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Affiliation(s)
- Michael Staehler
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Annabel K. Spek
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Severin Rodler
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Melanie Schott
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Jozefina Casuscelli
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Lena Mittelmeier
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Marcus Schlemmer
- Department of Medical Oncology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
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Reichardt P, Schlemmer M, Delgado Perez JR, Papai Z, Prausova J, Melichar B, Fumagalli E, Barone C, Bauer S, Pustowka A, Crippa S, Castellana R, Quiering C, Le Cesne A. Safety of Imatinib Mesylate in a Multicenter Expanded Access Program in Adult Patients with Gastrointestinal Stromal Tumors in the Adjuvant Setting. Oncol Res Treat 2019; 42:629-635. [PMID: 31550719 DOI: 10.1159/000502749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/19/2018] [Accepted: 08/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors most often caused by activating mutations of the KIT gene. KIT tyrosine kinase inhibitors provide targeted therapy for the underlying genetic mutation, and adjuvant therapy is indicated for patients who are at significant risk of relapse following GIST resection. This is a report of the safety of imatinib in patients with GIST in the adjuvant setting in an expanded access program. METHODS In this multicenter, open-label, single-arm trial, safety was assessed based on the frequency of adverse events (AEs). RESULTS Three hundred patients were treated and analyzed; 40 patients discontinued treatment. Median overall exposure during the program was 181 days (range 9-420); most patients (260/300 treated) completed the study. Six patients had disease recurrence, 4 of whom discontinued. In line with previously published reports, the most frequent AEs were nausea, diarrhea, and periorbital edema. The AEs were mild to moderate in most cases (76%). CONCLUSIONS These findings are in agreement with the known safety profile of imatinib and confirm the safety of imatinib at 400 mg/day in the adjuvant setting. The incidence of severe AEs was low.
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Affiliation(s)
- Peter Reichardt
- Department of Oncology and Palliative Care, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Marcus Schlemmer
- Department of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany,
| | - Juan R Delgado Perez
- Department of Medical Oncology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Zsuzsanna Papai
- Department of Oncology, Medical Centre, Hungarian Defense Forces, Budapest, Hungary
| | - Jana Prausova
- Department of Oncology, University Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czechia
| | - Bohuslav Melichar
- Department of Oncology, Palacky University Medical School and Teaching Hospital Olomouc, Olomouc, Czechia
| | - Elena Fumagalli
- Adult Mesenchymal Tumour and Rare Cancer Medical Oncology Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Barone
- Division of Medical Oncology, University Hospital A. Gemelli, Rome, Italy
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital, University of Duisburg-Essen, Essen, Germany
| | | | | | | | | | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy Institute of Oncology, Villejuif, France
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Vogel C, Ziegelmüller B, Ljungberg B, Bensalah K, Bex A, Canfield S, Giles RH, Hora M, Kuczyk MA, Merseburger AS, Powles T, Albiges L, Stewart F, Volpe A, Graser A, Schlemmer M, Yuan C, Lam T, Staehler M. Imaging in Suspected Renal-Cell Carcinoma: Systematic Review. Clin Genitourin Cancer 2019; 17:e345-e355. [DOI: 10.1016/j.clgc.2018.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/08/2018] [Accepted: 07/30/2018] [Indexed: 01/14/2023]
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Schlemmer M, Spek A, Rodler S, Schott M, Casuscelli J, Staehler M. Sequential Treatment Based on Sunitinib and Sorafenib in Patients with Metastatic Renal Cell Carcinoma. Cureus 2019; 11:e4244. [PMID: 31131167 PMCID: PMC6516620 DOI: 10.7759/cureus.4244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives: The aim of our study was to evaluate the outcome of alternative sequences of sunitinib followed by sorafenib versus sorafenib followed by sunitinib therapies in patients with metastatic renal cell carcinoma (mRCC). Materials and Methods: This single-center study analyzed patients with mRCC on systemic therapy between January 2005 and August 2011. Patients were treated with the recommended first-line therapy (sunitinib, sorafenib, pazopanib, or immunotherapy) until progression or intolerable toxicity and afterward switched to another guideline-recommended systemic therapy. Only patients starting first-line therapy on either sorafenib or sunitinib and switching to the other of these drugs were included in this analysis. Results: Out of 266 patients (females: 85, males: 181) with a median age of 57.1 years (30 - 76 years), 57 patients with a sequence of sunitinib and sorafenib were identified. First-line sorafenib therapy was followed by sunitinib (So-Su) in 32 patients; sunitinib was followed by sorafenib (Su-So) in 25 patients. Progression-free survival (PFS) for patients with first-line sorafenib was 11.6 months and was 8.7 months for sunitinib. Overall survival (OS) rates for Su-So was 118.8 months and 83.3 months with So-Su (p = 0.82). No new safety signals were detected. Conclusion: None of the therapeutic first-line approaches was superior to the other. Sequencing tyrosine kinase inhibitor (TKI) therapy seems to be effective in mRCC and superior to single-line therapy. Further studies should focus on the efficacy of single treatment lines rather than treatment sequences to estimate more potent drugs based on PFS rather than overall survival (OS).
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Affiliation(s)
- Marcus Schlemmer
- Department of Palliative Care, Barmherzige Brueder Hospital, Munich, DEU
| | - Annabel Spek
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, DEU
| | - Severin Rodler
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, DEU
| | - Melanie Schott
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, DEU
| | - Jozefina Casuscelli
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, DEU
| | - Michael Staehler
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, DEU
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Vogl M, Schildmann E, Leidl R, Hodiamont F, Kalies H, Maier BO, Schlemmer M, Roller S, Bausewein C. Redefining diagnosis-related groups (DRGs) for palliative care - a cross-sectional study in two German centres. BMC Palliat Care 2018; 17:58. [PMID: 29622004 PMCID: PMC5887171 DOI: 10.1186/s12904-018-0307-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. METHODS Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013). Data were analysed for the total group receiving hospital care covering, but not exclusively, palliative care (group A) and the subgroup receiving palliative care only (group B). Patient and care characteristics predictive of inpatient costs of palliative care were derived by generalised linear models and investigated by classification and regression tree analysis. RESULTS Between 7/2012 and 12/2013, 2151 patients received care in the two hospitals including, but not exclusively, on the PCUs (group A). In 2013, 784 patients received care on the two PCUs only (group B). Mean total costs per case were € 7392 (SD 7897) (group A) and € 5763 (SD 3664) (group B), mean total reimbursement per case € 5155 (SD 6347) (group A) and € 4278 (SD 2194) (group B). For group A/B on the ward, 58%/67% of the overall costs and 48%/53%, 65%/82% and 64%/72% of costs for nursing, physicians and infrastructure were reimbursed, respectively. Main diagnosis did not significantly influence costs. However, duration of palliative care and total length of stay were (related to the cost calculation method) identified as significant cost drivers. CONCLUSIONS Related to the cost calculation method, total length of stay and duration of palliative care were identified as significant cost drivers. In contrast, main diagnosis did not reflect costs. In addition, results show that reimbursement within the German Diagnosis-Related Groups system does not reproduce the costs adequately, but causes a financing gap for inpatient palliative care.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum Munich, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Eva Schildmann
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum Munich, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Farina Hodiamont
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Helen Kalies
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Bernd Oliver Maier
- St. Josephs-Hospital, Department of Palliative Medicine and Interdisciplinary Oncology, Wiesbaden, Germany
| | - Marcus Schlemmer
- Krankenhaus Barmherzige Brüder Munich, Department of Palliative Medicine, Munich, Germany
| | - Susanne Roller
- Krankenhaus Barmherzige Brüder Munich, Department of Palliative Medicine, Munich, Germany
| | - Claudia Bausewein
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
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Joensuu H, Wardelmann E, Sihto H, Eriksson M, Sundby Hall K, Reichardt A, Hartmann JT, Pink D, Cameron S, Hohenberger P, Al-Batran SE, Schlemmer M, Bauer S, Nilsson B, Kallio R, Junnila J, Vehtari A, Reichardt P. Effect of KIT and PDGFRA Mutations on Survival in Patients With Gastrointestinal Stromal Tumors Treated With Adjuvant Imatinib: An Exploratory Analysis of a Randomized Clinical Trial. JAMA Oncol 2017; 3:602-609. [PMID: 28334365 DOI: 10.1001/jamaoncol.2016.5751] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Little is known about whether the duration of adjuvant imatinib influences the prognostic significance of KIT proto-oncogene receptor tyrosine kinase (KIT) and platelet-derived growth factor receptor α (PDGFRA) mutations. Objective To investigate the effect of KIT and PDGFRA mutations on recurrence-free survival (RFS) in patients with gastrointestinal stromal tumors (GISTs) treated with surgery and adjuvant imatinib. Design, Setting, and Participants This exploratory study is based on the Scandinavian Sarcoma Group VIII/Arbeitsgemeinschaft Internistische Onkologie (SSGXVIII/AIO) multicenter clinical trial. Between February 4, 2004, and September 29, 2008, 400 patients who had undergone surgery for GISTs with a high risk of recurrence were randomized to receive adjuvant imatinib for 1 or 3 years. Of the 397 patients who provided consent, 341 (85.9%) had centrally confirmed, localized GISTs with mutation analysis for KIT and PDGFRA performed centrally using conventional sequencing. During a median follow-up of 88 months (completed December 31, 2013), 142 patients had GIST recurrence. Data of the evaluable population were analyzed February 4, 2004, through December 31, 2013. Main Outcomes and Measures The main outcome was RFS. Mutations were grouped by the gene and exon. KIT exon 11 mutations were further grouped as deletion or insertion-deletion mutations, substitution mutations, insertion or duplication mutations, and mutations that involved codons 557 and/or 558. Results Of the 341 patients (175 men and 166 women; median age at study entry, 62 years) in the 1-year group and 60 years in the 3-year group), 274 (80.4%) had GISTs with a KIT mutation, 43 (12.6%) had GISTs that harbored a PDGFRA mutation, and 24 (7.0%) had GISTs that were wild type for these genes. PDGFRA mutations and KIT exon 11 insertion or duplication mutations were associated with favorable RFS, whereas KIT exon 9 mutations were associated with unfavorable outcome. Patients with KIT exon 11 deletion or insertion-deletion mutation had better RFS when allocated to the 3-year group compared with the 1-year group (5-year RFS, 71.0% vs 41.3%; P < .001), whereas no significant benefit from the 3-year treatment was found in the other mutational subgroups examined. KIT exon 11 deletion mutations, deletions that involved codons 557 and/or 558, and deletions that led to pTrp557_Lys558del were associated with poor RFS in the 1-year group but not in the 3-year group. Similarly, in the subset with KIT exon 11 deletion mutations, higher-than-the-median mitotic counts were associated with unfavorable RFS in the 1-year group but not in the 3-year group. Conclusions and Relevance Patients with KIT exon 11 deletion mutations benefit most from the longer duration of adjuvant imatinib. The duration of adjuvant imatinib modifies the risk of GIST recurrence associated with some KIT mutations, including deletions that affect exon 11 codons 557 and/or 558. Trial Registration clinicaltrials.gov Identifier: NCT00116935.
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Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Harri Sihto
- Laboratory of Molecular Oncology and Translational Cancer Biology Program, Biomedicum, University of Helsinki, Helsinki, Finland
| | - Mikael Eriksson
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Kirsten Sundby Hall
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Annette Reichardt
- Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Jörg T Hartmann
- Department of Hematology, Oncology, Immunology, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld, Germany
| | - Daniel Pink
- Department of Hematology, Oncology and Palliative Care, HELIOS Klinikum Bad Saarow, Germany
| | - Silke Cameron
- Department of Gastroenterology/Endocrinology, University of Göttingen, Göttingen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Salah-Eddin Al-Batran
- Clinical Cancer Research, Krankenhaus Nordwest, Universitäres Centrum für Tumorerkrankungen University Cancer Center Frankfurt, Frankfurt, Germany
| | - Marcus Schlemmer
- Department of Internal Medicine III, University Hospital-Großhadern, Ludwig Maximilians University, Munich, Germany
| | - Sebastian Bauer
- Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Bengt Nilsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raija Kallio
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | | | - Aki Vehtari
- Helsinki Institute for Information Technology, Department of Computer Science, Aalto University, Espoo, Finland
| | - Peter Reichardt
- Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany
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Hellbach K, Sterzik A, Sommer W, Karpitschka M, Hummel N, Casuscelli J, Ingrisch M, Schlemmer M, Graser A, Staehler M. Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer. Eur Radiol 2016; 27:2532-2537. [PMID: 27678131 DOI: 10.1007/s00330-016-4597-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the potential role of dual energy CT (DECT) to visualize antiangiogenic treatment effects in patients with metastatic renal cell cancer (mRCC) while treated with tyrosine-kinase inhibitors (TKI). METHODS 26 patients with mRCC underwent baseline and follow-up single-phase abdominal contrast enhanced DECT scans. Scans were performed immediately before and 10 weeks after start of treatment with TKI. Virtual non-enhanced (VNE) and colour coded iodine images were generated. 44 metastases were measured at the two time points. Hounsfield unit (HU) values for VNE and iodine density (ID) as well as iodine content (IC) in mg/ml of tissue were derived. These values were compared to the venous phase DECT density (CTD) of the lesions. Values before and after treatment were compared using a paired Student's t test. RESULTS Between baseline and follow up, mean CTD and DECT-derived ID both showed a significant reduction (p < 0.005). The relative reduction measured in percent was significantly greater for ID than for CTD (49.8 ± 36,3 % vs. 29.5 ± 20.8 %, p < 0.005). IC was also significantly reduced under antiangiogenic treatment (p < 0.0001). CONCLUSIONS Dual energy CT-based quantification of iodine content of mRCC metastases allows for significantly more sensitive and reproducible detection of antiangiogenic treatment effects. KEY POINTS • A sign of tumour response to antiangiogenic treatment is reduced tumour perfusion. • DECT allows visualizing iodine uptake, which serves as a marker for vascularization. • More sensitive detection of antiangiogenic treatment effects in mRCC is possible.
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Affiliation(s)
- K Hellbach
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - A Sterzik
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - W Sommer
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Karpitschka
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - N Hummel
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - J Casuscelli
- Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Ingrisch
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - M Schlemmer
- Department of Palliative Care, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Germany
| | - A Graser
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
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Abstract
Real-time collision-free trajectory control is dealt with by semi- infinite optimization techniques. This allows an optimal control problem incorporating a robotlobstacle distance function for col lision detection to be reduced to a finite-dimensional parameter- optimization problem. This reduced problem can be solved effi ciently by the numerical parameter-optimization method of sequen tial quadratic programming. In the case of a time-varying robot environment, a series of such optimization problems is solved in an iterative time frame, constituting a real-time optimization loop.
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Affiliation(s)
- M. Schlemmer
- DLR Oberpfaffenhofen Institute for Robotics and System Dynamics Wessling 82234, Germany
| | - G. Gruebel
- DLR Oberpfaffenhofen Institute for Robotics and System Dynamics Wessling 82234, Germany
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Joensuu H, Eriksson M, Sundby Hall K, Reichardt A, Hartmann JT, Pink D, Ramadori G, Hohenberger P, Al-Batran SE, Schlemmer M, Bauer S, Wardelmann E, Nilsson B, Sihto H, Bono P, Kallio R, Junnila J, Alvegård T, Reichardt P. Adjuvant Imatinib for High-Risk GI Stromal Tumor: Analysis of a Randomized Trial. J Clin Oncol 2015; 34:244-50. [PMID: 26527782 DOI: 10.1200/jco.2015.62.9170] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Three years of adjuvant imatinib therapy are recommended for patients with GI stromal tumor (GIST) with high-risk features, according to survival findings in the Scandinavian Sarcoma Group XVIII/AIO (Arbeitsgemeinschaft Internistische Onkologie) trial. To investigate whether the survival benefits have persisted, we performed the second planned analysis of the trial. PATIENTS AND METHODS Eligible patients had macroscopically completely excised, KIT-positive GIST with a high risk of recurrence, as determined by using the modified National Institutes of Health criteria. After surgery, the patients were randomly assigned to receive imatinib for either 1 or 3 years. The primary objective was recurrence-free survival (RFS), and the secondary objectives included survival. RESULTS A total of 400 patients were entered onto this open-label study between February 4, 2004, and September 29, 2008. During a median follow-up of 90 months, 171 recurrences and 69 deaths were detected. Patients assigned to the 3-year group had longer RFS than those assigned to the 1- year group; 5-year RFS was 71.1% versus 52.3%, respectively (hazard ratio [HR], 0.60; 95% CI 0.44 to 0.81; P < .001), and survival was 91.9% versus 85.3% (HR, 0.60; 95% CI, 0.37 to 0.97; P = .036). Patients in the 3-year group survived longer in the subset with centrally confirmed GIST and without macroscopic metastases at study entry (93.4% v 86.8%; HR, 0.53; 95% CI, 0.30 to 0.93; P = .024). Similar numbers of cardiac events and second cancers were recorded in the groups. CONCLUSION Three years of adjuvant imatinib therapy results in longer survival than 1 year of imatinib. High 5-year survival rates are achievable in patient populations with high-risk GIST.
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Affiliation(s)
- Heikki Joensuu
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany. heikki.joensuu@hus
| | - Mikael Eriksson
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Kirsten Sundby Hall
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Annette Reichardt
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Jörg T Hartmann
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Daniel Pink
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Giuliano Ramadori
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Peter Hohenberger
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Salah-Eddin Al-Batran
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Marcus Schlemmer
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Sebastian Bauer
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Eva Wardelmann
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Bengt Nilsson
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Harri Sihto
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Petri Bono
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Raija Kallio
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Jouni Junnila
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Thor Alvegård
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Peter Reichardt
- Heikki Joensuu and Petri Bono, Comprehensive Cancer Center Helsinki; Heikki Joensuu, Harri Sihto, and Petri Bono, University of Helsinki, Helsinki; Raija Kallio, Oulu University Hospital, Oulu; Jouni Junnila, 4Pharma, Turku, Finland; Mikael Eriksson and Thor Alvegård, Lund University, Lund; Bengt Nilsson, Sahlgrenska University Hospital, Gothenburg, Sweden; Kirsten Sundby Hall, Oslo University Hospital, Oslo, Norway; Annette Reichardt, Daniel Pink, and Peter Reichardt, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin; Jörg T. Hartmann, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld; Giuliano Ramadori, University of Göttingen, Göttingen; Peter Hohenberger, Mannheim University Medical Center, Mannheim; Salah-Eddin Al-Batran, Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Frankfurt; Marcus Schlemmer, University Hospital Großhadern, Ludwig Maximilians University, Munich; Sebastian Bauer, Sarcoma Center, West German Cancer Center, Essen; and Eva Wardelmann, Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany
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Joensuu H, Eriksson M, Sundby Hall K, Reichardt A, Ramadori G, Hohenberger P, Al-Batran SE, Schlemmer M, Bauer S, Pink D, Duyster J, Nilsson BE, Monge OR, Kallio R, Bono P, Junnila J, Wardelmann E, Alvegard T, Reichardt P. Three vs. 1 year of adjuvant imatinib (IM) for operable high-risk GIST: The second planned analysis of the randomized SSGXVIII/AIO trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | | | - Annette Reichardt
- HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | | | | | | | | | - Sebastian Bauer
- Universitaetsklinikum Essen-Innere Medizin-Essen, Essen, Germany
| | - Daniel Pink
- Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | | | | | - Odd R Monge
- Haukeland University Hospital, Bergen, Norway
| | | | - Petri Bono
- Helsinki University Central Hospital, Helsinki, Finland
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Schlemmer M, Suchner U, Schäpers B, Duerr EM, Alteheld B, Zwingers T, Stehle P, Zimmer HG. Is glutamine deficiency the link between inflammation, malnutrition, and fatigue in cancer patients? Clin Nutr 2015; 34:1258-65. [PMID: 25614125 DOI: 10.1016/j.clnu.2014.12.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 08/05/2014] [Revised: 12/10/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Evaluation of potential associations between plasma glutamine levels and the incidence of cancer related fatigue, physical performance, poor nutritional status, and inflammation in patients with solid tumors. STUDY DESIGN Mono-center cross-sectional study recruiting 100 (34 women) consecutive patients (September 2009-March 2011; ≥18 y) with solid tumors and causal tumor therapy. METHODOLOGY Fasting venous blood was harvested for routine clinical chemistry, amino acid (HPLC) and inflammation marker analyses. Clinical assessments included global, physical, affective and cognitive fatigue (questionnaire) and Karnofsky performance status. Nutritional status was evaluated using bioelectrical impedance analysis, the Prognostic Inflammatory and Nutritional Index and plasma protein levels. Regression analyses were performed to correlate continuous variables with plasma glutamine (95% confidence intervals). RESULTS Nutritional status was impaired in 19% of the patients. Average plasma glutamine concentration (574.0 ± 189.6 μmol/L) was within normal range but decreased with impaired physical function. Plasma glutamine was linked to the ratio extracellular to body cell mass (p < 0.044), CRP (p < 0.001), physical (p = 0.014), affective (p = 0.041), and global fatigue (p = 0.030). Markers of inflammation increased with low physical performance. CONCLUSIONS The data support our working hypothesis that in cancer patients systemic inflammation maintains a catabolic situation leading to malnutrition symptoms and glutamine deprivation, the latter being associated with cancer related fatigue.
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Affiliation(s)
- Marcus Schlemmer
- Department of Internal Medicine III, Ludwig-Maximilians-University-Großhadern, Munich, Germany
| | | | | | - Eva-Maria Duerr
- Department of Internal Medicine III, Ludwig-Maximilians-University-Großhadern, Munich, Germany
| | - Birgit Alteheld
- Department of Nutrition and Food Sciences - Nutritional Physiology, University of Bonn, Bonn, Germany
| | | | - Peter Stehle
- Department of Nutrition and Food Sciences - Nutritional Physiology, University of Bonn, Bonn, Germany.
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Joensuu H, Eriksson M, Hall KS, Hartmann JT, Pink D, Schütte J, Ramadori G, Hohenberger P, Duyster J, Al-Batran SE, Schlemmer M, Bauer S, Wardelmann E, Sarlomo-Rikala M, Nilsson B, Sihto H, Ballman KV, Leinonen M, DeMatteo RP, Reichardt P. Risk factors for gastrointestinal stromal tumor recurrence in patients treated with adjuvant imatinib. Cancer 2014; 120:2325-33. [PMID: 24737415 PMCID: PMC4209960 DOI: 10.1002/cncr.28669] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [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: 12/21/2013] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about the factors that predict for gastrointestinal stromal tumor (GIST) recurrence in patients treated with adjuvant imatinib. METHODS Risk factors for GIST recurrence were identified, and 2 risk stratification scores were developed using the database of the Scandinavian Sarcoma Group (SSG) XVIII trial, where 358 patients with high-risk GIST with no overt metastases were randomly assigned to adjuvant imatinib 400 mg/day either for 12 or 36 months after surgery. The findings were validated in the imatinib arm of the American College of Surgeons Oncology Group Z9001 trial, where 359 patients with GIST were randomized to receive imatinib and 354 were to receive placebo for 12 months. RESULTS Five factors (high tumor mitotic count, nongastric location, large size, rupture, and adjuvant imatinib for 12 months) were independently associated with unfavorable recurrence-free survival (RFS) in a multivariable analysis in the SSGXVIII cohort. A risk score based on these 5 factors had a concordance index with GIST recurrence of 78.9%. When a simpler score consisting of the 2 strongest predictive factors (mitotic count and tumor site) was devised, the groups with the lowest, intermediate high, and the highest risk had 5-year RFS of 76.7%, 47.5%, and 8.4%, respectively. Both scores were strongly associated with RFS in the validation cohort (P < .001 for each comparison). CONCLUSIONS The scores generated were effective in stratifying the risk of GIST recurrence in patient populations treated with adjuvant imatinib. Patients with nongastric GIST with a high mitotic count are at a particularly high risk for recurrence.
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Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
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Stemmler H, Schlemmer M, Reilich S. Rationale Bildgebung bei metastasierten Tumorerkrankungen. Internist (Berl) 2013; 54:803-9. [DOI: 10.1007/s00108-012-3241-0] [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: 10/26/2022]
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Schramm N, Englhart E, Schlemmer M, Hittinger M, Übleis C, Becker CR, Reiser MF, Berger F. Tumor response and clinical outcome in metastatic gastrointestinal stromal tumors under sunitinib therapy: comparison of RECIST, Choi and volumetric criteria. Eur J Radiol 2013; 82:951-8. [PMID: 23518148 DOI: 10.1016/j.ejrad.2013.02.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 01/21/2013] [Accepted: 02/16/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Purpose of the study was to compare radiological treatment response according to RECIST, Choi and volumetry in GIST-patients under 2nd-line-sunitinib-therapy and to correlate the results of treatment response assessment with disease-specific survival (DSS). PATIENTS AND METHODS 20 patients (mean: 60.7 years; 12 male/8 female) with histologically proven GIST underwent baseline-CT of the abdomen under imatinib and follow-up-CTs 3 months and 1 year after change to sunitinib. 68 target lesions (50 hepatic, 18 extrahepatic) were investigated. Therapy response (partial response (PR), stable disease (SD), progressive disease (PD)) was evaluated according to RECIST, Choi and volumetric criteria. Response according to the different assessment systems was compared and correlated to the DSS of the patients utilizing Kaplan-Meier statistics. RESULTS The mean DSS (in months) of the response groups 3 months after therapy change was: RECIST: PR (0/20); SD (17/20): 30.4 (months); PD (3/20) 11.6. Choi: PR (10/20) 28.6; SD (8/20) 28.1; PD (2/20) 13.5. Volumetry: PR (4/20) 29.6; SD (11/20) 29.7; PD (5/20) 17.2. Response groups after 1 year of sunitinib showed the following mean DSS: RECIST: PR (3/20) 33.6; SD (9/20) 29.7; PD (8/20) 20.3. Choi: PR (10/20) 21.5; SD (4/20) 42.9; PD (6/20) 23.9. Volumetry: PR (6/20) 27.3; SD (5/20) 38.5; PD (9/20) 19.3. CONCLUSION One year after modification of therapy, only partial response according to RECIST indicated favorable survival in patients with GIST. The value of alternate response assessment strategies like Choi criteria for prediction of survival in molecular therapy still has to be demonstrated.
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Affiliation(s)
- N Schramm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Abstract
BACKGROUND Breast cancer is the most common malignancy and the second leading cause of death in women. Because bone metastases are a common finding in patients with breast cancer, they are of major clinical concern. METHODS In 115 consecutive patients with bone metastases secondary to breast cancer, 132 surgical procedures were performed. Medical records and imaging procedures were reviewed for age, treatment of the primary tumor, clinical symptoms, surgical treatment, complications, and survival. RESULTS The overall survival of patients with metastatic breast cancer was dependent on the site and the amount of the metastases. Age was not a prognostic factor for survival. If the result of the orthopaedic surgery was a wide resection (R0) survival was significantly better than in the R1 (marginal resection - tumor resection in sane tissue) or R2 (intralesional resection) situation. Concerning the orthopaedic procedures there was no survival difference. CONCLUSION In conclusion a wide (R0) resection and the absence of pathological fracture and visceral metastases were predictive for longer survival in univariate analysis. Age and the type of orthopaedic surgery had no impact on survival in multivariate analysis. The resection margins lost significance. The standard of care for patients with metastatic breast cancer to the bone requires a multidisciplinary approach.
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Affiliation(s)
- Bernd Wegener
- Orthopedic Oncology, Department of Orthopedic Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, D-81377, München, Gemany
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Reichardt P, Blay JY, Boukovinas I, Brodowicz T, Broto JM, Casali PG, Decatris M, Eriksson M, Gelderblom H, Kosmidis P, Le Cesne A, Pousa AL, Schlemmer M, Verweij J, Joensuu H. Adjuvant therapy in primary GIST: state-of-the-art. Ann Oncol 2012; 23:2776-2781. [PMID: 22831984 DOI: 10.1093/annonc/mds198] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The management of primary gastrointestinal stromal tumours (GISTs) has evolved with the introduction of adjuvant therapy. Recently reported results of the SSG XVIII/AIO trial by the Scandinavian Sarcoma Group (SSG) and the German Working Group on Medical Oncology (AIO) represent a significant change in the evidence for adjuvant therapy duration. The objectives of this European Expert Panel meeting were to describe the optimal management and best practice for the systemic adjuvant treatment of patients with primary GISTs. MATERIALS AND METHODS A panel of medical oncology experts from European sarcoma research groups were invited to a 1-day workshop. Several questions and discussion points were selected by the organising committee prior to the conference. The experts reviewed the current literature of all clinical trials available on adjuvant therapy for primary GISTs, considered the quality evidence and formulated recommendations for each discussion point. RESULTS Clinical issues were identified and provisional clinical opinions were formulated for adjuvant treatment patient selection, imatinib dose, duration and patient recall, mutational analysis and follow-up of primary GIST patients. Adjuvant imatinib 400 mg/day for 3 years duration is a standard treatment in all patients with significant risk of recurrence following resection of primary GISTs. Patient selection for adjuvant therapy should be based on any of the three commonly used patient risk stratification schemes. R1 surgery (versus R0) alone is not an indication for adjuvant imatinib in low-risk GIST. Recall and imatinib restart could be proposed in patients who discontinued 1-year adjuvant imatinib within the previous 3 months and may be considered on a case-by-case basis in patients who discontinued within the previous year. Mutational analysis is recommended in all cases of GISTs using centralised laboratories with good quality control. Treatment is not recommended in an imatinib-insensitive D842V-mutated GIST. During adjuvant treatment, patients are recommended to be clinically assessed at 1- to 3-month intervals. Upon discontinuation, computed tomography scan (CT) scans are recommended every 3 to 4 months for 2 years when the risk of relapse is highest, followed by every 6 months until year 5 and annually until year 10 after treatment discontinuation. CONCLUSIONS Key points in systemic adjuvant treatment and clinical management of primary GISTs as well as open questions were identified during this European Expert Panel meeting on GIST management.
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Affiliation(s)
- P Reichardt
- Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
| | - J-Y Blay
- Department of Medicine, Centre Léon-Bérard, Lyon, France
| | - I Boukovinas
- 2nd Department of Medical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - T Brodowicz
- Department of Internal Medicine 1/Division of Oncology, Medical University Vienna--General Hospital, Vienna, Austria
| | - J M Broto
- COTMES (Comité de Tumores Músculo-Esqueléticos), Mallorca, Spain
| | - P G Casali
- Department of Cancer Medicine, Istituto Nazionale dei Tumori, Milan, Italy
| | - M Decatris
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - M Eriksson
- Skane University Hospital and Lund University, Lund, Sweden
| | - H Gelderblom
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - P Kosmidis
- Medical Oncology Department, Hygeia Hospital, Athens, Greece
| | - A Le Cesne
- Department of Medicine, Institut Gustave Roussy, Villejuif Cedex, France
| | - A L Pousa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Schlemmer
- Medical Clinic III, Ludwig Maximilians University, Munich, Germany
| | - J Verweij
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
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Joensuu H, Eriksson M, Sundby Hall K, Hartmann JT, Pink D, Schütte J, Ramadori G, Hohenberger P, Duyster J, Al-Batran SE, Schlemmer M, Bauer S, Wardelmann E, Sarlomo-Rikala M, Nilsson B, Sihto H, Monge OR, Bono P, Kallio R, Vehtari A, Leinonen M, Alvegård T, Reichardt P. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA 2012; 307:1265-72. [PMID: 22453568 DOI: 10.1001/jama.2012.347] [Citation(s) in RCA: 632] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Adjuvant imatinib administered for 12 months after surgery has improved recurrence-free survival (RFS) of patients with operable gastrointestinal stromal tumor (GIST) compared with placebo. OBJECTIVE To investigate the role of imatinib administration duration as adjuvant treatment of patients who have a high estimated risk for GIST recurrence after surgery. DESIGN, SETTING, AND PATIENTS Patients with KIT-positive GIST removed at surgery were entered between February 2004 and September 2008 to this randomized, open-label phase 3 study conducted in 24 hospitals in Finland, Germany, Norway, and Sweden. The risk of GIST recurrence was estimated using the modified National Institutes of Health Consensus Criteria. INTERVENTION Imatinib, 400 mg per day, orally for either 12 months or 36 months, started within 12 weeks of surgery. MAIN OUTCOME MEASURES The primary end point was RFS; the secondary end points included overall survival and treatment safety. RESULTS Two hundred patients were allocated to each group. The median follow-up time after randomization was 54 months in December 2010. Diagnosis of GIST was confirmed in 382 of 397 patients (96%) in the intention-to-treat population at a central pathology review. KIT or PDGFRA mutation was detected in 333 of 366 tumors (91%) available for testing. Patients assigned for 36 months of imatinib had longer RFS compared with those assigned for 12 months (hazard ratio [HR], 0.46; 95% CI, 0.32-0.65; P < .001; 5-year RFS, 65.6% vs 47.9%, respectively) and longer overall survival (HR, 0.45; 95% CI, 0.22-0.89; P = .02; 5-year survival, 92.0% vs 81.7%). Imatinib was generally well tolerated, but 12.6% and 25.8% of patients assigned to the 12- and 36-month groups, respectively, discontinued imatinib for a reason other than GIST recurrence. CONCLUSION Compared with 12 months of adjuvant imatinib, 36 months of imatinib improved RFS and overall survival of GIST patients with a high risk of GIST recurrence. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00116935.
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Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 180, FIN-00029 Helsinki, Finland.
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Reichardt P, Blay JY, Gelderblom H, Schlemmer M, Demetri GD, Bui-Nguyen B, McArthur GA, Yazji S, Hsu Y, Galetic I, Rutkowski P. Phase III study of nilotinib versus best supportive care with or without a TKI in patients with gastrointestinal stromal tumors resistant to or intolerant of imatinib and sunitinib. Ann Oncol 2012; 23:1680-7. [PMID: 22357255 DOI: 10.1093/annonc/mdr598] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This phase III open-label trial investigated the efficacy of nilotinib in patients with advanced gastrointestinal stromal tumors following prior imatinib and sunitinib failure. PATIENTS AND METHODS Patients were randomized 2:1 to nilotinib 400 mg b.i.d. or best supportive care (BSC; BSC without tyrosine kinase inhibitor, BSC+imatinib, or BSC+sunitinib). Primary efficacy end point was progression-free survival (PFS) based on blinded central radiology review (CRR). Patients progressing on BSC could cross over to nilotinib. RESULTS Two hundred and forty-eight patients enrolled. Median PFS was similar between arms (nilotinib 109 days, BSC 111 days; P=0.56). Local investigator-based intent-to-treat (ITT) analysis showed a significantly longer median PFS with nilotinib (119 versus 70 days; P=0.0007). A trend in longer median overall survival (OS) was noted with nilotinib (332 versus 280 days; P=0.29). Post hoc subset analyses in patients with progression and only one prior regimen each of imatinib and sunitinib revealed a significant difference in median OS of >4 months in favor of nilotinib (405 versus 280 days; P=0.02). Nilotinib was well tolerated. CONCLUSION In the ITT analysis, no significant difference in PFS was observed between treatment arms based on CRR. In the post hoc subset analyses, nilotinib provided significantly longer median OS.
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Affiliation(s)
- P Reichardt
- HELIOS Klinikum Bad Saarow, Sarkomzentrum Berlin-Brandenburg, Bad Saarow, Germany.
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Schlemmer M, Bauer S, Schütte R, Hartmann JT, Bokemeyer C, Hosius C, Reichardt P. Activity and side effects of imatinib in patients with gastrointestinal stromal tumors: data from a German multicenter trial. Eur J Med Res 2011; 16:206-12. [PMID: 21719393 PMCID: PMC3352192 DOI: 10.1186/2047-783x-16-5-206] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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: 12/31/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) are mesenchymal tumors that in the past were classified as leiomyosarcomas or leiomyomas not responding to standard sarcoma chemotherapy. In several phase I and II trials the efficacy and safety of imatinib was shown before the largest trial ever performed in a single sarcoma entity revealed response rates (CR/PR) of 52 %. This multicenter phase II trial presented here was performed to open access to imatinib for patients with unresectable or metastastatic GIST when the EORTC 62005 trial had been closed before imatinib was approved in Germany. It was designed to follow the best clinical response and to assess the efficacy, safety and tolerability of imatinib 400mg/d in patients with unresectable or metastatic gastrointestinal stromal tumor. - 95 patients were treated in this trial with Imatinib 400mg/d. Four patients (4.6 %) attained a complete response and 26 patients (29.9%) a partial response to imatinib treatment. Forty-one patients (47.1 %) revealed a stable disease and 16 patients (18.4 %) had a progressive disease. - Of the progressive patients 22% showed a partial response and 67 % showed stable disease after escalating the dose to 800 mg. According to SWOG tumor response classification, 66 patients (70%) were free of progression within the first year of treatment. - Seventy-one patients (74.7%) experienced adverse events or severe adverse events with a suspected relationship to the study drug. Among these, the most common were nausea (n=27 patients, 28.4 %), eyelid edema and peripheral edema in 23 patients each (24.2 %), diarrhea in 20 patients (21.1 %), muscle cramps in 15 patients (15.8 %) and fatigue in 13 patients (13.7 %). - Imatinib 400 mg/d led to disease stabilisation in 81,6% of patients with unresectable or metastatic malignant GIST. Thirty-four percent of patients attained a tumor remission (partial or complete response). The safety profile of imatinib based on adverse event assessment is favorable. Imatinib is generally well tolerated in patients with gastrointestinal stromal tumors.
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Joensuu H, Eriksson M, Hatrmann J, Sundby Hall K, Schutte J, Reichardt A, Schlemmer M, Wardelmann E, Ramadori G, Al-Batran S, Nilsson BE, Monge O, Kallio R, Sarlomo-Rikala M, Bono P, Leinonen M, Hohenberger P, Alvegard T, Reichardt P. Twelve versus 36 months of adjuvant imatinib (IM) as treatment of operable GIST with a high risk of recurrence: Final results of a randomized trial (SSGXVIII/AIO). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
LBA1 Background: Adjuvant IM administered for 12 months (mos) after surgery improves recurrence-free survival (RFS) of patients (pts) diagnosed with operable GIST. We compared 12 vs 36 mos of adjuvant IM as treatment of pts with a high risk for GIST recurrence after surgery. Methods: Pts with histologically diagnosed KIT-positive GIST were entered to this prospective, open-label, multicenter, randomized Phase III study (identifier NCT00116935 ). The risk of recurrence was estimated according to the modified Consensus Criteria. The primary objective was RFS. The secondary objectives included survival (OS) and treatment safety. The key exclusion criteria were ECOG PS >2, metastatic or inoperable GIST, and >12 wks from surgery to the study entry. IM was administered orally 400 mg/d. The sample size (n =200 in each group to obtain ≥110 events) was estimated by simulating log-rank tests assuming an overall hazard ratio (HR) of 0.44, a 20% drop-out rate, 2-sided type-I error rate of .05 and power 0.80. Analysis was based on the intention-to-treat population (ITT). Tumor histology was centrally reviewed. Results: 400 pts were entered to the study from Feb 2004 to Sep 2008. Three pts were excluded due to lack of consent from the ITT, which includes 15 pts who did not have GIST at a central review. The median FU time was 54 mos. RFS was longer in the 36-mo group compared to the 12-mo group (HR 0.46, 95% CI 0.32-0.65; p <.0001; 5-y RFS 65.6% vs 47.9%, respectively). Pts assigned to 36-mo of IM had longer OS (HR 0.45, 0.22-0.89; p =.019; 5-y OS 92.0% vs 81.7%). IM was generally well tolerated. The proportion of pts who discontinued IM during the assigned treatment period for reasons other than GIST recurrence was 25.8% in the 36-mo group and 12.6% in the 12-mo group. Exploratory efficacy subgroup analyses including KIT and PDGFRA mutation analysis data from 366 tumors will be presented. Conclusions: IM administered for 36 mos improves RFS and OS compared to 12 mos of administration as adjuvant treatment of GIST pts who have a high estimated risk of recurrence after surgery.
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Affiliation(s)
- H. Joensuu
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - M. Eriksson
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - J. Hatrmann
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - K. Sundby Hall
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - J. Schutte
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - A. Reichardt
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - M. Schlemmer
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - E. Wardelmann
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - G. Ramadori
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - S. Al-Batran
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - B. E. Nilsson
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - O. Monge
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - R. Kallio
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - M. Sarlomo-Rikala
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - P. Bono
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - M. Leinonen
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - P. Hohenberger
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - T. Alvegard
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
| | - P. Reichardt
- Helsinki University Central Hospital, Helsinki, Finland; Lund University Hospital, Lund, Sweden; Universitatsklinikum Schleswig-Holstein, Kiel, Germany; Oslo University Hospital, Oslo, Norway; Marien Hospital Duesseldorf, Duesseldorf, Germany; HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany; University Hospitals-Grosshadern, Ludwig Maximilians University, Munich, Germany; University of Bonn, Bonn, Germany; University of Goettingen, Goettingen, Germany; Krankenhaus Nordwest
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Joensuu H, Eriksson M, Hatrmann J, Sundby Hall K, Schutte J, Reichardt A, Schlemmer M, Wardelmann E, Ramadori G, Al-Batran S, Nilsson BE, Monge O, Kallio R, Sarlomo-Rikala M, Bono P, Leinonen M, Hohenberger P, Alvegard T, Reichardt P. Twelve versus 36 months of adjuvant imatinib (IM) as treatment of operable GIST with a high risk of recurrence: Final results of a randomized trial (SSGXVIII/AIO). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.lba1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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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Schramm N, Schlemmer M, Englhart E, Hittinger M, Becker C, Reiser M, Berger F. Dual Energy CT for Monitoring Targeted Therapies in Patients with Advanced Gastrointestinal Stromal Tumor: Initial Results. Curr Pharm Biotechnol 2011; 12:547-57. [DOI: 10.2174/138920111795164066] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 07/20/2010] [Indexed: 11/22/2022]
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Geiger S, Horster S, Haug AR, Hausmann A, Schlemmer M, Stemmler HJ. Suspected osseous recurrence visualized on a 68Ga- DOTATATE PET/CT scan during the follow-up of a patient with a resected pulmonary carcinoid tumour. Nuklearmedizin 2011. [DOI: 10.1055/s-0037-1621660] [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: 10/28/2022]
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Geiger S, Horster S, Haug AR, Hausmann A, Schlemmer M, Stemmler HJ. Suspected osseous recurrence visualized on a (68)Ga-DOTATATE PET/CT scan during the follow-up of a patient with a resected pulmonary carcinoid tumour. Nuklearmedizin 2011; 50:N57-N59. [PMID: 21953072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 05/15/2011] [Indexed: 05/31/2023]
Affiliation(s)
- S Geiger
- Department of Hematology/Oncology, Ludwig Maximilians University of Munich - Campus Grosshadern, Germany
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Schlemmer M, Schinwald N, Bruns C, Berger F, Reichardt P. Response to nilotinib as a first-line treatment for metastatic gastrointestinal stromal tumors. J Gastrointest Cancer 2010; 43:385-7. [PMID: 20922581 DOI: 10.1007/s12029-010-9208-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Effective and safe treatment options are needed for patients with advanced gastrointestinal stromal tumors (GIST) who are initially unresponsive to the tyrosine kinase inhibitor (TKI) imatinib, or develop acquired secondary imatinib resistance. CASE REPORT We report a 39-year-old woman with primary rectal GIST who underwent abdominoperineal resection in December 2004, achieving R0 margins. In August 2009, the patient was referred to our clinic, and we detected metastatic GIST of the liver, as well as peritoneal and gluteal lesions. The patient was treated with imatinib 400 mg/day for 3 weeks and subsequently switched to nilotinib (400 mg bid) after enrolling in a clinical trial. After 8 weeks of nilotinib treatment, a response was observed in the liver metastasis, and metabolic activity was no longer detected. Also, the gluteal and peritoneal lesions were no longer detected. After 16 weeks of nilotinib treatment, a cystic mass was identified in the liver metastasis. Tumor rupture was considered a strong possibility, prompting resection of the liver metastasis. Greater than 80% of the resected tumor mass was necrotic, consistent with the lack of metabolism observed 8 weeks prior. The patient resumed nilotinib treatment (400 mg bid) shortly after surgery and continues treatment while remaining disease-free for more than 9 months with normal liver function. CONCLUSION This is the first report demonstrating the feasibility of nilotinib (400 mg bid) for the first-line treatment of metastatic GIST. Furthermore, these results underscore that responses to TKIs may be underestimated by Response Evaluation Criteria in Solid Tumors.
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Affiliation(s)
- Marcus Schlemmer
- Department of Internal Medicine III-Hematology/Oncology, University Hospital Munich-Campus Grosshadern, Munich, Germany.
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Vyhnalek B, Heilmeier B, Beyer A, Lorenzl S, Schlemmer M, Borasio GD. Spezialisierte Ambulante Palliativversorgung im städtischen Ballungsraum – Erfahrungen der ersten 6 Monate. Palliativmedizin 2010. [DOI: 10.1055/s-0030-1265443] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schramm N, Schlemmer M, Rist C, Issels R, Reiser MF, Berger F. [Combined functional and morphological imaging of sarcomas: significance for diagnostics and therapy monitoring]. Radiologe 2010; 50:339-48. [PMID: 20221579 DOI: 10.1007/s00117-009-1973-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
(18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET) and especially hybrid FDG-PET/CT is becoming more and more accepted for the clinical management of adult and pediatric patients with sarcomas. By integrating the CT component the specificity in particular but also the sensitivity of the modality are improved further. With PET/CT a complete staging including the detection of lung metastases is feasible in a single examination. For patients with primary bone and soft tissue sarcomas FDG-PET/CT is utilized for diagnosis, staging and restaging, metabolic tumor grading, guidance of biopsies, detection of tumor recurrence and therapy monitoring. Furthermore, it has been demonstrated that FDG uptake of the tumor prior to treatment and changes of FDG uptake after therapy significantly correlate with histopathologic response and survival of patients. Therefore, PET and PET/CT have a prognostic value. In the future new perspectives of hybrid PET/CT imaging will arise by introducing novel radiotracers and combined functional imaging of tumor metabolism and perfusion. High resolution MRI is essential for local evaluation of the primary tumor and preoperative planning with assessment of possible infiltration of vascular or neural structures. Contrast-enhanced MRI remains a key tool in the diagnosis of recurrent disease, especially in tumors which are not hypermetabolic. Dynamic contrast-enhanced MR sequences can significantly contribute to therapy monitoring. More research is necessary to prospectively compare dynamic contrast-enhanced MRI and FDG-PET/CT for evaluation of local and recurrent diseases.
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Affiliation(s)
- N Schramm
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland
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Reichardt P, Blay J, Gelderblom H, Schlemmer M, Demetri GD, Bin Bui N, McArthur GA, Yazji S, Hsu Y, Rutkowski P. Phase III trial of nilotinib in patients with advanced gastrointestinal stromal tumor (GIST): First results from ENEST g3. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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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Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2010; 20 Suppl 4:64-7. [PMID: 19454466 DOI: 10.1093/annonc/mdp131] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- P G Casali
- Department of Cancer Medicine, Istituto Nazionale dei Tumori, Milan, Italy
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Schlemmer M, Wendtner CM, Lindner L, Abdel-Rahman S, Hiddemann W, Issels RD. Thermochemotherapy in patients with extremity high-risk soft tissue sarcomas (HR-STS). Int J Hyperthermia 2010; 26:127-35. [DOI: 10.3109/02656730903335995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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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Jarius S, Arnold S, Linke R, Noachtar S, Schlemmer M, Issels R, Voltz R. Long term survival in anti-Hu associated adult neuroblastoma. J Neurol Sci 2009; 284:205-8. [DOI: 10.1016/j.jns.2009.04.007] [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] [Received: 10/06/2008] [Revised: 03/24/2009] [Accepted: 04/02/2009] [Indexed: 12/31/2022]
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Abstract
MR-thermometry methods have been developed for the guidance and control of thermal therapies such as thermal ablation or regional hyperthermia. However, they are limited to the measurement of temperature changes and, thus, cannot be used to assess absolute temperature values. Paramagnetic thermosensitive liposomes are innovative contrast agents offering the potential to overcome these limitations. They are composed of a gadolinium- or manganese-based compound enclosed by a phospholipid membrane with a distinct gel-to-liquid crystalline phase transition temperature (Tm). At this temperature, the phospholipid membrane changes from a gel-phase to a liquid-crystalline phase which is associated with an increased transmembrane permeability towards solutes and water. Under these conditions, both types of paramagnetic thermosensitive liposomes demonstrate a significant increase in longitudinal (T1) relaxivity, attributed to the release of paramagnetic material from the liposome and/or to the increased water exchange rate between the liposome interior and exterior. Paramagnetic thermosensitive liposomes have already been successfully studied in animal models and have demonstrated a clear correlation between tissue temperature changes and signal intensity changes in MRI. Nevertheless, before entering clinical trials they have to be studied in more detail with regard to dose, pharmacokinetics and toxicity.
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Affiliation(s)
- L H Lindner
- Department of Medicine III, University Hospital Grosshadern, CCG Hyperthermia, GSF-National Research Center for Environment and Health, Ludwig-Maximilians-University, Munich, Germany.
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Fiegl M, Schlemmer M, Wendtner CM, Abdel-Rahman S, Fahn W, Issels RD. Ifosfamide, carboplatin and etoposide (ICE) as second-line regimen alone and in combination with regional hyperthermia is active in chemo-pre-treated advanced soft tissue sarcoma of adults. Int J Hyperthermia 2009; 20:661-70. [PMID: 15370821 DOI: 10.1080/02656730410001714959] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of the combination of ICE (ifosfamide 1.5 g m(-2), carboplatin 100 mg m(-2) and etoposide 150 mg m(-2), days 1-4, q 28 days, G-CSF 5 microg kg(-1) starting from day 6) alone and in combination with regional hyperthermia (RHT) in soft tissue sarcoma (STS) refractory to previous standard doxorubicin-ifosfamide-based chemotherapy. PATIENTS AND METHODS Twenty patients with advanced STS of different histological sub-types were treated with the ICE regimen with 13 patients receiving additional RHT. A median of four courses of ICE were administered with RHT on days 1 and 3 (60 min, T(max) 42 degrees C). RESULTS The objective response rate was 20%, with four partial responses (all treated with hyperthermia). In addition, two patients showed mixed responses and five patients stable disease. After a median follow-up time of 15 months, median time to progression was 6 months. Progression free rate estimates were 60% and 45% at 3 and 6 months, respectively. Median overall survival for all patients was 14.6 months. CONCLUSION These results suggest that ICE alone or combined with RHT shows activity as second-line therapy in doxorubicin-ifosfamide-refractory STS.
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Affiliation(s)
- M Fiegl
- Department of Internal Medicine III, University Hospital Grosshadern, Ludwig-Maximilians University, Marchioninistrasse 15, 81377 Munich, Germany
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Janeway KA, Albritton KH, Van Den Abbeele AD, D'Amato GZ, Pedrazzoli P, Siena S, Picus J, Butrynski JE, Schlemmer M, Heinrich MC, Demetri GD. Sunitinib treatment in pediatric patients with advanced GIST following failure of imatinib. Pediatr Blood Cancer 2009; 52:767-71. [PMID: 19326424 DOI: 10.1002/pbc.21909] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sunitinib inhibits KIT and other members of the split-kinase-domain family of receptor tyrosine kinases. Sunitinib prolongs survival in adult patients with imatinib-resistant gastrointestinal stromal tumor (GIST). We report the experience with sunitinib in pediatric patients with advanced GIST following failure of imatinib. PROCEDURE Sunitinib therapy was provided through a treatment-use protocol. Patients were 10-17 years old at enrollment. All patients had GIST resistant to imatinib therapy. Sunitinib was administered daily for 4 weeks in 6-week treatment cycles. KIT and platelet-derived growth factor receptor alpha (PDGFRA) genotyping of tumor tissue were performed. RESULTS One patient achieved a partial response, five patients had stable disease and one patient had progressive disease on sunitinib. The duration of disease stabilization was between 7 and 21+ months, with a mean of 15 months. Time to tumor progression was longer on sunitinib than on prior imatinib treatment for five of six patients. Two patients experienced grade 3 adverse events. All other adverse events were grade 1-2. None of the five patients tested had mutations in KIT or PDGFRA. CONCLUSION Sunitinib treatment was associated with substantial initial antitumor activity and acceptable tolerability in this group of pediatric patients with imatinib-resistant GIST.
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Affiliation(s)
- Katherine A Janeway
- Pediatric Oncology, Dana-Farber Cancer Institute and Department of Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA
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Schramm N, Schlemmer M, Englhart E, Nikolaou K, Becker CR, Reiser MF, Berger F. Dual-Energy CT zum Monitoring spezifischer molekularer Therapien bei Patienten mit fortgeschrittenem gastrointestinalem Stromatumor. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221275] [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: 10/20/2022]
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Schlemmer M, Kuehl M, Schalhorn A, Rauch J, Jauch KW, Hentrich M. Tissue Levels of Reduced Folates in Patients with Colorectal Carcinoma After Infusion of Folinic Acid at Various Dose Levels. Clin Cancer Res 2008; 14:7930-4. [DOI: 10.1158/1078-0432.ccr-08-0258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Berger F, Hittinger M, Schlemmer M, Saam T, Nikolaou K, Becker C, Reiser M. Initial experiences utilizing perfusion CT in the follow-up of patients with gastrointestinal stromal tumors under imatinib mesylate treatment. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-0028-1085909] [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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38
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de Wit M, Brenner W, Hartmann M, Kotzerke J, Hellwig D, Lehmann J, Franzius C, Kliesch S, Schlemmer M, Tatsch K, Heicappell R, Geworski L, Amthauer H, Dohmen B, Schirrmeister H, Cremerius U, Bokemeyer C, Bares R. [18F]-FDG–PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial. Ann Oncol 2008; 19:1619-23. [DOI: 10.1093/annonc/mdn170] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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39
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Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY. Gastrointestinal stromal tumors: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2008; 19 Suppl 2:ii35-8. [PMID: 18456761 DOI: 10.1093/annonc/mdn080] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- P G Casali
- Department of Cancer Medicine, Istituto Nazionale dei Tumori, Milan, Italy
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Berger F, Sourbron SP, Schlemmer M, Schinwald N, Saam T, Nikolaou K, Becker C, Reiser M. Perfusions-CT zum Monitoring spezifischer molekularer Pharmakotherapie bei Patienten mit metastasiertem Gastrointestinalen Stromatumor. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073853] [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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Frassl W, Kowoll R, Katz N, Speth M, Stangl A, Brechtel L, Joscht B, Boldt LH, Meier-Buttermilch R, Schlemmer M, Roecker L, Gunga HC. Cardiac markers (BNP, NT-pro-BNP, Troponin I, Troponin T, in female amateur runners before and up until three days after a marathon. Clin Lab 2008; 54:81-87. [PMID: 18630737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Transient cardiac ventricular dysfunction or sudden cardiac deaths have been reported for male athletes participating in marathon racing. Less is known about the myocardial response in females. We examined natriuretic peptides and cardiac troponins in female athletes after a marathon. METHODS At the 31st real,- Berlin Marathon plasma levels of NT-pro-BNP, BNP, cTnI and cTnT were measured in 15 women (age 35+/-6 years; finishing times between 3:22 h and 5:21 h) at four different time points (before, immediately after, day one and day three). RESULTS An increase in [NT-pro-BNP] was observed immediately after the marathon (median [NT-pro-BNP] before: 39.6 pg ml(-1), after: 138.6 pg ml(-1), p=0.003) with a further increase on day one. [BNP] did not increase immediately after the marathon but increased on day one (median [BNP] before: 15 pg ml(-1), day one: 27.35 pg ml(-1), p=0.006). On day three, [NT-pro-BNP] and [BNP] returned to initial values. [cTnI] was under the detection limit prior to the marathon in all runners. [cTnT] was under the detection limit before the marathon except in one runner who presented a concentration of 0.03 ng ml(-1). Cardiac troponins (median [cTnl] after: 0.098 ng ml(-1), p=0.028; median [cTnT] after: 0.032 ng ml(-1), p=0.012) increased immediately after the marathon and returned to initial values on day one [cTnT] and three [cTnI]. DISCUSSION Parameters representing cardiac stress increased in females after a marathon. Different kinetics of natriuretic peptides BNP and NT-pro-BNP post-marathon could be due to their different half-lives and dependence on renal function. The increase of cTnI and cTnT may result from minor myocardial lesions.
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Affiliation(s)
- W Frassl
- Center for Space Medicine Berlin (ZWMB), Department of Physiology, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Rüttinger D, van den Engel NK, Winter H, Schlemmer M, Pohla H, Grützner S, Wagner B, Schendel DJ, Fox BA, Jauch KW, Hatz RA. Adjuvant therapeutic vaccination in patients with non-small cell lung cancer made lymphopenic and reconstituted with autologous PBMC: first clinical experience and evidence of an immune response. J Transl Med 2007; 5:43. [PMID: 17868452 PMCID: PMC2020458 DOI: 10.1186/1479-5876-5-43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 09/14/2007] [Indexed: 12/21/2022] Open
Abstract
Background Given the considerable toxicity and modest benefit of adjuvant chemotherapy for non-small cell lung cancer (NSCLC), there is clearly a need for new treatment modalities in the adjuvant setting. Active specific immunotherapy may represent such an option. However, clinical responses have been rare so far. Manipulating the host by inducing lymphopenia before vaccination resulted in a magnification of the immune response in the preclinical setting. To evaluate feasibility and safety of an irradiated, autologous tumor cell vaccine given following induction of lymphopenia by chemotherapy and reinfusion of autologous peripheral blood mononuclear cells (PBMC), we are currently conducting a pilot-phase I clinical trial in patients with NSCLC following surgical resection. This paper reports on the first clinical experience and evidence of an immune response in patients suffering from NSCLC. Methods NSCLC patients stages I-IIIA are recruited. Vaccines are generated from their resected lung specimens. Patients undergo leukapheresis to harvest their PBMC prior to or following the surgical procedure. Furthermore, patients receive preparative chemotherapy (cyclophosphamide 350 mg/m2 and fludarabine 20 mg/m2 on 3 consecutive days) for induction of lymphopenia followed by reconstitution with their autologous PBMC. Vaccines are administered intradermally on day 1 following reconstitution and every two weeks for a total of up to five vaccinations. Granulocyte-macrophage-colony-stimulating-factor (GM-CSF) is given continuously (at a rate of 50 μg/24 h) at the site of vaccination via minipump for six consecutive days after each vaccination. Results To date, vaccines were successfully manufactured for 4 of 4 patients. The most common toxicities were local injection-site reactions and mild constitutional symptoms. Immune responses to chemotherapy, reconstitution and vaccination are measured by vaccine site and delayed type hypersensitivity (DTH) skin reactions. One patient developed positive DTH skin tests so far. Immunohistochemical assessment of punch biopsies taken at the local vaccine site reaction revealed a dense lymphocyte infiltrate. Further immunohistochemical differentiation showed that CD1a+ cells had been attracted to the vaccine site as well as predominantly CD4+ lymphocytes. The 3-day combination chemotherapy consisting of cyclophosphamide and fludarabine induced a profound lymphopenia in all patients. Sequential FACS analysis revealed that different T cell subsets (CD4, CD8, CD4CD25) as well as granulocytes, B cells and NK cells were significantly reduced. Here, we report on clinical safety and feasibility of this vaccination approach during lymphoid recovery and demonstrate a patient example. Conclusion Thus far, all vaccines were well tolerated. The overall trial design seems safe and feasible. Vaccine site reactions associated with infusion of GM-CSF via mini-pump are consistent with the postulated mechanism of action. More detailed immune-monitoring is required to evaluate a potential systemic immune response. Further studies to exploit homeostasis-driven T cell proliferation for the induction of a specific anti-tumor immune response in this clinical setting are warranted.
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MESH Headings
- Adjuvants, Pharmaceutic/administration & dosage
- Adjuvants, Pharmaceutic/adverse effects
- Adjuvants, Pharmaceutic/therapeutic use
- Aged
- Biopsy
- Blood Cell Count
- Cancer Vaccines/administration & dosage
- Cancer Vaccines/adverse effects
- Cancer Vaccines/immunology
- Cancer Vaccines/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/pathology
- Female
- Granulocyte-Macrophage Colony-Stimulating Factor/administration & dosage
- Granulocyte-Macrophage Colony-Stimulating Factor/immunology
- Humans
- Immunity/immunology
- Immunohistochemistry
- Injections, Intradermal
- Leukocytes, Mononuclear/immunology
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/immunology
- Lung Neoplasms/pathology
- Lymphopenia/complications
- Lymphopenia/immunology
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Radiography, Thoracic
- Vaccination
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Affiliation(s)
- Dominik Rüttinger
- Department of Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany
| | - Natasja K van den Engel
- Department of Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany
| | - Hauke Winter
- Department of Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany
| | - Marcus Schlemmer
- Department of Internal Medicine III, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Heike Pohla
- Laboratory of Tumor Immunology, Ludwig-Maximilians-University, Munich, Germany
- Institute of Molecular Immunology, and Clinical Cooperation Group "Immune Monitoring", GSF National Research Center for Environment and Health, Munich, Germany
| | - Stefanie Grützner
- Department of Transfusion Medicine, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Beate Wagner
- Department of Transfusion Medicine, Grosshadern Medical Center, Ludwig-Maximilians-University, Munich, Germany
| | - Dolores J Schendel
- Institute of Molecular Immunology, and Clinical Cooperation Group "Immune Monitoring", GSF National Research Center for Environment and Health, Munich, Germany
| | - Bernard A Fox
- Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute, Providence Portland Medical Center, Portland, Oregon, USA
| | - K-W Jauch
- Department of Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany
| | - Rudolf A Hatz
- Department of Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany
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Abstract
10033 Background: Angiosarcomas represent a heterogenous group of rare sarcomas with specific clinical behaviour and risk factors. Paclitaxel has been suggested to induce tumor control in a proportion of pts with angiosarcoma while being inactive in other soft tissue sarcomas subtypes. The objective of this retrospective study was to investigate the antitumor activity of this compound in a larger series and a multicenter setting. Patients and Methods: Data from pts with angiosarcoma treated with paclitaxel in centers of the EORTC Soft Tissue and Bone Sarcoma Group were collected using a standardized data collection form. Results: Data from 32 pts were collected from 10 centers. There were 17 males and 15 females with a median age of 60.4 years (range 24–91). Eight pts (25%) had angiosarcomas of the face and scalp, 24 pts (75%) at other primary sites. Ten (31 %) pts had a previous cancer history, 7 of whom had been irradiated for breast cancer. Ten (31 %) pts had received 1st line chemotherapy (ctx) and 3 pts 2nd line ctx prior to treatment with paclitaxel. All 13 (40%) pretreated pts had doxorubicin, 5 pts in combination with ifosfamide as 1st line and 3 pts ifosfamide as 2nd line ctx. 21 (66 %) pts received paclitaxel 175 mg/m2 every 3 weeks, and 11 (34 %) received 75–100 mg/m2weekly. The overall response rate (RR) was 62.5 % [including 1 CR (3%) and 19 PR (59%)]; in pts with face and scalp primary sites the RR was 75% (1CR, 5 PR), whereas pts with angiosarcoma at other sites achieved a response in 58% (14 PR). PFS was 7.6 months for all 32 pts. Conclusion: Paclitaxel was an active agent in angiosarcoma in this retrospective multicenter study, also in angiosarcoma originating at other sites than scalp and face. These results need to be confirmed in a controlled, prospective phase II study. No significant financial relationships to disclose.
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Affiliation(s)
- M. Schlemmer
- Klinikum Grosshadern, Munich, Germany; University Charité, Berlin, Germany; Erasmus Medical Center, Rotterdam, The Netherlands; Ebert Kalrs University, Tuebingen, Germany; Royal Marsden NHS, London, United Kingdom; Centre Antoine Lacassagne, Nice, France; Centre Leon Berard, Lyon, France
| | - P. Reichardt
- Klinikum Grosshadern, Munich, Germany; University Charité, Berlin, Germany; Erasmus Medical Center, Rotterdam, The Netherlands; Ebert Kalrs University, Tuebingen, Germany; Royal Marsden NHS, London, United Kingdom; Centre Antoine Lacassagne, Nice, France; Centre Leon Berard, Lyon, France
| | - J. Verweij
- Klinikum Grosshadern, Munich, Germany; University Charité, Berlin, Germany; Erasmus Medical Center, Rotterdam, The Netherlands; Ebert Kalrs University, Tuebingen, Germany; Royal Marsden NHS, London, United Kingdom; Centre Antoine Lacassagne, Nice, France; Centre Leon Berard, Lyon, France
| | - J. T. Hartmann
- Klinikum Grosshadern, Munich, Germany; University Charité, Berlin, Germany; Erasmus Medical Center, Rotterdam, The Netherlands; Ebert Kalrs University, Tuebingen, Germany; Royal Marsden NHS, London, United Kingdom; Centre Antoine Lacassagne, Nice, France; Centre Leon Berard, Lyon, France
| | - I. Judson
- Klinikum Grosshadern, Munich, Germany; University Charité, Berlin, Germany; Erasmus Medical Center, Rotterdam, The Netherlands; Ebert Kalrs University, Tuebingen, Germany; Royal Marsden NHS, London, United Kingdom; Centre Antoine Lacassagne, Nice, France; Centre Leon Berard, Lyon, France
| | - A. Thyss
- Klinikum Grosshadern, Munich, Germany; University Charité, Berlin, Germany; Erasmus Medical Center, Rotterdam, The Netherlands; Ebert Kalrs University, Tuebingen, Germany; Royal Marsden NHS, London, United Kingdom; Centre Antoine Lacassagne, Nice, France; Centre Leon Berard, Lyon, France
| | - J. Y. Blay
- Klinikum Grosshadern, Munich, Germany; University Charité, Berlin, Germany; Erasmus Medical Center, Rotterdam, The Netherlands; Ebert Kalrs University, Tuebingen, Germany; Royal Marsden NHS, London, United Kingdom; Centre Antoine Lacassagne, Nice, France; Centre Leon Berard, Lyon, France
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Tschoep K, Kohlmann A, Schlemmer M, Haferlach T, Issels RD. Gene expression profiling in sarcomas. Crit Rev Oncol Hematol 2007; 63:111-24. [PMID: 17555981 DOI: 10.1016/j.critrevonc.2007.04.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2005] [Revised: 02/28/2007] [Accepted: 04/11/2007] [Indexed: 12/30/2022] Open
Abstract
Sarcomas are a heterogeneous group of malignant mesenchymal tumors of difficult classification. There is considerable variability in both histological appearance and responsiveness to therapy. Their overall poor clinical prognosis is reflected by the fact that >65% of patients suffering retroperitoneal soft tissue sarcoma die within 5 years [Heslin MJ, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 1997;15(8):2832-9]. A greater understanding of the biology of sarcomas is needed in order to increase the potential for identifying new therapeutic targets and strategies. Microarray analysis permits a global approach to gene expression analysis of thousands of genes at the same time and has proven to be useful for further molecular characterization of tumor tissue and cell lines. This article provides a comprehensive review of possible new biomarkers identified in gene expression studies of sarcomas. These markers give new insight into the pathogenesis of sarcomas, such as malignant fibrous histiocytoma [Lee YF, et al. Molecular classification of synovial sarcomas, leiomyosarcomas and malignant fibrous histiocytomas by gene expression profiling. Br J Cancer 2003;88(4):510-5], allow a further subclassifcation of tumors like calponin-positive and calponin-negative leiomyosarcoma, or may help to predict treatment responsiveness and prognosis in patients based on an individual gene expression pattern. In some studies candidate targets for possible new treatment strategies were identified. For instance newly identified markers such as ERBB2 [Allander SV, et al. Expression profiling of synovial sarcoma by cDNA microarrays: association of ERBB2, IGFBP2, and ELF3 with epithelial differentiation. Am J Pathol 2002;161(5):1587-95] and EGFR [Nielsen TO, et al. Molecular characterization of soft tissue tumours: a gene expression study. Lancet 2002;359(9314):1301-7] might lead to the possible therapeutic use of Trastuzumab, Gefitinib or Cetuximab in synovial sarcoma, comparable to the use of tyrosine kinase inhibitor STI (Gleevec) that is the standard treatment today of CD117-positive gastrointestinal stromal tumors.
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Affiliation(s)
- Katharina Tschoep
- Medizinische Klinik und Poliklinik III, Ludwig-Maximilians-University, Medical Center-Grosshadern, Munich, Germany.
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Schlemmer M, Wendtner CM, Falk M, Abdel-Rahman S, Licht T, Baumert J, Straka C, Hentrich M, Salat C, Hiddemann W, Issels RD. Efficacy of Consolidation High-Dose Chemotherapy with Ifosfamide, Carboplatin and Etoposide (HD-ICE) Followed by Autologous Peripheral Blood Stem Cell Rescue in Chemosensitive Patients with Metastatic Soft Tissue Sarcomas. Oncology 2007; 71:32-9. [PMID: 17344669 DOI: 10.1159/000100447] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 12/09/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prognosis of patients with metastatic soft tissue sarcomas (MSTS) is poor even after response to doxorubicin-based chemotherapy. We report phase II data of high-dose chemotherapy and peripheral blood stem cell (PBSC) rescue in patients with MSTS responding to AI-G chemotherapy. PATIENTS AND METHODS From 1997 to 2002, 55 patients with MSTS were prospectively treated with 4 cycles of AI-G (doxorubicin 75 mg/m(2), ifosfamide 6 g/m(2) with G-CSF support). Responders received 2 further cycles of AI-G with collection of PBSCs. High-dose chemotherapy consisted of ifosfamide 12 g/m(2), carboplatin 1.2 g/m(2) and etoposide 1.2 g/m(2) (HD-ICE) followed by reinfusion of PBSCs. RESULTS Twenty-one of 55 patients (38%) were assessed as responders (3 complete response, 18 partial response). All but 2 patients refusing treatment received high-dose chemotherapy with PBSC rescue leading to grade IV hematologic toxicity without severe infections in all patients. No toxic death occurred. After a median follow-up time of 30 months, the median progression-free time was 12 months and survival time was 22 months for the entire group. By intent-to-treat analysis the probability of 5-year progression-free survival was significantly higher for patients allocated to HD-ICE compared to patients receiving second-line chemotherapy after failure of AI-G (14 vs. 3%; p = 0.003). The estimated 5-year overall survival between the 2 groups was different (27% vs. not reached) but did not reach significance (p = 0.08). CONCLUSION HD-ICE is feasible and promising in patients with chemosensitive MSTS. A randomized phase III trial is warranted to further define the role of HD-ICE as consolidation treatment in these patients.
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Affiliation(s)
- Marcus Schlemmer
- Department of Internal Medicine III, Klinikum Grosshadern Medical Center, Munich, Germany.
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Überfuhr P, Schlemmer M, Kaczmarek I, Schönberg G, Weiss M, Issels R, Reichart B. Treating cardiac sarcoma by heart transplantation – a multidisciplinary approach. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967694] [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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48
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Valenti G, Fraszl W, Addabbo F, Tamma G, Procino G, Satta E, Cirillo M, De Santo NG, Drummer C, Bellini L, Kowoll R, Schlemmer M, Vogler S, Kirsch KA, Svelto M, Gunga HC. Water immersion is associated with an increase in aquaporin-2 excretion in healthy volunteers. Biochimica et Biophysica Acta (BBA) - Biomembranes 2006; 1758:1111-6. [PMID: 16764820 DOI: 10.1016/j.bbamem.2006.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 02/23/2006] [Accepted: 03/24/2006] [Indexed: 11/22/2022]
Abstract
Here, we report the alterations in renal water handling in healthy volunteers during a 6 h thermoneutral water immersion at 34 to 36 degrees C. We found that water immersion is associated with a reversible increase in total urinary AQP2 excretion.
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Affiliation(s)
- G Valenti
- Department of General and Environmental Physiology, University of Bari, Italy.
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Abstract
For high-risk soft tissue sarcomas (HR-STS) of adults, new treatment strategies are needed to improve outcome with regard to local control and overall survival. Systemic chemotherapy has been integrated either after (adjuvant) or before (neoadjuvant) optimal local treatment by surgery and radiotherapy in HR-STS. This short overview summarizes the results of the combination with regional hyperthermia as a new treatment strategy to open a new therapeutic window.
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Affiliation(s)
- Rolf D Issels
- University Hospital Medical Center Grosshadern Medical Clinic III, GSF-National Research Center for the Environment and Health, 81377 Munich, Germany.
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Debiec-Rychter M, Sciot R, Le Cesne A, Schlemmer M, Hohenberger P, van Oosterom AT, Blay JY, Leyvraz S, Stul M, Casali PG, Zalcberg J, Verweij J, Van Glabbeke M, Hagemeijer A, Judson I. KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours. Eur J Cancer 2006; 42:1093-103. [PMID: 16624552 DOI: 10.1016/j.ejca.2006.01.030] [Citation(s) in RCA: 613] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 01/25/2006] [Indexed: 12/12/2022]
Abstract
A recent randomized EORTC phase III trial, comparing two doses of imatinib in patients with advanced gastrointestinal stromal tumours (GISTs), reported dose dependency for progression-free survival. The current analysis of that study aimed to assess if tumour mutational status correlates with clinical response to imatinib. Pre-treatment samples of GISTs from 377 patients enrolled in phase III study were analyzed for mutations of KIT or PDGFRA by combination of D-HPLC and direct sequencing of tumour genomic DNA. Mutation types were correlated with patients' survival data. The presence of exon 9-activating mutations in KIT was the strongest adverse prognostic factor for response to imatinib, increasing the relative risk of progression by 171% (P<0.0001) and the relative risk of death by 190% (P<0.0001) when compared with KIT exon 11 mutants. Similarly, the relative risk of progression was increased by 108% (P<0.0001) and the relative risk of death by 76% (P=0.028) in patients without detectable KIT or PDGFRA mutations. In patients whose tumours expressed an exon 9 KIT oncoprotein, treatment with the high-dose regimen resulted in a significantly superior progression-free survival (P=0.0013), with a reduction of the relative risk of 61%. We conclude that tumour genotype is of major prognostic significance for progression-free survival and overall survival in patients treated with imatinib for advanced GISTs. Our findings suggest the need for differential treatment of patients with GISTs, with KIT exon 9 mutant patients benefiting the most from the 800 mg daily dose of the drug.
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Affiliation(s)
- Maria Debiec-Rychter
- Department of Human Genetics, University of Leuven and University Hospital Gasthuisberg, O&N Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
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