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de Vries EGE, Rüschoff J, Lolkema M, Tabernero J, Gianni L, Voest E, de Groot DJA, Castellano D, Erb G, Naab J, Donica M, Deurloo R, van der Heijden MS, Viale G. Phase II study (KAMELEON) of single-agent T-DM1 in patients with HER2-positive advanced urothelial bladder cancer or pancreatic cancer/cholangiocarcinoma. Cancer Med 2023. [PMID: 37119523 DOI: 10.1002/cam4.5893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/09/2023] [Accepted: 03/22/2023] [Indexed: 05/01/2023] Open
Abstract
The antibody-drug conjugate trastuzumab emtansine (T-DM1) is approved for human epidermal growth factor receptor 2 (HER2/ERBB2)-positive breast cancer. We aimed to study tumor HER2 expression and its effects on T-DM1 responses in patients with HER2-positive urothelial bladder cancer (UBC) or pancreatic cancer (PC)/cholangiocarcinoma (CC). In the phase II KAMELEON study (NCT02999672), HER2 status was centrally assessed by immunohistochemistry, with positivity defined as non-focal homogeneous or heterogeneous overexpression of HER2 in ≥30% of stained cells. We also performed exploratory biomarker analyses (e.g., gene-protein assay) on tissue samples collected from study participants and consenting patients who failed screening. Of the 284 patients successfully screened for HER2 status (UBC, n = 69; PC/CC, n = 215), 13 with UBC, four with PC, and three with CC fulfilled eligibility criteria. Due to recruitment difficulty, the sponsor terminated KAMELEON prematurely. Of the five responders in the UBC cohort (overall response rate, 38.5%), HER2 expression was heterogeneous in two and homogeneous in three. The one responder in the PC/CC cohort had PC, and the tumor displayed homogeneous expression. In the biomarker-evaluable population, composed of screen-failed and enrolled patients, 24.3% (9/37), 1.5% (1/66), and 8.2% (4/49) of those with UBC, PC, or CC, respectively, had HER2-positive tumors. In a gene-protein assay combining in situ hybridization with immunohistochemistry, greater HER2 homogeneity was associated with increased ERBB2 amplification ratio. In conclusion, KAMELEON showed that some patients with HER2-positive UBC or PC can respond to T-DM1 and provided insight into the prevalence of HER2 positivity and expression patterns in three non-breast tumor types.
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Affiliation(s)
- Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Martijn Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Josep Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
| | | | - Emile Voest
- Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - Derk Jan A de Groot
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, i + 12 Research Institute, Madrid, Spain
| | - Gilles Erb
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Julia Naab
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | | | - Giuseppe Viale
- IEO, European Institute of Oncology IRCCS, Milan, Italy
- University of Milan, Milan, Italy
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Montemurro F, Delaloge S, Barrios C, Wuerstlein R, Anton A, Brain E, Hatschek T, Kelly C, Peña-Murillo C, Yilmaz M, Donica M, Ellis P. Trastuzumab emtansine (T-DM1) in patients with HER2-positive metastatic breast cancer and brain metastases: exploratory final analysis of cohort 1 from KAMILLA, a single-arm phase IIIb clinical trial☆. Ann Oncol 2020; 31:1350-1358. [DOI: 10.1016/j.annonc.2020.06.020] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/04/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022] Open
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Redondo A, Colombo N, McCormack M, Dreosti L, Nogueira-Rodrigues A, Scambia G, Lorusso D, Joly F, Schenker M, Ruff P, Estevez-Diz M, Irahara N, Donica M, Gonzalez-Martín A. Primary results from CECILIA, a global single-arm phase II study evaluating bevacizumab, carboplatin and paclitaxel for advanced cervical cancer. Gynecol Oncol 2020; 159:142-149. [PMID: 32763109 DOI: 10.1016/j.ygyno.2020.07.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Adding bevacizumab to cisplatin-paclitaxel for advanced cervical cancer significantly improves overall and progression-free survival. We evaluated bevacizumab with a widely used carboplatin-paclitaxel backbone. METHODS Patients with metastatic/recurrent/persistent cervical cancer not amenable to curative surgery and/or radiotherapy received 3-weekly bevacizumab 15 mg/kg, paclitaxel 175 mg/m2, and carboplatin AUC 5 until progression or unacceptable toxicity. Maintenance bevacizumab was allowed. Patients with ongoing bladder/rectal involvement, prior cobalt radiotherapy, a history of fistula/gastrointestinal perforation, or recent bowel resection/chemoradiation were excluded. The primary objective was to determine incidences of gastrointestinal perforation/fistula, gastrointestinal-vaginal fistula, and genitourinary fistula. RESULTS Among 150 treated patients, disease at study entry was persistent in 21%, recurrent in 56%, and newly diagnosed metastatic in 23%. After 27.8 months' median follow-up, median bevacizumab duration was 6.7 months; 57% received maintenance bevacizumab. Seventeen patients (11.3%; 95% CI: 6.7-17.5%) experienced ≥1 perforation/fistula event: gastrointestinal perforation/fistula in 4.7% (1.9-9.4%), gastrointestinal-vaginal fistula in 4.0% (1.5-8.5%), and genitourinary fistula in 4.7% (1.9-9.4%). Of these, 16 were previously irradiated, several with ongoing radiation effects. The most common grade 3/4 adverse events were neutropenia (25%), anemia (19%), and hypertension (14%). Five patients (3%) had fatal adverse events. Objective response rate was 61% (95% CI: 52-69%), median progression-free survival was 10.9 (10.1-13.7) months, and median overall survival was 25.0 (20.9-30.4) months. CONCLUSIONS Bevacizumab can be combined with carboplatin-paclitaxel in the CECILIA study population. The fistula/gastrointestinal perforation incidence is in line with GOG-0240; efficacy results are encouraging. TRIAL REGISTRATION NUMBER NCT02467907 (ClinicalTrials.gov).
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Affiliation(s)
| | - Nicoletta Colombo
- European Institute of Oncology, IRCCS, University of Milan-Bicocca, Milan, Italy
| | - Mary McCormack
- Department of Oncology, University College London Hospitals, London, UK
| | - Lydia Dreosti
- Department of Medical Oncology, University of Pretoria, Pretoria, South Africa
| | - Angelica Nogueira-Rodrigues
- Medical Oncology Department, Federal University of Minas Gerais Brazil and Brazilian Group of Gynecologic Oncology, Belo Horizonte, Brazil
| | | | - Domenica Lorusso
- Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy; Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | | | - Paul Ruff
- Division of Medical Oncology, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Maria Estevez-Diz
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Natsumi Irahara
- Product Development Medical Affairs, F Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Margarita Donica
- Pharma Development Biostatistics Oncology, F Hoffmann-La Roche Ltd, Basel, Switzerland
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Redondo A, Colombo N, Dreosti L, McCormack M, Rodrigues AN, Scambia G, Roszak A, Donica M, Ulker B, Martín AG. Primary results from CECILIA, a global single-arm phase II study evaluating bevacizumab (BEV), carboplatin (C) and paclitaxel (P) for advanced cervical cancer (aCC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.061] [Citation(s) in RCA: 3] [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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Korach J, Colombo N, Mendiola C, Selle F, Dolado I, Donica M, Oza AM. Outcome according to residual disease (surgeon's report vs pre-chemotherapy imaging) in patients with bevacizumab-treated ovarian cancer: Analysis of the ROSiA study. J Surg Oncol 2019; 120:786-793. [PMID: 31368160 DOI: 10.1002/jso.25647] [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: 03/07/2019] [Accepted: 07/17/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES The single-arm ROSiA study evaluated frontline bevacizumab for advanced ovarian cancer. We explored how discordant surgically and radiologically assessed postoperative residual disease affects outcomes. METHODS After debulking surgery, 1021 patients received 4 to 8 cycles of carboplatin-paclitaxel plus bevacizumab until progression or up to 24 months. The primary endpoint was safety; progression-free survival (PFS) was a secondary endpoint. We performed post hoc exploratory PFS analyses in four subgroups: surgeon-reported no visible residuum (NVR) without target lesions; surgeon-reported NVR with target lesions; macroscopic (≤1 cm) residuum; and >1 cm residuum. RESULTS Surgical and radiological assessments were concordant in 94% of patients; 61 patients (6%; 21% of those with surgeon-reported NVR) had NVR with target lesions. Median PFS was numerically longest in patients with concordant surgically/radiologically assessed NVR (35.5 months), intermediate for surgeon-reported NVR with target lesions (31.8 months), and shortest for visible residuum (27.9 and 20.2 months for visible residuum ≤1 and >1 cm, respectively). One-year and 2-year PFS rates showed the same pattern. CONCLUSIONS These analyses suggest that prognosis is potentially worse in patients with radiologically detected target lesions despite surgeon-reported NVR compared with concordant NVR by both assessment methods. Postsurgical imaging may add valuable prognostic information.
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Affiliation(s)
- Jacob Korach
- Gynecologic Oncology Department, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Tel Aviv, Israel
| | - Nicoletta Colombo
- Division of Medical Gynecologic Oncology, IEO, European Institute of Oncology IRCCS and University of Milan-Bicocca, Milan, Italy
| | - Cesar Mendiola
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Frédéric Selle
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon and Alliance Pour la Recherche en Cancérologie, Paris, France
| | - Ignacio Dolado
- Pharma Development Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Margarita Donica
- Pharma Development Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Amit M Oza
- Department of Medical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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Montemurro F, Ellis P, Anton A, Wuerstlein R, Delaloge S, Bonneterre J, Quenel-Tueux N, Linn SC, Irahara N, Donica M, Lindegger N, Barrios CH. Safety of trastuzumab emtansine (T-DM1) in patients with HER2-positive advanced breast cancer: Primary results from the KAMILLA study cohort 1. Eur J Cancer 2019; 109:92-102. [PMID: 30708264 DOI: 10.1016/j.ejca.2018.12.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 12/05/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many patients with metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) are candidates for trastuzumab emtansine (T-DM1) treatment sometime in their disease history. KAMILLA evaluated safety of T-DM1 in patients with previously treated HER2-positive locally advanced or metastatic BC (advanced BC). METHODS KAMILLA (NCT01702571) is a single-arm, open-label, international, phase IIIb safety study of patients with HER2-positive advanced BC with progression after prior treatment with chemotherapy and a HER2-directed agent for MBC or within 6 months of completing adjuvant therapy. Patients received T-DM1 (3.6 mg/kg every 3 weeks) until unacceptable toxicity, withdrawal or disease progression. RESULTS Among 2002 treated patients, median age was 55 years (range, 26-88; 373 [18.6%] aged ≥65 years), 1321 (66.0%) received ≥2 prior metastatic treatment lines and 398 (19.9%) had baseline central nervous system metastases. Adverse events (AEs) and serious AEs occurred in 1862 (93.0%) and 427 (21.3%) patients, respectively. Grade ≥3 AEs occurred in 751 (37.5%) patients; the three most common (individual Medical Dictionary for Regulatory Activity terms) were anaemia (3.0%), thrombocytopaenia (2.7%) and fatigue (2.5%). Median progression-free survival (PFS) was 6.9 months (95% confidence interval [CI], 6.0-7.6). Median overall survival (OS) was 27.2 months (95% CI, 25.5-28.7). With increasing lines of prior advanced therapy (0-1 versus 4+), median PFS and OS decreased numerically from 8.3 to 5.6 months and from 31.3 to 22.5 months, respectively. CONCLUSIONS KAMILLA is the largest cohort of T-DM1-treated patients studied to date. Results are consistent with prior randomised studies, thereby supporting T-DM1 as safe, tolerable and efficacious treatment for patients with previously treated HER2-positive advanced BC.
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Affiliation(s)
- Filippo Montemurro
- Investigative Clinical Oncology (INCO), Candiolo Cancer Institute, FPO-IRCCS, Provincial Road 142, 10060, Candiolo, Torino, Italy.
| | - Paul Ellis
- Guy's Hospital and Sarah Cannon Research Institute, Great Maze Pond, London, SE1 9RT, United Kingdom.
| | - Antonio Anton
- University Hospital Miguel Servet, Aragón Health Research Institute (IIS Aragón), Avda Isabel la Católica 1-3, 50009, Zaragoza, Spain.
| | - Rachel Wuerstlein
- Breast Center, University Hospital Munich, Department of Gynecology and Obstetrics Comprehensive Cancer Center, Ludwig Maximilian University, Marchioninistraße 15, 81377, Munich, Germany.
| | - Suzette Delaloge
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Jacques Bonneterre
- Centre Oscar-Lambret, Université Lille Nord de France, 3 Rue Frédéric Combemale, 59000, Lille, France.
| | - Nathalie Quenel-Tueux
- Institut Bergonié Comprehensive Cancer Center, 229 Cours de l'Argonne, 33000, Bordeaux, France.
| | - Sabine C Linn
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Natsumi Irahara
- F. Hoffmann-La Roche Ltd., Konzern-Hauptsitz, Grenzacherstrasse 124, CH-4070, Basel, Switzerland.
| | - Margarita Donica
- F. Hoffmann-La Roche Ltd., Konzern-Hauptsitz, Grenzacherstrasse 124, CH-4070, Basel, Switzerland.
| | - Nicolas Lindegger
- F. Hoffmann-La Roche Ltd., Konzern-Hauptsitz, Grenzacherstrasse 124, CH-4070, Basel, Switzerland.
| | - Carlos H Barrios
- Hospital São Lucas, PUCRS, Av. Ipiranga, 6690 - Jardim Botânico, Porto Alegre, RS 90619-900, Brazil.
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Gridelli C, de Castro Carpeno J, Dingemans AMC, Griesinger F, Grossi F, Langer C, Ohe Y, Syrigos K, Thatcher N, Das-Gupta A, Truman M, Donica M, Smoljanovic V, Bennouna J. Safety and Efficacy of Bevacizumab Plus Standard-of-Care Treatment Beyond Disease Progression in Patients With Advanced Non-Small Cell Lung Cancer: The AvaALL Randomized Clinical Trial. JAMA Oncol 2018; 4:e183486. [PMID: 30177994 DOI: 10.1001/jamaoncol.2018.3486] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Bevacizumab treatment beyond progression has been investigated in breast and metastatic colorectal cancers. Avastin in All Lines Lung (AvaALL) is the first randomized phase 3 study of bevacizumab across multiple lines of treatment beyond progression in non-small cell lung cancer (NSCLC). Objective To assess the efficacy and safety of continuous bevacizumab treatment beyond first progression in NSCLC. Design, Setting, and Participants AvaALL was a randomized, open-label, phase 3b trial, conducted from 2011 to 2015 in 123 centers worldwide. Patients with nonsquamous NSCLC previously treated with first-line bevacizumab plus platinum-doublet chemotherapy and at least 2 cycles of bevacizumab maintenance were randomized (1:1) at first progression to receive bevacizumab plus standard of care (SOC) or SOC alone. Interventions Patients received bevacizumab (7.5 or 15 mg/kg intravenously every 21 days) and/or investigator's choice of SOC. For subsequent lines, patients treated with bevacizumab received SOC with or without bevacizumab; the SOC arm received SOC only. Main Outcomes and Measures The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival from first to second (PFS2) and third progression (PFS3), time to second (TTP2) and third progression (TTP3), and safety. Results Between June 2011 and January 2015, 485 patients (median age, 63.0 years [range, 26-84 years]; 293 [60.4%] male) were randomized. Median OS was not significantly longer with bevacizumab plus SOC vs SOC alone: 11.9 (90% CI, 10.2-13.7) vs 10.2 (90% CI, 8.6-11.9) months (hazard ratio [HR], 0.84; 90% CI, 0.71-1.00; P = .104). Median PFS2 was numerically longer with bevacizumab plus SOC vs SOC alone: 5.5 (90% CI, 4.2-5.7) vs 4.0 (90% CI, 3.4-4.3) months (HR, 0.83; 90% CI, 0.70-0.98; P = .06). Median PFS3 appeared longer with bevacizumab plus SOC vs SOC alone: 4.0 (90% CI, 2.9-4.5) vs 2.6 (90% CI, 2.3-2.9) months (HR, 0.63; 90% CI, 0.49-0.83), as did TTP2 and TTP3. Grade 3/4 adverse events were more frequent with bevacizumab plus SOC (186 [76.5%]) vs SOC alone (140 [60.3%]). No new safety signals were observed. Conclusions and Relevance The primary end point was not met; however, OS was underpowered according to initial statistical assumptions. Continued therapy beyond first progression led to improved PFS3 (but not PFS2), TTP2, and TTP3. Although a result with P = .06 for PFS2 would conventionally be considered significant at a specified 2-sided α of .10, in the absence of adjustments for multiplicity, this result could be a chance finding. No new safety signals were identified with bevacizumab treatment beyond progression. Trial Registration clinicaltrialsregister.eu Identifier: 2010-022645-14; ClinicalTrials.gov identifier: NCT01351415.
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Affiliation(s)
- Cesare Gridelli
- Division of Medical Oncology, S.G. Moscati Hospital, Avellino, Italy
| | | | - Anne-Marie C Dingemans
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frank Griesinger
- Department of Hematology and Oncology, University Department of Internal Medicine-Oncology, Pius-Hospital, University of Oldenburg, Oldenburg, Germany
| | - Francesco Grossi
- Lung Cancer Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Corey Langer
- Thoracic Oncology Unit, Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Nick Thatcher
- Christie Hospital NHS Trust, Manchester, United Kingdom
| | | | - Matt Truman
- Roche Products Pty Ltd, Sydney, New South Wales, Australia.,Now with OzBiostat Pty Ltd, Manly, New South Wales, Australia
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Redondo A, Colombo N, Dreosti LM, McCormack M, Rodrigues AN, Donica M, Morales L, González-Martín A. Preliminary results from CECILIA, an open-label global safety study of bevacizumab (BEV), carboplatin (C) and paclitaxel (P) therapy for metastatic, recurrent or persistent cervical cancer (CC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
- Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Nicoletta Colombo
- European Institute of Oncology and University of Milan-Bicocca, Milano, Italy
| | | | - Mary McCormack
- University College London Hospitals, London, United Kingdom
| | - Angelica Nogueira Rodrigues
- Federal University of Minas Gerais Brazil and Brazilian Group of Gynecologic Oncology, Belo Horizonte, Brazil
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Griesinger F, Bennouna J, de Castro Carpeno J, Dingemans AM, Grossi F, Langer C, Ohe Y, Syrigos K, Thatcher N, Das-Gupta A, Donica M, Smoljanovic V, Gridelli C. Efficacy and safety results from AvaALL: an open-label, randomized phase III trial of standard of care (SOC) with or without continuous bevacizumab (Bev) treatment beyond progression (PD) in patients (pts) with advanced non-small-cell lung cancer (NSCLC) progressing after first-line Bev and chemotherapy (chemo). Pneumologie 2018. [DOI: 10.1055/s-0037-1619221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- F Griesinger
- Department of Hematology and Oncology, University Hospital, Pius-Hospital Oldenburg
| | - J Bennouna
- Institut de Cancérologie de L'ouest, Nantes
| | - J de Castro Carpeno
- Translational Oncology Unit at Medical Oncology Division; Hospital Universitario La Paz; Idipaz
| | - AM Dingemans
- Department of Pulmonology; Maastricht University Medical Center
| | - F Grossi
- Lung Cancer Unit, National Institute for Cancer Research, Genova, Italien
| | - C Langer
- Thoracic Oncology Unit; Abramson Cancer Center; University of Pennsylvania, Philadelphia
| | - Y Ohe
- National Cancer Center Hospital, Tokyo
| | - K Syrigos
- Athens Medical Center; National & Kapodistrian University of Athens Medical School
| | | | | | | | | | - C Gridelli
- Division of Medical Oncology; S.G. Moscati Hospital, Avellino, Italien
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Bennouna J, De Castro J, Dingemans AMC, Griesinger F, Grossi F, Langer CJ, Ohe Y, Syrigos KN, Thatcher N, Das-Gupta A, Donica M, Smoljanovic V, Gridelli C. Efficacy and safety results from AvaALL: An open-label, randomized phase III trial of standard of care (SOC) with or without continuous bevacizumab (Bev) treatment beyond progression (PD) in patients (pts) with advanced non-small cell lung cancer (NSCLC) progressing after first-line Bev and chemotherapy (chemo). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9004 Background: The role of treatment with Bev beyond PD is unclear in the multiline treatment strategy of advanced NSCLC.AvaALL(NCT01351415), a multinational, open-label, randomized phase III trial, assessed continuous Bev and SOC beyond first PD (PD1) in pts with NSCLC following first-line treatment with platinum-based chemo plus Bev. Here we present efficacy and safety data from AvaALL. Methods: Pts with NSCLC who received 4–6 cycles of chemo + Bev and ≥2 cycles of maintenance Bev were randomized after PD1 to second-line SOC therapy (docetaxel, pemetrexed or erlotinib) ± Bev. After second PD (PD2) and third PD (PD3), pts received third-line or fourth-line SOC ± Bev treatment, respectively. Primary endpoint was overall survival (OS). Secondary endpoints were OS rates (6, 12, and 18-months [mos]), progression-free survival (PFS) from PD1 to PD2/from PD2 to PD3, overall response rate (ORR), disease control rate (DCR), and safety. Data cut-off: 24 Jun 2016. Results: Overall, 485 pts were randomized (n = 475 treated). Pt characteristics were well balanced between the two arms. Bev plus chemo resulted in a median OS of 11.9 mos versus 10.2 mos for SOC alone (HR 0.84, 90% CI 0.71–1.00; p = 0.1016; 387 OS events). The primary endpoint was not met (416 OS events were required, at 10% two-sided significance level). OS rates were 10% higher in the Bev arm vs SOC alone at 6-, 12- and 18-mos. Median PFS2 was 4.9 mos with Bev vs 3.8 mos with SOC (HR 0.85, 90% CI 0.72–1.00; p = 0.0907). PFS3 was significantly improved (3.5 mos for Bev, 2.4 mos for SOC; HR 0.65, 90% CI 0.51–0.84; p = 0.0047). ORR and DCR were slightly higher in the Bev arm versus the SOC arm (ORR 9.7% vs 6.7%; DCR 86.2% vs 79.3%, respectively). No new safety signals were identified. Grade ≥3 adverse events were reported in 78.2% of Bev pts and 61.6% of SOC pts. Conclusions: Although the primary endpoint was not met, efficacy data suggest a positive trend for continued Bev plus SOC after PD1 compared with SOC alone. No cumulative safety signals were identified. Clinical trial information: NCT01351415.
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Affiliation(s)
| | - Javier De Castro
- Translational Oncology Unit at Medical Oncology Division, Hospital Universitario La Paz, IdipAZ, Madrid, Spain
| | | | - Frank Griesinger
- Pius Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany
| | | | - Corey J. Langer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital East, Tokyo, Japan
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Andersson M, López-Vega JM, Petit T, Zamagni C, Donica M, Kamber J, Perez EA. The co-administration of pertuzumab (P) and trastuzumab (T) as a single infusion, followed by vinorelbine (V), in first-line (1L) treatment of HER2-positive locally advanced or metastatic breast cancer (MBC) patients (pts): VELVET study interim analysis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.586] [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)
| | | | - Thierry Petit
- Department of Medical Oncology, Paul Strauss Cancer Center and University of Strasbourg, Strasbourg, France
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Jeffries MA, Donica M, Annan A, Stevenson M, Humphrey MB, James JA, Sawalha AH. A4.24 Global transcriptome analysis in osteoarthritic cartilage reveals significant differential gene expression and associations with histologic disease progression. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Grothey A, Arnold D, Van Cutsem E, Bekaii-Saab T, Kozloff M, Bennouna J, Revil C, Donica M, Sommer N, Leutgeb B, Ekstrand-Olsen M, Hermann F, Hurwitz H. Overall Survival According to Patient Subgroups: Results from a Pooled Analysis of 5 Observational or Phase Iv Studies of Bevacizumab in Metastatic Colorectal Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Abstract
Choice of target population is an essential part at the design stage of clinical trials. Data from earlier clinical development might suggest that the treatment is more effective in a subpopulation, but there might not be enough evidence to restrict the target population upfront. Adaptive designs allow modification of the target population based on interim data. Decision for modification should be based on objective decision rules. The presented decision rules maximize the weighted probability of correct interim decisions based on prior assumptions. Evaluation of decision rules in the planning phase can improve probabilities of correct interim decision and power.
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Affiliation(s)
- Heiko Götte
- a Global Biostatistics, Merck KGaA , Darmstadt , Germany
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15
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Houede N, Faivre SJ, Awada A, Raymond E, Italiano A, Besse-Hammer T, Donica M, Rejeb N, Luepfert C, Ongarello S, Delord J. Safety and evidence of activity of MSC1936369, an oral MEK1/2 inhibitor, in patients with advanced malignancies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Delord J, Houede N, Awada A, Taamma A, Faivre SJ, Besse-Hammer T, Italiano A, Vignaud C, Donica M, Raymond E. First-in-human phase I safety, pharmacokinetic (PK), and pharmacodynamic (PD) analysis of the oral MEK-inhibitor AS703026 (two regimens [R]) in patients (pts) with advanced solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2504] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Raoul JL, Finn RS, Kang YK, Park JW, Harris R, Coric V, Donica M, Walters I. An open-label phase II study of first- and second-line treatment with brivanib in patients with hepatocellular carcinoma (HCC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4577] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4577 Background: Brivanib is an orally available dual inhibitor of vascular endothelial growth factor and fibroblast growth factor (FGF) signaling. FGF pathway activation is of increasing importance in the setting of liver fibrosis and HCC. This phase II study aimed to assess the efficacy and safety of brivanib in patients (pts) with unresectable, locally advanced or metastatic HCC who had received either no prior systemic therapy (Cohort A) or one prior regimen of angiogenesis inhibitor (Cohort B). Methods: Eligible pts had biopsy-proven HCC or had radiological evidence of HCC and were serology positive for Hep B or C with alpha fetoprotein levels ≥ 400 μg/L. Pts received brivanib 800 mg qd. Efficacy endpoints included OS, PFS, TTP, ORR, and DCR. Safety was assessed throughout the study. Serum levels of a biomarker, Collagen IV (a component of the basement membrane of blood vessels), were measured on day 1, weeks 3 and 6, and at end of treatment. Results: Interim results are reported. From December 2006 to October 2008, 96 patients were enrolled (Cohort A: 55 pts; Cohort B: 41 pts). In Cohort B, 38 pts had failed sorafenib and 3 had failed thalidomide. In Cohort A, median OS (95% CI) was 10 (6.8,-) months. Most frequently reported grade 3/4 AEs were fatigue (16%), AST elevation (19%), and hyponatremia (41%) in Cohort A and hypertension (7.3%), diarrhea (4.9%), and headache (4.9%) in Cohort B. 24 pts died in Cohort A and 5 pts in Cohort B, none were considered treatment-related. Treatment-induced reductions in serum Collagen IV appear to correlate with long term outcome (PFS and OS). Conclusions: Brivanib has activity as both first-line and second-line post-sorafenib systemic treatment in HCC. Collagen IV, a novel serum angiogenic biomarker, appears to be associated with outcome. [Table: see text] [Table: see text]
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Affiliation(s)
- J. L. Raoul
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
| | - R. S. Finn
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
| | - Y. K. Kang
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
| | - J. W. Park
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
| | - R. Harris
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
| | - V. Coric
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
| | - M. Donica
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
| | - I. Walters
- Centre Eugène Marquis, Rennes, France; UCLA, Los Angeles, CA; University of Ulsan College of Medicine, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Bristol-Myers Squibb, Princeton, NJ
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