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Frei AL, McGuigan A, Sinha RRAK, Jabbar F, Gneo L, Tomasevic T, Harkin A, Iveson T, Saunders MP, Oien KA, Maka N, Pezzella F, Campo L, Browne M, Glaire M, Kildal W, Danielsen HE, Hay J, Edwards J, Sansom O, Kelly C, Tomlinson I, Kerr R, Kerr D, Domingo E, Church DN, Koelzer VH. Multiplex analysis of intratumoural immune infiltrate and prognosis in patients with stage II-III colorectal cancer from the SCOT and QUASAR 2 trials: a retrospective analysis. Lancet Oncol 2024; 25:198-211. [PMID: 38301689 DOI: 10.1016/s1470-2045(23)00560-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Tumour-infiltrating CD8+ cytotoxic T cells confer favourable prognosis in colorectal cancer. The added prognostic value of other infiltrating immune cells is unclear and so we sought to investigate their prognostic value in two large clinical trial cohorts. METHODS We used multiplex immunofluorescent staining of tissue microarrays to assess the densities of CD8+, CD20+, FoxP3+, and CD68+ cells in the intraepithelial and intrastromal compartments from tumour samples of patients with stage II-III colorectal cancer from the SCOT trial (ISRCTN59757862), which examined 3 months versus 6 months of adjuvant oxaliplatin-based chemotherapy, and from the QUASAR 2 trial (ISRCTN45133151), which compared adjuvant capecitabine with or without bevacizumab. Both trials included patients aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-1. Immune marker predictors were analysed by multiple regression, and the prognostic and predictive values of markers for colorectal cancer recurrence-free interval by Cox regression were assessed using the SCOT cohort for discovery and QUASAR 2 cohort for validation. FINDINGS After exclusion of cases without tissue microarrays and with technical failures, and following quality control, we included 2340 cases from the SCOT trial and 1069 from the QUASAR 2 trial in our analysis. Univariable analysis of associations with recurrence-free interval in cases from the SCOT trial showed a strong prognostic value of intraepithelial CD8 (CD8IE) as a continuous variable (hazard ratio [HR] for 75th vs 25th percentile [75vs25] 0·73 [95% CI 0·68-0·79], p=2·5 × 10-16), and of intrastromal FoxP3 (FoxP3IS; 0·71 [0·64-0·78], p=1·5 × 10-13) but not as strongly in the epithelium (FoxP3IE; 0·89 [0·84-0·96], p=1·5 × 10-4). Associations of other markers with recurrence-free interval were moderate. CD8IE and FoxP3IS retained independent prognostic value in bivariable and multivariable analysis, and, compared with either marker alone, a composite marker including both markers (CD8IE-FoxP3IS) was superior when assessed as a continuous variable (adjusted [a]HR75 vs 25 0·70 [95% CI 0·63-0·78], p=5·1 × 10-11) and when categorised into low, intermediate, and high density groups using previously published cutpoints (aHR for intermediate vs high 1·68 [95% CI 1·29-2·20], p=1·3 × 10-4; low vs high 2·58 [1·91-3·49], p=7·9 × 10-10), with performance similar to the gold-standard Immunoscore. The prognostic value of CD8IE-FoxP3IS was confirmed in cases from the QUASAR 2 trial, both as a continuous variable (aHR75 vs 25 0·84 [95% CI 0·73-0·96], p=0·012) and as a categorical variable for low versus high density (aHR 1·80 [95% CI 1·17-2·75], p=0·0071) but not for intermediate versus high (1·30 [0·89-1·88], p=0·17). INTERPRETATION Combined evaluation of CD8IE and FoxP3IS could help to refine risk stratification in colorectal cancer. Investigation of FoxP3IS cells as an immunotherapy target in colorectal cancer might be merited. FUNDING Medical Research Council, National Institute for Health Research, Cancer Research UK, Swedish Cancer Society, Roche, and Promedica Foundation.
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Affiliation(s)
- Anja L Frei
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Life Science Zurich Graduate School, PhD Program in Biomedicine, University of Zurich, Zurich, Switzerland
| | - Anthony McGuigan
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ritik R A K Sinha
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Faiz Jabbar
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Luciana Gneo
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tijana Tomasevic
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrea Harkin
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | | | | | - Karin A Oien
- School of Cancer Sciences, University of Glasgow, Glasgow, UK; Glasgow Tissue Research Facility, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Noori Maka
- Glasgow Tissue Research Facility, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Francesco Pezzella
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, UK
| | - Leticia Campo
- Department of Oncology, University of Oxford, Oxford, UK
| | - Molly Browne
- Department of Oncology, University of Oxford, Oxford, UK
| | - Mark Glaire
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wanja Kildal
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Havard E Danielsen
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, UK; Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Jennifer Hay
- Glasgow Tissue Research Facility, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Joanne Edwards
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Owen Sansom
- School of Cancer Sciences, University of Glasgow, Glasgow, UK; Cancer Research UK Beatson Institute of Cancer Research, Glasgow, UK; Cancer Research UK Scotland Centre, Glasgow and Edinburgh, UK
| | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Ian Tomlinson
- Department of Oncology, University of Oxford, Oxford, UK
| | - Rachel Kerr
- Department of Oncology, University of Oxford, Oxford, UK
| | - David Kerr
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, UK
| | - Enric Domingo
- Department of Oncology, University of Oxford, Oxford, UK; Cancer Research UK Scotland Centre, Glasgow and Edinburgh, UK
| | - David N Church
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford NIHR Comprehensive Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Oncology, University of Oxford, Oxford, UK
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Dillon MT, Guevara J, Mohammed K, Patin EC, Smith SA, Dean E, Jones GN, Willis SE, Petrone M, Silva C, Thway K, Bunce C, Roxanis I, Nenclares P, Wilkins A, McLaughlin M, Jayme-Laiche A, Benafif S, Nintos G, Kwatra V, Grove L, Mansfield D, Proszek P, Martin P, Moore L, Swales KE, Banerji U, Saunders MP, Spicer J, Forster MD, Harrington KJ. Durable responses to ATR inhibition with ceralasertib in tumors with genomic defects and high inflammation. J Clin Invest 2024; 134:e175369. [PMID: 37934611 PMCID: PMC10786692 DOI: 10.1172/jci175369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUNDPhase 1 study of ATRinhibition alone or with radiation therapy (PATRIOT) was a first-in-human phase I study of the oral ATR (ataxia telangiectasia and Rad3-related) inhibitor ceralasertib (AZD6738) in advanced solid tumors.METHODSThe primary objective was safety. Secondary objectives included assessment of antitumor responses and pharmacokinetic (PK) and pharmacodynamic (PD) studies. Sixty-seven patients received 20-240 mg ceralasertib BD continuously or intermittently (14 of a 28-day cycle).RESULTSIntermittent dosing was better tolerated than continuous, which was associated with dose-limiting hematological toxicity. The recommended phase 2 dose of ceralasertib was 160 mg twice daily for 2 weeks in a 4-weekly cycle. Modulation of target and increased DNA damage were identified in tumor and surrogate PD. There were 5 (8%) confirmed partial responses (PRs) (40-240 mg BD), 34 (52%) stable disease (SD), including 1 unconfirmed PR, and 27 (41%) progressive disease. Durable responses were seen in tumors with loss of AT-rich interactive domain-containing protein 1A (ARID1A) and DNA damage-response defects. Treatment-modulated tumor and systemic immune markers and responding tumors were more immune inflamed than nonresponding.CONCLUSIONCeralasertib monotherapy was tolerated at 160 mg BD intermittently and associated with antitumor activity.TRIAL REGISTRATIONClinicaltrials.gov: NCT02223923, EudraCT: 2013-003994-84.FUNDINGCancer Research UK, AstraZeneca, UK Department of Health (National Institute for Health Research), Rosetrees Trust, Experimental Cancer Medicine Centre.
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Affiliation(s)
- Magnus T. Dillon
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeane Guevara
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kabir Mohammed
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Emma Dean
- Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | | | | | - Marcella Petrone
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Carlos Silva
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Khin Thway
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Anna Wilkins
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Adoracion Jayme-Laiche
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah Benafif
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Georgios Nintos
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vineet Kwatra
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lorna Grove
- The Institute of Cancer Research, London, United Kingdom
| | | | - Paula Proszek
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Philip Martin
- Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Luiza Moore
- Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Udai Banerji
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - James Spicer
- King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Martin D. Forster
- UCL Cancer Institute and University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Kevin J. Harrington
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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3
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Saunders MP, Iype R, Kelly C, Crosby J, Kerr R, Harkin A, Allan K, McQueen J, Pearson SR, Cassidy J, Medley LC, Raouf S, Harrison M, Brewster A, Rees C, Ellis R, Thomas AL, Churn M, Iveson T, Maka N. SCOT: Tumor Sidedness and the Influence of Adjuvant Chemotherapy Duration on Disease Free Survival (DFS). Clin Colorectal Cancer 2023; 22:231-237. [PMID: 36967267 DOI: 10.1016/j.clcc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
AIM Patients with loco-regional right-sided colorectal tumors have a worse overall survival (OS). Here we investigate the difference in disease free survival (DFS) between colorectal patients with right and left sided tumors in the SCOT study. METHODS The SCOT study showed 3-months of oxaliplatin-containing adjuvant chemotherapy (OxFp) is non-inferior to 6-months for patients with stage III and high-risk stage II colorectal cancer. We divided the cohort into patients with left and right sided tumors, and evaluated the effect on DFS and the principle 3 versus 6-months analysis. RESULTS 6088 patients with Stage III/high risk Stage II colorectal cancers were randomized between 27th March 2008 and 29th November 2013 from 244 centers internationally. In February 2017 (3-years FU) information on sidedness was available for 3309 patients (1238 R-sided, 2071 L-sided). Patients with right-sided tumors had a significantly worse DFS (3-year DFS right: 73.3% (se = 1.3%), left: 80.2% (se = 0.9%) HR 1.423 (95% CI 1.237-1.637; P < .0001). Adjusting for T and N-stage reduced the HR to 1.230 (95% CI 1.066-1.420, P = .005). The data did not suggest that sidedness affected the impact of chemotherapy duration on 3-year DFS (R: HR 1.024 [0.831-1.261], L: HR 0.944 [0.783-1.139]). Test for heterogeneity, P = .571. Further sub-set analysis was limited due to cohort size. CONCLUSIONS This is the first study to show that unselected patients with right-sided tumors had a worse DFS compared to left-sided tumors. Tumor sidedness did not impact upon the 3-months versus 6-months comparison in SCOT.
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Affiliation(s)
| | - Rohan Iype
- The Christie, Manchester, United Kingdom
| | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Jana Crosby
- Queen Elizabeth University Department of Pathology and Biorepository, Glasgow, United Kingdom
| | - Rachel Kerr
- University of Oxford, Oxford, United Kingdom
| | - Andrea Harkin
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Karen Allan
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - John McQueen
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | | | - James Cassidy
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Louise C Medley
- Royal United Hospital Bath, Bath, United Kingdom; South Devon Healthcare NHS Foundation Trust, Torquay, United Kingdom
| | | | | | | | - Charlotte Rees
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom
| | | | | | - Mark Churn
- Worcester Royal Hospital, Worcester, United Kingdom
| | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Noori Maka
- Queen Elizabeth University Department of Pathology and Biorepository, Glasgow, United Kingdom
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4
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Roxburgh CSD, Hanna CR, Graham J, Saunders MP, Samuel LM, MacLeod NJ, Devlin L, Edwards J, Hillson L, McMahon RK, Jones LA, Kelly C, Lewsley LA, Morrison P, Atherton P, Walker N, Gourlay J, Tiplady E, Adams R, O'Cathail SM. Durvalumab (MEDI 4736) with extended neoadjuvant regimens in rectal cancer: A randomised phase II trial (PRIME-RT). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
TPS282 Background: Advances in multi-modality treatment of locally advanced rectal cancer (LARC) have resulted in low local recurrence rates, but many patients still die from distant disease. There is increasing recognition that with neoadjuvant treatment some patients achieve a complete response and may avoid surgical resection. PRIME-RT tests the inclusion of neoadjuvant immunotherapy with the aim of enhancing complete response rates, improving stoma-free survival and reducing distant relapse. Methods: PRIME-RT is a multi-centre, open label, phase II, randomised trial for patients with newly diagnosed LARC. Eligible patients are randomised to Arm A: short course radiotherapy (25 Gray in 5 fractions) with concomitant durvalumab, followed by durvalumab and FOLFOX chemotherapy, or Arm B: long course chemoradiotherapy (50 Gray to primary tumour, 45 Gray to elective nodes, in 25 fractions with capecitabine) with concomitant durvalumab followed by FOLFOX and durvalumab. The primary endpoint is complete response rate in each arm. Bio-specimens including serial tumour biopsies and peripheral blood samples are collected prior to, during, and following treatment to explore the molecular and immunological factors underpinning treatment response. The main trial will recruit up to 42 patients and commence after a safety run-in which is recruiting patients with metastatic disease. After opening in January 2021, the four patients completed the safety run in and the main trial commenced in March 2022. The trial is currently open across 5 UK sites. Up to date recruitment details will be provided at the time of presentation but at the time of writing this is ahead of target. Early recruitment to PRIME-RT has shown that adding immunotherapy in the neoadjuvant setting for LARC is feasible. Furthermore, on treatment biospecimen collection is also feasible across multiple sites. The expectation is that the trial will provide efficacy and safety information which allows the optimal treatment approach to be tested within a larger phase clinical trial. Core funding (Glasgow CRUK CTU) and trial-specific funding (Astrazeneca). Clinical trial: NCT04621370; ISRCTN18138369. Clinical trial information: ISRCTN18138369 .
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Affiliation(s)
| | | | - Janet Graham
- The Beatson Cancer Centre, Glasgow, United Kingdom
| | | | | | | | - Lynsey Devlin
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | | | | | | | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, United Kingdom
| | | | | | | | - Nicola Walker
- CR-UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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5
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André T, Falcone A, Shparyk Y, Moiseenko F, Polo-Marques E, Csöszi T, Campos-Bragagnoli A, Liposits G, Chmielowska E, Aubel P, Martín L, Fougeray R, Amellal N, Saunders MP. Trifluridine-tipiracil plus bevacizumab versus capecitabine plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer ineligible for intensive therapy (SOLSTICE): a randomised, open-label phase 3 study. Lancet Gastroenterol Hepatol 2023; 8:133-144. [PMID: 36470291 DOI: 10.1016/s2468-1253(22)00334-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Received: 07/12/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Trifluridine-tipiracil plus bevacizumab has shown efficacy in previous phase 2 studies including patients with unresectable metastatic colorectal cancer. We aimed to investigate first-line trifluridine-tipiracil plus bevacizumab versus capecitabine plus bevacizumab in patients with unresectable metastatic colorectal cancer ineligible for intensive treatment. METHODS In this open-label, randomised, phase 3 study, we enrolled patients aged 18 years and older with histologically confirmed metastatic colorectal cancer, ineligible for full-dose doublet or triplet chemotherapy and curative resection across 25 countries and regions. Participants were randomly allocated (1:1) to trifluridine-tipiracil plus bevacizumab or capecitabine plus bevacizumab until disease progression or unacceptable toxicity using an interactive web response system, stratified by Eastern Cooperative Oncology Group (ECOG) performance status (0 vs 1 vs 2), primary tumour location (right vs left colon), and the main reason for not being a candidate for intensive therapy (clinical condition vs non-clinical condition). The primary endpoint was investigator-assessed progression-free survival, defined as the time from randomisation to radiological progression or death from any cause, in the intention-to-treat population. Safety was assessed in all patients having taken at least one dose of the study drug. The trial is ongoing, findings presented here are those of the primary analysis of progression-free survival, conducted after 629 events had occurred. This study is registered with ClinicalTrials.gov, NCT03869892. FINDINGS Between March 21, 2019, and Sept 14, 2020, 856 patients (54% male, 46% female) were randomly assigned to trifluridine-tipiracil plus bevacizumab (n=426) or capecitabine plus bevacizumab (n=430). After a median follow-up of 16·6 months (95% CI 16·5-17·1), the hazard ratio for progression-free survival for trifluridine-tipiracil plus bevacizumab versus capecitabine plus bevacizumab was 0·87 (0·75-1·02; p=0·0464; protocol-defined significance level of p=0·021 not met). Investigator-assessed median progression-free survival was 9·4 months (95% CI 9·1-10·9) with trifluridine-tipiracil plus bevacizumab versus 9·3 months (8·9-9·8) with capecitabine plus bevacizumab. The most common grade 3 and higher treatment-emergent adverse events were neutropenia (220 [52%] of 423 patients in the trifluridine-tipiracil plus bevacizumab group vs six [1%] of 427 in the capecitabine plus bevacizumab group), decreased neutrophil count (78 [18%] vs four [<1%]), anaemia (60 [14%] vs 16 [4%]), and hand-foot syndrome (none vs 61 [15%]). Nine deaths (five in the trifluridine-tipiracil plus bevacizumab group and four in the capecitabine plus bevacizumab group) were treatment related. INTERPRETATION First-line trifluridine-tipiracil plus bevacizumab was not superior to capecitabine plus bevacizumab in this population. As expected, the safety profile differed between the two treatments, but there were no new safety concerns. Trifluridine-tipiracil plus bevacizumab represents a feasible alternative to capecitabine plus bevacizumab in this population. FUNDING Servier International Research Institute, Suresnes, France.
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Affiliation(s)
- Thierry André
- Sorbonne University and Saint-Antoine Hospital, Department of Medical Oncology, Paris, France.
| | | | | | - Fedor Moiseenko
- Saint Petersburg Clinical Research and Practical Centre for Specialized Types of Medical Care (Oncological), St Petersburg, Russia
| | | | - Tibor Csöszi
- Géza Hetényi Hospital-Jász-Nagykun-Szolnok County Hospital Oncology Centre, Szolnok, Hungary
| | | | | | - Ewa Chmielowska
- Specialistic Oncologic Hospital Nu-Med, Tomaszów Mazowiecki, Poland
| | - Paul Aubel
- Servier International Research Institute, Suresnes, France
| | - Lourdes Martín
- Servier International Research Institute, Suresnes, France
| | - Ronan Fougeray
- Servier International Research Institute, Suresnes, France
| | - Nadia Amellal
- Servier International Research Institute, Suresnes, France
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Bhullar D, O'Dwyer S, Wilson M, Saunders MP, Kochhar R, Barriuso J, Aziz O. ASO Visual Abstract: RAS Mutation Status Should not be Used to Predict Outcome from Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases. Ann Surg Oncol 2023; 30:802-803. [PMID: 36404378 DOI: 10.1245/s10434-022-12780-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Dilraj Bhullar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah O'Dwyer
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, The Christie NHSFT, Manchester, UK
| | - Malcolm Wilson
- Colorectal and Peritoneal Oncology Centre, The Christie NHSFT, Manchester, UK
| | - Mark P Saunders
- Colorectal and Peritoneal Oncology Centre, The Christie NHSFT, Manchester, UK
| | - Rohit Kochhar
- Colorectal and Peritoneal Oncology Centre, The Christie NHSFT, Manchester, UK
| | - Jorge Barriuso
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, The Christie NHSFT, Manchester, UK
| | - Omer Aziz
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Colorectal and Peritoneal Oncology Centre, The Christie NHSFT, Manchester, UK.
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7
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Propper DJ, Gao F, Saunders MP, Sarker D, Hartley JA, Spanswick VJ, Lowe HL, Hackett LD, Ng TT, Barber PR, Weitsman GE, Pearce S, White L, Lopes A, Forsyth S, Hochhauser D. PANTHER: AZD8931, inhibitor of EGFR, ERBB2 and ERBB3 signalling, combined with FOLFIRI: a Phase I/II study to determine the importance of schedule and activity in colorectal cancer. Br J Cancer 2023; 128:245-254. [PMID: 36352028 PMCID: PMC9902557 DOI: 10.1038/s41416-022-02015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) is a therapeutic target to which HER2/HER3 activation may contribute resistance. This Phase I/II study examined the toxicity and efficacy of high-dose pulsed AZD8931, an EGFR/HER2/HER3 inhibitor, combined with chemotherapy, in metastatic colorectal cancer (CRC). METHODS Treatment-naive patients received 4-day pulses of AZD8931 with irinotecan/5-FU (FOLFIRI) in a Phase I/II single-arm trial. Primary endpoint for Phase I was dose limiting toxicity (DLT); for Phase II best overall response. Samples were analysed for pharmacokinetics, EGFR dimers in circulating exosomes and Comet assay quantitating DNA damage. RESULTS Eighteen patients received FOLFIRI and AZD8931. At 160 mg bd, 1 patient experienced G3 DLT; 160 mg bd was used for cohort expansion. No grade 5 adverse events (AE) reported. Seven (39%) and 1 (6%) patients experienced grade 3 and grade 4 AEs, respectively. Of 12 patients receiving 160 mg bd, best overall response rate was 25%, median PFS and OS were 8.7 and 21.2 months, respectively. A reduction in circulating HER2/3 dimer in the two responding patients after 12 weeks treatment was observed. CONCLUSIONS The combination of pulsed high-dose AZD8931 with FOLFIRI has acceptable toxicity. Further studies of TKI sequencing may establish a role for pulsed use of such agents rather than continuous exposure. TRIAL REGISTRATION NUMBER ClinicalTrials.gov number: NCT01862003.
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Affiliation(s)
- David J Propper
- Barts Cancer Institute, Queen Mary, University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Fangfei Gao
- UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK
| | | | - Debashis Sarker
- School of Cancer and Pharmaceutical Sciences, King's College London, London, WC2R 2LS, UK
| | - John A Hartley
- UCL ECMC GCLP Facility, UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK
| | - Victoria J Spanswick
- UCL ECMC GCLP Facility, UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK
| | - Helen L Lowe
- UCL ECMC GCLP Facility, UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK
| | - Louise D Hackett
- UCL ECMC GCLP Facility, UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK
| | - Tony T Ng
- Barts Cancer Institute, Queen Mary, University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
- UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK
- Breast Cancer Now Research Unit, Department of Research Oncology, Guy's Hospital, King's College London, London, SE1 9RT, UK
| | - Paul R Barber
- UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK
| | - Gregory E Weitsman
- Richard Dimbleby Laboratory of Cancer Research, School of Cancer & Pharmaceutical Sciences, King's College London, London, SE1 1UL, UK
| | - Sarah Pearce
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, W1T 4TJ, UK
| | - Laura White
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, W1T 4TJ, UK
| | - Andre Lopes
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, W1T 4TJ, UK
| | - Sharon Forsyth
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, W1T 4TJ, UK
| | - Daniel Hochhauser
- UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK.
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8
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Bhullar D, O’Dwyer S, Wilson M, Saunders MP, Kochhar R, Barriuso J, Aziz O. RAS Mutation Status Should Not Be Used to Predict Outcome from Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases. Ann Surg Oncol 2023; 30:792-801. [PMID: 36400886 PMCID: PMC9807544 DOI: 10.1245/s10434-022-12704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Genetic biomarkers guide systemic anti-cancer treatment (SACT) in metastatic colorectal cancer. It has been suggested they have a role in selecting patients with colorectal peritoneal metastases (CRPM) for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). This study aims to quantify the effect of mutation status on overall survival (OS), adjusting for confounders such as pre-operative systemic anticancer treatment (SACT). PATIENTS AND METHODS Retrospective analysis of patients undergoing CRS/HIPEC for CRPM at a national peritoneal tumour centre (2004-2017) was performed. Demographics, treatment history and operative data were extracted. Known biomarker gene mutation status was noted including: KRAS, NRAS, BRAF, PIK3CA and MMR. Cox regression analysis and Kaplan-Meier curves were used to determine overall survival. RESULTS One hundred ninety-five patients were included. Median follow-up time was 34.7 months (range 5.4-184.9 months) and median OS was 38.7 months (95% CI 32.4-44.9 months). Biomarker status was as follows: KRAS (n = 114), NRAS (n = 85), BRAF (n = 44), PIK3CA (n = 15) and MMR (n = 21). Mutation rates were 45.6%, 3.5%, 13.6%, 13.3% and 14.3%, respectively. Seventy-four per cent underwent complete cytoreduction (CC = 0), 81% received SACT pre-CRS/HIPEC and 65% post-CRS/HIPEC. RAS (p = 0.21) or BRAF (p = 0.109) mutation status did not predict OS. Nodal involvement, extramural vascular invasion, Peritoneal Cancer Index (PCI) score, CC score, SACT post-HIPEC and NRAS mutation were significant negative predictors of OS in univariate analysis (p < 0.05). Multivariate Cox regression confirmed CC-score > 1 (HR: 7.599, 95% CI 3.402-16.974, p < 0.0001) as a negative predictor of OS. RAS mutation status did not affect outcome (HR: 1.682, 95% CI 0.995-2.843, p = 0.052). CONCLUSIONS RAS mutation status should not in isolation be used to select patients for CRS/HIPEC.
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Affiliation(s)
- Dilraj Bhullar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah O’Dwyer
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK ,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Malcolm Wilson
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark P. Saunders
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Rohit Kochhar
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Jorge Barriuso
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK ,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Omer Aziz
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK ,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
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9
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Saunders MP, Graham J, Cunningham D, Plummer R, Church D, Kerr R, Cook S, Zheng S, La Thangue N, Kerr D. CXD101 and nivolumab in patients with metastatic microsatellite-stable colorectal cancer (CAROSELL): a multicentre, open-label, single-arm, phase II trial. ESMO Open 2022; 7:100594. [PMID: 36327756 PMCID: PMC9808483 DOI: 10.1016/j.esmoop.2022.100594] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 02/01/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with microsatellite stable (MSS) colorectal carcinoma (CRC) do not respond to immune checkpoint inhibitors. Preclinical models suggested synergistic anti-tumour activity combining CXD101 and anti-programmed cell death protein 1 treatment; therefore, we assessed the clinical combination of CXD101 and nivolumab in heavily pre-treated patients with MSS metastatic CRC (mCRC). PATIENTS AND METHODS This single-arm, open-label study enrolled patients aged 18 years or older with biopsy-confirmed MSS CRC; at least two lines of systemic anticancer therapies (including oxaliplatin and irinotecan); at least one measurable lesion; Eastern Cooperative Oncology Group performance status of 0, 1 or 2; predicted life expectancy above 3 months; and adequate organ and bone marrow function. Nine patients were enrolled in a safety run-in study to define a tolerable combination schedule of CXD101 and nivolumab, followed by 46 patients in the efficacy assessment phase. Patients in the efficacy assessment cohort were treated orally with 20 mg CXD101 twice daily for 5 consecutive days every 3 weeks, and intravenously with 240 mg nivolumab every 2 weeks. The primary endpoint was immune disease control rate (iDCR). RESULTS Between 2018 and 2020, 55 patients were treated with CXD101 and nivolumab. The combination therapy was well tolerated with the most frequent grade 3 or 4 adverse events being neutropenia (18%) and anaemia (7%). Immune-related adverse reactions commonly ascribed to checkpoint inhibitors were surprisingly rare although we did see single cases of pneumonitis, hypothyroidism and hypopituitarism. There were no treatment-related deaths. Of 46 patients assessable for efficacy, 4 (9%) achieved partial response and 18 (39%) achieved stable disease, translating to an immune disease control rate of 48%. The median overall survival (OS) was 7.0 months (95% confidence interval 5.13-10.22 months). CONCLUSIONS The primary endpoint was met in this phase II study, which showed that the combination of CXD101 and nivolumab, at full individual doses in the treatment of advanced or metastatic MSS CRC, was both well tolerated and efficacious.
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Affiliation(s)
- M P Saunders
- The Christie NHS Foundation Trust, Manchester, UK.
| | - J Graham
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Cunningham
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - D Church
- The Churchill Hospital Oxford University Hospitals NHS Trust, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - R Kerr
- The Churchill Hospital Oxford University Hospitals NHS Trust, Oxford, UK
| | - S Cook
- Celleron Therapeutics Limited, Oxford, UK
| | - S Zheng
- Celleron Therapeutics Limited, Oxford, UK
| | | | - D Kerr
- The Churchill Hospital Oxford University Hospitals NHS Trust, Oxford, UK; Celleron Therapeutics Limited, Oxford, UK
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10
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Rao S, Anandappa G, Capdevila J, Dahan L, Evesque L, Kim S, Saunders MP, Gilbert DC, Jensen LH, Samalin E, Spindler KL, Tamberi S, Demols A, Guren MG, Arnold D, Fakih M, Kayyal T, Cornfeld M, Tian C, Catlett M, Smith M, Spano JP. A phase II study of retifanlimab (INCMGA00012) in patients with squamous carcinoma of the anal canal who have progressed following platinum-based chemotherapy (POD1UM-202). ESMO Open 2022; 7:100529. [PMID: 35816951 PMCID: PMC9463376 DOI: 10.1016/j.esmoop.2022.100529] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 02/07/2023] Open
Abstract
Background Locally advanced or metastatic squamous carcinoma of the anal canal (SCAC) has poor prognosis following platinum-based chemotherapy. Retifanlimab (INCMGA00012), a humanized monoclonal antibody targeting programmed death protein-1 (PD-1), demonstrated clinical activity across a range of solid tumors in clinical trials. We present results from POD1UM-202 (NCT03597295), an open-label, single-arm, multicenter, phase II study evaluating retifanlimab in patients with previously treated advanced or metastatic SCAC. Patients and methods Patients ≥18 years of age had measurable disease and had progressed following, or were ineligible for, platinum-based therapy. Retifanlimab 500 mg was administered intravenously every 4 weeks. The primary endpoint was overall response rate (ORR) by independent central review. Secondary endpoints were duration of response (DOR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety. Results Overall, 94 patients were enrolled. At a median follow-up of 7.1 months (range, 0.9-19.4 months), ORR was 13.8% [95% confidence interval (CI) 7.6% to 22.5%], with one complete response (1.1%) and 12 partial responses (12.8%). Responses were observed regardless of human immunodeficiency virus or human papillomavirus status, programmed death ligand 1 (PD-L1) expression, or liver metastases. Stable disease was observed in 33 patients (35.1%) for a DCR of 48.9% (95% CI 38.5% to 59.5%). Median DOR was 9.5 months (range, 5.6 months-not estimable). Median (95% CI) PFS and OS were 2.3 (1.9-3.6) and 10.1 (7.9-not estimable) months, respectively. Retifanlimab safety in this population was consistent with previous experience for the PD-(L)1 inhibitor class. Conclusions Retifanlimab demonstrated clinically meaningful and durable antitumor activity, and an acceptable safety profile in patients with previously treated locally advanced or metastatic SCAC who have progressed on or are intolerant to platinum-based chemotherapy. Retifanlimab (PD-1 inhibitor) monotherapy demonstrated encouraging results in patients with platinum-refractory SCAC. Clinically meaningful antitumor activity was reported with ORR of 13.8% and stable disease in 35.1%, for a DCR of 48.9%. Observed responses in advanced SCAC were durable (median 9.5 months). Acceptable safety profile consistent with that reported for the PD-(L)1 inhibitor class. Promising results warrant further investigation of retifanlimab in advanced SCAC as well as earlier stages of disease.
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Affiliation(s)
- S Rao
- The Royal Marsden, London, UK.
| | | | - J Capdevila
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Teknon-IOB, Barcelona, Spain
| | - L Dahan
- Hôpital de la Timone, Marseille, France
| | - L Evesque
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - S Kim
- Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | | | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - L H Jensen
- University Hospital of Southern Denmark, Vejle, Denmark
| | - E Samalin
- Department of Digestive Oncology, Montpellier Cancer Institute (ICM), Montpellier University, Montpellier, France
| | | | - S Tamberi
- Department of Oncology/Haematology, AUSL Romagna Oncology Unit Faenza Hospital (RA), Faenza, Italy
| | - A Demols
- Department of Gastroenterology and GI Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Anderlecht, Belgium
| | - M G Guren
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | - D Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
| | - M Fakih
- City of Hope Comprehensive Cancer Center, Duarte, USA
| | - T Kayyal
- Renovatio Clinical, Houston, USA
| | | | - C Tian
- Incyte Corporation, Wilmington, USA
| | | | - M Smith
- Incyte Corporation, Wilmington, USA
| | - J-P Spano
- APHP-Sorbonne University-IUC, Paris, France
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11
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Mbanu P, Saunders MP, Mistry H, Mercer J, Malcomson L, Yousif S, Price G, Kochhar R, Renehan AG, van Herk M, Osorio EV. Clinical and radiomics prediction of complete response in rectal cancer pre-chemoradiotherapy. Phys Imaging Radiat Oncol 2022; 23:48-53. [PMID: 35800297 PMCID: PMC9253904 DOI: 10.1016/j.phro.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022] Open
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12
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Kopetz S, Morris VK, O'Neil B, Bridgewater JA, Graham J, Parkes EE, Saunders MP, Asken E, Goodwin L, Phillips C, Robertson J, Tilston C, Woodcock S, Cook N. A multi-arm, phase 2, open-label study to assess the efficacy of RXC004 as monotherapy and in combination with nivolumab in patients with ring finger protein 43 (RNF43) or R-spondin (RSPO) aberrated, metastatic, microsatellite stable colorectal cancer following standard treatments. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps3637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3637 Background: The Wnt pathway is a critical driver of cancer. RXC004 is a potent, selective, orally active inhibitor of the key Wnt pathway regulator, Porcupine. Inhibition of Porcupine blocks the release of all Wnt ligands from cells, preventing both tumour growth and tumour immune evasion. Wnt pathway alterations, including loss-of-function (LoF) RNF43 mutations and RSPO gene fusions, increase expression of the Wnt receptor Frizzled (Fzd) on the tumour cell surface, driving Wnt-ligand signalling. These alterations are present in ̃8% (Gao, 2013; Cerami, 2012; Shesagiri, 2012; Shinmura, 2014; Kleeman, 2019) of colorectal cancers (CRC). LoF RNF43 mutations are associated with poor prognosis in MSS CRC (Yaeger, 2018 ). Preclinical genetically selected CRC models showed disease stabilisation, differentiation towards a normal colonic phenotype with increased mucin secretion, and reduced metabolic activity on FDG-PET. In a Phase 1 study in patients with advanced solid tumours (NCT03447470), RXC004 was safe and tolerated at doses up to 2mg QD, the recommended phase 2 dose (RP2D), and showed a differentiated efficacy signal in Wnt-ligand dependent tumours (Cook, 2021 ). Methods: The PORCUPINE (NCT04907539) trial is a 2-arm Phase 2 trial of RXC004 monotherapy (Arm A) and RXC004 in combination with nivolumab (Arm B). 20 evaluable patients will be enrolled into each Arm. The study initially opened with Arm A; Arm B will be opened once the RP2D for RXC004 in combination with nivolumab is established in a separate phase 1 study. Once Arm B is opened, patients in Arm A may be treated with RXC004 + nivolumab if they have progressive disease on the first RECIST assessment scan. To be eligible for this study, patients must have metastatic microsatellite stable (MSS) CRC that has progressed following standard therapies. Tumours must have a LoF RNF43 mutation, or an RSPO2/3 fusion. As Wnt inhibition can affect bone metabolism, patients undergo a screening DEXA scan and receive prophylactic denosumab throughout the treatment period. The primary endpoint for Arm A is the disease control rate (DCR= CR+PR+SD at 16 wks), and for Arm B is objective response rate (ORR). Secondary endpoints are Safety and PK. Exploratory endpoints include FDG-PET changes and on-treatment changes in protein and gene expression in tumour biopsies. For Arm A, a target value (TV) of 60% DCR is considered a clinically significant improvement over standard of care against a lower reference value (LRV) of 40% DCR (Grothey, 2013; Mayer, 2015 ). For Arm B, a TV of 30% ORR is considered clinically significant against a LRV of 10% ORR (Eng, 201 9). RXC004 is also being investigated in a second Phase 2 trial, PORCUPINE 2 (NCT04907851), in Biliary Tract Cancers and RNF-43 mutated Pancreatic Cancers. Clinical trial information: NCT04907539.
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Affiliation(s)
- Scott Kopetz
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Van K. Morris
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Eileen E. Parkes
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | | | | | | | | | | | | | - Natalie Cook
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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13
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Shiu KK, Seligmann JF, Graham J, Wilson RH, Saunders MP, Iveson T, Kayhanian H, Khan KH, Rodriguez-Justo M, Jansen M, Obichere A, Plumb A, Seward E, Irvine S, Wilson W, Bhat R, Forsyth S, White L. NEOPRISM-CRC: Neoadjuvant pembrolizumab stratified to tumor mutation burden for high-risk stage 2 or stage 3 deficient-MMR/MSI-high colorectal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps3645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3645 Background: The prognostic advantage of early stage deficient-MMR/MSI-High CRC is lost after relapse, so there is a pressing clinical need to maximize the chance of cure in the early stages where prevalence of dMMR is higher comprising approximately 12% of Stage 3 and 20% of Stage 2 CRC. The efficacy of adjuvant checkpoint inhibition in this patient group has yet to be demonstrated in the context of micrometastatic disease without a supporting immune-competent microenvironment. Longitudinal studies especially in the neoadjuvant setting would optimally interrogate post-immunotherapy changes both in time and space. The NEOPRISM-CRC (NEOadjuvant PembRolizumab In Stratified Medicine – ColoReCtal) study is a Phase II Trial to determine whether neoadjuvant Pembrolizumab stratified to tumour mutation burden (TMB) is efficacious and safe. It will also be a platform to explore the relationships between possible predictive novel biomarkers and response to Pembrolizumab in blood, tumour tissue and microbiome. Methods: The study population consists of subjects with newly diagnosed operable dMMR/MSI-H CRC. Patients must be fit and eligible for planned curative surgery based on a) radiological node positive T1-4 CRC or b) high risk T3 defined as EITHER ≥ 5mm of extramural depth of invasion or unequivocal EMVI on imaging (regardless of depth), or T4 disease. They will receive one of two pre-operative regimens depending upon their TMB based on the FoundationOne®CDx test (FM1CDx). All patients will have one 21 day cycle of Pembrolizumab 200 mg IV. Prior to cycle 2 and with the result of the FM1CDx test, patients will continue their treatment as follows: A) TMB-high (defined as ≥20 mutations per Mb) or TMB-medium (defined as 6-19 mutations per Mb), or MSI-H on PCR if FM1CDx test is not evaluable: A further 2 cycles of Pembrolizumab 200 mg IV every 21 days. B) TMB-low (defined as ≤5 mutations per Mb), or if FM1CDx and PCR tests are not evaluable: No further Pembrolizumab given. Surgery to remove the CRC will be performed 4-6 weeks after the last dose of Pembrolizumab in both arms. Following resection patients may receive adjuvant chemotherapy in accordance with local institutional guidelines. The primary end point is pathological complete response rate (pCR). Secondary endpoints include 3 year RFS, OS, safety and health-related quality of life. Up to 32 patients will be registered over a 18-24 month period assuming that the pCR with 3 cycles of Pembrolizumab will be ≥ 33% for patients with high or medium TMB based on the FM1CDx profile, and intend to rule out a percentage ≤10%. To reach 80% power with 5% statistical significance, 19 patients are required in the high/medium TMB arm. The trial will be considered a success if at least 5/19 patients have a pCR after 3 cycles of Pembrolizumab. Enrolment will commence in March 2022. Clinical trial information: NCT05197322.
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Affiliation(s)
- Kai-Keen Shiu
- University College Hospital, NHS Foundation Trust, London, United Kingdom
| | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Richard H. Wilson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Khurum H. Khan
- North Middlesex University Hospital (NMUH) Cancer Services, National Health Service (NHS), United Kingdom (UK), London, United Kingdom
| | | | | | | | - Andrew Plumb
- UCLH NHS Foundation Trust, London, United Kingdom
| | | | | | - William Wilson
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, United Kingdom
| | - Reshma Bhat
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - Sharon Forsyth
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
| | - Laura White
- Cancer Research UK & University College London Cancer Trials Centre, London, United Kingdom
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14
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Mbanu P, Osorio EV, Mistry H, Malcomson L, Yousif S, Aznar M, Kochhar R, Van Herk M, Renehan AG, Saunders MP. Clinico-pathological predictors of clinical complete response in rectal cancer. Cancer Treat Res Commun 2022; 31:100540. [PMID: 35231874 DOI: 10.1016/j.ctarc.2022.100540] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Prediction of clinical complete response in rectal cancer before neoadjuvant chemo-radiotherapy treatment enables treatment selection. Patients predicted to have complete response could have chemo-radiotherapy, and others could have additional doublet chemotherapy at this stage of their treatment to improve their overall outcome. This work investigates the role of clinical variables in predicting clinical complete response. METHOD Using the UK-based OnCoRe database (2008 to 2019), we performed a propensity-score matched study of 322 patients who received neoadjuvant chemoradiotherapy. We collected pre-treatment clinic-pathological, inflammatory and radiotherapy-related characteristics. We determined the odds for the occurrence of cCR using conditional logistic regression models. We derived the post-model Area under the Curve (AUC) as an indicator of discrimination performance and stated a priori that an AUC of 0.75 or greater was required for potential clinical utility. RESULTS Pre-treatment tumour diameter, mrT-stage, haemoglobin, alkaline phosphate and total radiotherapy depths were associated with cCR on univariable and multivariable analysis. Additionally, neutrophil to lymphocyte ratio (NLR), neutrophil-monocyte to lymphocyte ratio (NMLR), lymphocyte count and albumin were all significantly associated with cCR on multivariable analysis. A nomogram using the above parameters was developed with a resulting ROC AUC of 0.75. CONCLUSION We identified routine clinic-pathological, inflammatory and radiotherapy-related variables which are independently associated with cCR. A nomogram was developed to predict cCR. The performance characteristics from this model were on the prior clinical utility threshold. Additional research is required to develop more associated variables to better select patients with rectal cancer undergoing chemoradiotherapy who may benefit from pursuing a W&W strategy.
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Affiliation(s)
- P Mbanu
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - E Vasquez Osorio
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - H Mistry
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - L Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, United Kingdom
| | - S Yousif
- Department of Clinical Oncology, Lancashire Teaching Hospital, Preston, United Kingdom
| | - M Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - R Kochhar
- Department of Radiological Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M P Saunders
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, United Kingdom
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15
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Hanna CR, O'Cathail SM, Graham J, Saunders MP, Samuel LM, Devlin L, Edwards J, Maka N, Kelly C, Dempsey L, Jones L, Lewsley LA, Morrison P, Atherton P, Dillon S, Gourlay J, Platt J, Tiplady E, Adams R, Roxburgh CSD. Durvalumab (MEDI 4736) with extended neoadjuvant regimens in rectal cancer: A randomized phase II trial (PRIME-RT). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.tps231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS231 Background: Advances in multi-modality treatment of locally advanced rectal cancer (LARC) have resulted in low local recurrence rates, but many patients still die from distant disease. There is increasing recognition that with neoadjuvant treatment some patients achieve a complete response and may avoid surgical resection. The PRIME-RT trial tests the inclusion of neoadjuvant immunotherapy with the aim of enhancing complete response rates, improving stoma-free survival and reducing distant relapse. Methods: PRIME-RT is a multi-centre, open label, phase II, randomised trial for patients with newly diagnosed LARC. Eligible patients are randomised to Arm A: short course radiotherapy (25 Gray in 5 fractions) with concomitant durvalumab, followed by durvalumab and FOLFOX chemotherapy, or Arm B: long course chemoradiotherapy (50 Gray to primary tumour, 45 Gray to elective nodes, in 25 fractions with capecitabine) with concomitant durvalumab followed by FOLFOX and durvalumab. The primary endpoint is complete response rate in each arm. Bio-specimens including serial tumour biopsies and peripheral blood samples are collected prior to, during, and following treatment to explore the molecular and immunological factors underpinning treatment response. The main trial will recruit up to 42 patients and commence after a safety run-in (n≥6) which is recruiting patients with metastatic disease. After opening in January 2021, three patients have been treated within the safety run-in; 2 in Arm A and 1 in Arm B. Early recruitment to PRIME-RT has shown that adding immunotherapy in the neoadjuvant setting for LARC is feasible. The expectation is that the trial will provide efficacy and safety information which allows the optimal treatment approach to be tested within a larger phase clinical trial. Funding information Core funding (Glasgow CRUK CTU) and trial specific funding (Astrazeneca). Trial registration Clinicaltrials.gov NCT04621370 (Registered 9 Nov 2020) ISRCTN18138369 (Registered 27 October 2020) Clinical trial information: NCT04621370.
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Affiliation(s)
| | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - Lynsey Devlin
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | - Noori Maka
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, United Kingdom
| | - Laura Dempsey
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow,, Glasgow, United Kingdom
| | - Leia Jones
- University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | | | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
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16
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Church D, Sansom O, Maka N, Edwards J, Oien K, Iveson T, Saunders MP, Boukovinas I, Messaritakis I, Moustou E, Chondrozoumaki M, Georgoulias V, Kassambara A, Catteau A, Galon J, Dempsey L, Hay J, Kelly C, Sougklakos I, Harkin A. Clinical performance of Immunoscore in stage III colorectal cancer patients in the SCOT and IDEA-HORG cohorts. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
196 Background: The ESMO clinical practice guidelines recommend consideration of Immunoscore (IS) for risk assessment of early colon cancer patients. IS clinical performance was assessed in the SCOT and IDEA-HORG trials evaluating 3 vs. 6 months (3m vs. 6m) of mFOLFOX6 adjuvant chemotherapy in stage III colorectal cancer (CRC). Methods: 1,002 formalin-fixed paraffin-embedded (FFPE) tumor samples (762 from SCOT;240 from HORG) were collected, of which 851 were eligible for biomarker analysis. Eligible samples were classified into 2 groups using pre-defined cut-offs (IS-Low, IS- High) and the performance of IS to predict 3 year disease-free survival (3y-DFS) was evaluated. Results: IS was successfully assessed in 846 cases (99%). 615 (72.7%) samples were classified as IS-High (311 and 304 in 3m and 6m arm, respectively). No significant association between IS and patients’ gender, age, PS, BMI or primary tumour location was observed. However, a significant difference between IS-High (43.7%) and IS Low (57.1%) was observed in the proportion of high risk (T4 and/or N2) tumours (p=0.001). Patients with IS-High tumors had significantly longer 3y-DFS (79.4%, 95%CI: 75.9%-82.4%) compared to those with IS-Low tumors (65.0%, 95%CI: 58.3%-70.9%); adjusted hazard ratio (HR) 1.9 (95%CI: 1.46-2.46; p<0.0001). Similarly, IS-High was significantly correlated with longer 3y-DFS in both treatment arms: 78.5% (95% CI 73.4%-82.7%) for IS-High and 65.8% (95% CI 56.1%-73.9%) for IS-Low in 3m arm; 80.3% (95% CI 75.3%-84.5%) for IS-High and 64.4% (95% CI 54.8%-72.6%) for IS-Low in 6m arm. The estimated HRs according to treatment duration and IS classification were 1.80 (95% CI 1.25-2.60) in 3m arm, 2.00 (95% CI 1.38-2.92) in 6m arm and 1.89 (95% CI 1.46-2.47) in the total study population; interaction p = 0.687. Conclusions: The results of this study confirm the prognostic value of IS observed in the IDEA-France trial (Pagès F et al 2020). However, this analysis was not powered to determine the predictive value of IS for treatment duration. Similar analysis of patients treated with CAPOX is warranted.
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Affiliation(s)
- David Church
- Wellcome Centre for Human Genetics & Oxford Cancer Centre, University of Oxford Roosevelt Drive, Oxford, United Kingdom
| | - Owen Sansom
- Beatson Institute of Cancer Research, Glasgow, United Kingdom
| | - Noori Maka
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | - Karin Oien
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | - Ippokratis Messaritakis
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Heraklion, Greece
| | - Eleni Moustou
- Lab of Pathology, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Chondrozoumaki
- Lab of Translational Oncology Medical School University of Crete, Heraklion, Greece
| | - Vassilis Georgoulias
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Athens, Greece
| | | | | | | | - Laura Dempsey
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow,, Glasgow, United Kingdom
| | - Jennifer Hay
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Glasgow, United Kingdom
| | - Ioannis Sougklakos
- Lab of Translational Oncology Medical School University of Crete, Heraklion, Greece
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17
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Bordonaro R, Calvo A, Auriemma A, Hollebecque A, Rubovszky G, Saunders MP, Pápai Z, Prager G, Stein A, André T, Argilés G, Cubillo A, Dahan L, Edeline J, Leger C, Cattan V, Fougeray R, Amellal N, Tabernero J. Trifluridine/tipiracil in combination with oxaliplatin and either bevacizumab or nivolumab in metastatic colorectal cancer: a dose-expansion, phase I study. ESMO Open 2021; 6:100270. [PMID: 34547581 PMCID: PMC8453191 DOI: 10.1016/j.esmoop.2021.100270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/11/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background In preclinical studies trifluridine/tipiracil (FTD/TPI) plus oxaliplatin (Industriestrasse, Holzkirchen, Germany) sensitised microsatellite stable (MSS) metastatic colorectal cancer (mCRC) to anti-programmed cell death protein-1; the addition of oxaliplatin or bevacizumab (F Hoffmann- la ROCHE AG, Kaiseraugst, Switzerland) enhanced the antitumour effects of FTD/TPI. This study aimed to investigate the safety and efficacy of FTD/TPI plus oxaliplatin and either bevacizumab or nivolumab (Uxbridge business Park, Uxbridge, United Kingdom) in patients with mCRC who had progressed after at least one prior line of treatment. Patients and methods In 14-day cycles, patients received FTD/TPI 35 mg/m2 (twice daily, days 1-5) plus oxaliplatin 85 mg/m2 (day 1), and, on day 1, either bevacizumab 5 mg/kg (cohort A) or nivolumab 3 mg/kg (cohort B). Patients in Cohort B had confirmed MSS status. Results In total, 54 patients were enrolled: 37 in cohort A and 17 in cohort B. Recruitment in cohort B was stopped early due to the low response rate (RR) observed at interim analyses of efficacy. The most common adverse events (AEs) in cohort A were neutropenia/decreased neutrophils (75.7%), nausea (59.5%), vomiting (40.5%), diarrhoea (37.8%), peripheral sensory neuropathy (37.8%), fatigue (35.1%) and decreased appetite (35.1%). In cohort B, the most common AEs were neutropenia/decreased neutrophils (70.6%), diarrhoea (58.8%), nausea (47.1%), vomiting (47.1%), fatigue (47.1%), asthenia (41.2%), paraesthesia (41.2%), thrombocytopenia/decreased platelets (35.3%) and decreased appetite (35.3%). Confirmed objective RR was 17.1% in cohort A and 7.1% in cohort B; the corresponding values for median progression-free survival in the two cohorts were 6.3 and 6.0 months. Conclusion FTD/TPI plus oxaliplatin and bevacizumab or nivolumab had an acceptable safety profile and demonstrated antitumour activity in previously treated patients with mCRC. This study evaluated the safety and efficacy of FTD/TPI plus oxaliplatin and either bevacizumab or nivolumab in mCRC patients. FTD/TPI plus oxaliplatin in combination with bevacizumab or nivolumab had an acceptable and manageable safety profile. Antitumour activity was observed following treatment with FTD/TPI plus oxaliplatin and bevacizumab. Despite a modest RR with the addition of nivolumab, survival data were promising in these poor-prognosis patients.
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Affiliation(s)
- R Bordonaro
- Azienda Ospedaliera ARNAS Garibaldi, Catania, Italy.
| | - A Calvo
- Gregorio Marañon University General Hospital, Madrid, Spain
| | - A Auriemma
- Azienda Ospedaliera Universitaria Integrat, University of Verona, Verona, Italy
| | - A Hollebecque
- Drug Development Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - G Rubovszky
- Department of Medical Oncology and Clinical Pharmacology, National Institute of Oncology Hungary, Budapest, Hungary
| | | | - Z Pápai
- Department of Medical Oncology, Duna Medical Centre, Budapest, Hungary
| | - G Prager
- Comprehensive Cancer Centre Vienna, Medical University Vienna, Austria
| | - A Stein
- UKE Universitätsklinikum Hamburg-Eppendorf KMTZ, Hamburg, Germany
| | - T André
- Sorbonne Université et Hôpital Saint-Antoine, Service d'Oncologie Médicale, Paris, France
| | - G Argilés
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - A Cubillo
- Medical Oncology, Hospital Universitario Madrid Sanchinarro Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - L Dahan
- Aix Marseille University; Assistance Publique Hôpitaux de Marseille, Centre d'Essais Précoces en Cancérologie de Marseille CLIP, Marseille, France
| | - J Edeline
- Department of Medical Oncology, Centre Eugene Marquis, ARPEGO network, Rennes, France
| | - C Leger
- Institut de Recherches Internationales Servier, Suresnes, France
| | - V Cattan
- Institut de Recherches Internationales Servier, Suresnes, France
| | - R Fougeray
- Institut de Recherches Internationales Servier, Suresnes, France
| | - N Amellal
- Institut de Recherches Internationales Servier, Suresnes, France
| | - J Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; UVic-UCC, IOB-Quiron, Barcelona, Spain
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18
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King J, Swinton M, Grant G, Buckley L, Lavin V, Alam N, Saunders MP. Is it Time to Look for Better Prognostic Markers and Reconsider Adjuvant Chemotherapy for Locally Advanced Anal Cancers? Clin Oncol (R Coll Radiol) 2021; 33:e465-e466. [PMID: 34127351 DOI: 10.1016/j.clon.2021.05.010] [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] [Received: 04/24/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J King
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - M Swinton
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - G Grant
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - L Buckley
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - V Lavin
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - N Alam
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - M P Saunders
- The Christie Hospital NHS Foundation Trust, Manchester, UK
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19
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Iveson TJ, Sobrero AF, Yoshino T, Souglakos I, Ou FS, Meyers JP, Shi Q, Grothey A, Saunders MP, Labianca R, Yamanaka T, Boukovinas I, Hollander NH, Galli F, Yamazaki K, Georgoulias V, Kerr R, Oki E, Lonardi S, Harkin A, Rosati G, Paul J. Duration of Adjuvant Doublet Chemotherapy (3 or 6 months) in Patients With High-Risk Stage II Colorectal Cancer. J Clin Oncol 2021; 39:631-641. [PMID: 33439695 PMCID: PMC8078416 DOI: 10.1200/jco.20.01330] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/17/2020] [Accepted: 10/23/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE As oxaliplatin results in cumulative neurotoxicity, reducing treatment duration without loss of efficacy would benefit patients and healthcare providers. PATIENTS AND METHODS Four of the six studies in the International Duration of Adjuvant Chemotherapy (IDEA) collaboration included patients with high-risk stage II colon and rectal cancers. Patients were treated (clinician and/or patient choice) with either fluorouracil, leucovorin, and oxaliplatin (FOLFOX) or capecitabine and oxaliplatin (CAPOX) and randomly assigned to receive 3- or 6-month treatment. The primary end point is disease-free survival (DFS), and noninferiority of 3-month treatment was defined as a hazard ratio (HR) of < 1.2- v 6-month arm. To detect this with 80% power at a one-sided type one error rate of 0.10, a total of 542 DFS events were required. RESULTS 3,273 eligible patients were randomly assigned to either 3- or 6-month treatment with 62% receiving CAPOX and 38% FOLFOX. There were 553 DFS events. Five-year DFS was 80.7% and 83.9% for 3-month and 6-month treatment, respectively (HR, 1.17; 80% CI, 1.05 to 1.31; P [for noninferiority] .39). This crossed the noninferiority limit of 1.2. As in the IDEA stage III analysis, the duration effect appeared dependent on the chemotherapy regimen although a test of interaction was negative. HR for CAPOX was 1.02 (80% CI, 0.88 to 1.17), and HR for FOLFOX was 1.41 (80% CI, 1.18 to 1.68). CONCLUSION Although noninferiority has not been demonstrated in the overall population, the convenience, reduced toxicity, and cost of 3-month adjuvant CAPOX suggest it as a potential option for high-risk stage II colon cancer if oxaliplatin-based chemotherapy is suitable. The relative contribution of the factors used to define high-risk stage II disease needs better understanding.
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Affiliation(s)
| | | | | | - Ioannis Souglakos
- Department of Medical Oncology, University Hospital of Heraklion, Iraklio, Greece
| | | | | | | | - Axel Grothey
- West Cancer Center and Research Institute, Germantown, TN
| | | | - Roberto Labianca
- Cancer Center, Ospedale Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Kanagawa, Japan
| | | | | | - Fabio Galli
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | | | - Rachel Kerr
- University of Oxford, Oxford, United Kingdom
| | - Eiji Oki
- Kyushu University, Fukuoka, Japan
| | - Sara Lonardi
- Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Andrea Harkin
- University of Glasgow, Institute of Cancer Sciences, Scotland, United Kingdom
| | | | - James Paul
- University of Glasgow, Institute of Cancer Sciences, Scotland, United Kingdom
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20
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Barriuso J, Nagaraju RT, Belgamwar S, Chakrabarty B, Burghel GJ, Schlecht H, Foster L, Kilgour E, Wallace AJ, Braun M, Dive C, Evans DG, Bristow RG, Saunders MP, O'Dwyer ST, Aziz O. Early Adaptation of Colorectal Cancer Cells to the Peritoneal Cavity Is Associated with Activation of "Stemness" Programs and Local Inflammation. Clin Cancer Res 2021; 27:1119-1130. [PMID: 33257424 PMCID: PMC7611320 DOI: 10.1158/1078-0432.ccr-20-3320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/20/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE At diagnosis, colorectal cancer presents with synchronous peritoneal metastasis in up to 10% of patients. The peritoneum is poorly characterized with respect to its superspecialized microenvironment. Our aim was to describe the differences between peritoneal metastases and their matched primary tumors excised simultaneously at the time of surgery. Also, we tested the hypothesis of these differences being present in primary colorectal tumors and having prognostic capacity. EXPERIMENTAL DESIGN We report a comprehensive analysis of 30 samples from peritoneal metastasis with their matched colorectal cancer primaries obtained during cytoreductive surgery. We tested and validated the prognostic value of our findings in a pooled series of 660 colorectal cancer primary samples with overall survival (OS) information and 743 samples with disease-free survival (DFS) information from publicly available databases. RESULTS We identified 20 genes dysregulated in peritoneal metastasis that promote an early increasing role of "stemness" in conjunction with tumor-favorable inflammatory changes. When adjusted for age, gender, and stage, the 20-gene peritoneal signature proved to have prognostic value for both OS [adjusted HR for the high-risk group (vs. low-risk) 2.32 (95% confidence interval, CI, 1.69-3.19; P < 0.0001)] and for DFS [adjusted HR 2.08 (95% CI, 1.50-2.91; P < 0.0001)]. CONCLUSIONS Our findings indicated that the activation of "stemness" pathways and adaptation to the peritoneal-specific environment are key to early stages of peritoneal carcinomatosis. The in silico analysis suggested that this 20-gene peritoneal signature may hold prognostic information with potential for development of new precision medicine strategies in this setting.
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Affiliation(s)
- Jorge Barriuso
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom.
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, United Kingdom
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - Raghavendar T Nagaraju
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, United Kingdom
| | - Shreya Belgamwar
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - Bipasha Chakrabarty
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - George J Burghel
- NW GLH (Manchester), Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
| | - Helene Schlecht
- NW GLH (Manchester), Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
| | - Lucy Foster
- Department of Pathology, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
| | - Elaine Kilgour
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, University of Manchester, Manchester, England, United Kingdom
| | - Andrew J Wallace
- NW GLH (Manchester), Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
| | - Michael Braun
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, United Kingdom
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - Caroline Dive
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, University of Manchester, Manchester, England, United Kingdom
| | - D Gareth Evans
- Department of Genomic Medicine, Division of Evolution and Genomic Science, University of Manchester, England, United Kingdom
| | - Robert G Bristow
- Manchester Cancer Research Centre, CRUK Manchester Institute, University of Manchester, Manchester, England, United Kingdom
| | - Mark P Saunders
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - Sarah T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, United Kingdom
| | - Omer Aziz
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, England, United Kingdom.
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England, United Kingdom
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21
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Kamposioras K, Lim KHJ, Saunders MP, Marti K, Anderson D, Cutting M, McCool D, Connell J, Simpson L, Hasan J, Braun M, Lavin V, Mullamitha S, Barriuso J. The impact of changes in service delivery in patients with colorectal cancer during the first peak of the COVID-19 pandemic. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
28 Background: Increased levels of anxiety and distress in both patients and physicians have been reported in response to the significant impact COVID-19 has on cancer service delivery globally. We aimed to investigate how these changes have been perceived by patients diagnosed with colorectal cancer and identify determinants of increased anxiety. Methods: Survey (32-item) of consecutive patients diagnosed with colorectal cancer attending a large tertiary comprehensive cancer centre in the United Kingdom (18 May to 1 July 2020). Self-reported GAD-7 (both paper/electronic forms) was used as a screening tool for anxiety. Statistical analyses of associations:Chi-square, Fisher’s exact, and uni- and multi-variable analyses were performed using SPSS v19 and R. Results: A total of 143 patients (response rate 67%), 82% male, and median age of 61-70 years were included. Majority of patients had telephone consultation (78%), including 40% who had scan results discussed over the phone; with favourable feedback received with both respectively. Twenty-three patients (18%) were considered to have anxiety, with 7 (6%) scoring for moderate or severe anxiety. Three items asked patients if they had concerns about getting COVID-19, were worried that COVID-19 would have effect on mental health, and affect their experience of cancer care. Patients answering positively to any of these items were most likely to have anxiety; multivariate analysis – OR 2.361 (95% CI 1.187-4.694, p=0.014), 3.219 (95% CI 1.401-7.395, p=0.006) and 3.206 (95% CI 1.036-9.920, p=0.043), respectively. Majority of the patients did not feel that they needed support during the pandemic period and hence the available well-being services were not used. Patients felt that friends and family had been very supportive but less so the primary care services (p<0.05). However, they felt they were supported by the clinical team. Conclusions: At our centre, during the first-peak of COVID-19 pandemic in the UK, patients with colorectal cancer did not display increased rates of significant anxiety. The findings of this survey suggests that some service changes implemented, including increased telephone follow-up, may have already improved the overall experience of cancer care. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasising the need to continue to provide comprehensive cancer care even if we get a “2nd wave” of COVID-19.
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Affiliation(s)
| | | | | | - Kalena Marti
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel Anderson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mark Cutting
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Danielle McCool
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Lilly Simpson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jurjees Hasan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael Braun
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Victoria Lavin
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Jorge Barriuso
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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22
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Van Cutsem E, Danielewicz I, Saunders MP, Pfeiffer P, Argiles G, Borg C, Glynne-Jones R, Punt CJA, van de Wouw AJ, Fedyanin M, Stroyakovskiy D, Kroening H, Garcia-Alfonso P, Wasan HS, Falcone A, Aubel P, Egorov A, Amellal N, Moiseenko V. Phase II study evaluating trifluridine/tipiracil + bevacizumab and capecitabine + bevacizumab in first-line unresectable metastatic colorectal cancer (mCRC) patients who are noneligible for intensive therapy (TASCO1): Results of the final analysis on the overall survival. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.14] [Citation(s) in RCA: 4] [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
14 Background: Our phase II randomized study was conducted in patients with previously untreated unresectable mCRC not eligible to receive standard oxaliplatin- or irinotecan- based chemotherapy regimens. The results of the primary study analysis were reported earlier and demonstrated a promising efficacy in terms of progression-free survival (PFS) and an acceptable safety profile for the combination of trifluridine/tipiracil + bevacizumab (E. Van Cutsem et al. Ann. Oncol. 2020). Here we present the final end-of-study analysis on the overall survival (OS). Methods: Eligible patients were randomized in 1:1 ratio to receive either trifluridine/tipiracil administered orally at 35 mg/m²/dose bid from days 1-5 and days 8-12, and bevacizumab at 5 mg/kg on days 1 and 15 of a 28-day treatment cycle (TT-B), or capecitabine administered orally at 1250 or 1000 mg/m²/dose bid (according to the patient’s status) from days 1-14 and bevacizumab at 7.5 mg/kg on day 1 of a 21-day treatment cycle (C-B). Cycles were repeated until documented disease progression, unacceptable toxicity, or investigator’s/patient’s decision. Following the treatment discontinuation, all patients were followed for OS until the end-of-study, which was defined as the date of the withdrawal visit for the last patient. In the absence of death confirmation or for patients alive as of the end-of-study date, survival time was censored at the date of their last study follow-up. For the OS analysis the HR and the corresponding 2-sided 80% and 2-sided 95% CIs for TT-B versus C-B were estimated using a Cox proportional hazard model adjusting for the stratification factors based on IWRS data. OS was summarized using Kaplan-Meier curves and further characterized in terms of the median and survival probabilities at 6, 12, 18, and 24 months along with the corresponding 2-sided 80% and 2-sided 95% CI (Brookmeyer and Crowley CI for median and Kalbfleisch and Prentice CI for survival probabilities). Results: From April 2016 to March 2017, 153 patients were randomized and followed until end-of-study on September 1, 2020. Twenty-one patients, 11 from TT-B and 10 from C-B, were alive and censored for the analysis. Median OS was 22.31 months in TT-B and 17.67 months in C-B with HR 0.78 (95% CI, 0.55, 1.10). Survival probability at 18 months in TT-B was 0.62 (95% CI, 0.50, 0.72), and 0.47 (95% CI, 0.35, 0.57) in C-B. Conclusions: Our study demonstrated earlier a median PFS of 9.2 months for TT-B and 7.8 months for C-B when administered to patients with previously untreated unresectable mCRC ineligible for standard combination chemotherapy. The final study analysis performed on OS, the main secondary endpoint, provided further evidence for TT-B as a noteworthy valuable regimen in this population settings. Clinical trial information: NCT02743221.
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Affiliation(s)
- Eric Van Cutsem
- University Hospital Gasthuisberg and University of Leuven, Leuven, Belgium
| | - Iwona Danielewicz
- Szpitale Wojewodzkie w Gdyni/Gdansk Medical University, Gdynia, Poland
| | | | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Guillem Argiles
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC, TTD Group, Barcelona, Spain
| | - Christophe Borg
- Department of Medical Oncology, Besancon University Hospital, Besancon, France
| | | | - Cornelis J. A. Punt
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Mikhail Fedyanin
- Federal State Budgetary Institution N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation (N.N. Blokhin NMRCO), Moscow, Russian Federation
| | | | - Hendrik Kroening
- Schwerpunktpraxis für Hämatologie und Onkologie, Magdeburg, Germany
| | | | - Harpreet Singh Wasan
- Hammersmith Hospital, Division of Cancer, Imperial College London, London, United Kingdom
| | | | - Paul Aubel
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Anton Egorov
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Nadia Amellal
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Vladimir Moiseenko
- Saint-Petersburg Scientific Practical Center for Specialized Medical Care, St. Petersburg, Russian Federation
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Sekhar H, Kochhar R, Carrington B, Kaye T, Tolan D, Saunders MP, Sperrin M, Sebag-Montefiore D, van Herk M, Renehan AG. Three-dimensional (3D) magnetic resonance volume assessment and loco-regional failure in anal cancer: early evaluation case-control study. BMC Cancer 2020; 20:1165. [PMID: 33256671 PMCID: PMC7706015 DOI: 10.1186/s12885-020-07613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The primary aim was to test the hypothesis that deriving pre-treatment 3D magnetic resonance tumour volume (mrTV) quantification improves performance characteristics for the prediction of loco-regional failure compared with standard maximal tumour diameter (1D) assessment in patients with squamous cell carcinoma of the anus undergoing chemoradiotherapy. Methods We performed an early evaluation case-control study at two UK centres (2007–2014) in 39 patients with loco-regional failure (cases), and 41 patients disease-free at 3 years (controls). mrTV was determined using the summation of areas method (Volsum). Reproducibility was assessed using intraclass concordance correlation (ICC) and Bland-Altman limits of agreements. We derived receiver operating curves using logistic regression models and expressed accuracy as area under the curve (ROCAUC). Results The median time per patient for Volsum quantification was 7.00 (inter-quartile range, IQR: 0.57–12.48) minutes. Intra and inter-observer reproducibilities were generally good (ICCs from 0.79 to 0.89) but with wide limits of agreement (intra-observer: − 28 to 31%; inter-observer: − 28 to 46%). Median mrTVs were greater for cases (32.6 IQR: 21.5–53.1 cm3) than controls (9.9 IQR: 5.7–18.1 cm3, p < 0.0001). The ROCAUC for mrT-size predicting loco-regional failure was 0.74 (95% CI: 0.63–0.85) improving to 0.82 (95% CI: 0.72–0.92) when replaced with mrTV (test for ROC differences, p = 0.024). Conclusion Preliminary results suggest that the replacement of mrTV for mrT-size improves prediction of loco-regional failure after chemoradiotherapy for squamous cell carcinoma of the anus. However, mrTV calculation is time consuming and variation in its reproducibility are drawbacks with the current technology. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07613-7.
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Affiliation(s)
- Hema Sekhar
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK.
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Thomas Kaye
- Department of Clinical Radiology, St James' University Hospital, Leeds, UK
| | - Damian Tolan
- Department of Clinical Radiology, St James' University Hospital, Leeds, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David Sebag-Montefiore
- Leeds Institute of Cancer & Pathology, University of Leeds, St James' University Hospital, Leeds, UK
| | - Marcel van Herk
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Andrew G Renehan
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
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Germetaki T, Nicholls C, Adams RA, Braun M, Rogan J, Moghadam S, Lenfert E, Lukas A, Edelstein DL, Jones FS, Saunders MP. Blood-based RAS mutation testing: concordance with tissue-based RAS testing and mutational changes on progression. Future Oncol 2020; 16:2177-2189. [PMID: 32716216 DOI: 10.2217/fon-2020-0523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: To determine the concordance between plasma and tissue RAS mutation status in metastatic colorectal cancer patients to gauge whether blood-based testing is a viable alternative. We also evaluated the change in mutation status on progression. Materials/methods: RAS testing was performed on plasma from patients commencing first-line therapy (OncoBEAM™ RAS CEIVD kit). Results were then compared with formalin-fixed paraffin embedded tumor samples. Results: The overall percentage agreement (concordance) was 86.0% (86/100), which demonstrates that blood-based testing is an alternative to tissue-based testing. Reproducibility was 100% between three laboratories and 20% showed changes in their RAS mutational status on progression. Conclusion: These results show good concordance between tissue and plasma samples and suggest the need for longitudinal plasma testing during treatment to guide management decisions.
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Affiliation(s)
- Theodora Germetaki
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Camille Nicholls
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Richard A Adams
- Department of Medical Oncology, Velindre Hospital, Velindre Road, Cardiff, Wales CF14 2TL, UK
| | - Michael Braun
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Jane Rogan
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Sharzad Moghadam
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Eva Lenfert
- Sysmex Inostics GmbH, Falkenried 88, Hamburg 20251, Germany
| | - Antje Lukas
- Sysmex Inostics GmbH, Falkenried 88, Hamburg 20251, Germany
| | | | | | - Mark P Saunders
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
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Renehan A, Saunders MP, Hill JE, James R, O'Dwyer ST. Radiotherapy versus combined modality therapy for anal carcinoma. Hippokratia 2020. [DOI: 10.1002/14651858.cd004652.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew Renehan
- Institute of Cancer Studies, University of Manchester; Christie Hospital NHS Trust; Manchester UK
| | - Mark P Saunders
- Department of Radiation Oncology; Christie Hospital NHS Trust; Manchester UK
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26
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Rao S, Sclafani F, Eng C, Adams RA, Guren MG, Sebag-Montefiore D, Benson A, Bryant A, Peckitt C, Segelov E, Roy A, Seymour MT, Welch J, Saunders MP, Muirhead R, O’Dwyer P, Bridgewater J, Bhide S, Glynne-Jones R, Arnold D, Cunningham D. International Rare Cancers Initiative Multicenter Randomized Phase II Trial of Cisplatin and Fluorouracil Versus Carboplatin and Paclitaxel in Advanced Anal Cancer: InterAAct. J Clin Oncol 2020; 38:2510-2518. [PMID: 32530769 PMCID: PMC7406334 DOI: 10.1200/jco.19.03266] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To compare cisplatin plus fluorouracil (FU) versus carboplatin plus paclitaxel in chemotherapy-naïve advanced anal cancer to establish the optimal regimen. PATIENTS AND METHODS Patients who had not received systemic therapy for advanced anal cancer were randomly assigned 1:1 to intravenous cisplatin 60 mg/m2 (day 1) plus FU 1,000 mg/m2 (days 1-4) every 21 days or carboplatin (area under the curve, 5; day 1) plus paclitaxel 80 mg/m2 (days 1, 8, and 15) every 28 days for 24 weeks, until disease progression, intolerable toxicity, or withdrawal of consent. Primary end point was objective response rate (ORR). Primary and secondary end points were assessed in a hierarchic model to compare the regimens and pick the winner. RESULTS We conducted an international multicenter randomized phase II study in 60 centers between December 2013 and November 2017. Median follow-up was 28.6 months. A total of 91 patients were randomly assigned: 46 to cisplatin plus FU and 45 to carboplatin plus paclitaxel. ORR was 57% (95% CI, 39.4% to 73.7%) for cisplatin plus FU versus 59% (95% CI, 42.1% to 74.4%) for carboplatin plus paclitaxel. More serious adverse events were noted in the cisplatin plus FU arm (62%) compared with the carboplatin plus paclitaxel arm (36%; P = .016). Median progression-free survival was 5.7 months (95% CI, 3.3 to 9.0 months) for cisplatin plus FU compared with 8.1 months (95% CI, 6.6 to 8.8 months) for carboplatin plus paclitaxel. Median overall survival was 12.3 months for cisplatin plus FU (95% CI, 9.2 to 17.7 months) compared with 20 months (95% CI, 12.7 months to not reached) for carboplatin plus paclitaxel (hazard ratio, 2.00; 95% CI, 1.15 to 3.47; P = .014). CONCLUSION This is the first international randomized trial to our knowledge conducted in chemotherapy-naïve advanced anal cancer. Although there was no difference in ORR, the association with clinically relevant reduced toxicity and a trend toward longer survival suggest that carboplatin plus paclitaxel should be considered as a new standard of care.
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Affiliation(s)
- Sheela Rao
- Royal Marsden Hospital, London, United Kingdom
| | | | - Cathy Eng
- MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | | | - Eva Segelov
- Monash Health and Monash University, Melbourne, VIC, Australia
| | - Amitesh Roy
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | | | | | | | | | - Peter O’Dwyer
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network, Philadelphia, PA
| | | | - Shree Bhide
- Institute of Cancer Research, London, United Kingdom
| | | | - Dirk Arnold
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network, Philadelphia, PA
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27
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Van Cutsem E, Danielewicz I, Saunders MP, Pfeiffer P, Argilés G, Borg C, Glynne-Jones R, Punt CJA, Van de Wouw AJ, Fedyanin M, Stroyakovskiy D, Kroening H, Garcia-Alfonso P, Wasan H, Falcone A, Kanehisa A, Egorov A, Aubel P, Amellal N, Moiseenko V. Trifluridine/tipiracil plus bevacizumab in patients with untreated metastatic colorectal cancer ineligible for intensive therapy: the randomized TASCO1 study. Ann Oncol 2020; 31:1160-1168. [PMID: 32497736 DOI: 10.1016/j.annonc.2020.05.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We designed an open-label, noncomparative phase II study to assess the safety and efficacy of first-line treatment with trifluridine/tipiracil plus bevacizumab (TT-B) and capecitabine plus bevacizumab (C-B) in untreated patients with unresectable metastatic colorectal cancer (mCRC) who were not candidates for combination with cytotoxic chemotherapies. PATIENTS AND METHODS From 29 April 2016 to 29 March 2017, 153 patients were randomly assigned (1:1) to either TT-B (N = 77) or C-B (N = 76). The primary end point was progression-free survival (PFS). The primary PFS analysis was performed after 100 events (radiological progression or death) were observed. Secondary end points included overall survival (OS), quality of life (QoL; QLQ-C30 and QLQ-CR29 questionnaires), and safety. RESULTS Median (range) duration of treatment was 7.8 (6.0-9.7) months and 6.2 (4.1-9.1) months in the TT-B and C-B groups, respectively. Median (range) PFS was 9.2 (7.6-11.6) and 7.8 (5.5-10.1) months, respectively. Median (range) OS was 18 (15.2 to NA) and 16.2 (12.5 to NA) months, respectively. QoL questionnaires showed no relevant changes over time for either treatment. Therapies were well tolerated. Patients receiving TT-B had more grade ≥3 neutropenia (47% versus 5% with C-B). Patients receiving C-B had more grade ≥3 hand-foot syndrome (12% versus 0% with TT-B) and grade ≥3 diarrhea (8% versus 1% with TT-B), consistent with the known safety profiles of these agents. CONCLUSION TT-B treatment showed promising clinical activity in untreated patients with unresectable mCRC ineligible for intensive therapy, with an acceptable safety profile and no clinically relevant changes in QoL. CLINICAL TRIAL INFORMATION NCT02743221 (ClinicalTrials.gov).
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Affiliation(s)
- E Van Cutsem
- University Hospitals Leuven and KU Leuven, Leuven, Belgium.
| | - I Danielewicz
- Szpitale Wojewodzkie w Gdyni/Gdansk Medical University, Gdynia, Poland
| | - M P Saunders
- Christie Hospital NHS Foundation Trust, Manchester, UK
| | - P Pfeiffer
- Odense University Hospital, Odense, Denmark
| | - G Argilés
- Vall d'Hebrón Institute of Oncology and Vall d'Hebrón University Hospital, Barcelona, Spain
| | - C Borg
- University Hospital Besançon, Besançon, France
| | | | - C J A Punt
- Amsterdam University Medical Centers, Amsterdam
| | - A J Van de Wouw
- VieCuri Medisch Centrum Noord-Limburg, Venlo, The Netherlands
| | - M Fedyanin
- NN Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | | | - H Kroening
- Schwerpunktpraxis für Haematologie und Onkologie Hasselbachplatz, Magdeburg, Germany
| | | | - H Wasan
- Hammersmith Hospital, Imperial College London, London, UK
| | - A Falcone
- University Hospital of Pisa, Department of Oncology, Pisa, Italy
| | - A Kanehisa
- Institut de Recherches Internationales Servier, Suresnes, France
| | - A Egorov
- Institut de Recherches Internationales Servier, Suresnes, France
| | - P Aubel
- Institut de Recherches Internationales Servier, Suresnes, France
| | - N Amellal
- Institut de Recherches Internationales Servier, Suresnes, France
| | - V Moiseenko
- Saint-Petersburg Scientific Practical Center for Specialized Medical Care, St Petersburg, Russia
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Sobrero AF, Andre T, Meyerhardt JA, Grothey A, Iveson T, Yoshino T, Sougklakos I, Meyers JP, Labianca R, Saunders MP, Vernerey D, Yamanaka T, Boukovinas I, Oki E, Georgoulias V, Torri V, Harkin A, Taieb J, Shields AF, Shi Q. Overall survival (OS) and long-term disease-free survival (DFS) of three versus six months of adjuvant (adj) oxaliplatin and fluoropyrimidine-based therapy for patients (pts) with stage III colon cancer (CC): Final results from the IDEA (International Duration Evaluation of Adj chemotherapy) collaboration. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
4004 Background: In overall population, IDEA pooled analysis did not demonstrate non-inferiority (NI) regarding 3y DFS in pts with stage III CC receiving 3m vs. 6m of adj FOLFOX/CAPOX. However, in pts treated with CAPOX (especially in low-risk pts), 3m of therapy was as effective as 6m. Results of OS and 5y DFS are reported. Methods: OS was defined as time from enrollment to death due to all causes. OS NI margin was conservatively set to be Hazard Ratio (HR) = 1.11, which is equivalent to: the maximum acceptable loss of OS efficacy, by shortening treatment to 3m, was half of the OS efficacy gained in MOSAIC trial (i.e., 2.26% absolute reduction in 5y OS rate). Pre-planned sub-group analyses included by regimen and risk group for both OS and 5y DFS. NI was to be declared if the one-sided false discovery rate adjusted (FDRa) NI p-value < 0.025. Results: With an overall median survival follow-up of 72 m (range per study, 62 to 84 m), 2584 deaths and 3777 DFS events among 12,835 pts from six trials were observed. Across 6 studies, 39.5% of pts received CAPOX (rate by study, 0% to 75.1%). Overall, the 5y OS rate was 82.4% (3m) and 82.8% (6m), with estimated OS HR of 1.02 (95% confidence interval [CI], 0.95-1.11; FDRa NI p, 0.058) and absolute 5-y OS rate difference of -0.4% (95% CI, -2.1 to 1.3%). Overall, the 5y DFS rate was 69.1% (3m) and 70.8% (6m), with estimated DFS HR of 1.08 (95%CI, 1.01-1.15, FDRa NI p, 0.22). HRs (95% CI) within subgroups see table. Conclusions: 5y OS rate reported in IDEA trials was higher than historical rates, regardless of duration of therapy. While overall survival in IDEA did not meet prior statistical assumptions for NI in overall population, the 0.4% difference in 5y OS should be placed in clinical context. OS and 5y DFS results continue to support the use of 3m adjuvant CAPOX for the vast majority of stage III colon cancer pts. This conclusion is strengthened by the substantial reduction of toxicities, inconveniencies and cost associated with shorter treatment duration. Clinical trial information: NCT01150045; 2009-010384-16; NCT00749450; ISRCTN59757862; 2007-003957-10; UMIN000008543; 2007-000354 . [Table: see text]
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Affiliation(s)
| | - Thierry Andre
- Saint-Antoine Hospital and Sorbonne Universités, Paris, France
| | | | | | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | | | | | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon, France
| | | | | | - Eiji Oki
- Kyushu University, Fukuoka, Japan
| | | | | | - Andrea Harkin
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Research, University of Glasgow, Glasgow, United Kingdom
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN
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Bordonaro R, Calvo A, Auriemma A, Hollebecque A, Rubovszky G, Saunders MP, Papai Z, Prager GW, Stein A, Andre T, Argiles G, Cubillo A, Dahan L, Edeline J, Leger C, Amellal N, Cattan V, Tabernero J. Trifluridine/tipiracil in combination with oxaliplatin and either bevacizumab or nivolumab: Results of the expansion part of a phase I study in patients with metastatic colorectal cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
140 Background: Trifluridine/tipiracil (FTD/TPI) is approved for use in patients (pts) with pretreated mCRC. In vivo studies have shown an increase in anti-tumor activity when combining FTD/TPI, oxaliplatin or bevacizumab, and an increase in tumor immunogenicity after treatment with FTD/TPI and oxaliplatin (Ghiringhelli, 2018). The recommended dose for expansion had been defined as FTD/TPI 35 mg/m² bid, days 1–5 q14, together with oxaliplatin 85 mg/m² (day 1). Methods: In addition to FTD/TPI and oxaliplatin, eligible pts received bevacizumab 5 mg/kg (Cohort A) or nivolumab 3 mg/kg (Cohort B) on day 1. Eligibility criteria included measurable disease, performance status (PS) 0-1, normal organ function, progression after > 1 prior anti-tumor therapy (excluding oxaliplatin), and confirmed MSS status (Cohort B). A Bayesian design was used for futility and efficacy assessments. Efficacy endpoints of objective response rate (ORR), disease control rate (DCR), progression free survival (PFS) and adverse events (AEs) were assessed for each cohort; biomarkers of immune function including PD-L1 expression for Cohort B. Results: A total of 37 and 17 pts were enrolled in Cohorts A and B respectively; with a median age of 64 years (range 33 to 83 years), 61% and 39% had an PS of 0 and 1. At baseline, no pt showed PD-L1 expression on tumor cells, and only 1 pt on immune cells (5% threshold). At data cutoff, 32 and 12 pts were evaluable for response in Cohorts A and B. In Cohort A, ORR was 13% (1 CR; 3 PR), and DCR was 91%. The mPFS was 6.9 months (95% IC, 4.3-9.3). In Cohort B, ORR was 8% (1 PR), DCR was 67%. The mPFS was 6.5 months (95% IC, 1.8-8.6). Overall, the most common treatment-related AEs (≥20% of pts) included neutropenia, nausea, diarrhoea, and fatigue; only 1 pt reported grade 3 febrile neutropenia; 5 pts discontinued due to AEs and no treatment-related death were reported. Conclusions: In this study, bevacizumab in addition to FTD/TPI and oxaliplatin showed antitumor activity. The cohort of nivolumab was prematurely discontinued due to lack of efficacy. Both cohorts showed an acceptable safety profile in pretreated mCRC pts. Clinical trial information: NCT02848443.
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Affiliation(s)
- Roberto Bordonaro
- Medical Oncology, National Specialist Hospital Garibaldi, Catania, Italy
| | - Aitana Calvo
- Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | | | | | | | - Zsuzsanna Papai
- Allami Egeszsegugyi Kozpont (State Health Center), Budapest, Hungary
| | | | - Alexander Stein
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Haematology, Stem Cell Transplantation and Pneumology, Hamburg, Germany
| | | | - Guillem Argiles
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC, TTD Group, Barcelona, Spain
| | | | | | | | - Catherine Leger
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Nadia Amellal
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Valerie Cattan
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain
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Sekhar H, Malcomson L, Kochhar R, Sperrin M, Alam N, Chakrbarty B, Fulford PE, Wilson MS, O'Dwyer ST, Saunders MP, Renehan AG. Temporal improvements in loco-regional failure and survival in patients with anal cancer treated with chemo-radiotherapy: treatment cohort study (1990-2014). Br J Cancer 2020; 122:749-758. [PMID: 31932755 PMCID: PMC7078229 DOI: 10.1038/s41416-019-0689-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 05/06/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023] Open
Abstract
Background We evaluated oncological changes in patients with squamous cell carcinoma of the anus (SCCA) treated by chemoradiotherapy (CRT) from a large UK institute, to derive estimates of contemporary outcomes. Methods We performed a treatment-cohort analysis in 560 patients with non-metastatic SCCA treated with CRT over 25 years. The primary outcomes were 3-year loco-regional failure (LRF), 5-year overall survival (OS), and 5-year cancer-specific survival (CSS). We developed prediction models; and overlaid estimates on published results from historic trials. Results Age distributions, proportions by gender and cT stage remained stable over time. The median follow-up was 61 (IQR: 36–79) months. Comparing the first period (1990–1994) with the last period (2010–2014), 3-year LRF declined from 33 to 16% (Ptrends < 0.001); 5-year OS increased from 60% to 76% (Ptrends = 0.001); and 5-year CCS increased from 62% in to 80% (Ptrends = 0.001). For 2020, the models predicted a 3-year LRF of 14.7% (95% CIs: 0–31.3); 5-year OS of 74.7% (95% CIs: 54.6–94.9); and 5-year CSS of 85.7% (95% CIs: 75.3–96.0). Reported oncological outcomes from historic trials generally underestimated contemporary outcomes. Conclusions Current and predicted rates for 3-year LRF and 5-year survivals are considerably improved compared with those in historic trials.
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Affiliation(s)
- Hema Sekhar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biological, Medicine and Health, University of Manchester, Manchester, UK
| | - Lee Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biological, Medicine and Health, University of Manchester, Manchester, UK
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, UK
| | - Nooreen Alam
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Bipasha Chakrbarty
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Paul E Fulford
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Malcolm S Wilson
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biological, Medicine and Health, University of Manchester, Manchester, UK. .,Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
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Iveson T, Boyd KA, Kerr RS, Robles-Zurita J, Saunders MP, Briggs AH, Cassidy J, Hollander NH, Tabernero J, Haydon A, Glimelius B, Harkin A, Allan K, McQueen J, Pearson S, Waterston A, Medley L, Wilson C, Ellis R, Essapen S, Dhadda AS, Harrison M, Falk S, Raouf S, Rees C, Olesen RK, Propper D, Bridgewater J, Azzabi A, Farrugia D, Webb A, Cunningham D, Hickish T, Weaver A, Gollins S, Wasan H, Paul J. 3-month versus 6-month adjuvant chemotherapy for patients with high-risk stage II and III colorectal cancer: 3-year follow-up of the SCOT non-inferiority RCT. Health Technol Assess 2019; 23:1-88. [PMID: 31852579 PMCID: PMC6936167 DOI: 10.3310/hta23640] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Oxaliplatin and fluoropyrimidine chemotherapy administered over 6 months is the standard adjuvant regimen for patients with high-risk stage II or III colorectal cancer. However, the regimen is associated with cumulative toxicity, characterised by chronic and often irreversible neuropathy. OBJECTIVES To assess the efficacy of 3-month versus 6-month adjuvant chemotherapy for colorectal cancer and to compare the toxicity, health-related quality of life and cost-effectiveness of the durations. DESIGN An international, randomised, open-label, non-inferiority, Phase III, parallel-group trial. SETTING A total of 244 oncology clinics from six countries: UK (England, Scotland, Wales and Northern Ireland), Denmark, Spain, Sweden, Australia and New Zealand. PARTICIPANTS Adults aged ≥ 18 years who had undergone curative resection for high-risk stage II or III adenocarcinoma of the colon or rectum. INTERVENTIONS The adjuvant treatment regimen was either oxaliplatin and 5-fluorouracil or oxaliplatin and capecitabine, randomised to be administered over 3 or 6 months. MAIN OUTCOME MEASURES The primary outcome was disease-free survival. Overall survival, adverse events, neuropathy and health-related quality of life were also assessed. The main cost categories were chemotherapy treatment and hospitalisation. Cost-effectiveness was assessed through incremental cost comparisons and quality-adjusted life-year gains between the options and was reported as net monetary benefit using a willingness-to-pay threshold of £30,000 per quality-adjusted life-year per patient. RESULTS Recruitment is closed. In total, 6088 patients were randomised (3044 per group) between 27 March 2008 and 29 November 2013, with 6065 included in the intention-to-treat analyses (3-month analysis, n = 3035; 6-month analysis, n = 3030). Follow-up for the primary analysis is complete. The 3-year disease-free survival rate in the 3-month treatment group was 76.7% (standard error 0.8%) and in the 6-month treatment group was 77.1% (standard error 0.8%), equating to a hazard ratio of 1.006 (95% confidence interval 0.909 to 1.114; p-value for non-inferiority = 0.012), confirming non-inferiority for 3-month adjuvant chemotherapy. Frequent adverse events (alopecia, anaemia, anorexia, diarrhoea, fatigue, hand-foot syndrome, mucositis, sensory neuropathy, neutropenia, pain, rash, altered taste, thrombocytopenia and watery eye) showed a significant increase in grade with 6-month duration; the greatest difference was for sensory neuropathy (grade ≥ 3 was 4% for 3-month vs.16% for 6-month duration), for which a higher rate of neuropathy was seen for the 6-month treatment group from month 4 to ≥ 5 years (p < 0.001). Quality-of-life scores were better in the 3-month treatment group over months 4-6. A cost-effectiveness analysis showed 3-month treatment to cost £4881 less over the 8-year analysis period, with an incremental net monetary benefit of £7246 per patient. CONCLUSIONS The study achieved its primary end point, showing that 3-month oxaliplatin-containing adjuvant chemotherapy is non-inferior to 6 months of the same regimen; 3-month treatment showed a better safety profile and cost less. For future work, further follow-up will refine long-term estimates of the duration effect on disease-free survival and overall survival. The health economic analysis will be updated to include long-term extrapolation for subgroups. We expect these analyses to be available in 2019-20. The Short Course Oncology Therapy (SCOT) study translational samples may allow the identification of patients who would benefit from longer treatment based on the molecular characteristics of their disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN59757862 and EudraCT 2007-003957-10. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 64. See the NIHR Journals Library website for further project information. This research was supported by the Medical Research Council (transferred to NIHR Evaluation, Trials and Studies Coordinating Centre - Efficacy and Mechanism Evaluation; grant reference G0601705), the Swedish Cancer Society and Cancer Research UK Core Clinical Trials Unit Funding (funding reference C6716/A9894).
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Affiliation(s)
- Timothy Iveson
- Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Kathleen A Boyd
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel S Kerr
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | - Andrew H Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jim Cassidy
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Niels Henrik Hollander
- Department of Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrew Haydon
- Australasian Gastro-Intestinal Trials Group, Camperdown, NSW, Australia
| | | | - Andrea Harkin
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Karen Allan
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - John McQueen
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Pearson
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | | | | | | | | | - Sharadah Essapen
- St Luke's Cancer Centre, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | | | | | - Sherif Raouf
- Barking Havering and Redbridge University Hospital NHS Trust, Barking, UK
| | - Charlotte Rees
- Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Rene K Olesen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - David Propper
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Ashraf Azzabi
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Farrugia
- Gloucestershire Oncology Centre, Cheltenham General Hospital, UK
| | - Andrew Webb
- Brighton and Sussex University Hospital Trust, Brighton, UK
| | | | | | - Andrew Weaver
- Department of Oncology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | | | - Harpreet Wasan
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - James Paul
- The Christie Hospital NHS Foundation Trust, Manchester, UK
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Marti FEM, Jayson GC, Manoharan P, O'Connor J, Renehan AG, Backen AC, Mistry H, Ortega F, Li K, Simpson KL, Allen J, Connell J, Underhill S, Misra V, Williams KJ, Stratford I, Jackson A, Dive C, Saunders MP. Novel phase I trial design to evaluate the addition of cediranib or selumetinib to preoperative chemoradiotherapy for locally advanced rectal cancer: the DREAMtherapy trial. Eur J Cancer 2019; 117:48-59. [PMID: 31229949 DOI: 10.1016/j.ejca.2019.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The DREAMtherapy (Dual REctal Angiogenesis MEK inhibition radiotherapy) trial is a novel intertwined design whereby two tyrosine kinase inhibitors (cediranib and selumetinib) were independently evaluated with rectal chemoradiotherapy (CRT) in an efficient manner to limit the extended follow-up period often required for radiotherapy studies. PATIENTS AND METHODS Cediranib or selumetinib was commenced 10 days before and then continued with RT (45 Gy/25#/5 wks) and capecitabine (825 mg/m2 twice a day (BID)). When three patients in the cediranib 15-mg once daily (OD) cohort were in the surveillance period, recruitment to the selumetinib cohort commenced. This alternating schedule was followed throughout. Three cediranib (15, 20 and 30 mg OD) and two selumetinib cohorts (50 and 75 mg BID) were planned. Circulating and imaging biomarkers of inflammation/angiogenesis were evaluated. RESULTS In case of cediranib, dose-limiting diarrhoea, fatigue and skin reactions were seen in the 30-mg OD cohort, and therefore, 20 mg OD was defined as the maximum tolerated dose. Forty-one percent patients achieved a clinical or pathological complete response (7/17), and 53% (9/17) had an excellent clinical or pathological response (ECPR). Significantly lower level of pre-treatment plasma tumour necrosis factor alpha (TNFα) was found in patients who had an ECPR. In case of selumetinib, the 50-mg BID cohort was poorly tolerated (fatigue and diarrhoea); a reduced dose cohort of 75-mg OD was opened which was also poorly tolerated, and further recruitment was abandoned. Of the 12 patients treated, two attained an ECPR (17%). CONCLUSIONS This novel intertwined trial design is an effective way to independently investigate multiple agents with radiotherapy. The combination of cediranib with CRT was well tolerated with encouraging efficacy. TNFα emerged as a potential predictive biomarker of response and warrants further evaluation.
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Affiliation(s)
| | - G C Jayson
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P Manoharan
- The Christie NHS Foundation Trust, Manchester, UK; Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - J O'Connor
- The Christie NHS Foundation Trust, Manchester, UK; Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - A G Renehan
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A C Backen
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - H Mistry
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK
| | - F Ortega
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK
| | - K Li
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - K L Simpson
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - J Allen
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Connell
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Underhill
- The Christie NHS Foundation Trust, Manchester, UK
| | - V Misra
- The Christie NHS Foundation Trust, Manchester, UK
| | - K J Williams
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK; Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - I Stratford
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK
| | - A Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - C Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester, UK
| | - M P Saunders
- The Christie NHS Foundation Trust, Manchester, UK.
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Gray V, Briggs S, Palles C, Jaeger E, Iveson T, Kerr R, Saunders MP, Paul J, Harkin A, McQueen J, Summers MG, Johnstone E, Wang H, Gatcombe L, Maughan TS, Kaplan R, Escott-Price V, Al-Tassan NA, Meyer BF, Wakil SM, Houlston RS, Cheadle JP, Tomlinson I, Church DN. Pattern Recognition Receptor Polymorphisms as Predictors of Oxaliplatin Benefit in Colorectal Cancer. J Natl Cancer Inst 2019; 111:828-836. [PMID: 30649440 PMCID: PMC6695319 DOI: 10.1093/jnci/djy215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/22/2018] [Accepted: 11/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Constitutional loss of function (LOF) single nucleotide polymorphisms (SNPs) in pattern recognition receptors FPR1, TLR3, and TLR4 have previously been reported to predict oxaliplatin benefit in colorectal cancer. Confirmation of this association could substantially improve patient stratification. METHODS We performed a retrospective biomarker analysis of the Short Course in Oncology Therapy (SCOT) and COIN/COIN-B trials. Participant status for LOF variants in FPR1 (rs867228), TLR3 (rs3775291), and TLR4 (rs4986790/rs4986791) was determined by genotyping array or genotype imputation. Associations between LOF variants and disease-free survival (DFS) and overall survival (OS) were analyzed by Cox regression, adjusted for confounders, using additive, dominant, and recessive genetic models. All statistical tests were two-sided. RESULTS Our validation study populations included 2929 and 1948 patients in the SCOT and COIN/COIN-B cohorts, respectively, of whom 2728 and 1672 patients had functional status of all three SNPs determined. We found no evidence of an association between any SNP and DFS in the SCOT cohort, or with OS in either cohort, irrespective of the type of model used. This included models for which an association was previously reported for rs867228 (recessive model, multivariable-adjusted hazard ratio [HR] for DFS in SCOT = 1.19, 95% confidence interval [CI] = 0.99 to 1.45, P = .07; HR for OS in COIN/COIN-B = 0.92, 95% CI = 0.63 to 1.34, P = .66), and rs4986790 (dominant model, multivariable-adjusted HR for DFS in SCOT = 0.86, 95% CI = 0.65 to 1.13, P = .27; HR for OS in COIN/COIN-B = 1.08, 95% CI = 0.90 to 1.31, P = .40). CONCLUSION In this prespecified analysis of two large clinical trials, we found no evidence that constitutional LOF SNPs in FPR1, TLR3, or TLR4 are associated with differential benefit from oxaliplatin. Our results suggest these SNPs are unlikely to be clinically useful biomarkers.
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Affiliation(s)
- Victoria Gray
- See the Notes section for the full list of authors’ affiliations
| | - Sarah Briggs
- See the Notes section for the full list of authors’ affiliations
| | - Claire Palles
- See the Notes section for the full list of authors’ affiliations
| | - Emma Jaeger
- See the Notes section for the full list of authors’ affiliations
| | - Timothy Iveson
- See the Notes section for the full list of authors’ affiliations
| | - Rachel Kerr
- See the Notes section for the full list of authors’ affiliations
| | - Mark P Saunders
- See the Notes section for the full list of authors’ affiliations
| | - James Paul
- See the Notes section for the full list of authors’ affiliations
| | - Andrea Harkin
- See the Notes section for the full list of authors’ affiliations
| | - John McQueen
- See the Notes section for the full list of authors’ affiliations
| | | | - Elaine Johnstone
- See the Notes section for the full list of authors’ affiliations
| | - Haitao Wang
- See the Notes section for the full list of authors’ affiliations
| | - Laura Gatcombe
- See the Notes section for the full list of authors’ affiliations
| | | | - Richard Kaplan
- See the Notes section for the full list of authors’ affiliations
| | | | - Nada A Al-Tassan
- See the Notes section for the full list of authors’ affiliations
| | - Brian F Meyer
- See the Notes section for the full list of authors’ affiliations
| | - Salma M Wakil
- See the Notes section for the full list of authors’ affiliations
| | | | - Jeremy P Cheadle
- See the Notes section for the full list of authors’ affiliations
| | - Ian Tomlinson
- See the Notes section for the full list of authors’ affiliations
| | - David N Church
- See the Notes section for the full list of authors’ affiliations
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Iveson T, Sobrero AF, Yoshino T, Sougklakos I, Ou FS, Meyers JP, Shi Q, Saunders MP, Labianca R, Yamanaka T, Boukovinas I, Hollander NH, Torri V, Yamazaki K, Georgoulias V, Lonardi S, Harkin A, Rosati G, Paul J. Prospective pooled analysis of four randomized trials investigating duration of adjuvant (adj) oxaliplatin-based therapy (3 vs 6 months {m}) for patients (pts) with high-risk stage II colorectal cancer (CC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3501] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
3501 Background: 6m of oxaliplatin-based treatment is an option as adj chemotherapy for patients with high risk stage II CC (T4, inadequate nodal harvest, poorly differentiated, obstruction, perforation or vascular/perineural invasion). The IDEA collaboration showed shorter treatment duration to be appropriate for most pts with stage III colon cancer. The results of the 4 IDEA studies with stage II pts are presented here. Methods: A prospective, pre-planned pooled analysis of high-risk stage II patients from 4 concurrently conducted randomized phase III trials (SCOT, TOSCA, ACHIEVE-2, HORG) was performed to evaluate non-inferiority (NI) of 3m compared with 6m (ref) of adj FOLFOX/CAPOX (regimen preselected, not randomized). The primary endpoint was disease-free survival (DFS), NI was to be declared if the 2-sided 80% confidence interval (CI) for DFS hazard ratio (HR 3m v 6m) estimated by a stratified Cox model was below 1.2. 542 DFS events were required to provide 80% power to declare NI. NI was also examined within regimen, T4 (Yes v No) and inadequate nodal harvest (Yes v No) as pre-planned subgroups. Results: The primary analysis included 3273 randomised pts of which 1254 had FOLFOX and 2019 had CAPOX. There were 552 events and the median follow-up was 60.2 m. There was significantly less grade 3-5 toxicity with 3m treatment (p < .0001). The 5-year DFS rate was 80.7% and 84.0% for 3m and 6m treatment with an estimated DFS HR of 1.18 (80% CI:1.05-1.31, p for NI = 0.404). For CAPOX the estimated HR was 1.02 (80% CI: 0.88-1.17, p for NI = 0.087) and for FOLFOX the estimated HR was 1.42 (80% CI: 1.19-1.70, p for NI = 0.894). The test for interaction between duration and regimen was not statistically significant (p = .174 adjusted for multiple testing) but was stronger than that for the other subgroups examined. Conclusions: In the overall population non-inferiority for 3m adj treatment in pts with high-risk stage II CC was not shown. As with the stage III population the choice of adj regimen appears important (although this did not reach statistical significance) with a small difference in DFS between 3 and 6 m treatment if CAPOX is used. Clinical trial information: ISRCTN59757862.
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Affiliation(s)
- Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | | | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Valter Torri
- IRCCS Istituto Di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Vassilis Georgoulias
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Athens, AZ, Greece
| | | | | | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - James Paul
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Research, University of Glasgow, Glasgow, United Kingdom
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Bhullar DS, Barriuso J, Mullamitha S, Saunders MP, O'Dwyer ST, Aziz O. Biomarker concordance between primary colorectal cancer and its metastases. EBioMedicine 2019; 40:363-374. [PMID: 30733075 PMCID: PMC6413540 DOI: 10.1016/j.ebiom.2019.01.050] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 11/04/2018] [Revised: 01/13/2019] [Accepted: 01/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background The use of biomarkers to target anti-EGFR treatments for metastatic colorectal cancer (CRC) is well-established, requiring molecular analysis of primary or metastatic biopsies. We aim to review concordance between primary CRC and its metastatic sites. Methods A systematic review and meta-analysis of all published studies (1991–2018) reporting on biomarker concordance between primary CRC and its metastatic site(s) was undertaken according to PRISMA guidelines using several medical databases. Studies without matched samples or using peripheral blood for biomarker analysis were excluded. Findings 61 studies including 3565 patient samples were included. Median biomarker concordance for KRAS (n = 50) was 93.7% [[67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]], NRAS (n = 11) was 100% [[90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]], BRAF (n = 22) was 99.4% [[80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]], and PIK3CA (n = 17) was 93% [[42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100]]. Meta-analytic pooled discordance was 8% for KRAS (95% CI = 5–10%), 8% for BRAF (95% CI = 5–10%), 7% for PIK3CA (95% CI = 2–13%), and 28% overall (95% CI = 14–44%). The liver was the most commonly biopsied metastatic site (n = 2276), followed by lung (n = 438), lymph nodes (n = 1123), and peritoneum (n = 132). Median absolute concordance in multiple biomarkers was 81% (5–95%). Interpretation Metastatic CRC demonstrates high concordance across multiple biomarkers, suggesting that molecular testing of either the primary or liver and lung metastasis is adequate. More research on colorectal peritoneal metastases is required.
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Affiliation(s)
- D S Bhullar
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - J Barriuso
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - S Mullamitha
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - M P Saunders
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - S T O'Dwyer
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - O Aziz
- Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK.
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Moiseyenko V, Saunders MP, Wasan HS, Argiles G, Borg C, Creemers GJ, Fedyanin M, Glynne-Jones R, Pfeiffer P, Punt CJA, Stroyakovskiy D, Ten Tije AJ, Van de Wouw AW, Kanehisa A, Fougeray R, Sabater J, Amellal N, Van Cutsem E. QoL from TASCO1: Health-related quality of life of trifluridine/tipiracil-bevacizumab and capecitabine-bevacizumab as first-line treatments in metastatic colorectal cancer patients not eligible for intensive chemotherapy—Results from the TASCO1 phase II study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.676] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
676 Background: TASCO1 is a phase II study which evaluated the safety and efficacy of trifluridine/tipiracil + bevacizumab (TT-B) and capecitabine + bevacizumab (C-B) in first-line unresectable mCRC patients non-eligible for intensive therapy. Promising activity was shown on progression-free survival with TT-B (9.2 months) and C-B (7.8 months). Here we present the Quality of Life (QoL) analysis of the two treatment arms. Methods: In TASCO1, patients were randomized 1:1 to receive TT-B (n = 76) on a four-week cycle or C-B (n = 77) on a three-week cycle. QoL was assessed in TASCO1 at baseline and at each 12 weeks thereafter, until discontinuation of study treatment, using the QLQ-C30 and QLQ-CR29 questionnaires. Responses were described separately in each arm using descriptive statistics. Results: For QLQ-C30, 121 patients completed baseline questionnaire. No clinically relevant difference was observed on treatment in mean change of score from baseline for the global health status, functioning scales, and for most of the symptom scales, except for nausea/vomiting and diarrhoea (worsening in the TT-B group and stable in the C-B group for both symptoms), fatigue (stable in the TT-B group and worsening in the C-B), loss appetite (worsening in the two groups) and insomnia (improvement in the two groups). For QLQ-CR29, 117 patients completed baseline questionnaire. No clinically relevant difference on treatment was observed in mean change of score from baseline for most of items except for the following: hair loss, trouble with taste (worsening for both symptoms in the TT-B group while stable for hair loss and improvement for trouble with taste in the C-B group), sore skin, dry mouth (stable in the TT-B group and worsening in the C-B group for both symptoms), and anxiety (stable in the TT-B group and improvement in the C-B group). Conclusions: The Global Health Scale was maintained in Trifluridine/tipiracil+bevacizumab arm as well as in the capecitabine+bevacizumab arm. No clinically relevant difference from baseline was observed over time in both groups except for few sub-scales. Clinical trial information: NCT02743221.
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Affiliation(s)
- Vladimir Moiseyenko
- Clinical and Research Center of Specialized Types of Medical Care (Oncological), St. Petersburg, Russian Federation
| | | | | | - Guillem Argiles
- Medical Oncology Department, Vall d’Hebron University Hospital; Vall d’Hebron Institute of Oncology (VHIO)., Barcelona, Spain
| | | | | | - Mikhail Fedyanin
- Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center of Oncology» of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | | | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | | | - Albert J. Ten Tije
- Department of Medical Oncology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | | | - Ronan Fougeray
- Institut de Recherches Internationales Servier, Suresnes, France
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Fish R, Sanders C, Adams R, Brewer J, Brookes ST, DeNardo J, Kochhar R, Saunders MP, Sebag-Montefiore D, Williamson PR, Renehan AG. A core outcome set for clinical trials of chemoradiotherapy interventions for anal cancer (CORMAC): a patient and health-care professional consensus. Lancet Gastroenterol Hepatol 2018; 3:865-873. [PMID: 30507470 DOI: 10.1016/s2468-1253(18)30264-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022]
Abstract
Chemoradiotherapy is the primary treatment for patients with squamous cell carcinoma of the anus, but variations in the reported outcomes have restricted between-study comparisons. Treatment-related morbidity is considerable; however, no trial has comprehensively quantified long-term side-effects or quality of life. Therefore, we established the first international health-care professional and patient consensus to develop a core outcome set, using the Core Outcome Measures in Effectiveness Trials method. We used the results from our previous systematic review and combined them in this Review with patient interviews to derive a comprehensive list of outcomes, followed by a two-round Delphi survey completed by 149 participants (55 patients and 94 health-care professionals) from 11 countries. The Delphi results were discussed at a consensus meeting of health-care professionals and patients. Agreement was reached on 19 outcomes across four domains: disease activity, survival, toxicity, and life impact. Implementation of the Core Outcome Research Measures in Anal Cancer (CORMAC) set in future trials will serve as a framework to achieve standardisation, facilitate selection of health-area-specific evaluation tools, reduce redundancy of outcome lists, allow between-study comparisons, and ultimately enhance the relevance of trial findings to health-care professionals, trialists, and patients.
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Affiliation(s)
- Rebecca Fish
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK.
| | - Caroline Sanders
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Richard Adams
- Centre for Trials Research, Cardiff University School of Medicine, Cardiff, UK; Velindre Cancer Centre, Cardiff, UK
| | - Julie Brewer
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | - Sara T Brookes
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jill DeNardo
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | - Rohit Kochhar
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
| | | | - Paula R Williamson
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Cancer Research Centre and National Institute for Health Research, Manchester Biomedical Research Centre, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, Christie National Health Service Foundation Trust, Manchester, UK
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Jayson GC, Zhou C, Backen A, Horsley L, Marti-Marti K, Shaw D, Mescallado N, Clamp A, Saunders MP, Valle JW, Mullamitha S, Braun M, Hasan J, McEntee D, Simpson K, Little RA, Watson Y, Cheung S, Roberts C, Ashcroft L, Manoharan P, Scherer SJ, Del Puerto O, Jackson A, O'Connor JPB, Parker GJM, Dive C. Plasma Tie2 is a tumor vascular response biomarker for VEGF inhibitors in metastatic colorectal cancer. Nat Commun 2018; 9:4672. [PMID: 30405103 PMCID: PMC6220185 DOI: 10.1038/s41467-018-07174-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
Abstract
Oncological use of anti-angiogenic VEGF inhibitors has been limited by the lack of informative biomarkers. Previously we reported circulating Tie2 as a vascular response biomarker for bevacizumab-treated ovarian cancer patients. Using advanced MRI and circulating biomarkers we have extended these findings in metastatic colorectal cancer (n = 70). Bevacizumab (10 mg/kg) was administered to elicit a biomarker response, followed by FOLFOX6-bevacizumab until disease progression. Bevacizumab induced a correlation between Tie2 and the tumor vascular imaging biomarker, Ktrans (R:-0.21 to 0.47) implying that Tie2 originated from the tumor vasculature. Tie2 trajectories were independently associated with pre-treatment tumor vascular characteristics, tumor response, progression free survival (HR for progression = 3.01, p = 0.00014; median PFS 248 vs. 348 days p = 0.0008) and the modeling of progressive disease (p < 0.0001), suggesting that Tie2 should be monitored clinically to optimize VEGF inhibitor use. A vascular response is defined as a 30% reduction in Tie2; vascular progression as a 40% increase in Tie2 above the nadir. Tie2 is the first, validated, tumor vascular response biomarker for VEGFi.
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Affiliation(s)
- Gordon C Jayson
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK.
| | - Cong Zhou
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester, M20 4GJ, UK
| | - Alison Backen
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
| | - Laura Horsley
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Kalena Marti-Marti
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Danielle Shaw
- Clatterbridge Cancer Centre, Liverpool, CH63 4JY, UK
| | - Nerissa Mescallado
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Andrew Clamp
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mark P Saunders
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Juan W Valle
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Saifee Mullamitha
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mike Braun
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Jurjees Hasan
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Delyth McEntee
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Kathryn Simpson
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
| | - Ross A Little
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Yvonne Watson
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Susan Cheung
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Caleb Roberts
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Linda Ashcroft
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Prakash Manoharan
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Stefan J Scherer
- Novartis Pharmaceuticals Corporation, One Health Plaza, 337, East Hanover, NJ, 07936-1080, USA
| | - Olivia Del Puerto
- Del Puerto Limited, 23 Porters Wood; Saint Albans, Hertfordshire, AL3 6PQ, UK
| | - Alan Jackson
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - James P B O'Connor
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester, M20 4GJ, UK
| | - Geoff J M Parker
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
- Bioxydyn Ltd, Manchester, M15 6SZ, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
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Chadi SA, Malcomson L, Ensor J, Riley RD, Vaccaro CA, Rossi GL, Daniels IR, Smart NJ, Osborne ME, Beets GL, Maas M, Bitterman DS, Du K, Gollins S, Sun Myint A, Smith FM, Saunders MP, Scott N, O'Dwyer ST, de Castro Araujo RO, Valadao M, Lopes A, Hsiao CW, Lai CL, Smith RK, Paulson EC, Appelt A, Jakobsen A, Wexner SD, Habr-Gama A, Sao Julião G, Perez R, Renehan AG. Factors affecting local regrowth after watch and wait for patients with a clinical complete response following chemoradiotherapy in rectal cancer (InterCoRe consortium): an individual participant data meta-analysis. Lancet Gastroenterol Hepatol 2018; 3:825-836. [PMID: 30318451 DOI: 10.1016/s2468-1253(18)30301-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [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] [Received: 08/03/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In patients with rectal cancer who achieve clinical complete response after neoadjuvant chemoradiotherapy, watch and wait is a novel management strategy with potential to avoid major surgery. Study-level meta-analyses have reported wide variation in the proportion of patients with local regrowth. We did an individual participant data meta-analysis to investigate factors affecting occurrence of local regrowth. METHODS We updated search results of a recent systematic review by searching MEDLINE and Embase from Jan 1, 2016, to May 5, 2017, and used expert knowledge to identify published studies reporting on local regrowth in patients with rectal cancer managed by watch and wait after clinical complete response to neoadjuvant chemoradiotherapy. We restricted studies to those that defined clinical complete response using criteria equivalent to São Paulo benchmarks (ie, absence of residual ulceration, stenosis, or mass within the rectum on clinical and endoscopic examination). The primary outcome was 2-year cumulative incidence of local regrowth, estimated with a two-stage random-effects individual participant data meta-analysis. We assessed the effects of clinical and treatment factors using Cox frailty models, expressed as hazard ratios (HRs). From these models, we derived percentage differences in mean θ as an approximation of the effect of measured covariates on between-centre heterogeneity. This study is registered with PROSPERO, number CRD42017070934. FINDINGS We obtained individual participant data from 11 studies, including 602 patients enrolled between March 11, 1990, and Feb 13, 2017, with a median follow-up of 37·6 months (IQR 25·0-58·7). Ten of the 11 datasets were judged to be at low risk of bias. 2-year cumulative incidence of local regrowth was 21·4% (random-effects 95% CI 15·3-27·6), with high levels of between-study heterogeneity (I2=61%). We noted wide between-centre variation in patient, tumour, and treatment characteristics. We found some evidence that increasing cT stage was associated with increased risk of local regrowth (random-effects HR per cT stage 1·40, 95% CI 1·00-1·94; ptrend=0·048). In a subgroup of 459 patients managed after 2008 (when pretreatment staging by MRI became standard), 2-year cumulative incidence of local regrowth was 19% (95% CI 13-28) for stage cT1 and cT2 tumours, 31% (26-37) for cT3, and 37% (21-60) for cT4 (random-effects HR per cT stage 1·50, random-effects 95% CI 1·03-2·17; ptrend=0·0330). We estimated that measured factors contributed 4·8-45·3% of observed between-centre heterogeneity. INTERPRETATION In patients with rectal cancer and clinical complete response after chemoradiotherapy managed by watch and wait, we found some evidence that increasing cT stage predicts for local regrowth. These data will inform clinician-patient decision making in this setting. Research is needed to determine other predictors of a sustained clinical complete response. FUNDING None.
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Affiliation(s)
- Sami A Chadi
- Division of Surgical Oncology and General Surgery, Princess Margaret Hospital and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lee Malcomson
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Joie Ensor
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Carlos A Vaccaro
- Servicio Cirugia General, Sector de Coloproctologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo L Rossi
- Servicio Cirugia General, Sector de Coloproctologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ian R Daniels
- Exeter Colorectal Unit, and Exeter Surgical Health Sciences Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Neil J Smart
- Exeter Colorectal Unit, and Exeter Surgical Health Sciences Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Melanie E Osborne
- Exeter Colorectal Unit, and Exeter Surgical Health Sciences Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands; GROW, School of Oncology and Developmental Biology, University of Maastricht, Maastricht, Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Kevin Du
- Department of Radiation Oncology, New York University Langone Medical Center, New York, NY, USA
| | | | | | - Fraser M Smith
- Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Nigel Scott
- Royal Preston NHS Foundation Trust, Preston, UK
| | - Sarah T O'Dwyer
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Rodrigo Otavio de Castro Araujo
- Department of Abdominal and Pelvic Surgery, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Marcus Valadao
- Department of Abdominal and Pelvic Surgery, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Alberto Lopes
- Department of Abdominal and Pelvic Surgery, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Cheng-Wen Hsiao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, China
| | - Chien-Liang Lai
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, China
| | - Radhika K Smith
- Department of Surgery, Philadelphia VA Medical Center, and Division of Colon and Rectal Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Carter Paulson
- Department of Surgery, Philadelphia VA Medical Center, and Division of Colon and Rectal Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ane Appelt
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark; Leeds Cancer Centre, St James's University Hospital, and Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Anders Jakobsen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Guilherme Sao Julião
- Ludwig Institute for Cancer Research, Molecular Biology and Genomics Lab, São Paulo, Brazil
| | - Rodiguo Perez
- Instituto Angelita e Joaquim Gama, São Paulo, Brazil; Ludwig Institute for Cancer Research, Molecular Biology and Genomics Lab, São Paulo, Brazil
| | - Andrew G Renehan
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
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Beech J, Germetaki T, Judge M, Paton N, Collins J, Garbutt A, Braun M, Fenwick J, Saunders MP. Management and grading of EGFR inhibitor-induced cutaneous toxicity. Future Oncol 2018; 14:2531-2541. [DOI: 10.2217/fon-2018-0187] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Janette Beech
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Theodora Germetaki
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Mary Judge
- Department of Dermatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Nina Paton
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Joanne Collins
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | | | - Michael Braun
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
| | - Jill Fenwick
- Merck Serono Ltd., Feltham, UK (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Mark P Saunders
- Department of Medical/Clinical Oncology, Christie Hospital, 550 Wilmslow Road, Manchester, UK
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Srivastava P, Malcolmson L, Saunders MP, Renehan A. Chemotherapy dose reductions in obese patients undergoing adjuvant chemotherapy for colorectal cancer: secondary analyses of trial data and the Greater Manchester and Cheshire Cancer Network Audit. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
763 Background: In patients with stage II/III colorectal cancer receiving adjuvant chemotherapy, doses are calculated using body surface area (BSA) but often capped at BSA > 2.0. Dose capping might be a mechanism of reported poorer survival in obese patients. We aimed to investigate the different dosing schedules across BMI categories, using trial and ‘real world’ audit datasets, and determine its impact upon overall survival. Methods: Data was accessed for 1122 patients from the control arm of the MOSAIC trial (accessed via the Data Project Sphere) and 327 patients from the Greater Manchester and Cheshire Cancer Network (GMCCN) audit. Pearson’s χ2 and correlation coefficient were used to assess the relationship between BMI (expressed as normal, overweight and obese: and as continuous, respectively) and dose reductions. A multiple logistic regression model was constructed to compare the odds of receiving dose reductions in each BMI category. 4-year overall survival was calculated for each BMI category and dose status. Results: In MOSAIC, there were increasing dose reductions by BMI category: normal, 3%; overweight, 5%; and obese, 11%, with similar patterns in the GMCCN OxMdG group. Obese patients in MOSAIC and the GMCCN OxMdG group had 3- and 12-fold higher odds (OR = 3.4 and 12.5, CI = 1.6-7.0 and 2.0-78.1), respectively, of receiving dose reductions. However, these differences did not translate to differences in overall survival by BMI category or dose status. Conclusions: In our investigated datasets, there appears to be a relationship between increasing BMI and dose reductions, though it is modest and does not manifest as a detrimental influence on overall survival. Our findings agreed with other studies performed using stage IV cancer patients, although the relationship between increasing BMI and dose reductions is more prominent in patients with metastatic disease. Investigating other outcome measures such as cancer-specific survival and chemotherapy related toxicity is required for clarity.
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Affiliation(s)
| | - Lee Malcolmson
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Andrew Renehan
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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Saunders MP, Paul J, Crosby J, Brown G, Iveson T, Kerr R, Harkin A, Allan K, McQueen J, Pearson SR, Cassidy J, Medley LC, Raouf S, Harrison M, Brewster A, Rees C, Ellis R, Thomas AL, Churn M, Maka N. SCOT: Tumor sidedness and the influence of chemotherapy duration on DFS. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.558] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
558 Background: Patients with R-sided tumours who develop metastatic disease have a worse prognosis compared to patients with L-sided tumours. The latter may also have a greater benefit from treatment with EGFR inhibitors. In general, registry studies and meta-analyses have shown that patients with loco-regional R-sided tumours have a worse overall survival (OS). This has recently been confirmed by the PETACC8 study but only after they had relapsed. There was not a significant difference in disease free survival (DFS). Methods: The SCOT study showed that 3-months of oxaliplatin-containing adjuvant chemotherapy (OxFp) was non-inferior to 6-months for patients with stage III and high-risk stage II colorectal cancer. Here we divide the population into left and right-sided tumours to see whether sidedness had an impact on DFS. We also evaluated whether sidedness impacted on the 3 vs. 6-months comparison in SCOT. Results: 6088 patients with Stage III/high risk Stage II cancers or the colon or rectum were randomised between March 27, 2008 and November 29, 2013 from 244 centres (164 UK, 32 Australia, 19 Spain, 14 Sweden, 10 Denmark and 5 New Zealand). In February 2017 (3-years FU) information on sidedness was available for 3219 patients (1207 R-sided, 2012 L-sided). Characteristics: Right: median age: 65, Male: 53%, T4 41%, Stage II: 17%; Left: median age: 65, Male: 66%, T4 24%, Stage II: 21%). Patients with R-sided tumours had a significantly worse DFS (3-year DFS right: 73% (se=1%), left: 80% (se=1%). HR 1.401 (95% CI 1.216-1.615; p=0.000004). Adjusting for T and N-stage reduced the HR to 1.215 (95% ci 1.051-1.404, p=0.009). The data did not suggest that sidedness affected the impact of chemotherapy duration on 3-year DFS (R: HR (3 month/6 month) 1.049 (0.849 -1.296) L: 0.910 (0.753-1.099). Test for homogeneity, p=0.327). Further sub-set analysis was limited due to cohort size. Conclusions: This is the first study to show that unselected patients with R-sided tumours had a worse DFS compared to L-sided tumours. This implies that prognosis is influenced primarily by greater recurrence rather than the contributing factors that influence OS. Tumour sidedness did not impact on the 3-months vs. 6-months comparison in SCOT. Clinical trial information: ISRCTN59757862.
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Affiliation(s)
| | - James Paul
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jana Crosby
- NHS Greater Glasgow and Clyde Place, Glasgow, United Kingdom
| | - Gordon Brown
- NHS Greater Glasgow and Clyde Place, Glasgow, United Kingdom
| | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rachel Kerr
- University of Oxford, Oxford, United Kingdom
| | | | - Karen Allan
- CRUK Clinical Trials Unit, Glasgow, United Kingdom
| | | | | | | | | | - Sherif Raouf
- BR University Trust, Romford, Essex, United Kingdom
| | | | | | - Charlotte Rees
- Southampton University Hospital, Basingstoke Hampshire, United Kingdom
| | | | | | - Mark Churn
- Worcester Royal Hospital, Worcester, United Kingdom
| | - Noori Maka
- NHS Greater Glasgow and Clyde Place, Glasgow, United Kingdom
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Abstract
An interim goal of the NHS National Cancer Plan is that, by 2005, patients with cancer should be treated within one month of diagnosis and within two months from urgent general practitioner referral. Preoperative radiotherapy for rectal cancer reduces the risk of local recurrence and may translate into improved patient survival. We conducted a prospective audit of existing waiting times for preoperative radiotherapy experienced by 65 patients with rectal cancer referred to the Christie Cancer Centre, Manchester, UK, between May and November 2002. The median time between referral from the surgeon to the start of radiotherapy was 40 days (range 11-85). Only 4 patients (6%) received radiotherapy within 28 days of referral by the surgeon. 62 patients (95%) underwent surgery within 14 days of completing radiotherapy. Delays in the provision of preoperative radiotherapy were primarily due to shortages of radiography staff and equipment. Lack of such infrastructure will prove a major stumbling block to achieving the targets of the NHS Cancer Plan.
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Affiliation(s)
- S E Duff
- Department of Surgery, Christie Hospital NHS Trust, Manchester M20 4BX, UK.
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44
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Sekhar H, Zwahlen M, Trelle S, Malcomson L, Kochhar R, Saunders MP, Sperrin M, van Herk M, Sebag-Montefiore D, Egger M, Renehan AG. Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study. Lancet Oncol 2017; 18:1348-1359. [PMID: 28802802 DOI: 10.1016/s1470-2045(17)30456-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In patients with squamous cell carcinoma of the anus (SCCA), lymph node positivity (LNP) indicates poor prognosis for survival and is central to radiotherapy planning. Over the past three decades, LNP proportion has increased, mainly reflecting enhanced detection with newer imaging modalities; a process known as nodal stage migration. If accompanied by constant T stage distributions, prognosis for both lymph node-positive and lymph node-negative groups may improve without any increase in overall survival for individual patients; a paradox termed the Will Rogers phenomenon. Here, we aim to systematically evaluate the impact of nodal stage migration on survival in SCCA and address a novel hypothesis that this phenomenon results in reduced prognostic discrimination. METHODS We did a systematic review and meta-regression to quantify changes in LNP over time and the impact of this change on survival and prognostic discrimination. We searched MEDLINE, Embase, and the Cochrane Library to identify randomised trials and observational studies in patients with SCCA published between Jan 1, 1970, and Oct 11, 2016. Studies were eligible if patients received chemoradiotherapy or radiotherapy as the main treatment, reported LNP proportions (all studies), and reported overall survival (not necessarily present in all studies). We excluded studies with fewer than 50 patients. We extracted study-level data with a standardised, piloted form. The primary outcome measure was 5-year overall survival. To investigate scenarios in which reduced prognostic discrimination might occur, we simulated varying true LNP proportions and true overall survival, and compared these with expected observed outcomes for varying levels of misclassification of true nodal state. FINDINGS We identified 62 studies reporting LNP proportions, which included 10 569 patients. From these, we included 45 studies (6302 patients) with whole cohort 5-year overall survival, 11 studies with 5-year survival stratified by nodal status, and 20 studies with hazard ratios in our analyses of temporal changes. In 62 studies, the LNP proportions increased from a mean estimate of 15·3% (95% CI 10·5-20·1) in 1980 to 37·1% (34·0-41·3) in 2012 (p<0·0001). In 11 studies with prognostic data, increasing LNP was associated with improved overall survival in both lymph node-positive and lymph node-negative categories, whereas the proportions with combined tumour stage T3 and T4 remained constant. In 20 studies, across a range of LNP proportions from 15% to 40%, the hazard ratios for overall survival of lymph node-positive versus lymph node-negative patients decreased significantly from 2·5 (95% CI 1·8-3·3) at 15% LNP to 1·3 (1·2-1·9; p=0·014) at 40% LNP. The simulated scenarios reproduced this effect if the true LNP proportions were 20% or 25%, but not if the true LNP proportions were 30% or greater. INTERPRETATION We describe a consequence of staging misclassification in anal cancer that we have termed reduced prognostic discrimination. We used this new observation to infer that the LNP proportions of more than 30% seen in modern clinical series (11 out of 15 studies with a median year since 2007) are higher than the true LNP proportion. The introduction of new staging technologies in oncology might misclassify true disease stage, spuriously informing disease management and ultimately increasing the risk of overtreatment. FUNDING Bowel Disease Research Foundation.
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Affiliation(s)
- Hema Sekhar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sven Trelle
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Lee Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Farr Institute, MRC Health eResearch Centre (HeRC), Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - David Sebag-Montefiore
- Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK.
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Iveson T, Kerr R, Saunders MP, Hollander NH, Tabernero J, Haydon AM, Glimelius B, Harkin A, Scudder C, Boyd K, Waterston AM, Medley LC, Wilson C, Ellis R, Essapen S, Dhadda AS, Harrison M, Falk S, Raouf S, Paul J. Final DFS results of the SCOT study: An international phase III randomised (1:1) non-inferiority trial comparing 3 versus 6 months of oxaliplatin based adjuvant chemotherapy for colorectal cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3502 Background: Six months of oxaliplatin-based treatment has been the mainstay of adjuvant chemotherapy for colorectal cancer for the last 13 years. Neurotoxicity from oxaliplatin is cumulative, dose limiting, and potentially irreversible. A shorter duration of treatment would save patients significant toxicity/time and substantially reduce the costs of the drug, its administration, and treatment of adverse effects. Methods: SCOT is a non-inferiority randomised study designed to determine whether 3 months of adjuvant chemotherapy with OxMdG or Xelox (physician/patient choice) in Stage III/high risk Stage II colorectal cancer is as effective as 6 months treatment. Non-inferiority was determined to be a maximum 2.5% fall in 3-year disease-free survival (DFS) on the 3 month arm (from 78% on the 6 month arm) corresponding to a hazard ratio upper limit of 1.13. The study was designed with 90% power at the 2.5% 1-sided level of statistical significance and aimed to recruit 9500 patients to observe 2,750 DFS events (relapses/deaths/new colorectal cancers). Analysis used a Cox model adjusted for study minimisation factors. Results: 6088 patients (60% male, median age 65) with Stage III/high risk Stage II cancers of the colon or rectum were randomised between 27th March 2008 and 29th November 2013. The arms were balanced for clinical and pathological factors. Intended treatment was OxMdG for 1981 and Xelox for 4107 patients. There were 1469 DFS events (734 in 3 month arm and 735 in 6 month arm) giving the study 66% power. 3 year DFS was 76.8% (se = .8%) for the 3 month arm and 77.4% (se = .8%) for the 6 month arm (HR 1.008, 95% CI 0.910-1.117, test for non-inferiority p = 0.014). Non-inferiority appeared stronger for Xelox than OxMdG (test for heterogeneity, p = .059). Results will be shown broken down by stage, site, age, gender and achieved duration of treatment. Conclusions: The SCOT study has shown that 3 months adjuvant treatment is not inferior to 6 months treatment. However the SCOT study is part of the IDEA consortium and the results from the 6 studies in the IDEA consortium addressing the same duration question will also be presented at ASCO 2017. Clinical trial information: ISRCTN59757862.
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Affiliation(s)
- Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rachel Kerr
- University of Oxford, Oxford, United Kingdom
| | | | | | - Josep Tabernero
- Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Andrea Harkin
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Research, University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | | | | | | | - Mark Harrison
- Mount Vernon Cancer Centre, Middlesex, United Kingdom
| | - Stephen Falk
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Sherif Raouf
- BR Univeristy Trust, Romford, Essex, United Kingdom
| | - James Paul
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Research, University of Glasgow, Glasgow, United Kingdom
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46
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Jayson GC, Zhou C, Horsley LH, Marti K, Shaw D, Mescallado N, Clamp AR, Saunders MP, Valle JW, Backen AC, Simpson K, Little R, Watson Y, Cheung S, Roberts C, Manoharan P, Jackson A, O'Connor J, Parker GJM, Dive C. Inter-tumor validation, through advanced MRI and circulating biomarkers, of plasma Tie2 as the vascular response biomarker for bevacizumab. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.11521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11521 Background: VEGF inhibitor (VEGFi) use is compromised by lack of predictive/ response biomarkers. Previously, we identified plasma Tie2 (pTie2) as a vascular response biomarker (VRB) for bevacizumab (bev) in ovarian cancer (OC). Here, we applied dynamic contrast-enhanced MRI (DCE-MRI) and circulating biomarkers in colorectal cancer (CRC), to validate pTie2 as the first tumor VRB. Methods: Seventy patients were recruited, with untreated, mCRC and ≥1 lesion of 3-10cm diameter for DCE-MRI. Patients received bev 10mg/kg for 2 weeks to elicit a biomarker response and then FOLFOX6/bev until progressive disease (PD) Thirteen circulating and 6 imaging biomarkers were measured before and during treatment and at PD. Unsupervised correlation analysis identified bev-induced biomarker correlations. Biomarkers were evaluated by clustered parameter-time course studies to determine their epithelial or vascular origin. Clinical significance was determined by relating the biomarker data to tumor 3D volumetric change assessed by MRI and PFS. The emergent vascular biomarker signal was modelled with epithelial biomarkers to assess the independent contribution of the vascular compartment to PD. Results: Bev induced significant correlations between pTie2, Ang2 and Ktrans. Cluster analysis of Tie2 concentration-time course curves showed that pTie2 reflected tumor Ktransbut not CK18, an epithelial antigen, i.e. changes in pTie2 reflected tumor vascular biology Patients who had the greatest area under the pTie2-time curve had tumors with high Ktransand/or low pVEGFR2, pre-treatment. They also had the greatest reduction in tumor volume and longest PFS. Fusion of pTie2 and CK18 data significantly improved modelling of PD. Conclusions: Bev impacts tumor vasculature causing proportional changes in pTie2. Information from pTie2 adds clinical value to that derived from the epithelial compartment. Thus (i) pTie2 is the first vascular response biomarker for bev and probably all VEGFi and (ii) demonstration of separate vascular and epithelial compartments in ovarian and CRC validates the vascular compartment as a target. This work identifies the first assay that could optimise use of VEGFi. Clinical trial information: 2009-011377-33.
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Affiliation(s)
| | - Cong Zhou
- University of Manchester, Manchester, United Kingdom
| | | | - Kalena Marti
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Danielle Shaw
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | - Andrew R. Clamp
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | | | - Juan W. Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Ross Little
- Wolfson Molecular Imaging Centre, Manchester, United Kingdom
| | - Yvonne Watson
- Wolfson Molecular Imaging Centre, Manchester, United Kingdom
| | - Susan Cheung
- Wolfson Molecular Imaging Centre, Manchester, United Kingdom
| | - Caleb Roberts
- Wolfson Molecular Imaging Centre, Manchester, United Kingdom
| | - Prakash Manoharan
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Alan Jackson
- Cancer and Enabling Sciences, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, United Kingdom
| | | | - Geoff J M Parker
- Cancer and Enabling Sciences, Wolfson Molecular Imaging Centre, University of Manchester, Manchester, United Kingdom
| | - Caroline Dive
- CRUK Manchester Institute, Manchester, United Kingdom
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47
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Wyrwicz L, Saunders MP, Andre T, Sarosiek T, Nemecek R, Rogowski W, Leśniewski-Kmak K, Fisher GA, Stecher M, Mohanty P, Simard J, Hickish T. MABp1 to improve clinical outcomes of patients with symptomatic refractory metastatic colorectal cancer patients: Per-protocol population analysis of phase III study (PT026). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3530 Background: Refractory metastatic colorectal cancer (mCRC) patients derive minimal benefit from further exposure to toxic agents. MABp1 is an anti-interleukin 1 alpha antibody that is shown to prolong survival (NCT01767857) and improves outcomes when assessed with a primary endpoint based on a constellation of objective and patient self-reported measures (NCT02138422) (Hickish T. et al Lancet Oncology 2017). In the latter study, clinically advanced patients were enrolled (symptomatic, ECOG 1,2), and 18% of patients progressed prior to reaching the endpoint assessments. Here we present the outcomes in per-protocol population (PP), those patients completing week 8 assessments. Methods: 309 patients randomized 2:1 to receive MABp1 versus placebo. Patients were ECOG 1-2, with mCRC refractory to chemotherapy, any degree of weight loss, and cancer-associated symptoms. The composite primary endpoint assessed the rate of patients achieving stabilization or improvement in lean body mass (LBM) and two of three symptom measures (pain, fatigue, appetite loss) from screening to the week 8 assessment. The study was designed for placebo cross-over, thus OS analysis for MABp1 vs placebo was not possible. Results: 57 patients (38 MABp1 [18%] and 19 placebo [19%]) discontinued study prior to the week 8 assessment due to disease progression, including 17 (8%) and 11 (11%) deaths in MABp1 and placebo respectively. 62% of placebo patients received MABp1 after 8 weeks. 252 patients, 40% in MABp1 (68/169) vs 23% in placebo (19/83) met the primary endpoint (p = 0.003). 139 patients were available for PP survival analysis (90 MABp1 vs 49 Placebo). Median OS of those achieving the primary endpoint was 11.7 months vs 5.7 months for those that did not (HR 0.39; p < 0.0001). Radiographic stable disease was improved (42% vs 12%; p < 0.001) and incidence of SAEs (6% vs 15%; p = 0.11) reduced in those achieving the primary endpoint. Conclusions: Achieving the primary endpoint was associated with improvement in outcomes, RECIST stabilization, SAEs and survival. Further study should confirm the effect of MABp1 on survival in this population. Clinical trial information: NCT02138422.
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Affiliation(s)
- Lucjan Wyrwicz
- Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland
| | | | - Thierry Andre
- Medical Oncology Department, Saint-Antoine Hospital, Paris, France
| | | | - Radim Nemecek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | | | | | | | | | - Tamas Hickish
- Royal Bournemouth Hospital and Poole General Hospital, Bournemouth, United Kingdom
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Lenz HJ, Tabernero J, Yoshino T, Lonardi S, Falcone A, Limón Mirón ML, Saunders MP, Sobrero AF, Park YS, Ferreiro Monteagudo R, Hong YS, Tomasek J, Taniguchi H, Ciardiello F, Sassi M, Peil B, Hastedt C, Studeny M, Van Cutsem E. Nintedanib (N) plus best supportive care (BSC) versus placebo plus BSC for the treatment of patients (pts) with metastatic colorectal cancer (mCRC) refractory to standard therapies: Health-related quality of life (HRQoL) results of the Phase III LUME-Colon 1 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
671 Background: N is a multiple angiokinase inhibitor (including VEGFR, PDGFR and FGFR). A randomised Phase III study, LUME-Colon 1 (NCT02149108), evaluated the efficacy and safety of N in pts with refractory mCRC after failure of standard therapies. LUME-Colon 1 showed a statistically significant improvement in PFS (HR [95% CI] 0.58 [0.49–0.69]; p < 0.0001) but no difference in OS (HR [95% CI]: 1.01 [0.86–1.19]; p = 0.8659). Here, we report the HRQoL outcomes. Methods: 768 pts with mCRC adenocarcinoma refractory to standard chemotherapy were randomised 1:1 to receive either N (200 mg bid) + BSC or P (bid) + BSC in 21-day courses until disease progression or undue toxicity. HRQoL was assessed every 21 days using the EORTC QLQ-C30 instrument; the main endpoints of interest were the differences in mean scores up to median follow-up time (treatment difference, TD) for physical functioning (PF) and global health status/QoL (QL) scales using a longitudinal model, with 95% CIs and associated p-values adjusted for baseline stratification factors. Time to deterioration (TTD) of scores and status change ( ≥ 10 point change from baseline) were also assessed. Results: Compliance with questionnaire completion was high ( > 85% in first 12 cycles). Mean baseline (N vs P) PF (80 vs 80) and QL (65 vs 65) scale scores were balanced between treatment arms. The mean TD favoured N vs P for PF scale scores (TD 2.66 [95% CI: 0.97–4.34]; p = 0.0020) and QL scale scores (TD 1.61 [95% CI: −0.04–3.27]; p = 0.0555). TTD of PF (HR 0.84; 95% CI: 0.69–1.03; p = 0.0904) and QL (HR 0.90; 95% CI: 0.75–1.08; p = 0.2674) scores were not significantly different between treatment groups, although the percentage of patients with improved PF (17.2% vs 11.8%; p = 0.0462) and QL scores (30.3% vs 21.6%: p = 0.0102) were both significantly higher for N vs P. Conclusions: In LUME-Colon 1, patient reported outcomes confirmed that overall HRQoL was not impaired by treatment with N. There was evidence for improvement of PF and QL with N vs P, corresponding to the significant increase in PFS observed. Clinical trial information: NCT02149108.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Young Suk Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Yong Sang Hong
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Hiroya Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Sharma RA, Plummer R, Stock JK, Greenhalgh TA, Ataman O, Kelly S, Clay R, Adams RA, Baird RD, Billingham L, Brown SR, Buckland S, Bulbeck H, Chalmers AJ, Clack G, Cranston AN, Damstrup L, Ferraldeschi R, Forster MD, Golec J, Hagan RM, Hall E, Hanauske AR, Harrington KJ, Haswell T, Hawkins MA, Illidge T, Jones H, Kennedy AS, McDonald F, Melcher T, O'Connor JPB, Pollard JR, Saunders MP, Sebag-Montefiore D, Smitt M, Staffurth J, Stratford IJ, Wedge SR. Clinical development of new drug-radiotherapy combinations. Nat Rev Clin Oncol 2016; 13:627-42. [PMID: 27245279 DOI: 10.1038/nrclinonc.2016.79] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around 40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic radiotherapy, and proton therapy enable higher doses of radiotherapy to be delivered to the tumour with significantly lower doses to normal surrounding tissues. However, apart from the combination of traditional cytotoxic chemotherapy with radiotherapy, little progress has been made in identifying and defining optimal targeted therapy and radiotherapy combinations to improve the efficacy of cancer treatment. The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) formed a Joint Working Group with representatives from academia, industry, patient groups and regulatory bodies to address this lack of progress and to publish recommendations for future clinical research. Herein, we highlight the Working Group's consensus recommendations to increase the number of novel drugs being successfully registered in combination with radiotherapy to improve clinical outcomes for patients with cancer.
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Affiliation(s)
- Ricky A Sharma
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martin D Forster
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | - Julian Golec
- Vertex Pharmaceuticals (Europe) Ltd, Abingdon, UK
| | | | - Emma Hall
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | - Kevin J Harrington
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | | | | | | | | | - Fiona McDonald
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | | | | | | | | | | | - John Staffurth
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
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50
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Freeman K, Saunders MP, Uthman OA, Taylor-Phillips S, Connock M, Court R, Gurung T, Sutcliffe P, Clarke A. Is monitoring of plasma 5-fluorouracil levels in metastatic / advanced colorectal cancer clinically effective? A systematic review. BMC Cancer 2016; 16:523. [PMID: 27456697 PMCID: PMC4960837 DOI: 10.1186/s12885-016-2581-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/02/2015] [Accepted: 07/19/2016] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacokinetic guided dosing of 5-fluorouracil chemotherapies to bring plasma 5-fluorouracil into a desired therapeutic range may lead to fewer side effects and better patient outcomes. High performance liquid chromatography and a high throughput nanoparticle immunoassay (My5-FU) have been used in conjunction with treatment algorithms to guide dosing. The objective of this study was to assess accuracy, clinical effectiveness and safety of plasma 5-fluorouracil guided dose regimen(s) versus standard regimens based on body surface area in colorectal cancer. Methods We undertook a systematic review. MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; EMBASE; Cochrane Library; Science Citation Index and Conference Proceedings (Web of Science); and NIHR Health Technology Assessment Programme were searched from inception to January 2014. We reviewed evidence on accuracy of My5-FU for estimating plasma 5-fluorouracil and on the clinical effectiveness of pharmacokinetic dosing compared to body surface area dosing. Estimates of individual patient data for overall survival and progression-free survival were reconstructed from published studies. Survival and adverse events data were synthesised and examined for consistency across studies. Results My5-FU assays were found to be consistent with reference liquid chromatography tandem mass spectrometry. Comparative studies pointed to gains in overall survival and in progression-free survival with pharmacokinetic dosing, and were consistent across multiple studies. Conclusions Although our analyses are encouraging, uncertainties remain because evidence is mainly from outmoded 5-fluorouracil regimens; a randomised controlled trial is urgently needed to investigate new dose adjustment methods in modern treatment regimens. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2581-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karoline Freeman
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | | | - Olalekan A Uthman
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Martin Connock
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
| | - Rachel Court
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Tara Gurung
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Paul Sutcliffe
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Aileen Clarke
- Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
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