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Stocker G, Lorenzen S, Ettrich T, Herz AL, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Larcher-Senn J, Keller G, Lordick F, Haag GM. S-1 maintenance therapy in Caucasian patients with metastatic esophagogastric adenocarcinoma-final results of the randomized AIO MATEO phase II trial. ESMO Open 2023; 8:101572. [PMID: 37270871 PMCID: PMC10373924 DOI: 10.1016/j.esmoop.2023.101572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE Platinum-fluoropyrimidine combinations are standard of care for treatment of metastatic esophagogastric adenocarcinoma. The optimal duration of first-line chemotherapy is unknown, however, and maintenance strategies have not yet been established. DESIGN MATEO is an international randomized phase II trial exploring efficacy and safety of S-1 maintenance therapy in human epidermal growth factor receptor 2 (HER2)-negative advanced esophagogastric adenocarcinoma. After 3 months of first-line platinum-fluoropyrimidine-based induction therapy, patients without progression were randomized in a 2 : 1 allocation to receive S-1 monotherapy (arm A) or to continue combination chemotherapy (arm B). The primary objective was to show non-inferiority of overall survival in the S-1 maintenance group. Progression-free survival, adverse events, and quality of life were secondary endpoints. RESULTS From 2014 to 2019, 110 and 55 patients were randomized in arm A and arm B, respectively (recruitment closed prematurely). Median overall survival from randomization was 13.4 months for arm A and 11.4 months for arm B [hazard ratio 0.97 (80% confidence interval 0.76-1.23), P = 0.86]. Median progression-free survival from randomization was 4.3 and 6.1 months for arm A versus arm B, respectively [hazard ratio 1.10 (80% confidence interval 0.86-1.39), P = 0.62]. Patients in arm A had numerically fewer treatment-related adverse events (84.9% versus 93.9%) and significantly less peripheral sensory polyneuropathy ≥grade 2 (9.4% versus 36.7%). CONCLUSIONS S-1 maintenance following platinum-based induction therapy leads to non-inferior survival outcomes compared with the continuation of platinum-based combination. Toxicity patterns favor a fluoropyrimidine maintenance strategy. These data challenge the continued use of platinum combination chemotherapy after response to 3 months induction therapy in patients with advanced human epidermal growth factor receptor 2-negative esophagogastric adenocarcinoma.
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Affiliation(s)
- G Stocker
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - S Lorenzen
- Clinic and Policlinic for Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - T Ettrich
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - A-L Herz
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Longo
- Ramon y Cajal University Hospital, IRYCIS, CIBERONC, Madrid, Spain
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - M Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - J Trojan
- Medical Clinic 1, Goethe University Hospital, Frankfurt am Main, Germany
| | - R Mahlberg
- Department of Internal Medicine I, Klinikum Mutterhaus der Borromaerinnen, Trier, Germany
| | - N Moosmann
- Department of Hematology and Oncology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - B Chibaudel
- Department of Medical Oncology, Franco-British Hospital, Fondation Cognacq-Jay, Levallois-Perret, France
| | - S Kubicka
- Cancer Center Reutlingen, Reutlingen, Germany
| | - R Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - S Daum
- Department of Gastroenterology, Campus B. Franklin, Charité - Universitätsmedizin, Berlin, Germany
| | | | - J Larcher-Senn
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - G Keller
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - F Lordick
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases) and University Cancer Center Leipzig, University of Leipzig Medical Center, Leipzig, Germany
| | - G M Haag
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Applied Tumor-Immunity, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Seufferlein T, Uhl W, Kornmann M, Algül H, Friess H, König A, Ghadimi M, Gallmeier E, Bartsch DK, Lutz MP, Metzger R, Wille K, Gerdes B, Schimanski CC, Graupe F, Kunzmann V, Klein I, Geissler M, Staib L, Waldschmidt D, Bruns C, Wittel U, Fichtner-Feigl S, Daum S, Hinke A, Blome L, Tannapfel A, Kleger A, Berger AW, Kestler AMR, Schuhbaur JS, Perkhofer L, Tempero M, Reinacher-Schick AC, Ettrich TJ. Perioperative or only adjuvant gemcitabine plus nab-paclitaxel for resectable pancreatic cancer (NEONAX)-a randomized phase II trial of the AIO pancreatic cancer group. Ann Oncol 2023; 34:91-100. [PMID: 36209981 DOI: 10.1016/j.annonc.2022.09.161] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 07/15/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Data on perioperative chemotherapy in resectable pancreatic ductal adenocarcinoma (rPDAC) are limited. NEONAX examined perioperative or adjuvant chemotherapy with gemcitabine plus nab-paclitaxel in rPDAC (National Comprehensive Cancer Network criteria). PATIENTS AND METHODS NEONAX is a prospective, randomized phase II trial with two independent experimental arms. One hundred twenty-seven rPDAC patients in 22 German centers were randomized 1 : 1 to perioperative (two pre-operative and four post-operative cycles, arm A) or adjuvant (six cycles, arm B) gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) on days 1, 8 and 15 of a 28-day cycle. RESULTS The primary endpoint was disease-free survival (DFS) at 18 months in the modified intention-to-treat (ITT) population [R0/R1-resected patients who started neoadjuvant chemotherapy (CTX) (A) or adjuvant CTX (B)]. The pre-defined DFS rate of 55% at 18 months was not reached in both arms [A: 33.3% (95% confidence interval [CI] 18.5% to 48.1%), B: 41.4% (95% CI 20.7% to 62.0%)]. Ninety percent of patients in arm A completed neoadjuvant treatment, and 42% of patients in arm B started adjuvant chemotherapy. R0 resection rate was 88% (arm A) and 67% (arm B), respectively. Median overall survival (mOS) (ITT population) as a secondary endpoint was 25.5 months (95% CI 19.7-29.7 months) in arm A and 16.7 months (95% CI 11.6-22.2 months) in the upfront surgery arm. This difference corresponds to a median DFS (mDFS) (ITT) of 11.5 months (95% CI 8.8-14.5 months) in arm A and 5.9 months (95% CI 3.6-11.5 months) in arm B. Treatment was safe and well tolerable in both arms. CONCLUSIONS The primary endpoint, DFS rate of 55% at 18 months (mITT population), was not reached in either arm of the trial and numerically favored the upfront surgery arm B. mOS (ITT population), a secondary endpoint, numerically favored the neoadjuvant arm A [25.5 months (95% CI 19.7-29.7months); arm B 16.7 months (95% CI 11.6-22.2 months)]. There was a difference in chemotherapy exposure with 90% of patients in arm A completing pre-operative chemotherapy and 58% of patients starting adjuvant chemotherapy in arm B. Neoadjuvant/perioperative treatment is a novel option for patients with resectable PDAC. However, the optimal treatment regimen has yet to be defined. The trial is registered with ClinicalTrials.gov (NCT02047513) and the European Clinical Trials Database (EudraCT 2013-005559-34).
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Affiliation(s)
- T Seufferlein
- Department of Internal Medicine I, Ulm University, Ulm, Germany.
| | - W Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - M Kornmann
- Department of General and Visceral Surgery, Ulm University, Ulm, Germany
| | - H Algül
- CCC Munich-TUM and Department of Internal Medicine II, TUM, Munich, Germany
| | - H Friess
- Department of General and Visceral Surgery, TUM, Munich, Germany
| | - A König
- Department of Gastroenterology, GI-Oncology and Endocrinology, University Medical Center, Göttingen, Germany
| | - M Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - E Gallmeier
- Department of Gastroenterology and Endocrinology, University of Marburg, Marburg, Germany
| | - D K Bartsch
- Department of General and Visceral Surgery, University of Marburg, Marburg, Germany
| | - M P Lutz
- Department of Gastroenterology, Caritasklinik St. Theresia, Saarbrücken, Germany
| | - R Metzger
- Department of General and Visceral Surgery, Caritasklinik St. Theresia, Saarbrücken, Germany
| | - K Wille
- Department of Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, Ruhr-University Bochum, Bochum, Germany
| | - B Gerdes
- Department of General and Visceral Surgery Minden, Ruhr-University Bochum, Minden, Germany
| | - C C Schimanski
- Department of Internal Medicine and Gastroenterology, Darmstadt Hospital, Darmstadt, Germany
| | - F Graupe
- Department of General and Visceral Surgery, Darmstadt Hospital, Darmstadt, Germany
| | - V Kunzmann
- Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany
| | - I Klein
- Department of General, Visceral, Vascular and Pediatric Surgery, Julius Maximilians University, Würzburg, Germany
| | - M Geissler
- Department of Hematology and Oncology, Esslingen Hospital, Esslingen, Germany
| | - L Staib
- Department of Surgery, Esslingen Hospital, Esslingen, Germany
| | - D Waldschmidt
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | - C Bruns
- Department of Visceral Surgery, University of Cologne, Cologne, Germany
| | - U Wittel
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - S Fichtner-Feigl
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - S Daum
- Department for Gastroenterology, Rheumatology and Infectology, Charite University Hospital Berlin, Berlin, Germany
| | - A Hinke
- Biostatistics, CCRC Cancer Clinical Research Consulting, Düsseldorf, Germany
| | - L Blome
- Biometrics, ClinAssess Gesellschaft für klinische Forschung mbH, Leverkusen, Germany
| | - A Tannapfel
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - A Kleger
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - A W Berger
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - A M R Kestler
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - J S Schuhbaur
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - L Perkhofer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - M Tempero
- UCSF Department of Medicine, University of California San Francisco, San Francisco, USA
| | - A C Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - T J Ettrich
- Department of Internal Medicine I, Ulm University, Ulm, Germany
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Novello S, Torri V, Grohe C, Kurz S, Serke M, Wehler T, Meyer A, Ladage D, Geissler M, Colantonio I, Cauchi C, Stoelben E, Ceribelli A, Kropf-Sanchen C, Valmadre G, Borra G, Schena M, Morabito A, Santo A, Gregorc V, Chiari R, Reck M, Schmid-Bindert G, Folprecht G, Griesinger F, Follador A, Pedrazzoli P, Bearz A, Caffo O, Dickgreber N, Irtelli L, Wiest G, Monica V, Porcu L, Manegold C, Scagliotti G. Corrigendum to “International Tailored Chemotherapy Adjuvant (ITACA) trial, a phase III multicenter randomized trial comparing adjuvant pharmacogenomic-driven chemotherapy versus standard adjuvant chemotherapy in completely resected stage II-IIIA non-small-cell lung cancer”. Ann Oncol 2022; 33:454. [DOI: 10.1016/j.annonc.2022.01.005] [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: 11/01/2022] Open
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Novello S, Torri V, Grohe C, Kurz S, Serke M, Wehler T, Meyer A, Ladage D, Geissler M, Colantonio I, Cauchi C, Stoelben E, Ceribelli A, Kropf-Sanchen C, Valmadre G, Borra G, Schena M, Morabito A, Santo A, Gregorc V, Chiari R, Reck M, Schmid-Bindert G, Folprecht G, Griesinger F, Follador A, Pedrazzoli P, Bearz A, Caffo O, Dickgreber NJ, Irtelli L, Wiest G, Monica V, Porcu L, Manegold C, Scagliotti GV. International Tailored Chemotherapy Adjuvant (ITACA) trial, a phase III multicenter randomized trial comparing adjuvant pharmacogenomic-driven chemotherapy versus standard adjuvant chemotherapy in completely resected stage II-IIIA non-small-cell lung cancer. Ann Oncol 2021; 33:57-66. [PMID: 34624497 DOI: 10.1016/j.annonc.2021.09.017] [Citation(s) in RCA: 6] [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: 06/14/2021] [Revised: 09/05/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several strategies have been investigated to improve the 4% survival advantage of adjuvant chemotherapy in early-stage non-small-cell lung cancer (NSCLC). In this investigator-initiated study we aimed to evaluate the predictive utility of the messenger RNA (mRNA) expression levels of excision repair cross complementation group 1 (ERCC1) and thymidylate synthase (TS) as assessed in resected tumor. PATIENTS AND METHODS Seven hundred and seventy-three completely resected stage II-III NSCLC patients were enrolled and randomly assigned in each of the four genomic subgroups to investigator's choice of platinum-based chemotherapy (C, n = 389) or tailored chemotherapy (T, n = 384). All anticancer drugs were administered according to standard doses and schedules. Stratification factors included stage and smoking status. The primary endpoint of the study was overall survival (OS). RESULTS Six hundred and ninety patients were included in the primary analysis. At a median follow-up of 45.9 months, 85 (24.6%) and 70 (20.3%) patients died in arms C and T, respectively. Five-year survival for patients in arms C and T was of 65.4% (95% CI (confidence interval): 58.5% to 71.4%) and 72.9% (95% CI: 66.5% to 78.3%), respectively. The estimated hazard ratio (HR) was 0.77 (95% CI: 0.56-1.06, P value: 0.109) for arm T versus arm C. HR for recurrence-free survival was 0.89 (95% CI: 0.69-1.14, P value: 0.341) for arm T versus arm C. Grade 3-5 toxicities were more frequently reported in arm C than in arm T. CONCLUSION In completely resected stage II-III NSCLC tailoring adjuvant chemotherapy conferred a non-statistically significant trend for OS favoring the T arm. In terms of safety, the T arm was associated with better efficacy/toxicity ratio related to the different therapeutic choices in the experimental arm.
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Affiliation(s)
- S Novello
- Department of Oncology at San Luigi Hospital, University of Torino, Orbassano (Torino), Italy.
| | - V Torri
- Laboratory of Methodology for Clinical Research, Oncology Department at Instituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Grohe
- Department of Respiratory Diseases, Evangelische Lungenklinik Berlin, Berlin, Germany
| | - S Kurz
- Evangelische Lungenklinik Berlin, Berlin, Germany
| | - M Serke
- Thorax Center Clinic for Haematology, Oncology, Pulmonology and Palliative Medicine, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - T Wehler
- Thorax Center Clinic for Haematology, Oncology, Pulmonology and Palliative Medicine, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - A Meyer
- Department of Pneumology, Maria Hilf Hospital, Moenchengladbach, Germany
| | - D Ladage
- Department of Pneumology, Maria Hilf Hospital, Moenchengladbach, Germany
| | - M Geissler
- Esslingen Cancer Center Department of Oncology, Gastroenterology and Infectious Diseases Klinikum Esslingen, Esslingen, Germany
| | - I Colantonio
- Division of Oncology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - C Cauchi
- Division of Oncology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - E Stoelben
- Lung Clinic, Cologne-Merheim Hospital, Cologne, Germany
| | - A Ceribelli
- Division of Clinical Oncology A, Istituto Nazionale Regina Elena per lo Studio e la Cura dei Tumori, Rome, Italy
| | - C Kropf-Sanchen
- Department of Pulmonology, Internal Medicine II, University of Ulm, Ulm, Germany
| | - G Valmadre
- Division of Clinical Oncology, Ospedale di Sondalo, Sondrio, Italy
| | - G Borra
- Division of Clinical Oncology, AOU Maggiore della Carità, Novara, Italy
| | - M Schena
- Division of Clinical Oncology I, AOU Città della Salute e della Scienza, Turin, Italy
| | - A Morabito
- Division of Clinical Oncology and Thoracic Pneumology, IRCCS Fondazione Pascale, Naples, Italy
| | - A Santo
- Complex Operative Unit of Oncology - Gruppo Interdisciplinare Veronese Oncologia Polmonare (GIVOP), Verona, Italy
| | - V Gregorc
- Division of Clinical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - R Chiari
- Division of Clinical Oncology, Azienda Ospedaliera di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - M Reck
- Oncology Department, LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - G Schmid-Bindert
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - G Folprecht
- University Hospital Carl Gustav Carus Medical Department I Dresden, Dresden, Germany
| | - F Griesinger
- Clinic for Haematology and Oncoloy, Medizinischer Campus Universität Oldenburg, Oldenburg, Germany
| | - A Follador
- Department of Oncology, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy
| | - P Pedrazzoli
- Oncology Division, University Hospital Santa Maria della Misericordia AOU Friuli Centrale, Udine, Italy
| | - A Bearz
- Division of Clinical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - O Caffo
- Division of Clinical Oncology, Ospedale Santa Chiara, Trento, Italy
| | - N J Dickgreber
- Department for Respiratory Medicine and Thoracic Oncology, Klinikum Rheine - Mathias-Spital, Rheine, Germany
| | - L Irtelli
- Oncology Clinic, Policlinico SS. Annunziata, Chieti, Italy
| | - G Wiest
- Asklepios Cancer Center Hamburg, Asklepios Klinikum Harburg, Hamburg, Harburg, Germany
| | - V Monica
- Department of Oncology at San Luigi Hospital, University of Torino, Orbassano (Torino), Italy
| | - L Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department at Instituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Manegold
- Department of Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - G V Scagliotti
- Department of Oncology at San Luigi Hospital, University of Torino, Orbassano (Torino), Italy
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Novello S, Monica V, Serke M, Grohe C, Meyer A, Geissler M, Colantonio I, Stoelben E, Cecere F, Schutte W, Schumann C, Valmadre G, Borra G, Schena M, Morabito A, Santo A, Chiari R, Gregorc V, Reck M, Manegold C, Griesinger F, Follador A, Ferrari A, Bearz A, Caffo O, Dickgreber N, Irtelli L, Wiest G, Sotoparra H, Spatafora M, Righi L, Torri V, Porcu L, Arizio F, Scagliotti G. PS01.04 International Tailored Chemotherapy Adjuvant Trial : ITACA Trial. Final Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haag G, Stocker G, Lorenzen S, Ettrich T, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Mann J, Lordick F. 1447P S-1 maintenance therapy in non-Asian patients with advanced, Her-2 negative esophagogastric adenocarcinoma – First results of the international MATEO trial initiated by the AIO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Loupakis F, Peeters M, Geissler M, Modest D, Valladares-Ayerbes M, Price T, Burdon P, Zhang Y, Taieb J. P-78 Early tumour shrinkage, depth of response and survival outcomes for RAS wild-type metastatic colorectal cancer patients classified by baseline tumour load: Retrospective pooled analysis of panitumumab PRIME/PEAK studies. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.160] [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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Kurreck A, Geissler M, Martens UM, Riera-Knorrenschild J, Greeve J, Florschütz A, Wessendorf S, Ettrich T, Kanzler S, Nörenberg D, Seidensticker M, Held S, Buechner-Steudel P, Atzpodien J, Heinemann V, Stintzing S, Seufferlein T, Tannapfel A, Reinacher-Schick AC, Modest DP. Dynamics in treatment response and disease progression of metastatic colorectal cancer (mCRC) patients with focus on BRAF status and primary tumor location: analysis of untreated RAS-wild-type mCRC patients receiving FOLFOXIRI either with or without panitumumab in the VOLFI trial (AIO KRK0109). J Cancer Res Clin Oncol 2020; 146:2681-2691. [PMID: 32449003 PMCID: PMC7467910 DOI: 10.1007/s00432-020-03257-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] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE In mCRC, disease dynamics may play a critical role in the understanding of long-term outcome. We evaluated depth of response (DpR), time to DpR, and post-DpR survival as relevant endpoints. METHODS We analyzed DpR by central review of computer tomography images (change from baseline to smallest tumor diameter), early tumor shrinkage (≥ 20% reduction in tumor diameter at first reassessment), time to DpR (study randomization to DpR-image), post-DpR progression-free survival (pPFS = DpR-image to tumor progression or death), and post-DpR overall survival (pOS = DpR-image to death) with special focus on BRAF status in 66 patients and primary tumor site in 86 patients treated within the VOLFI-trial, respectively. RESULTS BRAF wild-type (BRAF-WT) compared to BRAF mutant (BRAF-MT) patients had greater DpR (- 57.6% vs. - 40.8%, p = 0.013) with a comparable time to DpR [4.0 (95% CI 3.1-4.4) vs. 3.9 (95% CI 2.5-5.5) months; p = 0.8852]. pPFS was 6.5 (95% CI 4.9-8.0) versus 2.6 (95% CI 1.2-4.0) months in favor of BRAF-WT patients (HR 0.24 (95% CI 0.11-0.53); p < 0.001). This transferred into a significant difference in pOS [33.6 (95% CI 26.0-41.3) vs. 5.4 (95% CI 5.0-5.9) months; HR 0.27 (95% CI 0.13-0.55); p < 0.001]. Similar observations were made for patients stratified for primary tumor site. CONCLUSIONS BRAF-MT patients derive a less profound treatment response compared to BRAF-WT patients. The difference in outcome according to BRAF status is evident after achievement of DpR with BRAF-MT patients hardly deriving any further disease control beyond DpR. Our observations hint towards an aggressive tumor evolution in BRAF-MT tumors, which may already be molecularly detectable at the time of DpR.
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Affiliation(s)
- A Kurreck
- Department of Hematology, Oncology, and Tumor Immunology (CVK/CCM), Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - U M Martens
- Klinik für Innere Medizin III, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | | | - J Greeve
- St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | | | | | - T Ettrich
- Universitätsklinikum Ulm, Ulm, Germany
| | - S Kanzler
- Leopoldina Krankenhaus, Schweinfurt, Germany
| | - D Nörenberg
- Medical Faculty Mannheim, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - M Seidensticker
- Klinik Und Poliklinik für Radiologie, LMU Klinikum, München, Germany
| | - S Held
- ClinAssess, Leverkusen, Germany
| | | | - J Atzpodien
- Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - V Heinemann
- Department of Medicine III and Comprehensive Cancer Center, University Hospital Munich (LMU), Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center, Heidelberg, Germany
| | - S Stintzing
- Department of Hematology, Oncology, and Tumor Immunology (CVK/CCM), Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - A Tannapfel
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - A C Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - D P Modest
- Department of Hematology, Oncology, and Tumor Immunology (CVK/CCM), Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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9
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Geissler M, Klingler T, Modest D, Knorrenschild JR, Ettrich T, Kanzler S, Heinemann V, Held S, Martens U. Quality of life during 1st-line FOLFOXIRI+/- panitumumab in RAS wild-type metastatic colorectal cancer: Results from the randomized VOLFI trial (AIO KRK-0109). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.057] [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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10
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Al-Batran SE, Pauligk C, Hofheinz R, Lorenzen S, Wicki A, Siebenhuener A, Schenk M, Thuss-Patience P, Kretzschmar A, Bolling C, Eigendorff E, Angermeier S, Pink D, Geissler M, Goekkurt E, Schmalenberg H, Waberer L, Talbot J, Goetze T, Homann N. Perioperative atezolizumab in combination with FLOT versus FLOT alone in patients with resectable esophagogastric adenocarcinoma: DANTE, a randomized, open-label phase II trial of the German Gastric Group of the AIO and the SAKK. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Sartore-Bianchi A, Peeters M, Geissler M, Taieb J, García-Alfonso P, Price T, Burdon P, Zhang Y, Koehne CH. Early tumour shrinkage (ETS), depth of response (DpR) and associated survival outcomes in patients (pts) with RAS wild type (WT) metastatic colorectal cancer (mCRC) classified according to Köhne prognostic category: Retrospective analysis of the panitumumab (Pmab) PRIME study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.049] [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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Geissler M, Tannapfel A, Reinacher-Schick A, Martens U, Ricke J, Riera-Knorrenschield J, Kanzler S, Held S, Heinemann V, Seufferlein T, Modest D. Final results of the randomized phase II VOLFI trial (AIO- KRK0109): mFOLFOXIRI + Panitumumab versus FOLFOXIRI as first-line treatment in patients with RAS wild-type metastatic colorectal cancer (mCRC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Berger A, Ettrich T, Schwerdel D, Reinacher-Schick A, Algül H, König AO, Gallmeier E, Wille K, Daum S, Geissler M, Tannapfel A, Uhl W, Seufferlein T. A composite liquid biomarker for non-invasive diagnosis of resectable pancreatic ductal adenocarcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.044] [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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14
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Geissler M, Klingler T, Riera Knorrenschild J, Tannapfel A, Greeve J, Seufferlein T, Kanzler S, Held S, Heinemann V, Reinacher-Schick A, Martens U. 1st-line mFOLFOXIRI + panitumumab vs FOLFOXIRI treatment of RAS wt mCRC: A randomized phase II VOLFI trial of the AIO (KRK-0109). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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Geissler M, Klingler T, Riera-Knorrenschield J, Tannapfel A, Seufferlein T, Held S, Florschütz A, Kanzler S, Heinemann V, Reinacher-Schick A, Martens U. mFOLFOXIRI + Panitumumab versus FOLFOXIRI as first-line treatment in patients with RAS wild- type metastatic colorectal cancer m(CRC): a randomized phase II VOLFI trial of the AIO (AIO- KRK0109). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Taieb J, Geissler M, Rivera F, Karthaus M, Wilson R, Loupakis F, Price T, Tracy M, Burdon P, Peeters M. Early tumour shrinkage (ETS) and its impact on tumour-related symptoms in patients with previously untreated RAS wild-type metastatic colorectal cancer (mCRC): A retrospective analysis of three panitumumab studies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.011] [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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Geissler M, Martens U, Knorrenschield R, Greeve J, Florschuetz A, Tannapfel A, Wessendorf S, Seufferlein T, Kanzler S, Heinemann V, Held S, Reinacher-Schick A. mFOLFOXIRI + panitumumab versus FOLFOXIRI as first-line treatment in patients with RAS wild-type metastatic colorectal cancer m(CRC): A randomized phase II VOLFI trial of the AIO (AIO-KRK0109). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Faehling M, Schwenk B, Eckert R, Leschke M, Liewald FG, Geissler M. 38P Overall survival in non-smokers and quitters compared to smokers who develop lung cancer: Case–control data from routine clinical practice. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Martens U, Wessendorf S, Knorrenschild JR, Buechner-Steudel P, Florschuetz A, Atzpodien J, Greeve J, Kanzler S, Ettrich T, Lindig U, Egger M, Hebart H, Geissler M. 2049 AIO-KRK-0109: A randomized phase II trial of panitumumab plus FOLFOXIRI or FOLFOXIRI alone as 1st-line treatment in RAS-wild-type metastatic colorectal cancer (mCRC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30972-8] [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: 11/15/2022]
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Moehler M, Maderer A, Schimanski C, Kanzler S, Denzer U, Kolligs FT, Ebert MP, Distelrath A, Geissler M, Trojan J, Schütz M, Berie L, Sauvigny C, Lammert F, Lohse A, Dollinger MM, Lindig U, Duerr EM, Lubomierski N, Zimmermann S, Wachtlin D, Kaiser AK, Schadmand-Fischer S, Galle PR, Woerns M. Gemcitabine plus sorafenib versus gemcitabine alone in advanced biliary tract cancer: a double-blind placebo-controlled multicentre phase II AIO study with biomarker and serum programme. Eur J Cancer 2014; 50:3125-35. [PMID: 25446376 DOI: 10.1016/j.ejca.2014.09.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [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: 07/17/2014] [Revised: 09/13/2014] [Accepted: 09/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since sorafenib has shown activity in different tumour types and gemcitabine regimens improved the outcome for biliary tract cancer (BTC) patients, we evaluated first-line gemcitabine plus sorafenib in a double-blind phase II study. PATIENTS AND METHODS 102 unresectable or metastatic BTC patients with histologically proven adenocarcinoma of gallbladder or intrahepatic bile ducts, Eastern Cooperative Oncology Group (ECOG) 0-2 were randomised to gemcitabine (1000 mg/m2 once weekly, first 7-weeks+1-week rest followed by once 3-weeks+1-week rest) plus sorafenib (400 mg twice daily) or placebo. Treatment continued until progression or unacceptable toxicity. Tumour samples were prospectively stained for sorafenib targets and potential biomarkers. Serum samples (first two cycles) were measured for vascular endothelial growth factors (VEGFs), vascular endothelial growth factor receptor 2 (VEGFR-2) and stromal cell-derived factor 1 (SDF1)α by enzyme-linked immunosorbent assay (ELISA). RESULTS Gemcitabine plus sorafenib was generally well tolerated. Four and three patients achieved partial responses in the sorafenib and placebo groups, respectively. There was no difference in the primary end-point, median progression-free survival (PFS) for gemcitabine plus sorafenib versus gemcitabine plus placebo (3.0 versus 4.9 months, P=0.859), and no difference for median overall survival (OS) (8.4 versus 11.2 months, P=0.775). Patients with liver metastasis after resection of primary BTC survived longer with sorafenib (P=0.019) compared to placebo. Patients who developed hand-foot syndrome (HFS) showed longer PFS and OS than patients without HFS. Two sorafenib targets, VEGFR-2 and c-kit, were not expressed in BTC samples. VEGFR-3 and Hif1α were associated with lymph node metastases and T stage. Absence of PDGFRβ expression correlated with longer PFS. CONCLUSION The addition of sorafenib to gemcitabine did not demonstrate improved efficacy in advanced BTC patients. Biomarker subgroup analysis suggested that some patients might benefit from combined treatment.
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Affiliation(s)
- M Moehler
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany.
| | - A Maderer
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - C Schimanski
- Department of Internal Medicine, Marienhospital Darmstadt, Darmstadt, Germany
| | - S Kanzler
- 2nd Department of Medicine, Leopoldina Hospital, Schweinfurt, Germany
| | - U Denzer
- 1st Department of Medicine, University Hospital Hamburg, Hamburg, Germany
| | - F T Kolligs
- Department of Medicine II, University Hospital Munich, Munich, Germany
| | - M P Ebert
- 2nd Department of Medicine, University Hospital Mannheim, Mannheim, Germany
| | - A Distelrath
- Tumor Department, Hospital Fulda, Fulda, Germany
| | - M Geissler
- Department of Internal Medicine, Hospital Esslingen, Esslingen, Germany
| | - J Trojan
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - M Schütz
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - L Berie
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - C Sauvigny
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - F Lammert
- Department of Internal Medicine II, University Hospital Homburg, Homburg, Germany
| | - A Lohse
- 1st Department of Medicine, University Hospital Hamburg, Hamburg, Germany
| | - M M Dollinger
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - U Lindig
- Department of Internal Medicine II, University Hospital Jena, Jena, Germany
| | - E M Duerr
- Department of Medicine II, University Hospital Munich, Munich, Germany
| | - N Lubomierski
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - S Zimmermann
- Department of Internal Medicine II, University Hospital Homburg, Homburg, Germany
| | - D Wachtlin
- Interdisciplinary Center for Clinical Trials of the University Medical Center Mainz, Germany
| | - A-K Kaiser
- Interdisciplinary Center for Clinical Trials of the University Medical Center Mainz, Germany
| | - S Schadmand-Fischer
- Department of Radiology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - P R Galle
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - M Woerns
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
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Abstract
The epidermal growth factor receptor (EGFR) has been implicated in a multiplicity of cancer-related signal transduction pathways such as cellular proliferation, adhesion, migration, neoangiogenesis and apoptosis inhibition, all of them are important features of cancerogenesis and tumour progression. Its tyrosine kinase activity plays a central role in mediating these processes and has been intensely studied to exploit it as a therapeutic target. Inhibitors of this pathway have been developed and assessed in trials with significant efficacy in clinical applications. The current review focuses in particular on the clinical data of EGFR tyrosine kinase inhibition in different tumour entities, preferably non-small cell lung cancer and pancreatic cancer with emphasis to the approved small molecule erlotinib. Its clinical applications, evidence-based efficacy and toxicity as well as predictive markers of response are discussed.
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Affiliation(s)
- M Steins
- Clinic for Thoracic Diseases, University of Heidelberg, Amalienstr. 5, 69126, Heidelberg, Germany,
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Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, Fietkau R, Follmann M, Friess H, Galle P, Geissler M, Glanemann M, Gress T, Heinemann V, Hohenberger W, Hopt U, Izbicki J, Klar E, Kleeff J, Kopp I, Kullmann F, Langer T, Langrehr J, Lerch M, Löhr M, Lüttges J, Lutz M, Mayerle J, Michl P, Möller P, Molls M, Münter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Röcken C, Roeb E, Saeger H, Schmid R, Schmiegel W, Schoenberg M, Siveke J, Stuschke M, Tannapfel A, Uhl W, Unverzagt S, van Oorschot B, Vashist Y, Werner J, Yekebas E. [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 2013; 51:1395-440. [PMID: 24338757 DOI: 10.1055/s-0033-1356220] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- T Seufferlein
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - M Porzner
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - T Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Kiel
| | - V Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin
| | - G Ceyhan
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Esposito
- Institut für Allgemeine Pathologie, Klinikum rechts der Isar, TU München
| | - R Fietkau
- Strahlenklinik, Universitätsklinikum Erlangen
| | - M Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - H Friess
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - P Galle
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
| | - M Geissler
- Klinik für Allgemeine Innere Medizin, Onkologie/Hämatologie, Gastroenterologie und Infektiologie, Klinikum Esslingen
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes Homburg/Saar
| | - T Gress
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - V Heinemann
- Medizinischen Klinik und Poliklinik III, Klinikum der Universität München LMU
| | | | - U Hopt
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg
| | - J Izbicki
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - E Klar
- Klinik für Allgemeine Chirurgie, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock
| | - J Kleeff
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg
| | | | - T Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - J Langrehr
- Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus Berlin
| | - M Lerch
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - M Löhr
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - J Lüttges
- Institut für Pathologie, Marienkrankenhaus Hamburg
| | - M Lutz
- Medizinische Klinik - Schwerpunkt Gastroenterologie, Endokrinologie, Infektiologie, Caritasklinikum Saarbrücken
| | - J Mayerle
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - P Michl
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm
| | - M Molls
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, TU München
| | - M Münter
- Klinik für Strahlentherapie und Radioonkologie, Klinikum Stuttgart
| | - M Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Berlin
| | - H Oettle
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim
| | - A Reinacher-Schick
- Abt. für Hämatologie und Onkologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - C Röcken
- Institut für Pathologie, Universitätsklinikum Kiel
| | - E Roeb
- Medizinische Klinik II, SP Gastroenterologie, Universitätsklinikum Gießen und Marburg
| | - H Saeger
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Dresden
| | - R Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - W Schmiegel
- Medizinische Klinik, Klinikum der Ruhr-Universität Bochum
| | | | - J Siveke
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - M Stuschke
- Klinik für Strahlentherapie, Universitätsklinikum Essen
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum
| | - W Uhl
- Chirurgische Klinik, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - S Unverzagt
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - B van Oorschot
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg
| | - Y Vashist
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - J Werner
- Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg
| | - E Yekebas
- Klinik für Allgemein-, Thorax- und Viszeralchirurgie, Klinikum Darmstadt
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Buck A, Wenz J, Xu J, Khrennikov K, Schmid K, Heigoldt M, Mikhailova JM, Geissler M, Shen B, Krausz F, Karsch S, Veisz L. Shock-front injector for high-quality laser-plasma acceleration. Phys Rev Lett 2013; 110:185006. [PMID: 23683211 DOI: 10.1103/physrevlett.110.185006] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Indexed: 06/02/2023]
Abstract
We report the generation of stable and tunable electron bunches with very low absolute energy spread (ΔE ≈ 5 MeV) accelerated in laser wakefields via injection and trapping at a sharp downward density jump produced by a shock front in a supersonic gas flow. The peak of the highly stable and reproducible electron energy spectrum was tuned over more than 1 order of magnitude, containing a charge of 1-100 pC and a charge per energy interval of more than 10 pC/MeV. Laser-plasma electron acceleration with Ti:sapphire lasers using this novel injection mechanism provides high-quality electron bunches tailored for applications.
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Affiliation(s)
- A Buck
- Max-Planck-Insitut für Quantenoptik, Hans-Kopfermann-Strasse 1, 85748 Garching, Germany
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Boeck S, Jung A, Laubender RP, Neumann J, Egg R, Goritschan C, Vehling-Kaiser U, Winkelmann C, Fischer von Weikersthal L, Clemens MR, Gauler TC, Märten A, Klein S, Kojouharoff G, Barner M, Geissler M, Greten TF, Mansmann U, Kirchner T, Heinemann V. EGFR pathway biomarkers in erlotinib-treated patients with advanced pancreatic cancer: translational results from the randomised, crossover phase 3 trial AIO-PK0104. Br J Cancer 2012; 108:469-76. [PMID: 23169292 PMCID: PMC3566829 DOI: 10.1038/bjc.2012.495] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: We aimed to identify molecular epidermal growth factor receptor (EGFR) tissue biomarkers in pancreatic cancer (PC) patients treated with the anti-EGFR agent erlotinib within the phase 3 randomised AIO-PK0104 study. Methods: AIO-PK0104 was a multicenter trial comparing gemcitabine/erlotinib followed by capecitabine with capecitabine/erlotinib followed by gemcitabine in advanced PC; primary study end point was the time-to-treatment failure after first- and second-line therapy (TTF2). Translational analyses were performed for KRAS exon 2 mutations, EGFR expression, PTEN expression, the EGFR intron 1 and exon 13 R497K polymorphism (PM). Biomarker data were correlated with TTF, overall survival (OS) and skin rash. Results: Archival tumour tissue was available from 208 (74%) of the randomised patients. The KRAS mutations were found in 70% (121 out of 173) of patients and exclusively occurred in codon 12. The EGFR overexpression was detected in 89 out of 181 patients (49%) by immunohistochemistry (IHC), and 77 out of 166 patients (46%) had an EGFR gene amplification by fluorescence in-situ hybridisation (FISH); 30 out of 171 patients (18%) had a loss of PTEN expression, which was associated with an inferior TTF1 (first-line therapy; HR 0.61, P=0.02) and TTF2 (HR 0.66, P=0.04). The KRAS wild-type status was associated with improved OS (HR 1.68, P=0.005); no significant OS correlation was found for EGFR–IHC (HR 0.96), EGFR–FISH (HR 1.22), PTEN–IHC (HR 0.77), intron 1 (HR 0.91) or exon 13 R497K PM (HR 0.83). None of the six biomarkers correlated with the occurrence of skin rash. Conclusion: The KRAS wild-type was associated with an improved OS in erlotinib-treated PC patients in this phase 3 study; it remains to be defined whether this association is prognostic or predictive.
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Affiliation(s)
- S Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr 15, Munich D-81377, Germany.
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Kar S, Kakolee KF, Qiao B, Macchi A, Cerchez M, Doria D, Geissler M, McKenna P, Neely D, Osterholz J, Prasad R, Quinn K, Ramakrishna B, Sarri G, Willi O, Yuan XY, Zepf M, Borghesi M. Ion acceleration in multispecies targets driven by intense laser radiation pressure. Phys Rev Lett 2012; 109:185006. [PMID: 23215290 DOI: 10.1103/physrevlett.109.185006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Indexed: 06/01/2023]
Abstract
The acceleration of ions from ultrathin foils has been investigated by using 250 TW, subpicosecond laser pulses, focused to intensities of up to 3 × 10(20) W cm(-2). The ion spectra show the appearance of narrow-band features for protons and carbon ions peaked at higher energies (in the 5-10 MeV/nucleon range) and with significantly higher flux than previously reported. The spectral features and their scaling with laser and target parameters provide evidence of a multispecies scenario of radiation pressure acceleration in the light sail mode, as confirmed by analytical estimates and 2D particle-in-cell simulations. The scaling indicates that monoenergetic peaks with more than 100 MeV/nucleon are obtainable with moderate improvements of the target and laser characteristics, which are within reach of ongoing technical developments.
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Affiliation(s)
- S Kar
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast BT7 1NN, United Kingdom.
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Qiao B, Kar S, Geissler M, Gibbon P, Zepf M, Borghesi M. Dominance of radiation pressure in ion acceleration with linearly polarized pulses at intensities of 10(21) W cm(-2). Phys Rev Lett 2012; 108:115002. [PMID: 22540479 DOI: 10.1103/physrevlett.108.115002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Indexed: 05/31/2023]
Abstract
A novel regime is proposed where, by employing linearly polarized laser pulses at intensities 10(21) W cm(-2) (2 orders of magnitude lower than discussed in previous work [T. Esirkepov et al., Phys. Rev. Lett. 92, 175003 (2004)]), ions are dominantly accelerated from ultrathin foils by the radiation pressure and have monoenergetic spectra. In this regime, ions accelerated from the hole-boring process quickly catch up with the ions accelerated by target normal sheath acceleration, and they then join in a single bunch, undergoing a hybrid light-sail-target normal sheath acceleration. Under an appropriate coupling condition between foil thickness, laser intensity, and pulse duration, laser radiation pressure can be dominant in this hybrid acceleration. Two-dimensional particle-in-cell simulations show that 1.26 GeV quasimonoenergetic C(6+) beams are obtained by linearly polarized laser pulses at intensities of 10(21) W cm(-2).
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Affiliation(s)
- B Qiao
- School of Mathematics and Physics, Queen's University Belfast, Belfast, United Kingdom
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Harder J, Ihorst G, Heinemann V, Hofheinz R, Moehler M, Buechler P, Kloeppel G, Röcken C, Bitzer M, Boeck S, Endlicher E, Reinacher-Schick A, Schmoor C, Geissler M. Multicentre phase II trial of trastuzumab and capecitabine in patients with HER2 overexpressing metastatic pancreatic cancer. Br J Cancer 2012; 106:1033-8. [PMID: 22374460 PMCID: PMC3304403 DOI: 10.1038/bjc.2012.18] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: New therapeutic options for metastatic pancreatic cancer are urgently needed. In pancreatic cancer, overexpression of the epidermal growth factor receptor 2 (HER2) has been reported in up to 45%. This multicentre phase II study investigated the efficacy and toxicity of the HER2 antibody trastuzumab combined with capecitabine in the patients with pancreatic cancer and HER2 overexpression. Methods: Primary endpoint was progression-free survival (PFS) after 12 weeks. A total of 212 patients were screened for HER2 expression. Results: Immunohistochemical (IHC) HER2 expression was: 83 (40%) grade 0, 71 (34%) grade 1, 31 (15%) grade 2, 22 (11%) grade 3. A total of 17 patients with IHC +3 HER2 expression or gene amplification could be assessed for the treatment response. Grade 3/4 treatment toxicities were: each 7% leucopenia, diarrhoea, nausea and hand-foot syndrome. Progression-free survival after 12 weeks was 23.5%, median overall survival (OS) 6.9 months. Conclusion: This study demonstrates +3 HER2 expression or gene amplification in 11% of patients. Contrary to breast and gastric cancer, only 7 out of 11 (64%) patients with IHC +3 HER2 expression showed gene amplification. Although the therapy was well tolerated, PFS and OS did not perform favourably compared with standard chemotherapy. Together, we do not recommend further evaluation of anti-HER2 treatment in patients with metastatic pancreatic cancer.
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Affiliation(s)
- J Harder
- Medizinische Klinik II, Hegau- Bodensee Klinikum, Virchowstraße 10, D-78224 Singen, Germany.
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Yeung M, Zepf M, Geissler M, Dromey B. Angularly separated harmonic generation from intense laser interaction with blazed diffraction gratings. Opt Lett 2011; 36:2333-2335. [PMID: 21686011 DOI: 10.1364/ol.36.002333] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We made numerical simulations of the generation of narrowband beams of extreme ultraviolet radiation from intense laser interaction with a blazed grating surface. Strong fifth harmonic emission into its blazed diffraction order was observed as well as heavy suppression of the fundamental frequency with comparison to a typical harmonic spectrum from a flat target. The results demonstrate a new highly efficient method of generating near-monochromatic harmonics from the fundamental with minimal effect on the pulse duration.
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Affiliation(s)
- M Yeung
- Centre for Plasma Physics, Department of Physics and Astronomy, Queen's University Belfast, Belfast BT7 1NN, UK.
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Moehler MH, Schimanski CC, Kanzler S, Woerns MA, Denzer U, Kolligs FT, Ebert MP, Distelrath A, Geissler M, Zeuzem S, Lammert F, Lohse AW, Dollinger MM, Lindig U, Duerr EM, Lubomierski N, Zimmermann S, Kabisch M, Schadmann-Fischer S, Galle PR. A randomized, double-blind, multicenter phase II AIO trial with gemcitabine plus sorafenib versus gemcitabine plus placebo in patients with chemotherapy-naive advanced or metastatic biliary tract cancer: First safety and efficacy data. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boeck SH, Jung A, Laubender RP, Neumann J, Egg R, Goritschan C, Vehling-Kaiser U, Winkelmann C, Fischer von Weikersthal L, Clemens MR, Gauler TC, Marten A, Klein S, Kojouharoff G, Barner M, Geissler M, Greten TF, Mansmann U, Kirchner T, Heinemann V. Molecular markers of the EGFR pathway in erlotinib-treated patients with advanced pancreatic cancer (APC): Translational analyses of a randomized, cross-over AIO phase III trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Novello S, Scagliotti G, Torri V, Monica V, Papotti M, Grohe C, Valmadre G, Bria E, Colantonio I, Serke MH, Stoelben E, Geissler M, Schena M, Santo A, Alabiso O, Schumann C, Manegold C. International tailored chemotherapy adjuvant trial: ITACA trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e17514] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Borghesi M, Kar S, Prasad R, Kakolee FK, Quinn K, Ahmed H, Sarri G, Ramakrishna B, Qiao B, Geissler M, Ter-Avetisyan S, Zepf M, Schettino G, Stevens B, Tolley M, Ward A, Green J, Foster PS, Spindloe C, Gallegos P, Robinson AL, Neely D, Carroll DC, Tresca O, Yuan X, Quinn M, McKenna P, Dover N, Palmer C, Schreiber J, Najmudin Z, Sari I, Kraft M, Merchant M, Jeynes JC, Kirkby K, Fiorini F, Kirby D, Green S. Ion source development and radiobiology applications within the LIBRA project. ACTA ACUST UNITED AC 2011. [DOI: 10.1117/12.888262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Böhle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Höcht S, Hofheinz RD, Höfler H, Höhler T, Hölscher AH, Horneber M, Hübner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Körber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Mönig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Röcken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schütte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 2011; 49:461-531. [PMID: 21476183 DOI: 10.1055/s-0031-1273201] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M Moehler
- Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 Mainz.
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Arnold D, Stöltzing O, Timm S, Stein A, Geissler M, Lang H. [Resectable colorectal liver metastases: pro neoadjuvant therapy - contra neoadjuvant therapy]. Z Gastroenterol 2010; 48:1375-83. [PMID: 21125514 DOI: 10.1055/s-0029-1245715] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Approximately one third of patients with colorectal cancer (CRC) present with metastases confined to the liver only. In 15 % of these patients the metastases are primarily resectable. After resection of colorectal liver metastases the 5-year survival rate is 25 - 40 %. The EORTC trial of Nordlinger et al. has examined the role of perioperative/neoadjuvant chemotherapy of resectable liver metastases and found in the subgroup of resected patients a significant improvement in disease-free survival through chemotherapy. The results were not significant in the intent-to-treat population. Possible arguments pro neoadjuvant therapy of resectable liver metastases are the early eradication of disseminated tumour cells, the identification of a worse prognosis tumour biology in the individual patient and the higher dose density which can be achieved preoperatively versus postoperatively. Arguments against preoperative chemotherapy are the chemotherapy-induced hepatotoxicity and related increase in perioperative morbidity, the risk of achieving a complete remission of lesions which then cannot be detected intraoperatively and the uncertain optimal duration of chemotherapy. Especially surgical oncologists in Germany do not consider the neoadjuvant treatment of resectable liver metastases as a standard of care. In summary, because of the lack of level 1 evidence, patients with resectable liver metastases of colorectal cancer should be discussed within interdisciplinary tumour boards together with surgeons, gastroenterologists and medical oncologists. Potentially, overall survival data of the EORTC trial which is expected for late 2010 could change the level of evidence.
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Affiliation(s)
- D Arnold
- Hubertus-Wald-Tumorzentrum, Universitäres Cancer Center Hamburg, Universitätsklinikum Eppendorf, Hamburg.
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Qiao B, Zepf M, Borghesi M, Dromey B, Geissler M, Karmakar A, Gibbon P. Radiation-pressure acceleration of ion beams from nanofoil targets: the leaky light-sail regime. Phys Rev Lett 2010; 105:155002. [PMID: 21230914 DOI: 10.1103/physrevlett.105.155002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Indexed: 05/30/2023]
Abstract
A new ion radiation-pressure acceleration regime, the "leaky light sail," is proposed which uses sub-skin-depth nanometer foils irradiated by circularly polarized laser pulses. In the regime, the foil is partially transparent, continuously leaking electrons out along with the transmitted laser field. This feature can be exploited by a multispecies nanofoil configuration to stabilize the acceleration of the light ion component, supplementing the latter with an excess of electrons leaked from those associated with the heavy ions to avoid Coulomb explosion. It is shown by 2D particle-in-cell simulations that a monoenergetic proton beam with energy 18 MeV is produced by circularly polarized lasers at intensities of just 10¹⁹ W/cm². 100 MeV proton beams are obtained by increasing the intensities to 2 × 10²⁰ W/cm².
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Affiliation(s)
- B Qiao
- Jülich Supercomputing Center, Forschungzentrum Jülich GmbH, D-52425, Jülich, Germany
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Debayle A, Honrubia JJ, D'Humières E, Tikhonchuk VT, Micheau S, Geissler M. Integrated simulations of ignition scale fusion targets for the HiPER project. ACTA ACUST UNITED AC 2010. [DOI: 10.1088/1742-6596/244/2/022032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Geissler M, Hofheinz R, Moehler MH, Bitzer M, Boeck SH, Reinacher-Schick A, Heinemann V, Harder J. Trastuzumab and capecitabine in patients with HER2-expressing metastatic pancreatic cancer: A multicenter phase II study of the German AIO Pancreatic Cancer Group (AIO PK-0204). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4070] [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: 11/20/2022] Open
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Arnold D, Thuss-Patience PC, Stein A, Grothe W, Seufferlein T, Reinacher-Schick A, Geissler M, Hofheinz R, Moehler MH, Schmoll H. Docetaxel, oxaliplatin, and capecitabine (TEX regimen) in patients with advanced or metastatic gastric or gastroesophageal cancer (GC): Results from a phase II trial of the German AIO group. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4099] [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: 11/20/2022] Open
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Abstract
The epidermal growth factor receptor (EGFR) has been implicated in a multiplicity of cancer-related signal transduction pathways like cellular proliferation, adhesion, migration, neoangiogenesis, and apoptosis inhibition, all of them important features of cancerogenesis and tumour progression. Its tyrosine kinase activity plays a central role in mediating these processes and has been intensely studied to exploit it as a therapeutic target. Inhibitors of this pathway have been developed and assessed in trials with significant efficacy in clinical applications. The current review focuses in particular on the clinical data of EGFR tyrosine kinase inhibition in different tumour entities, preferably non-small cell lung cancer (NSCLC) and pancreatic cancer with emphasis on the approved small molecule erlotinib. Its clinical applications, evidence-based efficacy, and toxicity as well as predictive markers of response are discussed.
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Affiliation(s)
- M Steins
- Clinic for Thoracic Diseases, University of Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany.
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Möhler M, Mueller A, Trarbach T, Seufferlein T, Kubicka S, Lordick F, Geissler M, Daum S, Galle P, Kanzler S. 6579 Cetuximab with Irinotecan/Folinic Acid/5-FU as first-line treatment in advanced gastric cancer: a prospective multi-center phase II study and additional biomarkers of the Arbeitsgemeinschaft Internistische Onkologie. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71300-x] [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: 11/30/2022] Open
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Harder J, Hofheinz R, Möhler M, Büchler P, Klöppel G, Bitzer M, Endlicher E, Reinacher-Schick A, Heinemann V, Geissler M. 6597 Multicenter phase II trial of trastuzumab and capecitabine in patients with HER2 expressing metastasized pancreatic cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Moehler M, Kanzler S, Geissler M, Raedle J, Ebert MP, Daum S, Flieger D, Seufferlein T, Galle PR, Hoehler T. A randomized multicenter phase II study comparing capecitabine with irinotecan or cisplatin in metastatic adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol 2009; 21:71-7. [PMID: 19605504 DOI: 10.1093/annonc/mdp269] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The combination of irinotecan with 5-fluorouracil demonstrates efficacy with tolerable safety in the first-line treatment of metastatic gastroesophageal cancer (mGC). This randomized phase II trial compared for the first time capecitabine with irinotecan or cisplatin in this setting. PATIENTS AND METHODS Patients were randomly assigned to receive 3-week cycles of capecitabine 1000 mg/m(2), twice daily for 14 days, with on day 1 either irinotecan 250 mg/m(2) (XI) or cisplatin 80 mg/m(2) (XP). The primary end point was overall response rate (ORR) and secondary end points included progression-free survival (PFS), overall survival (OS) and safety. RESULTS Of 118 patients recruited, 112 were eligible for safety analysis and 103 for efficacy analysis. In the XI and XP treatment arms, there were no marked differences in ORR, 37.7% versus 42.0%, and median PFS, 4.2 versus 4.8 months, although median OS was longer, 10.2 versus 7.9 months, respectively. Grade 3/4 toxicity was higher in the XP regimen for thrombocytes (18.2% versus 1.8%), nausea (23.6% versus12.3%) and vomiting (16.4% versus 1.8%) and in the XI arm for diarrhea (22.8% versus 7.3%). CONCLUSION The comparable activity and safety of the XI and XP regimens establish XI as a relevant platinum-free first-line treatment choice for patients with mGC.
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Affiliation(s)
- M Moehler
- Department of Medicine, University of Mainz, Mainz, Germany.
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Dromey B, Rykovanov SG, Adams D, Hörlein R, Nomura Y, Carroll DC, Foster PS, Kar S, Markey K, McKenna P, Neely D, Geissler M, Tsakiris GD, Zepf M. Tunable enhancement of high harmonic emission from laser solid interactions. Phys Rev Lett 2009; 102:225002. [PMID: 19658870 DOI: 10.1103/physrevlett.102.225002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Indexed: 05/28/2023]
Abstract
Coherent wake emission is a unique source of extreme ultraviolet radiation and has been recently shown to provide the basis for intense attosecond light. Here we present a novel scheme, supported by particle-in-cell simulations, demonstrating that enhancement and spectral control of the coherent wake emission signal can be achieved by modifying the interaction plasma density ramp. Significant tunable enhancement of harmonic emission is verified experimentally, with factors of >50 in relative signal increase achieved in a narrow band of harmonics at the cutoff frequency.
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Affiliation(s)
- B Dromey
- Department of Physics and Astronomy, Queens University Belfast, BT7 INN, United Kingdom
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Moehler MH, Thuss-Patience P, Arnold D, Grothe W, Stein A, Seufferlein T, Mantovani Loeffler L, Geissler M, Hofheinz RD, Schmoll H. Docetaxel, oxaliplatin, and capecitabine (TEX regimen) for patients with metastatic gastric cancer: Interim results from a phase II trial by the German AIO Group. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4554 Background: Combination regimens of 3 drugs have shown promising activity as treatment for patients (pts) with metastatic gastric cancer (GC). Docetaxel combined with cisplatin and 5-FU (CF) improved overall survival and response rates when compared to standard CF. However, the identification of less toxic and more convenient variants of this regimen is still important. We have previously established a regimen with docetaxel (T) combined with oxaliplatin (E) and capecitabine (X) in a phase I trial [Grothe et al., Proc. ASCO 2006]. Results of a preplanned interim analysis of subsequent multicenter phase II trials of the TEX regimen are presented here. Methods: Pts with metastatic or locally advanced GC, adequate organ function, ECOG PS 0–2, and no prior chemotherapy for advanced disease (adjuvant allowed) were enrolled. TEX regimen was administered as defined: T 35 mg/m2 and E 70 mg/m2 on days (d) 1 and 8, with X 800 mg/m2 bid on d1–14 every 22 days Toxicity assessment was done 3-weekly while CT scans were repeated 9-weekly. Results: 35 of 48 pts were enrolled until 06/08: 28 male / 7 female, median age 59 (36–81) years, ECOG PS 0/1/2 69%/31%/0%, gastric / gastroesophageal cancer 60%/40%, distant metastases 96%, tumor in situ 37%. The most common toxicities reported were (CTC grade [gr] 3/4): diarrhea 20%/3%, vomiting 11%/3%, asthenia and neurotoxicity each 9%/0%. Mucositis and hand-foot-syndrome were observed in (grade 1+2 / grade 3) 29%/0% and 26%/3%, respectively. Hematoxicity was mild with grade 3 anemia in 10% and no other grade 3/4 toxicity except one episode of febrile neutropenia . Of 25 pts evaluable so far, first tumor response assessment revealed (RECIST criteria) partial response in 36% and stable disease in 40% of patients. Conclusions: TEX is a safe and tolerable regimen for patients with metastatic gastric cancer. Preliminary efficacy results indicate promising activity. Mature data including progression free survival will be presented at the meeting. [Table: see text]
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Affiliation(s)
- M. H. Moehler
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - P. Thuss-Patience
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - D. Arnold
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - W. Grothe
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - A. Stein
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - T. Seufferlein
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - L. Mantovani Loeffler
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - M. Geissler
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - R. D. Hofheinz
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
| | - H. Schmoll
- University of Mainz, Mainz, Germany; Charité, Campus Virchow, Berlin, Germany; Martin Luther University, Halle, Germany; Klinikum, Fulda, Germany; University of Ulm, Ulm, Germany; Klinikum St. Georg, Leipzig, Germany; Klinikum, Esslingen, Germany; University of Heidelberg/Mannheim, Mannheim, Germany
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Kanzler S, Trarbach T, Seufferlein T, Kubicka S, Lordick F, Geissler M, Daum S, Galle PR, Moehler M. Cetuximab with irinotecan/folinic acid/5-FU as first-line treatment in advanced gastric cancer: A nonrandomized multicenter AIO phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4534 Background: Cetuximab has demonstrated high efficacy in combination with irinotecan-based therapies in metastatic colorectal cancer and irinotecan/folinic acid/5-FU (IF) may be an effective alternative to cisplatin-based regimens in advanced gastric cancer. We therefore conducted a phase II AIO study to evaluate the tolerability and efficacy of cetuximab combined with IF as first-line treatment in patients with advanced gastric cancer. Methods: Patients (pts) were eligible with untreated adenocarcinoma of the stomach or oesophagogastric junction, with ECOG performance status (PS) < 2, measurable lesions and adequate organ functions. Pts received weekly cetuximab (first dose 400 mg/m2, subsequent doses 250 mg/m2) combined with chemotherapy consisting of irinotecan (80 mg/m2) plus 24 hours continuous infusion of sodium folinic acid (Na-FA: 200 mg/m2) and 5-FU (1500 mg/m2) on days 1, 8, 15, 22, 29 and 36 of a 50-day cycle. Treatment was continued until tumor progression and tumor assessments were performed every 2nd cycle. Results: Between Aug 2006 and Sep 2007, 49 pts were enrolled: 71% were males, median age was 63 years (range 33–77), median PS was 0 (65% pts), and 69% of pts and 31% of pts had gastric and oesophagogastric junction carcinomas, respectively. The median treatment time was 15.2 weeks (range 1.1–69.1). Grade 3/4 toxicities were diarrhoea (17% pts), skin reactions (13% pts), anorexia (9% pts), anaemia and fatigue (7%pts), allergic reactions, leucopoenia and neutropenia (4% pts each). Among 48 response-evaluable pts, the overall response rate (CR + PR) was 42% (CR 4%/PR 38%) and the tumour control rate was 73%. Median progression-free and overall survival times were 8.5 months (36.6 weeks; 95% CI 30.1; 48.1) and 16.6 months (71.1 weeks; 95% CI 50; 93.4), respectively. Conclusions: Cetuximab plus IF was well tolerated and encouraging survival data were observed. Cetuximab combined with chemotherapy in advanced or metastatic gastric cancer is under further investigation in an ongoing phase III trial. No significant financial relationships to disclose.
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Affiliation(s)
- S. Kanzler
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - T. Trarbach
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - T. Seufferlein
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - S. Kubicka
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - F. Lordick
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - M. Geissler
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - S. Daum
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - P. R. Galle
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - M. Moehler
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
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Qiao B, Zepf M, Borghesi M, Geissler M. Stable GeV ion-beam acceleration from thin foils by circularly polarized laser pulses. Phys Rev Lett 2009; 102:145002. [PMID: 19392446 DOI: 10.1103/physrevlett.102.145002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Indexed: 05/27/2023]
Abstract
A stable relativistic ion acceleration regime for thin foils irradiated by circularly polarized laser pulses is suggested. In this regime, the "light-sail" stage of radiation pressure acceleration for ions is smoothly connected with the initial relativistic "hole-boring" stage, and a defined relationship between laser intensity I0, foil density n{0}, and thickness l{0} should be satisfied. For foils with a wide range of n{0}, the required I0 and l{0} for the regime are theoretically estimated and verified with the particle-in-cell code ILLUMINATION. It is shown for the first time by 2D simulations that high-density monoenergetic ion beams with energy above GeV/u and divergence of 10 degrees are produced by circularly polarized lasers at intensities of 10;{22} W/cm;{2}, which are within reach of current laser systems.
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Affiliation(s)
- B Qiao
- Center for Plasma Physics, Department of Physics and Astronomy, Queen's University Belfast, Belfast BT7 1NN, United Kingdom
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47
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Fuerbach A, Miese C, Koehler W, Geissler M. Supercontinuum generation with a chirped-pulse oscillator. Opt Express 2009; 17:5905-5911. [PMID: 19333361 DOI: 10.1364/oe.17.005905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We demonstrate the generation of a high power ultrabroadband supercontinuum by coupling the uncompressed pulses from a Ti:Sapphire Chirped-pulse oscillator into a photonic crystal fibre that exhibits a highly anomalous dispersion at the centre wavelength of the laser. Our simulations show that the pulses first undergo quasi-linear compression before the actual supercontinuum is generated by soliton fission dynamics. This two-step process results in an optical spectrum that is remarkably independent on the input pulse energy. Moreover, the reduced peak intensity at the input facet of the fibre mitigates damage problems and allows the generation of high power white-light radiation.
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Affiliation(s)
- A Fuerbach
- Centre for Ultrahigh-bandwidth Devices for Optical Systems, MQPhotonics Research Centre, Macquarie University, Sydney, NSW, Australia.
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48
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Schmid K, Veisz L, Tavella F, Benavides S, Tautz R, Herrmann D, Buck A, Hidding B, Marcinkevicius A, Schramm U, Geissler M, Meyer-Ter-Vehn J, Habs D, Krausz F. Few-cycle laser-driven electron acceleration. Phys Rev Lett 2009; 102:124801. [PMID: 19392288 DOI: 10.1103/physrevlett.102.124801] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Indexed: 05/27/2023]
Abstract
We report on an electron accelerator based on few-cycle (8 fs full width at half maximum) laser pulses, with only 40 mJ energy per pulse, which constitutes a previously unexplored parameter range in laser-driven electron acceleration. The produced electron spectra are monoenergetic in the tens-of-MeV range and virtually free of low-energy electrons with thermal spectrum. The electron beam has a typical divergence of 5-10 mrad. The accelerator is routinely operated at 10 Hz and constitutes a promising source for several applications. Scalability of the few-cycle driver in repetition rate and energy implies that the present work also represents a step towards user friendly laser-based accelerators.
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Affiliation(s)
- K Schmid
- Max-Planck-Institut für Quantenoptik, Hans-Kopfermann-Strasse 1, 85748 Garching, Germany.
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49
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Ebert MP, Auernhammer C, Caca K, Eckel F, Fischbach W, Geissler M, Göke B, Greten T, Kubicka S, Lutz MP, Möhler M, Opitz O, Pavel M, Porschen R, Reinacher-Schick A, Schmiegel W, Seufferlein T, Wiedenmann B, Schmid RM. [Gastrointestinal oncology - therapy update 2008 / 2009]. Z Gastroenterol 2009; 47:296-306. [PMID: 19267319 DOI: 10.1055/s-2008-1027989] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As a consequence of recent studies the treatment of gastrointestinal cancers has become challenging and is undergoing constant changes on the basis of the results of new trials. The steering committee of the working group on gastrointestinal cancers of the Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten has decided to summarise and present recent updates of the current treatment guidelines and recommendations for the most relevant gastrointestinal malignancies. In this review we have included recent findings from large trials on esophageal, gastric, pancreatic, cholangiocellular and liver cancers, as well as colorectal cancers, neuroendocrine tumours and lymphomas. This includes an update on the combination with novel targeted agents and the introduction of potential predictive biomarkers in the selection of the appropriate treatment strategy.
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Affiliation(s)
- M P Ebert
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, 81675 München.
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50
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Henig A, Kiefer D, Geissler M, Rykovanov SG, Ramis R, Hörlein R, Osterhoff J, Major Z, Veisz L, Karsch S, Krausz F, Habs D, Schreiber J. Laser-driven shock acceleration of ion beams from spherical mass-limited targets. Phys Rev Lett 2009; 102:095002. [PMID: 19392529 DOI: 10.1103/physrevlett.102.095002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Indexed: 05/27/2023]
Abstract
We report on experimental studies of ion acceleration from spherical targets of diameter 15 microm irradiated by ultraintense (1x10(20) W/cm2) pulses from a 20-TW Ti:sapphire laser system. A highly directed proton beam with plateau-shaped spectrum extending to energies up to 8 MeV is observed in the laser propagation direction. This beam arises from acceleration in a converging shock launched by the laser, which is confirmed by 3-dimensional particle-in-cell simulations. The temporal evolution of the shock-front curvature shows excellent agreement with a two-dimensional radiation pressure model.
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Affiliation(s)
- A Henig
- Max-Planck-Institut für Quantenoptik, Garching, Germany.
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