% CI 0.99-1.37; P = 0.063) for FOLFOX4-bevacizumab versus FOLFOX4 and 1.15 (95% CI 0.95-1.39; P = 0.147) and 1.1 (95% CI 0.93-1.29; P = 0.269) for XELOX-bevacizumab versus FOLFOX4, respectively. CC-related deaths (n = 542) occurred in 157 (79.3%) patients receiving FOLFOX4, 205 (82.0%) receiving FOLFOX4-bevacizumab, and 180 (80.4%) receiving XELOX-bevacizumab (P = 0.764), while non-CC-related deaths occurred in 41 (20.7%), 45 (18.0%), and 44 (19.6%) patients, respectively. Cardiovascular-related and sudden deaths during treatment or follow-up were reported in 13 (6.6%), 17 (6.8%), and 14 (6.3%) patients, in the FOLFOX4, FOLFOX4-bevacizuamb, and XELOX-bevacizumab arms, respectively (P = 0.789). Treatment arm, sex, age, histological differentiation, performance status, T/ N stages, and localization of primary tumor were independent prognostic factors of OS in stage III. CONCLUSIONS S-AVANT confirms the initial AVANT report. No benefit of the bevacizumab addition to FOLFOX4 adjuvant therapy in patients with stage III CC was observed in terms of DFS with a negative effect in OS, without increase in non-CC related deaths. CLINICAL TRIAL IDENTIFICATION NCT00112918.
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Affiliation(s)
- T André
- Sorbonne Université and, Department of Medical Oncology, Saint-Antoine Hospital, Paris, France.
| | - D Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, INSERM UMR 1098, Besançon, France
| | - S A Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - G Bodoky
- Department of Medical Oncology, Combined Szent István and Szent László Hospitals, Budapest, Hungary
| | - R Buzzoni
- Department of Medical Oncology, Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, Milan, Italy
| | - S Reingold
- Department of Medical Oncology, William Osler Health Centre Brampton Civic Hospital, Brampton, Canada
| | - F Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J McKendrick
- Department of Medical Oncology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - W Scheithauer
- Department of Medical Oncology, Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - G Ravit
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - G Fountzilas
- Department of Medical Oncology, Papageorgiou Hospital Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - W P Yong
- Department of Hematology-Oncology, National University of Singapore, Singapore, Singapore
| | - R Isaacs
- Department of Medical Oncology, Palmerston North & Crest Hospitals, Palmerston North, New Zealand
| | - P Österlund
- Department of Oncology, Helsinki and Tampere University Hospitals, University of Helsinki, Helsinki/Tampere, Finland
| | - J T Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - G J Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Rakez
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France
| | - E Van Cutsem
- Department of Internal Medicine, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - D Cunningham
- Department of Medicine, The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic, IOB-Quiron, CIBERONC, TTD Group, Barcelona, Spain
| | - A de Gramont
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France; Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
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16
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András C, Bartek P, Battyáni I, Bezsilla J, Bodoky G, Bogner B, Bursics A, Csőszi T, Damjanovich L, Dank M, Dankovics Z, Deák PÁ, Dede K, Doros A, Dudás I, Györke T, Hahn O, Hartmann E, Hitre E, Horváth Z, Imre M, Kalmár Nagy K, Káposztás Z, Kóbori L, Kupcsulik P, Landherr L, Lóderer Z, Mangel L, Máthé Z, Mersich T, Mezei K, Mohos E, Oláh A, Pajor P, Palkó A, Pápai Z, Papp A, Patyánik M, Petri A, Révész J, Ruzsa Á, Schlachter K, Sikorszki L, Sipőcz I, Székely E, Szijártó A, Torday L, Tóth LB, Dósa E, Harsányi L, István G, Landherr L, Lázár G, Lövey J, Schaff Z, Szűcs Á, Vereczkei A. Colorectalis májmetastasisok komplex kezelése. Konszenzuskonferencia, Budapest, 2019. április 5. Orv Hetil 2019; 160:2-20. [DOI: 10.1556/650.2019.31580] [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: 11/19/2022]
Affiliation(s)
| | - Csilla András
- Onkológiai Klinika, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Péter Bartek
- Radiológiai Osztály, Petz Aladár Megyei Oktató Kórház Győr
| | - István Battyáni
- Radiológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - János Bezsilla
- Mellkas- és Érsebészeti Osztály, Borsod-Abaúj-Zemplén Megyei Központi Kórház Miskolc
| | - György Bodoky
- Onkológiai Osztály, Dél-pesti Centrumkórház Budapest
| | - Barna Bogner
- Pathologiai Intézet, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Attila Bursics
- Sebészeti-Onkosebészeti Osztály, Uzsoki Utcai Kórház Budapest
| | - Tibor Csőszi
- Onkológiai Osztály, Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház Szolnok
| | - László Damjanovich
- Sebészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | - Magdolna Dank
- Onkológiai Központ, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Zsófia Dankovics
- Onkoradiológiai Osztály, Markusovszky Egyetemi Oktatókórház Szombathely
| | - Pál Ákos Deák
- Transzplantációs és Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Kristóf Dede
- Sebészeti-Onkosebészeti Osztály, Uzsoki Utcai Kórház Budapest
| | - Attila Doros
- Transzplantációs és Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Ibolyka Dudás
- Városmajori Szív- és Érgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Tamás Györke
- Nukleáris Medicina Központ, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Oszkár Hahn
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Üllői út 78., 1082
| | - Erika Hartmann
- Transzplantációs és Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Erika Hitre
- „B” Belgyógyászati-Onkológiai Osztály és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet Budapest
| | - Zsolt Horváth
- Onkoradiológiai Központ, Bács-Kiskun-Szolnok Megyei Kórház Kecskemét
| | - Marianna Imre
- Radiológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Károly Kalmár Nagy
- Klinikai Központ, Sebészeti Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Zsolt Káposztás
- Viszcerális Daganatsebészeti Egység, Somogy Megyei Kaposi Mór Oktató Kórház Kaposvár
| | - László Kóbori
- Transzplantációs és Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Péter Kupcsulik
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Üllői út 78., 1082
| | | | - Zoltán Lóderer
- Ér- és Plasztikai Sebészeti Osztály, Markusovszky Egyetemi Oktatókórház, Általános Szombathely
| | - László Mangel
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Zoltán Máthé
- Transzplantációs és Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Tamás Mersich
- Daganatsebészeti Központ, Hasi Sebészeti Osztály, Országos Onkológiai Intézet Budapest
| | - Klára Mezei
- Onkoradiológiai Osztály, Szabolcs-Szatmár-Bereg Megyei Jósa András Oktatókórház Nyíregyháza
| | - Elemér Mohos
- Sebészeti Centrum, Általános Sebészeti Osztály, Csolnoky Ferenc Kórház Veszprém
| | - Attila Oláh
- Általános Sebészeti Osztály, Petz Aladár Megyei Oktató Kórház Győr
| | - Péter Pajor
- Központi Radiológia, Szent Borbála Kórház Tatabánya
| | - András Palkó
- Radiológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Zsuzsanna Pápai
- Onkológiai Osztály, Magyar Honvédség Egészségügyi Központ Budapest
| | - András Papp
- Klinikai Központ, Sebészeti Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | | | - András Petri
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - János Révész
- Klinikai Onkológiai és Sugárterápiás Centrum, Borsod-Abaúj-Zemplén Megyei Központi Kórház Miskolc
| | - Ágnes Ruzsa
- Klinikai Onkológiai Osztály, Somogy Megyei Kaposi Mór Oktató Kórház Kaposvár
| | | | - László Sikorszki
- Általános Sebészeti Osztály, Bács-Kiskun Megyei Kórház Kecskemét
| | - István Sipőcz
- Onkoradiológiai Osztály, Petz Aladár Megyei Oktató Kórház Győr
| | - Eszter Székely
- II. Patológiai Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Attila Szijártó
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Üllői út 78., 1082
| | - László Torday
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Lajos Barna Tóth
- Sebészeti Osztály, Szabolcs-Szatmár-Bereg Megyei Jósa András Oktatókórház Nyíregyháza
| | - Edit Dósa
- Városmajori Szív- és Érgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - László Harsányi
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Üllői út 78., 1082
| | - Gábor István
- II. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | | | - György Lázár
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - József Lövey
- Sugárterápiás Osztály, Országos Onkológiai Intézet Budapest
| | - Zsuzsa Schaff
- II. Patológiai Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Ákos Szűcs
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Üllői út 78., 1082
| | - András Vereczkei
- Klinikai Központ, Sebészeti Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
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Lukovich P, Pőcze B, Nagy J, Szpiszár T, György A, Boga A, Merza E, Szabó H, Tóth GT, Demeter G, Bodoky G. [Resection of vena cava inferior infiltrating by liver tumors]. Orv Hetil 2019; 160:1304-1310. [PMID: 31401861 DOI: 10.1556/650.2019.31521] [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] [Indexed: 11/19/2022]
Abstract
Introduction: Despite all new promising agents of oncotherapy, it is still liver resection that gives potential curative solution for primary and secondary liver tumors. The size of tumorous liver section for resection means no question any more but major vessel infiltration of tumor proposes challenge in liver surgery. Patients and method: Retrospective analysis was carried out covering 33 patients who underwent liver resection in St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019. Demographic, surgical, histological data and postoperative course were taken into consideration and comparison with two of our patients who needed vena cava excision simultaneously with liver resection. Results: Patients with liver resection only (LR) had a mean operation time of 91.7 minutes, while operation time for patients with cava resection (CR) was 250 minutes. The average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5 units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8 cases, R2 resection could be performed in 2 cases, in group CR in both cases R1 resection was registered. 5 patients with colorectal liver metastasis were operated after previous chemotherapy. Two patients underwent laparoscopic liver resection and two had synchronous colorectal and liver resection, one of these was treated via laparoscopic approach. Conclusion: Liver resections in case of large vessel (vena cava, hepatic vein) infiltrating by liver tumors are indicated the most challenging procedures of liver surgery. The relating literature refers to oncological liver resections with vena cava excision and reconstruction to be safe and applicable. Orv Hetil. 2019; 160(33): 1304-1310.
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Affiliation(s)
- Péter Lukovich
- Sebészeti Osztály, Szent János Kórház Budapest, Diós árok 1-3., 1125
| | - Balázs Pőcze
- Sebészeti Osztály, Szent János Kórház Budapest, Diós árok 1-3., 1125
| | - Jenő Nagy
- Sebészeti Osztály, Szent János Kórház Budapest, Diós árok 1-3., 1125
| | - Tamás Szpiszár
- Sebészeti Osztály, Szent János Kórház Budapest, Diós árok 1-3., 1125
| | - Alpár György
- Sebészeti Osztály, Szent János Kórház Budapest, Diós árok 1-3., 1125
| | - Adrienn Boga
- Aneszteziológiai Osztály, Szent János Kórház Budapest
| | - Emese Merza
- Aneszteziológiai Osztály, Szent János Kórház Budapest
| | - Huba Szabó
- Patológiai Osztály, Szent János Kórház Budapest
| | | | - Gyula Demeter
- Szent László Kórház Telephely, Onkológiai Osztály, Dél-pesti Centrumkórház Budapest
| | - György Bodoky
- Szent László Kórház Telephely, Onkológiai Osztály, Dél-pesti Centrumkórház Budapest
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18
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Su M, Chen L, Hitre E, Lee W, Bai L, Papai Z, Kang S, Dvorkin M, Lee M, Ludovic E, Choi H, Oh S, Bodoky G, Artru P, Hwang J, Bazin I, Bosc F, Bachet J, Horváth Z, Chang C, Lin J. EndoTAG-1 plus gemcitabine versus gemcitabine alone in patients with measurable locally advanced and/or metastatic adenocarcinoma of the pancreas failed on FOLFIRINOX treatment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Gargiulo P, Dietrich D, Herrmann R, Bodoky G, Ruhstaller T, Scheithauer W, Glimelius B, Berardi S, Pignata S, Brauchli P. Predicting mortality and adverse events in patients with advanced pancreatic cancer treated with palliative gemcitabine-based chemotherapy in a multicentre phase III randomized clinical trial: the APC-SAKK risk scores. Ther Adv Med Oncol 2019; 11:1758835918818351. [PMID: 30636977 PMCID: PMC6317152 DOI: 10.1177/1758835918818351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/05/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022] Open
Abstract
Background The prognosis of advanced pancreatic cancer (APC) is poor and differs considerably among patients. Therefore, it is clinically relevant to identify patients with APC who are more likely to benefit from palliative chemotherapy with reduced risk of toxicity. To date, there is no prognostic score universally recommended to help clinicians in planning the therapeutic management. Methods Using individual patient data from 319 cases of APC treated with gemcitabine-based chemotherapy and enrolled in the SAKK 44/00-CECOG/PAN.1.3.001 randomized trial, several baseline variables, including inflammatory markers, were analysed post hoc as predictors of mortality and/or grade 3 or 4 chemotherapy-related toxicity and separate risk scores were developed. Results Median survival of the study patients was 7.9 months (interquartile range 3.7-13.3 months). Independent predictors of mortality included increased Aspartate transaminase (ASAT), low performance status, increased derived neutrophil to lymphocyte ratio, increased Carbohydrate Antigen 19-9 (CA 19-9), low haemoglobin, presence of pain, presence of metastasis and increased alkaline phosphatase (ALP). During the study, 117 patients experienced at least one grade 3 or 4 adverse event. Independent predictors of toxicity included white blood cells, ALP, renal function and bilirubin levels at baseline. Both models displayed moderate levels of discrimination (C-statistic 0.68 and 0.64 for mortality and toxicity, respectively) and adequate calibration. Conclusions We developed simple-to-use prognostic scores for mortality and severe toxicity for patients with APC. These scores can be useful in daily practice to identify patients with increased risk of death or toxicity and to plan the most appropriate therapeutic strategy to improve survival and quality of life. Further prospective studies to validate such scores are needed.
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Affiliation(s)
- Piera Gargiulo
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Effingerstrasse 33, CH-3008 Bern, Switzerland
| | - Daniel Dietrich
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | | | | | | | | | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, University of Uppsala, Uppsala, Sweden
| | - Simona Berardi
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale", Naples, Italy
| | - Peter Brauchli
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
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20
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Yoshino T, Portnoy DC, Obermannová R, Bodoky G, Prausová J, Garcia-Carbonero R, Ciuleanu T, García-Alfonso P, Cohn AL, Van Cutsem E, Yamazaki K, Lonardi S, Muro K, Kim TW, Yamaguchi K, Grothey A, O'Connor J, Taieb J, Wijayawardana SR, Hozak RR, Nasroulah F, Tabernero J. Biomarker analysis beyond angiogenesis: RAS/RAF mutation status, tumour sidedness, and second-line ramucirumab efficacy in patients with metastatic colorectal carcinoma from RAISE-a global phase III study. Ann Oncol 2019; 30:124-131. [PMID: 30339194 PMCID: PMC6336001 DOI: 10.1093/annonc/mdy461] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background : Second-line treatment with ramucirumab+FOLFIRI improved overall survival (OS) versus placebo+FOLFIRI for patients with metastatic colorectal carcinoma (CRC) [hazard ratio (HR)=0.84, 95% CI 0.73-0.98, P = 0.022]. Post hoc analyses of RAISE patient data examined the association of RAS/RAF mutation status and the anatomical location of the primary CRC tumour (left versus right) with efficacy parameters. Patients and methods Patient tumour tissue was classified as BRAF mutant, KRAS/NRAS (RAS) mutant, or RAS/BRAF wild-type. Left-CRC was defined as the splenic flexure, descending and sigmoid colon, and rectum; right-CRC included transverse, ascending colon, and cecum. Results RAS/RAF mutation status was available for 85% of patients (912/1072) and primary tumour location was known for 94.4% of patients (1012/1072). A favourable and comparable ramucirumab treatment effect was observed for patients with RAS mutations (OS HR = 0.86, 95% CI 0.71-1.04) and patients with RAS/BRAF wild-type tumours (OS HR = 0.86, 95% CI 0.64-1.14). Among the 41 patients with BRAF-mutated tumours, the ramucirumab benefit was more notable (OS HR = 0.54, 95% CI 0.25-1.13), although, as with the other genetic sub-group analyses, differences were not statistically significant. Progression-free survival (PFS) data followed the same trend. Treatment-by-mutation status interaction tests (OS P = 0.523, PFS P = 0.655) indicated that the ramucirumab benefit was not statistically different among the mutation sub-groups, although the small sample size of the BRAF group limited the analysis. Addition of ramucirumab to FOLFIRI improved left-CRC median OS by 2.5 month over placebo (HR = 0.81, 95% CI 0.68-0.97); median OS for ramucirumab-treated patients with right-CRC was 1.1 month over placebo (HR = 0.97, 95% CI 0.75-1.26). The treatment-by-sub-group interaction was not statistically significant for tumour sidedness (P = 0.276). Conclusions In the RAISE study, the addition of ramucirumab to FOLFIRI improved patient outcomes, regardless of RAS/RAF mutation status, and tumour sidedness. Ramucirumab treatment provided a numerically substantial benefit in BRAF-mutated tumours, although the P-values were not statistically significant. ClinicalTrials.gov number NCT01183780.
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Affiliation(s)
- T Yoshino
- National Cancer Center Hospital East, Kashiwa, Japan.
| | | | | | - G Bodoky
- St. Laszlo Hospital, Budapest, Hungary
| | - J Prausová
- Fakultni Nemocnice v MOTOLE, Prague, Czech Republic
| | - R Garcia-Carbonero
- Hospital Universitario Doce de Octubre, IIS imas12, UCM, CNIO, CIBERONC, Madrid, Spain
| | - T Ciuleanu
- Institutul Oncologic Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | | | - A L Cohn
- Rocky Mountain Cancer Center, LLP, Denver, USA
| | - E Van Cutsem
- Univ Hospital Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | | | - S Lonardi
- Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - T W Kim
- Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - K Yamaguchi
- The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | | | - J O'Connor
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - J Taieb
- Sorbonne Paris Cité, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | | | - R R Hozak
- Eli Lilly and Company, Indianapolis, USA
| | - F Nasroulah
- Eli Lilly and Company, Buenos Aires, Argentina
| | - J Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
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21
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Chen LT, Siveke JT, Wang-Gillam A, Li CP, Bodoky G, Dean AP, Shan YS, Jameson GS, Macarulla T, Lee KH, Cunningham D, Blanc JF, Chiu CF, Schwartsmann G, Braiteh FS, Mamlouk K, Belanger B, de Jong FA, Hubner RA. Survival with nal-IRI (liposomal irinotecan) plus 5-fluorouracil and leucovorin versus 5-fluorouracil and leucovorin in per-protocol and non-per-protocol populations of NAPOLI-1: Expanded analysis of a global phase 3 trial. Eur J Cancer 2018; 105:71-78. [PMID: 30414528 DOI: 10.1016/j.ejca.2018.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 04/12/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the phase 3 randomised NAPOLI-1 clinical study, a 45% increase in median overall survival (OS) was shown with liposomal irinotecan, 5-fluorouracil and leucovorin (nal-IRI+5-FU/LV) versus 5-FU/LV in patients with metastatic pancreatic cancer progressing after gemcitabine-based therapy. Here, we report data from a pre-specified, expanded analysis of outcomes in the per-protocol (PP) population. MATERIALS AND METHODS The PP population comprised patients receiving ≥80% of planned treatment during the first 6 weeks, with no major protocol violations. A post-hoc analysis of the non-PP population was also performed. RESULTS For PP patients, median OS was 8.9 (95% confidence interval: 6.4-10.5) months with nal-IRI+5-FU/LV (n = 66) vs 5.1 (4.0-7.2) months with 5-FU/LV (n = 71; unstratified hazard ratio [HR] 0.57, p = 0.011). For non-PP patients, it was 4.4 (3.3-5.3) months with nal-IRI+5-FU/LV (n = 51) vs 2.8 (1.7-3.2) months with 5-FU/LV (n = 48; unstratified HR 0.64, p = 0.0648). CONCLUSION A statistically significant survival advantage was observed with nal-IRI+5-FU/LV vs 5-FU/LV in the PP patient population.
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Affiliation(s)
- Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes (NHRI), 367 Sheng-Li Road, Tainan 704, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan 704, Taiwan.
| | - Jens T Siveke
- Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany; German Cancer Consortium (DKTK, Partner Site Essen) and German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Andrea Wang-Gillam
- Division of Oncology, Washington University in St. Louis, 660 South Euclid Ave, St. Louis, MO 63110, USA
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, Beitou District, Taipei 112, Taiwan; National Yang-Ming University School of Medicine, No. 155, Section 2, Linong St, Beitou District, Taipei 112, Taiwan
| | - György Bodoky
- Department of Oncology, Szent László Hospital, Albert Flórián út 5, 1097 Budapest, Hungary
| | - Andrew P Dean
- St. John of God Hospital, 12 Salvado Rd, Subiaco, WA 6008, Australia
| | - Yan-Shen Shan
- Department of Surgery, National Cheng Kung University Hospital, No. 138, Shengli Rd, North District, Tainan 704, Taiwan
| | - Gayle S Jameson
- Virginia G. Piper Cancer Center at HonorHealth/TGen, 10460N 92(nd) St #206, Scottsdale, AZ 85258, USA
| | - Teresa Macarulla
- Vall d'Hebron University Hospital (HUVH), Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain; Vall d'Hebron Institute of Oncology (VHIO), Centro Cellex, Calle Natzaret, 115-117, 08035 Barcelona, Spain
| | - Kyung-Hun Lee
- Department of Internal Medicine and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, Seoul 03080, South Korea
| | - David Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, 203 Fulham Rd, Chelsea, SW3 6JJ London, UK; The Royal Marsden Hospital NHS Foundation Trust (Surrey), Downs Rd, Sutton, SM2 5PT Surrey, UK
| | | | - Chang-Fang Chiu
- China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan
| | - Gilberto Schwartsmann
- Federal University of Rio Grande do Sul, Av. Paulo Gama, 110 - Farroupilha, Porto Alegre, RS 90040-060, Brazil
| | - Fadi S Braiteh
- Comprehensive Cancer Centers of Nevada, University of Nevada School of Medicine, 3730 S Eastern Ave, Las Vegas, NV 89169, USA
| | - Khalid Mamlouk
- Ipsen Bioscience, Inc., 650 East Kendall St, Cambridge, MA 02142, USA
| | - Bruce Belanger
- Ipsen Bioscience, Inc., 650 East Kendall St, Cambridge, MA 02142, USA
| | | | - Richard A Hubner
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, 550 Wilmslow Rd, M20 4BX Manchester, UK
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Chau I, Al-Batran SE, Luft A, Kowalyszyn R, Hernandez C, Pfeiffer P, Wojcik E, Bodoky G, Madi A, Brenner B, De Vita F, Folprecht G, Peltola K, Lorenzen S, Denlinger C, Liepa A, Das M, Wei R, Fuchs C. Quality-of-life (QoL) results from RAINFALL: A randomized, double-blind, placebo (PL)-controlled phase III study of cisplatin (Cis) plus capecitabine (Cape) or 5FU with or without ramucirumab (RAM) as first-line therapy for metastatic gastric or gastroesophageal junction (G-GEJ) cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Macarulla Mercade T, Bodoky G, Siveke J, Lee KH, Chen J, Mirakhur B, Dean A, Chen LT, de Jong F. NAPOLI-1 phase III trial outcomes by prior surgery, and disease stage, in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.116] [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: 11/13/2022] Open
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24
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Goey KKH, Sørbye H, Glimelius B, Adams RA, André T, Arnold D, Berlin JD, Bodoky G, de Gramont A, Díaz-Rubio E, Eng C, Falcone A, Grothey A, Heinemann V, Hochster HS, Kaplan RS, Kopetz S, Labianca R, Lieu CH, Meropol NJ, Price TJ, Schilsky RL, Schmoll HJ, Shacham-Shmueli E, Shi Q, Sobrero AF, Souglakos J, Van Cutsem E, Zalcberg J, van Oijen MGH, Punt CJA, Koopman M. Consensus statement on essential patient characteristics in systemic treatment trials for metastatic colorectal cancer: Supported by the ARCAD Group. Eur J Cancer 2018; 100:35-45. [PMID: 29936065 DOI: 10.1016/j.ejca.2018.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 03/25/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient characteristics and stratification factors are key features influencing trial outcomes. However, there is substantial heterogeneity in reporting of patient characteristics and use of stratification factors in phase 3 trials investigating systemic treatment of metastatic colorectal cancer (mCRC). We aimed to develop a minimum set of essential baseline characteristics and stratification factors to include in such trials. METHODS We performed a modified, two-round Delphi survey among international experts with wide experience in the conduct and methodology of phase 3 trials of systemic treatment of mCRC. RESULTS Thirty mCRC experts from 15 different countries completed both consensus rounds. A total of 14 patient characteristics were included in the recommended set: age, performance status, primary tumour location, primary tumour resection, prior chemotherapy, number of metastatic sites, liver-only disease, liver involvement, surgical resection of metastases, synchronous versus metachronous metastases, (K)RAS and BRAF mutation status, microsatellite instability/mismatch repair status and number of prior treatment lines. A total of five patient characteristics were considered the most relevant stratification factors: RAS/BRAF mutation status, performance status, primary tumour sidedness and liver-only disease. CONCLUSIONS This survey provides a minimum set of essential baseline patient characteristics and stratification factors to include in phase 3 trials of systemic treatment of mCRC. Inclusion of these patient characteristics and strata in study protocols and final study reports will improve interpretation of trial results and facilitate cross-study comparisons.
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Affiliation(s)
- Kaitlyn K H Goey
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Halfdan Sørbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Thierry André
- Department of Medical Oncology, Hôpital St Antoine; Sorbonne Universités, UMPC Paris 06, Paris, France
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | - Jordan D Berlin
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | - György Bodoky
- Department of Medical Oncology, St. Laszlo Hospital, Budapest, Hungary
| | - Aimery de Gramont
- Department of Medical Oncology, Institut Hospitalier Franco Britannique, Levallois-Perret, Paris, France
| | - Eduardo Díaz-Rubio
- Department of Medical Oncology, Hospital Clínico San Carlos, Universidad Complutense, CIBERONC, Madrid, Spain
| | - Cathy Eng
- Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Alfredo Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy
| | - Axel Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Volker Heinemann
- Medical Department III, Comprehensive Cancer Center, University Clinic Munich, Munich, Germany
| | | | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Scott Kopetz
- Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Neal J Meropol
- Flatiron Health, New York, NY, USA; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Australia
| | | | - Hans-Joachim Schmoll
- Division Clinical Oncology Research, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - John Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | - Eric Van Cutsem
- Department of Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Martijn G H van Oijen
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Finn RS, Merle P, Granito A, Huang YH, Bodoky G, Pracht M, Yokosuka O, Rosmorduc O, Gerolami R, Caparello C, Cabrera R, Chang C, Sun W, LeBerre MA, Baumhauer A, Meinhardt G, Bruix J. Outcomes of sequential treatment with sorafenib followed by regorafenib for HCC: Additional analyses from the phase III RESORCE trial. J Hepatol 2018; 69:353-358. [PMID: 29704513 DOI: 10.1016/j.jhep.2018.04.010] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/09/2018] [Accepted: 04/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The RESORCE trial showed that regorafenib improves overall survival (OS) in patients with hepatocellular carcinoma progressing during sorafenib treatment (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.50-0.78; p <0.0001). This exploratory analysis describes outcomes of sequential treatment with sorafenib followed by regorafenib. METHODS In RESORCE, 573 patients were randomized 2:1 to regorafenib 160 mg/day or placebo for 3 weeks on/1 week off. Efficacy and safety were evaluated by last sorafenib dose. The time from the start of sorafenib to death was assessed. Time to progression (TTP) in RESORCE was analyzed by TTP during prior sorafenib treatment. RESULTS HRs (regorafenib/placebo) for OS by last sorafenib dose were similar (0.67 for 800 mg/day; 0.68 for <800 mg/day). Rates of grade 3, 4, and 5 adverse events with regorafenib by last sorafenib dose (800 mg/day vs. <800 mg/day) were 52%, 11%, and 15% vs. 60%, 10%, and 12%, respectively. Median times (95% CI) from the start of sorafenib to death were 26.0 months (22.6-28.1) for regorafenib and 19.2 months (16.3-22.8) for placebo. Median time from the start of sorafenib to progression on sorafenib was 7.2 months for the regorafenib arm and 7.1 months for the placebo arm. An analysis of TTP in RESORCE in subgroups defined by TTP during prior sorafenib in quartiles (Q) showed HRs (regorafenib/placebo; 95% CI) of 0.66 (0.45-0.96; Q1); 0.26 (0.17-0.40; Q2); 0.40 (0.27-0.60; Q3); and 0.54 (0.36-0.81; Q4). CONCLUSIONS These exploratory analyses show that regorafenib conferred a clinical benefit regardless of the last sorafenib dose or TTP on prior sorafenib. Rates of adverse events were generally similar regardless of the last sorafenib dose. LAY SUMMARY This analysis examined characteristics and outcomes of patients with hepatocellular carcinoma who were treated with regorafenib after they had disease progression during sorafenib treatment. Regorafenib provided clinical benefit to patients regardless of the pace of their disease progression during prior sorafenib treatment and regardless of their last sorafenib dose. The sequence of sorafenib followed by regorafenib for hepatocellular carcinoma may extend survival beyond what has been previously reported. ClinicalTrials.gov NCT01774344.
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Affiliation(s)
- Richard S Finn
- Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Philippe Merle
- Groupement Hospitalier Lyon Nord, Hepatology Unit, Lyon, France
| | - Alessandro Granito
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - György Bodoky
- Department of Oncology, St Laszlo Teaching Hospital, Budapest, Hungary
| | - Marc Pracht
- Service d'Oncologie Médicale, Centre Eugène Marquis, Rennes, France
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Chiba University, Chiba, Japan
| | - Olivier Rosmorduc
- Department of Gastroenterology and Hepatology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - René Gerolami
- Service d'Hépato-gastroentérologie, CHU Timone, Université de la Méditerranée, Marseille, France
| | - Chiara Caparello
- Medical Oncology Unit, Department of Translational Research and New Technologies in Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Roniel Cabrera
- University of Florida, Hepatology, UF Health Cancer Center, Gainesville, FL, USA
| | - Charissa Chang
- Liver Cancer Program, Division of Liver Diseases, Mount Sinai Medical Center, New York, NY, USA
| | - Weijing Sun
- Medical Oncology Division, University of Kansas School of Medicine, Kansas City, KS, USA
| | | | | | | | - Jordi Bruix
- BCLC Group, Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
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Lakatos G, Lee K, Siveke J, Blanc J, Mercadé TM, Dean A, Bodoky G, Mirakhur B, Chen J, Wang-Gillam A, Chen L, de Jong F. Prognostic value of baseline biliary stents on outcomes in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) in the NAPOLI-1 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.150] [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: 11/13/2022] Open
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Mercadé TM, Wang-Gillam A, Chen L, Blanc J, Lee K, Bodoky G, Dean A, Chen J, Mirakhur B, Siveke J, de Jong F. The effect of best response to prior anticancer therapy on efficacy outcomes in the NAPOLI-1 trial of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) previously treated with gemcitabine-based therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.151] [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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Mercadé TM, Wang-Gillam A, Chen L, Blanc J, Lee K, Bodoky G, Dean A, Siveke J, Mirakhur B, Chen J, de Jong F. Prognostic effect of primary tumor location in the NAPOLI-1 phase 3 study in metastatic pancreatic ductal adenocarcinoma (mPDAC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee K, Bodoky G, Blanc J, Siveke J, Mercadé TM, Wang-Gillam A, Chen L, Mirakhur B, Chen J, de Jong F. Decreased appetite (DA) at baseline impacts prognosis in the NAPOLI-1 phase 3 study in metastatic pancreatic ductal adenocarcinoma (mPDAC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Han G, Merle P, Granito A, Huang YH, Bodoky G, Yokosuka O, Rosmorduc O, Breder V, Gerolami R, Masi G, Ross PJ, Qin S, Song T, Bronowicki JP, Ollivier-Hourmand I, Kudo M, LeBerre MA, Baumhauer A, Meinhardt G, Bruix J. 4:12 PM Abstract No. 379 Updated overall survival (OS) analysis from the international, phase 3, randomized, placebo-controlled RESORCE trial of regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.420] [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: 11/25/2022] Open
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Tabernero J, Hozak RR, Yoshino T, Cohn AL, Obermannova R, Bodoky G, Garcia-Carbonero R, Ciuleanu TE, Portnoy DC, Prausová J, Muro K, Siegel RW, Konrad RJ, Ouyang H, Melemed SA, Ferry D, Nasroulah F, Van Cutsem E. Analysis of angiogenesis biomarkers for ramucirumab efficacy in patients with metastatic colorectal cancer from RAISE, a global, randomized, double-blind, phase III study. Ann Oncol 2018; 29:602-609. [PMID: 29228087 PMCID: PMC5888948 DOI: 10.1093/annonc/mdx767] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The phase III RAISE trial (NCT01183780) demonstrated that the vascular endothelial growth factor (VEGF) receptor (VEGFR)-2 binding monoclonal antibody ramucirumab plus 5-fluororuracil, leucovorin, and irinotecan (FOLFIRI) significantly improved overall survival (OS) and progression-free survival (PFS) compared with placebo + FOLFIRI as second-line metastatic colorectal cancer (mCRC) treatment. To identify patients who benefit the most from VEGFR-2 blockade, the RAISE trial design included a prospective and comprehensive biomarker program that assessed the association of biomarkers with ramucirumab efficacy outcomes. Patients and methods Plasma and tumor tissue collection was mandatory. Overall, 1072 patients were randomized 1 : 1 to the addition of ramucirumab or placebo to FOLFIRI chemotherapy. Patients were then randomized 1 : 2, for the biomarker program, to marker exploratory (ME) and marker confirmatory (MC) groups. Analyses were carried out using exploratory assays to assess the correlations of baseline marker levels [VEGF-C, VEGF-D, sVEGFR-1, sVEGFR-2, sVEGFR-3 (plasma), and VEGFR-2 (tumor tissue)] with clinical outcomes. Cox regression analyses were carried out for each candidate biomarker with stratification factor adjustment. Results Biomarker results were available from >80% (n = 894) of patients. Analysis of the ME subset determined a VEGF-D level of 115 pg/ml was appropriate for high/low subgroup analyses. Evaluation of the combined ME + MC populations found that the median OS in the ramucirumab + FOLFIRI arm compared with placebo + FOLFIRI showed an improvement of 2.4 months in the high VEGF-D subgroup [13.9 months (95% CI 12.5-15.6) versus 11.5 months (95% CI 10.1-12.4), respectively], and a decrease of 0.5 month in the low VEGF-D subgroup [12.6 months (95% CI 10.7-14.0) versus 13.1 months (95% CI 11.8-17.0), respectively]. PFS results were consistent with OS. No trends were evident with the other antiangiogenic candidate biomarkers. Conclusions The RAISE biomarker program identified VEGF-D as a potential predictive biomarker for ramucirumab efficacy in second-line mCRC. Development of an assay appropriate for testing in clinical practice is currently ongoing. Clinical trials registration NCT01183780.
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Affiliation(s)
- J Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; CIBERONC, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - R R Hozak
- Oncology, Eli Lilly and Company, Indianapolis, USA
| | - T Yoshino
- Division of Gastrointestinal Oncology/Digestive Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - A L Cohn
- Medical Oncology, Rocky Mountain Cancer Center/US Oncology, Denver, USA
| | - R Obermannova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - G Bodoky
- Oncology, Szent László Hospital, Budapest, Hungary
| | - R Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario 12 de Octubre, CNIO; CIBERONC, Universidad Complutense, Madrid, Spain
| | - T-E Ciuleanu
- Medical Oncology, Prof. Dr. I. Chiricuţă Institute of Oncology, Cluj-Napoca, Romania
| | | | - J Prausová
- Department of Oncology and Radiotherapy, University Hospital Motol, Prague, Czech Republic
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - R W Siegel
- Laboratory for Experimental Medicine, Eli Lilly and Company, Indianapolis, USA
| | - R J Konrad
- Laboratory for Experimental Medicine, Eli Lilly and Company, Indianapolis, USA
| | - H Ouyang
- Oncology, Eli Lilly and Company, Indianapolis, USA
| | - S A Melemed
- Oncology, Eli Lilly and Company, Indianapolis, USA
| | - D Ferry
- Oncology, Eli Lilly and Company, Indianapolis, USA
| | | | - E Van Cutsem
- Digestive Oncology, University Hospital Gasthuisberg, Leuven, Belgium; KU Leuven, Leuven, Belgium
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von Moos R, Koeberle D, Schacher S, Hayoz S, Winterhalder RC, Roth A, Bodoky G, Samaras P, Berger MD, Rauch D, Saletti P, Plasswilm L, Zwahlen D, Meier UR, Yan P, Izzo P, Klingbiel D, Bärtschi D, Zaugg K. Neoadjuvant radiotherapy combined with capecitabine and sorafenib in patients with advanced KRAS-mutated rectal cancer: A phase I/II trial (SAKK 41/08). Eur J Cancer 2017; 89:82-89. [PMID: 29241084 DOI: 10.1016/j.ejca.2017.11.005] [Citation(s) in RCA: 14] [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: 06/16/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND KRAS mutation occurs in ∼40% of locally advanced rectal cancers (LARCs). The multitarget tyrosine kinase inhibitor sorafenib has radiosensitising effects and might improve outcomes for standard preoperative chemoradiotherapy in patients with KRAS-mutated LARC. METHODS Adult patients with KRAS-mutated T3/4 and/or N1/2M0 LARC were included in this phase I/II study. The phase I dose-escalation study of capecitabine plus sorafenib and radiotherapy was followed by a phase II study assessing efficacy and safety. Primary end-points were to: establish the maximum tolerated dose of the regimen in phase I; determine the pathologic complete response (pCR) rate in phase II defined as Dworak regression grade 3 and 4. RESULTS Fifty-four patients were treated at 18 centres in Switzerland and Hungary; 40 patients were included in the single-arm phase II study. Recommended doses from phase I comprised radiotherapy (45 Gy in 25 fractions over 5 weeks) with capecitabine 825 mg/m2 twice daily × 33 plus sorafenib 400 mg/d. Median daily dose intensity in phase II was radiotherapy 100%, capecitabine 98.6%, and sorafenib 100%. The pCR rate (Dworak 3/4) was 60% (95% CI, 43.3-75.1%) by central independent pathologic review. Sphincter preservation was achieved in 89.5%, R0 resection in 94.7%, and downstaging in 81.6%. The most common grade 3 toxicities during phase II included diarrhoea (15.0%), skin toxicity outside radiotherapy field (12.5%), pain (7.5%), skin toxicity in radiotherapy field, proctitis, fatigue and cardiac ischaemia (each 5%). CONCLUSIONS Combining sorafenib and standard chemoradiotherapy with capecitabine is highly active in patients with KRAS-mutated LARC with acceptable toxicity and deserves further investigation. www.clinicaltrials.gov: NCT00869570.
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Affiliation(s)
| | | | | | | | | | - Arnaud Roth
- University Hospital Geneva, Geneva, Switzerland
| | | | | | | | | | | | - Ludwig Plasswilm
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Inselspital Bern, Bern, Switzerland
| | | | - Urs R Meier
- Kantonsspital Winterthur, Winterthur, Switzerland
| | - Pu Yan
- University Hospital Zürich, Zürich, Switzerland
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Blanc J, Hubner R, Li CP, Wang-Gillam A, Bodoky G, Dean A, Shan YS, Jameson G, Macarulla Mercade T, Lee KH, Cunningham D, Chiu CF, Schwartsmann G, Braiteh F, von Hoff D, Chen LT, Mamlouk K, de Jong F, Siveke J. Subgroup analysis by prior non-liposomal irinotecan therapy in NAPOLI-1: a phase 3 study of nal-IRI±5-fluorouracil/leucovorin in patients with metastatic pancreatic ductal adenocarcinoma previously treated with gemcitabine-based therapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx660.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fábián O, Pálházi B, Tihanyi D, Várkondi E, Mathiasz D, Hegedüs C, Schwáb R, Bodoky G, Vályi-Nagy I, Peták I. Decision support system for the interpretation of multiplex genetic tests in gastrointestinal cancers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx508.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tabernero J, Ohtsu A, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Ajani JA, Tomasek J, Safran H, Chandrawansa K, Hsu Y, Heathman M, Khan A, Ni L, Melemed AS, Gao L, Ferry D, Fuchs CS. Exposure-Response Analyses of Ramucirumab from Two Randomized, Phase III Trials of Second-line Treatment for Advanced Gastric or Gastroesophageal Junction Cancer. Mol Cancer Ther 2017; 16:2215-2222. [PMID: 28716815 DOI: 10.1158/1535-7163.mct-16-0895] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/06/2017] [Accepted: 06/22/2017] [Indexed: 11/16/2022]
Abstract
Ramucirumab is an IgG1 monoclonal antibody specific for the vascular endothelial growth factor receptor-2. Ramucirumab, 8 mg/kg every 2 weeks, administered as monotherapy (REGARD) or in combination with paclitaxel (RAINBOW), was safe and effective in patients with previously treated advanced gastric or gastroesophageal junction (GEJ) cancer. We evaluated exposure-efficacy and exposure-safety relationships of ramucirumab from two randomized, placebo-controlled phase III trials. Sparse pharmacokinetic samples were collected, and a population pharmacokinetic analysis was conducted to predict ramucirumab minimum trough concentration at steady state (Cmin,ss). Kaplan-Meier methods and Cox proportional hazards models were used to evaluate the ramucirumab exposure (Cmin,ss)-efficacy relationship to overall survival (OS) and progression-free survival (PFS). Logistic regression analyses were used to evaluate exposure-safety relationships. Analyses included 321 ramucirumab + paclitaxel and 335 placebo + paclitaxel patients from RAINBOW and 72 ramucirumab and 35 placebo patients from REGARD. Exposure-efficacy analysis showed ramucirumab Cmin,ss was a significant predictor of OS and PFS in both trials. Higher ramucirumab exposure was associated with longer OS and PFS. In RAINBOW, grade ≥3 hypertension, leukopenia, and neutropenia, but not febrile neutropenia, significantly correlated with Cmin,ss, with increased exposure leading to increased incidence. Exploratory exposure-response analyses suggest a positive relationship between efficacy and ramucirumab exposure with manageable toxicities at exposures generated from a dose of 8 mg/kg ramucirumab given every 2 weeks for patients with advanced gastric/GEJ cancer. These findings suggest an opportunity to further optimize benefit versus risk profiles of ramucirumab treatment in patients with gastric/GEJ cancer. Mol Cancer Ther; 16(10); 2215-22. ©2017 AACR.
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Affiliation(s)
- Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Atsushi Ohtsu
- National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kei Muro
- Aichi Cancer Center Hospital, Nagoya, Japan
| | | | | | | | | | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Yanzhi Hsu
- Eli Lilly and Company, Bridgewater, New Jersey
| | | | - Azhar Khan
- Eli Lilly and Company, Windlesham, Surrey, United Kingdom
| | - Lan Ni
- Eli Lilly and Company, Indianapolis, Indiana
| | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, New Jersey
| | - David Ferry
- Eli Lilly and Company, Indianapolis, Indiana
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Tabernero J, Hozak R, Yoshino T, Cohn A, Obermannova R, Bodoky G, Garcia-Carbonero R, Ciuleanu TE, Portnoy D, Muro K, Ouyang H, Melemed S, Ferry D, Nasroulah F, Van Cutsem E. Analysis of angiogenesis biomarkers for ramucirumab (RAM) efficacy in patients with metastatic colorectal cancer (mCRC) from RAISE, a global, randomized, double-blind, Phase 3 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hubner R, Chen LT, Li CP, Bodoky G, Dean A, Lee KH, Cunningham D, Siveke J, Braiteh F, de Jong F, Belanger B, Walls R, Mody P, von Hoff D, Wang-Gillam A. Prognostic value of baseline neutrophil-to-lymphocyte ratio for predicting clinical outcome in metastatic pancreatic ductal adenocarcinoma (mPDAC) patients treated with liposomal irinotecan (nal-IRI) + 5-fluorouracil and leucovorin (5-FU/LV) vs 5-FU/LV alone. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.124] [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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Cohn AL, Yoshino T, Heinemann V, Obermannova R, Bodoky G, Prausová J, Garcia-Carbonero R, Ciuleanu T, Garcia-Alfonso P, Portnoy DC, Van Cutsem E, Yamazaki K, Clingan PR, Polikoff J, Lonardi S, O'Brien LM, Gao L, Yang L, Ferry D, Nasroulah F, Tabernero J. Exposure-response relationship of ramucirumab in patients with advanced second-line colorectal cancer: exploratory analysis of the RAISE trial. Cancer Chemother Pharmacol 2017; 80:599-608. [PMID: 28744667 PMCID: PMC5573752 DOI: 10.1007/s00280-017-3380-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/27/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To characterize ramucirumab exposure-response relationships for efficacy and safety in patients with metastatic colorectal cancer (mCRC) using data from the RAISE study. METHODS Sparse pharmacokinetic samples were collected; a population pharmacokinetic analysis was conducted. Univariate and multivariate Cox proportional hazards models analyzed the relationship between predicted ramucirumab minimum trough concentration at steady state (C min,ss) and survival. Kaplan-Meier analysis was used to evaluate survival from patients in the ramucirumab plus folinic acid, 5-fluorouracil, and irinotecan (FOLFIRI) treatment arm stratified by C min,ss quartiles (Q). An ordered categorical model analyzed the relationship between C min,ss and safety outcomes. RESULTS Pharmacokinetic samples from 906 patients were included in exposure-efficacy analyses; samples from 905 patients were included in exposure-safety analyses. A significant association was identified between C min,ss and overall survival (OS) and progression-free survival (PFS) (p < 0.0001 for both). This association remained significant after adjusting for baseline factors associated with OS or PFS (p < 0.0001 for both). Median OS was 11.5, 12.9, 16.4, and 16.7, and 12.4 months for ramucirumab C min,ss Q1, Q2, Q3, Q4, and placebo group, respectively. Median PFS was 5.4, 4.6, 6.8, 8.5, and 5.2 months for ramucirumab C min,ss Q1, Q2, Q3, Q4, and placebo group, respectively. The risk of Grade ≥3 neutropenia was associated with an increase in ramucirumab exposure. CONCLUSIONS Exploratory exposure-response analyses suggested a positive relationship between efficacy and ramucirumab exposure with manageable toxicities in patients from the RAISE study with mCRC over the ranges of exposures achieved by a dose of 8 mg/kg every 2 weeks in combination with FOLFIRI.
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Affiliation(s)
- Allen Lee Cohn
- Rocky Mountain Cancer Center, 1800 Williams Street, Denver, CO, 80218, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sara Lonardi
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, NJ, USA
| | - Ling Yang
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
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Fuchs CS, Muro K, Tomasek J, Van Cutsem E, Cho JY, Oh SC, Safran H, Bodoky G, Chau I, Shimada Y, Al-Batran SE, Passalacqua R, Ohtsu A, Emig M, Ferry D, Chandrawansa K, Hsu Y, Sashegyi A, Liepa AM, Wilke H. Prognostic Factor Analysis of Overall Survival in Gastric Cancer from Two Phase III Studies of Second-line Ramucirumab (REGARD and RAINBOW) Using Pooled Patient Data. J Gastric Cancer 2017; 17:132-144. [PMID: 28680718 PMCID: PMC5489542 DOI: 10.5230/jgc.2017.17.e16] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 12/06/2016] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify baseline prognostic factors for survival in patients with disease progression, during or after chemotherapy for the treatment of advanced gastric or gastroesophageal junction (GEJ) cancer. MATERIALS AND METHODS We pooled data from patients randomized between 2009 and 2012 in 2 phase III, global double-blind studies of ramucirumab for the treatment of advanced gastric or GEJ adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing therapy (REGARD and RAINBOW). Forty-one key baseline clinical and laboratory factors common in both studies were examined. Model building started with covariate screening using univariate Cox models (significance level=0.05). A stepwise multivariable Cox model identified the final prognostic factors (entry+exit significance level=0.01). Cox models were stratified by treatment and geographic region. The process was repeated to identify baseline prognostic quality of life (QoL) parameters. RESULTS Of 1,020 randomized patients, 953 (93%) patients without any missing covariates were included in the analysis. We identified 12 independent prognostic factors of poor survival: 1) peritoneal metastases; 2) Eastern Cooperative Oncology Group (ECOG) performance score 1; 3) the presence of a primary tumor; 4) time to progression since prior therapy <6 months; 5) poor/unknown tumor differentiation; abnormally low blood levels of 6) albumin, 7) sodium, and/or 8) lymphocytes; and abnormally high blood levels of 9) neutrophils, 10) aspartate aminotransferase (AST), 11) alkaline phosphatase (ALP), and/or 12) lactate dehydrogenase (LDH). Factors were used to devise a 4-tier prognostic index (median overall survival [OS] by risk [months]: high=3.4, moderate=6.4, medium=9.9, and low=14.5; Harrell's C-index=0.66; 95% confidence interval [CI], 0.64-0.68). Addition of QoL to the model identified patient-reported appetite loss as an independent prognostic factor. CONCLUSIONS The identified prognostic factors and the reported prognostic index may help clinical decision-making, patient stratification, and planning of future clinical studies.
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Affiliation(s)
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eric Van Cutsem
- University Hospital Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | | | | | - Howard Safran
- Oncology Research Group, Brown University, Providence, RI, USA
| | | | - Ian Chau
- Royal Marsden Hospital, London and Surrey, United Kingdom
| | - Yasuhiro Shimada
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Salah-Eddin Al-Batran
- Institute of Clinical Research, Universitären Centrum für Tumorerkrankungen-University Cancer Center, Frankfurt, Germany
| | | | - Atsushi Ohtsu
- Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | | | | | | | - Yanzhi Hsu
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | | | - Hansjochen Wilke
- Departments of Oncology and Hematology with Integrated Palliative Care, Kliniken Essen-Mitte, Essen, Germany
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40
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Bodoky G. [Role of immunotherapy in the management of colorectal cancer]. Magy Onkol 2017; 61:147-151. [PMID: 28585616] [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] [Received: 02/24/2017] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Abstract
Immunotherapy proved to be effective in various forms of cancer but it is in its infancy in colorectal cancer, although the Immunoscore was developed to classify this tumor immunologically. Various forms of immunotherapy were tested in early clinical trials but anti-PD-1 antibodies seem the most promising so far. These studies also revealed that one particular molecular subgroup of colorectal cancer, the microsatellite instable variant, is extremely sensitive for such modality.
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Affiliation(s)
- György Bodoky
- Onkológiai osztály, Egyesített Szent István és Szent László Kórház, Budapest, Hungary.
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41
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Yoshino T, Obermannová R, Bodoky G, Garcia-Carbonero R, Ciuleanu T, Portnoy DC, Kim TW, Hsu Y, Ferry D, Nasroulah F, Tabernero J. Baseline carcinoembryonic antigen as a predictive factor of ramucirumab efficacy in RAISE, a second-line metastatic colorectal carcinoma phase III trial. Eur J Cancer 2017; 78:61-69. [PMID: 28412590 DOI: 10.1016/j.ejca.2017.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Received: 10/24/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND The RAISE phase III clinical trial demonstrated that ramucirumab + (folinic acid plus 5-fluorouracil plus irinotecan) FOLFIRI significantly improved overall survival (OS) versus placebo + FOLFIRI for second-line metastatic colorectal carcinoma (mCRC) patients failing bevacizumab- and oxaliplatin-based chemotherapy (hazard ratio [HR] = 0.84, 95% CI = 0.73-0.98, P = 0.022). Post hoc analyses of RAISE patient data examined the association of carcinoembryonic antigen (CEA) subgroups with efficacy parameters. METHODS CEA subgroups (≤10 versus >10 ng/ml) were based on 2X upper limit of normal (ULN) (5 ng/ml). The Kaplan-Meier method estimated the median OS and the progression-free survival (PFS). Log-rank test compared the survival distributions within the subgroups. Hazard ratio (HR) (95% confidence interval [CI]) and treatment-by-subgroup interaction p-values were calculated by Cox proportional hazards model. RESULTS Ramucirumab treatment prolonged survival for the CEA ≤10 subgroup (HR = 0.68; 95% CI = 0.50-0.92; P = 0.013) and CEA >10 subgroup (HR = 0.90; 95% CI = 0.76-1.07; P = 0.233). However, the ramucirumab OS benefit over placebo was greater for the CEA ≤10 subgroup than for the CEA >10 subgroup (median OS: 3.6 versus 0.8 months greater, respectively). The interaction P-value between CEA level and treatment effect on OS was 0.088. This trend was observed across randomisation strata and to a lesser extent for PFS (P = 0.594). CONCLUSIONS Although patients in both high- and low-CEA subgroups derive OS and PFS benefits from ramucirumab treatment, the low baseline CEA level may identify a subgroup of patients with mCRC who obtain greater benefit from ramucirumab.
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Affiliation(s)
| | | | | | | | - Tudor Ciuleanu
- Institutul Oncologic Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - David C Portnoy
- The West Clinic-University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Tae Won Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yanzhi Hsu
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
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42
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Evans TRJ, Van Cutsem E, Moore MJ, Bazin IS, Rosemurgy A, Bodoky G, Deplanque G, Harrison M, Melichar B, Pezet D, Elekes A, Rock E, Lin C, Strauss L, O'Dwyer PJ. Phase 2 placebo-controlled, double-blind trial of dasatinib added to gemcitabine for patients with locally-advanced pancreatic cancer. Ann Oncol 2017; 28:354-361. [PMID: 27998964 DOI: 10.1093/annonc/mdw607] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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] [Indexed: 01/16/2023] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) has a high mortality rate with limited treatment options. Gemcitabine provides a marginal survival benefit for patients with advanced PDAC. Dasatinib is a competitive inhibitor of Src kinase, which is overexpressed in PDAC tumors. Dasatinib and gemcitabine were combined in a phase 1 clinical trial where stable disease was achieved in two of eight patients with gemcitabine-refractory PDAC. Patients and methods This placebo-controlled, randomized, double-blind, phase II study compared the combination of gemcitabine plus dasatinib to gemcitabine plus placebo in patients with locally advanced, non-metastatic PDAC. Patients received gemcitabine 1000 mg/m2 (30-min IV infusion) on days 1, 8, 15 of a 28-day cycle combined with either 100 mg oral dasatinib or placebo tablets daily. The primary objective was overall survival (OS), with safety and progression-free survival (PFS) as secondary objectives. Exploratory endpoints included overall response rate, freedom from distant metastasis, pain and fatigue progression and response rate, and CA19-9 response rate. Results There was no statistically significant difference in OS between the two treatment groups (HR = 1.16; 95% confidence interval [CI]: 0.81-1.65; P = 0.5656). Secondary and exploratory endpoint analyses also showed no statistically significant differences. The burden of toxicity was higher in the dasatinib arm. Conclusions Dasatinib failed to show increased OS or PFS in patients with locally advanced PDAC. Alternative combinations or trial designs may show a role for src inhibition in PDAC treatment.
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Affiliation(s)
- T R J Evans
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - E Van Cutsem
- Department of Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - M J Moore
- Princess Margaret Cancer, Toronto, Canada
| | - I S Bazin
- Federal State Budgetary Institution, Dubna, Russia
| | - A Rosemurgy
- Surgery, Florida Hospital, Tampa, Tampa, USA
| | - G Bodoky
- Oncology, St.László Teaching Hospital, Budapest, Hungary
| | - G Deplanque
- Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M Harrison
- East and North Hertfordshire NHS Trust, Northwood, Middlesex, UK
| | - B Melichar
- Department of Oncology, Lekarska Fakulta Univerzity Palackeho a Fakultni Nemocnice, Olomouc, Czech Republic
| | - D Pezet
- CHU Estaing, Clermont-Ferrand, France
| | - A Elekes
- Otsuka Pharmaceutical Development and Commercialization, Princeton
| | - E Rock
- Otsuka Pharmaceutical Development and Commercialization, Princeton
| | - C Lin
- Otsuka Pharmaceutical Development and Commercialization, Princeton
| | - L Strauss
- Bristol-Myers Squibb Company, Princeton
| | - P J O'Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
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Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, Pracht M, Yokosuka O, Rosmorduc O, Breder V, Gerolami R, Masi G, Ross PJ, Song T, Bronowicki JP, Ollivier-Hourmand I, Kudo M, Cheng AL, Llovet JM, Finn RS, LeBerre MA, Baumhauer A, Meinhardt G, Han G. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017; 389:56-66. [PMID: 27932229 DOI: 10.1016/s0140-6736(16)32453-9] [Citation(s) in RCA: 2376] [Impact Index Per Article: 339.4] [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: 11/04/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are no systemic treatments for patients with hepatocellular carcinoma (HCC) whose disease progresses during sorafenib treatment. We aimed to assess the efficacy and safety of regorafenib in patients with HCC who have progressed during sorafenib treatment. METHODS In this randomised, double-blind, parallel-group, phase 3 trial done at 152 sites in 21 countries, adults with HCC who tolerated sorafenib (≥400 mg/day for ≥20 of last 28 days of treatment), progressed on sorafenib, and had Child-Pugh A liver function were enrolled. Participants were randomly assigned (2:1) by a computer-generated randomisation list and interactive voice response system and stratified by geographical region, Eastern Cooperative Oncology Group performance status, macrovascular invasion, extrahepatic disease, and α-fetoprotein level to best supportive care plus oral regorafenib 160 mg or placebo once daily during weeks 1-3 of each 4-week cycle. Investigators, patients, and the funder were masked to treatment assignment. The primary endpoint was overall survival (defined as time from randomisation to death due to any cause) and analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01774344. FINDINGS Between May 14, 2013, and Dec 31, 2015, 843 patients were screened, of whom 573 were enrolled and randomised (379 to regorafenib and 194 to placebo; population for efficacy analyses), and 567 initiated treatment (374 received regorafenib and 193 received placebo; population for safety analyses). Regorafenib improved overall survival with a hazard ratio of 0·63 (95% CI 0·50-0·79; one-sided p<0·0001); median survival was 10·6 months (95% CI 9·1-12·1) for regorafenib versus 7·8 months (6·3-8·8) for placebo. Adverse events were reported in all regorafenib recipients (374 [100%] of 374) and 179 (93%) of 193 placebo recipients. The most common clinically relevant grade 3 or 4 treatment-emergent events were hypertension (57 patients [15%] in the regorafenib group vs nine patients [5%] in the placebo group), hand-foot skin reaction (47 patients [13%] vs one [1%]), fatigue (34 patients [9%] vs nine patients [5%]), and diarrhoea (12 patients [3%] vs no patients). Of the 88 deaths (grade 5 adverse events) reported during the study (50 patients [13%] assigned to regorafenib and 38 [20%] assigned to placebo), seven (2%) were considered by the investigator to be related to study drug in the regorafenib group and two (1%) in the placebo group, including two patients (1%) with hepatic failure in the placebo group. INTERPRETATION Regorafenib is the only systemic treatment shown to provide survival benefit in HCC patients progressing on sorafenib treatment. Future trials should explore combinations of regorafenib with other systemic agents and third-line treatments for patients who fail or who do not tolerate the sequence of sorafenib and regorafenib. FUNDING Bayer.
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Affiliation(s)
- Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, IDIBAPS-Hospital Clínic de Barcelona, CIBERehd, Universitat de Barcelona, Catalonia, Spain.
| | - Shukui Qin
- Chinese People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Nanjing, China
| | - Philippe Merle
- Groupement Hospitalier Lyon Nord, Hepatology Unit, Lyon, France
| | - Alessandro Granito
- Department of Medical and Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital, Bologna, Italy
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Marc Pracht
- Service d'Oncologie Médicale, Centre Eugène Marquis, Rennes, France
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Chiba University, Chiba, Japan
| | - Olivier Rosmorduc
- Department of Hepatology, Hôpital de la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - Valeriy Breder
- Russian Cancer Research Center n.a.N.Blokhin, Moscow, Russia
| | - René Gerolami
- CHU Timone, Université de la Méditerranée, Marseille, France
| | - Gianluca Masi
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Paul J Ross
- King's College Hospital NHS Foundation Trust, London, UK
| | - Tianqiang Song
- Tianjin Medical University Cancer Hospital, Tianjin, China
| | | | | | | | - Ann-Lii Cheng
- Department of Medical Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Josep M Llovet
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, IDIBAPS-Hospital Clínic de Barcelona, CIBERehd, Universitat de Barcelona, Catalonia, Spain; Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Richard S Finn
- Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | | | - Guohong Han
- The First Affiliated Hospital (Xijing Hospital) of the Fourth Military Medical University, Xi'an, China
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Lakatos G, Petranyi A, Szűcs A, Nehéz L, Harsanyi L, Hegyi P, Bodoky G. Efficacy and Safety of FOLFIRINOX in Locally Advanced Pancreatic Cancer. A Single Center Experience. Pathol Oncol Res 2017; 23:753-759. [PMID: 28062950 DOI: 10.1007/s12253-016-0176-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022]
Abstract
The management of locally advanced pancreatic cancer (LAPC) is a major challenge. Although new drugs are available for the treatment of metastatic disease, the optimal treatment of non-metastatic cases remains controversial. The role of neoadjuvant therapy is still a question of debate in this setting. The aim of the study was to prospectively collect and analyse data on efficacy and safety of a modified FOLFIRINOX regimen in LAPC patients treated in a single institution. Another major objective was to assess the capability of FOLFIRINOX to render primary non-resectable cancer to resectable. No bolus fluorouracil was given and a 20% dose reduction of oxaliplatin and irinotecan was applied. Primary G-CSF prophylaxis was applied to prevent febrile neutropenia. Thirty-two patients (mean age 60.2 years, range: 40-77 years) have been enrolled into the study. All patients had ECOG performance status of 0 or 1. Best response to therapy was stable disease (SD) or partial regression (PR) in 18 (56.2%) and 6 (18.8%) cases. Two patients (6.3%) underwent surgical resection (100% R0). The most frequent grade 3/4 adverse events were nausea (18.8%), fatigue (12.5%) and diarrhea (12.5%). The incidence of severe neutropenia was 28.1%, with only one documented case of febrile neutropenia. The probability of disease progression was 25% and 50% after 75 and 160 days with 88.4% of possibility of disease progression after 500 days. OS probability was 92.1, 71.5% and 49.5% at 180-, 365 and 540 days. Our data does not support the capability of FOLFIRINOX to render primary non-resectable cancer to resectable. However, due to the high disease control rate observed, FOLFRINOX might be recommended as first line option for the palliative treatment of LAPC. Despite reduced chemotherapy doses significant toxicity has been seen.
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Affiliation(s)
- G Lakatos
- Department of Oncology, St. Istvan and St. Laszlo Hospital and Out-Patient Department, 5-7 Albert Flórián street, Budapest, H-1097, Hungary.
| | - A Petranyi
- Department of Oncology, St. Istvan and St. Laszlo Hospital and Out-Patient Department, 5-7 Albert Flórián street, Budapest, H-1097, Hungary
| | - A Szűcs
- First Department of Surgery, Semmelweis University, Budapest, Hungary
| | - L Nehéz
- First Department of Surgery, Semmelweis University, Budapest, Hungary
| | - L Harsanyi
- First Department of Surgery, Semmelweis University, Budapest, Hungary
| | - P Hegyi
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,First Department of Medicine, University of Pécs, Pécs, Hungary.,MTA-SZTE Translational Gastroenterology Research Group, University of Szeged, Szeged, Hungary
| | - G Bodoky
- Department of Oncology, St. Istvan and St. Laszlo Hospital and Out-Patient Department, 5-7 Albert Flórián street, Budapest, H-1097, Hungary
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Obermannová R, Van Cutsem E, Yoshino T, Bodoky G, Prausová J, Garcia-Carbonero R, Ciuleanu T, Garcia Alfonso P, Portnoy D, Cohn A, Yamazaki K, Clingan P, Lonardi S, Kim TW, Yang L, Nasroulah F, Tabernero J. Subgroup analysis in RAISE: a randomized, double-blind phase III study of irinotecan, folinic acid, and 5-fluorouracil (FOLFIRI) plus ramucirumab or placebo in patients with metastatic colorectal carcinoma progression. Ann Oncol 2016; 27:2082-2090. [PMID: 27573561 PMCID: PMC5091322 DOI: 10.1093/annonc/mdw402] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/27/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The RAISE phase III clinical trial demonstrated that ramucirumab + FOLFIRI improved overall survival (OS) [hazard ratio (HR) = 0.844, P = 0.0219] and progression-free survival (PFS) (HR = 0.793, P < 0.0005) compared with placebo + FOLFIRI for second-line metastatic colorectal carcinoma (mCRC) patients previously treated with first-line bevacizumab, oxaliplatin, and a fluoropyrimidine. Since some patient or disease characteristics could be associated with differential efficacy or safety, prespecified subgroup analyses were undertaken. This report focuses on three of the most relevant ones: KRAS status (wild-type versus mutant), age (<65 versus ≥65 years), and time to progression (TTP) on first-line therapy (<6 versus ≥6 months). PATIENTS AND METHODS OS and PFS were evaluated by the Kaplan-Meier analysis, with HR determined by the Cox proportional hazards model. Treatment-by-subgroup interaction was tested to determine whether treatment effect was consistent between subgroup pairs. RESULTS Patients with both wild-type and mutant KRAS benefited from ramucirumab + FOLFIRI treatment over placebo + FOLFIRI (interaction P = 0.526); although numerically, wild-type KRAS patients benefited more (wild-type KRAS: median OS = 14.4 versus 11.9 months, HR = 0.82, P = 0.049; mutant KRAS: median OS = 12.7 versus 11.3 months, HR = 0.89, P = 0.263). Patients with both longer and shorter first-line TTP benefited from ramucirumab (interaction P = 0.9434), although TTP <6 months was associated with poorer OS (TTP ≥6 months: median OS = 14.3 versus 12.5 months, HR = 0.86, P = 0.061; TTP <6 months: median OS = 10.4 versus 8.0 months, HR = 0.86, P = 0.276). The subgroups of patients ≥65 versus <65 years also derived a similar ramucirumab survival benefit (interaction P = 0.9521) (≥65 years: median OS = 13.8 versus 11.7 months, HR = 0.85, P = 0.156; <65 years: median OS = 13.1 versus 11.9 months, HR = 0.86, P = 0.098). The safety profile of ramucirumab + FOLFIRI was similar across subgroups. CONCLUSIONS These analyses revealed similar efficacy and safety among patient subgroups with differing KRAS mutation status, longer or shorter first-line TTP, and age. Ramucirumab is a beneficial addition to second-line FOLFIRI treatment for a wide range of patients with mCRC. TRIAL REGISTRATION ClinicalTrials.gov, NCT01183780.
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Affiliation(s)
- R Obermannová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - E Van Cutsem
- University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - G Bodoky
- Department of Oncology, St László Hospital, Budapest, Hungary
| | - J Prausová
- Onocology Clinic, Charles University, Prague, Czech Republic
| | - R Garcia-Carbonero
- Department of Oncology, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - T Ciuleanu
- Institutul Oncologic Ion Chiricuta and UMF, Cluj-Napoca, Romania
| | - P Garcia Alfonso
- Department of Oncology, Hospital General Universitario Gregorio Maraňón, Madrid, Spain
| | - D Portnoy
- The West Clinic-University of Tennessee Health Sciences Center, Memphis
| | - A Cohn
- Rocky Mountain Cancer Center, Denver, USA
| | - K Yamazaki
- Department of Gastrointestinal Oncology, Shizouka Cancer Center, Shizouka, Japan
| | - P Clingan
- Southern Medical Day Care Centre, Wollongong, NSW, Australia
| | - S Lonardi
- Department of Medical Oncology, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - T W Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - L Yang
- Eli Lilly and Company, Bridgewater, USA
| | - F Nasroulah
- Eli Lilly and Company, Buenos Aires, Argentine Republic
| | - J Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
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Nakajima T, Tabernero J, Van Cutsem E, Obermannova R, Bodoky G, Prausová J, Garcia-Carbonero R, Ciuleanu T, Alfonso PG, Portnoy D, Cohn A, Yamazaki K, Clingan P, Yoshino T, Lonardi S, Yang L, Nasroulah F. Subgroup analysis in RAISE: a phase III study of FOLFIRI + ramucirumab or placebo in patients with advanced mCRC. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw468.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Chen LT, Wang-Gillam A, Li CP, Bodoky G, Dean A, Shan YS, Jameson G, Macarulla T, Lee KH, Cunningham D, Blanc JF, Hubner R, Chiu CF, Schwartsmann G, Braiteh F, Belanger B, Bayever E, de Jong F, von Hoff D, Siveke J. Final results of NAPOLI-1: A phase 3 study of nal-IRI (MM-398) ± 5-fluorouracil and leucovorin (5-FU/LV) vs 5-FU/LV in metastatic pancreatic cancer (mPAC) previously treated with gemcitabine-based therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hubner R, Chen LT, Siveke J, Li CP, Bodoky G, Dean A, Shan YS, Jameson G, Macarulla T, Lee KH, Cunningham D, Blanc JF, Chiu CF, Schwartsmann G, Braiteh F, Mamlouk K, Belanger B, de Jong F, von Hoff D, Wang-Gillam A. Time course of selected treatment emergent adverse events (TEAEs) in NAPOLI-1: A phase 3 study of nal-IRI (MM-398) ± 5-fluorouracil and leucovorin (5-FU/LV) vs 5-FU/LV in metastatic pancreatic cancer (mPAC) previously treated with gemcitabine-based therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ciuleanu TE, Bodoky G, Garcia-Carbonero R, García Alfonso P, Van Cutsem E, Muro K, Mytelka D, Lipkovich O, Ferry D, Sashegyi A, Nasroulah F, Tabernero J. Is neutropenia a prognostic or a predictive factor for second line metastatic colorectal cancer (mCRC) patients (Pts)? Exploratory analysis from RAISE, a randomized, double-blind, phase III study of ramucirumab (RAM) + FOLFIRI vs placebo (PBO) + FOLFIRI. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bruix J, Merle P, Granito A, Huang YH, Bodoky G, Yokosuka O, Rosmorduc O, Breder V, Gerolami R, Masi G, Ross P, Qin S, Song T, Bronowicki JP, Ollivier-Hourmand I, Kudo M, LeBerre MA, Baumhauer A, Meinhardt G, Han G. Efficacy, safety, and health-related quality of life (HRQoL) of regorafenib in patients with hepatocellular carcinoma (HCC) progressing on sorafenib: Results of the international, double-blind phase 3 RESORCE trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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