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Margalit O, Lieberman S, Redinsky I, Halparin S, Honig N, Raskin S, Ben-Ayun M, Shacham-Shmueli E, Halpern N, Urban D, Ackerstein A, Shulman K, Ben-Ami E, Semenisty V, Purim O, Yarom N, Golan T, Boursi B, Appel S, Symon Z, Berger R, Mauro D, Krieg AM, Lawrence YR. Combination Treatment of Intratumoral Vidutolimod, Radiosurgery, Nivolumab, and Ipilimumab for Microsatellite Stable Colorectal Carcinoma With Liver Metastases. Clin Colorectal Cancer 2023; 22:442-449.e1. [PMID: 37657954 DOI: 10.1016/j.clcc.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023]
Abstract
INTRODUCTION Microsatellite stable metastatic colorectal cancer (MSS mCRC) is largely refractory to immune checkpoint inhibition. We hypothesized that a combination of intratumoral TLR9 agonist, radiosurgery and dual PD-1 and CTLA-4 blockade would induce a local focus of immune stimulation, evoking a systemic immune response. PATIENTS AND METHODS In this phase I single-institution study, patients with MSS mCRC were treated with a priming dose of s.c vidutolimod, 3 intratumoral injections of vidutolimod and radiosurgery, combined with nivolumab and ipilimumab. Cytokine levels were measured at baseline and at 7 (± 2) weeks. Patients were accrued to 4 consecutive cohorts: (1) Safety run-in without radiosurgery, (2) Radiosurgery prior to intratumoral therapy, (3) Radiosurgery prior to intratumoral therapy with a condensed timeline, and (4) Radiosurgery to extrahepatic lesion following completion of intratumoral therapy. RESULTS A total of 19 patients were accrued. Median age was 59 years (range 40-71), 68% were male, median number of previous systemic treatments was 3 (range 2-5). None of the patients responded, aside from 1 patient, attributed to high tumor mutational burden. Grade 3 liver toxicity was reported in 0%, 0%, 75%, and 17% in cohorts 1 to 4, respectively. Systemic levels of CXCL10 and IL-10 increased, with a median of 407 versus 78 pg/mL (P = .01), and 66 versus 40 pg/mL (P = .03), respectively. CONCLUSIONS The combination of intratumoral vidutolimod, radiosurgery, nivolumab and ipilimumab was not found to be efficacious in MSS mCRC with liver metastases. The juxtaposition of liver irradiation and intratumoral vidutolimod injection was associated with high hepatic toxicity.
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Affiliation(s)
- Ofer Margalit
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Sivan Lieberman
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ilanit Redinsky
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Sharon Halparin
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Nir Honig
- Department of Radiation Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Stephen Raskin
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Maoz Ben-Ayun
- Department of Radiation Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Einat Shacham-Shmueli
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Naama Halpern
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Damien Urban
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Aliza Ackerstein
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Katerina Shulman
- Department of Medical Oncology, Lady Davis Carmel Hospital, Haifa, Israel
| | - Eytan Ben-Ami
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Valeriya Semenisty
- Department of Medical Oncology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Purim
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nirit Yarom
- Department of Medical Oncology, Shamir Medical Center, Beer Yaacov, Israel
| | - Talia Golan
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ben Boursi
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Sarit Appel
- Department of Radiation Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Zvi Symon
- Department of Radiation Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Raanan Berger
- Department of Medical Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel
| | | | | | - Yaacov R Lawrence
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University-Jefferson Health, Phila, PA; Department of Radiation Oncology, Sheba Medical Center, Ramat Gan affiliated with Tel Aviv University, Tel Aviv, Israel.
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Sapir E, Pfeffer R, Wygoda M, Purim O, Levy A, Corn B, Amitay Y, Ohana P, Gabizon A. Pegylated Liposomal Mitomycin C Lipidic Prodrug in Combination With External Beam Radiation Therapy in Patients With Advanced Cancer: A Phase 1B Study. Int J Radiat Oncol Biol Phys 2023; 117:64-73. [PMID: 36933845 DOI: 10.1016/j.ijrobp.2023.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The aim of this study was to evaluate a formulation of pegylated liposomal mitomycin C lipidic prodrug (PL-MLP) in patients concomitantly undergoing external beam radiation therapy (RT). METHODS AND MATERIALS Patients with metastatic disease or inoperable primary solid tumors requiring RT for disease control or symptom relief were treated with 2 courses of PL-MLP (1.25, 1.5, or 1.8 mg/kg) at 21-day intervals, along with 10 fractions of conventional RT or 5 stereotactic body RT fractions initiated 1 to 3 days after the first PL-MLP dose and completed within 2 weeks. Treatment safety was monitored for 6 weeks, and disease status was re-evaluated at 6-week intervals thereafter. MLP levels were analyzed 1 hour and 24 hours after each PL-MLP infusion. RESULTS Overall, 19 patients with metastatic (18) or inoperable (1) disease received combination treatment, with 18 completing the full protocol. Most patients (16) had diagnoses of advanced gastrointestinal tract cancer. One grade 4 neutropenia event possibly related to study treatment was reported; other adverse events were mild or moderate. Of the 18 evaluable patients, 16 were free of RT target lesion progression at first re-evaluation. Median survival of the entire patient population was 63.3 weeks. Serum MLP level correlated with dose increases and similar long circulating profiles were observed before and after RT. CONCLUSIONS PL-MLP up to 1.8 mg/kg in combination with RT treatment is safe, with a high rate of tumor control. Drug clearance is not affected by radiation. PL-MLP is potentially an attractive option for chemoradiation therapy that warrants further evaluation in randomized studies in the palliative and curative settings.
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Affiliation(s)
- Eli Sapir
- Samson Assuta Ashdod University Hospital, Radiotherapy Institute, Ashdod, Israel
| | - Raphael Pfeffer
- Assuta Medical Center, Radiotherapy Institute, Tel Aviv, Israel
| | - Marc Wygoda
- Hadassah Hebrew University Medical Center, Radiotherapy Institute, Jerusalem, Israel
| | - Ofer Purim
- Samson Assuta Ashdod University Hospital, Radiotherapy Institute, Ashdod, Israel
| | - Adi Levy
- Hadassah Hebrew University Medical Center, Radiotherapy Institute, Jerusalem, Israel
| | - Benjamin Corn
- Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Oncology Institute, Jerusalem, Israel
| | | | | | - Alberto Gabizon
- Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Oncology Institute, Jerusalem, Israel; Lipomedix Pharmaceuticals Ltd, Jerusalem, Israel.
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Lawrence YR, Lieberman S, Redinsky I, Honig N, Shacham-Shmueli E, Halpern N, Raskin S, Urban D, Ackerstein A, Ben-Ayun M, Shulman K, Ben-Ami E, Semenisty V, Purim O, Yarom N, Golan T, Boursi B, Ziegler L, Krieg AM, Margalit O. Combination treatment of intratumoral vidutolimod (CMP-001), radiosurgery, nivolumab, and ipilimumab for metastatic colorectal carcinoma. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.123] [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: 01/25/2023] Open
Abstract
123 Background: Microsatellite stable (MSS) or mismatch repair proficient (MMR-P) metastatic colorectal cancer is refractory to immune checkpoint inhibition. We hypothesized that a combination of intratumoral TLR9 agonist, radiosurgery and dual PD-1 and CTLA-4 blockade would induce a local focus of immune stimulation, evoking a systemic immune response. Methods: In this single institution investigator-initiated phase I study, patients with MSS / MMR-P metastatic colorectal cancer were treated with a priming dose of subcutaneous (s.c.) vidutolimod, three intratumoral injections of vidutolimod, and radiosurgery to a metastasis, combined with nivolumab 3mg/kg every 2 weeks and ipilimumab 1 mg/kg every 6 weeks. Following conclusion of intratumoral therapy, s.c. injections of vidutolimod commenced. Efficacy endpoints were based upon a non-irradiated and non-injected lesion. Cytokine levels were measured at baseline and at 7 (± 2) weeks. Patients were placed in 4 cohorts: (1) Safety run-in without radiosurgery (No RT); (2) Radiosurgery prior to intratumoral therapy (Early Liver RT Slow). An amendment was made due to early patient fall-out due to progressive disease; (3) Radiosurgery prior to intratumoral therapy with a condensed timeline (Early Liver RT Quick). An additional amendment was made due to unacceptable liver toxicity; (4) Radiosurgery to extrahepatic lesion following completion of intratumoral therapy (Late Extrahepatic RT). ClinicalTrials.gov Identifier NCT03507699. Results: A total of 19 patients were accrued (No RT, n=2; Early Liver RT Slow, n=7; Early Liver RT Quick, n=4; Late Extrahepatic RT, n=6). Median age was 59 years (range 40-71), 68% were male, median number of previous systemic treatments was 3 (range 2 – 5). None of the patients responded, aside from one patient in cohort #4 who achieved complete response, and was subsequently found to have a high tumor mutational burden (TMB) 79 mutations / Mb. Grade 3 liver toxicity, including elevated transaminases and hyperbilirubinemia, was reported in 0%, 0%, 75% and 17% in cohorts 1-4, respectively. Reactions following intratumoral injections, typically within 12 hours, included fever (68%), tachycardia (21%), chills (63%) and hypotension (47%). There was an increase in systemic CXCL10 levels at 7 (± 2) weeks compared to baseline, with a median of 407 versus 78 pg/ml, respectively, p<0.01. Conclusions: Intratumoral liver injection of vidutolimod was associated with acute systemic symptoms attributed to cytokine release. The juxtaposition of liver irradiation and intratumoral vidutolimod injection to the same lesion was associated with unacceptable hepatic toxicity. The combination of intratumoral vidutolimod, radiosurgery, nivolumab and ipilimumab was not found to be efficacious in MSS / MMR-P colon cancer. Clinical trial information: NCT03507699 .
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Affiliation(s)
| | | | | | - Nir Honig
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Naama Halpern
- Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | | | | | | | | | | | | | | | - Ofer Purim
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nirit Yarom
- Shamir Medical Center, Beer Yaacov, ON, Israel
| | | | - Ben Boursi
- Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Ofer Margalit
- The Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
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Mor E, Assaf D, Laks S, Gilat EK, Hazzan D, Shacham-Shmueli E, Margalit O, Halpern N, Beller T, Boursi B, Purim O, Perelson D, Zippel D, Adileh M, Nissan A, Ben-Yaacov A. Pelvic Peritonectomy Poorly Affects Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Metastases. J Gastrointest Surg 2023; 27:131-140. [PMID: 36327025 DOI: 10.1007/s11605-022-05501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Constraints of pelvic anatomy render complete cytoreduction (CRS) challenging. The aim of this study is to investigate the impact of pelvic peritonectomy during CRS/HIPEC on colorectal peritoneal metastasis (CRPM) patients' outcomes. METHODS This is a retrospective analysis of a prospectively maintained CRS/hyperthermic intraperitoneal chemotherapy (HIPEC) database. The analysis included 217 patients with CRPM who had a CRS/HIPEC between 2014 and 2021. We compared perioperative and oncological outcomes of patients with pelvic peritonectomy (PP) (n = 63) to no pelvic peritonectomy (non-PP) (n = 154). RESULTS No differences in demographics were identified. The peritoneal cancer index (PCI) was higher in the PP group with a median PCI of 12 vs. 6 in the non-PP group (p < 0.001). Operative time was 4.9 vs. 4.3 h in the PP and non-PP groups, respectively (p = 0.63). Median hospitalization was longer in the PP group at 12 vs. 10 days (p = 0.007), and the rate of complications were higher in the PP group at 57.1% vs. 39.6% (p = 0.018). Pelvic peritonectomy was associated with worse disease-free (DFS) and overall survival (OS) with 3-year DFS and OS of 7.3 and 46.3% in the PP group vs. 28.2 and 87.8% in the non-PP group (p = 0.028, p .> 0.001). The univariate OS analysis identified higher PCI (p = 0.05), longer surgery duration (p = 0.02), and pelvic peritonectomy (p < 0.001) with worse OS. Pelvic peritonectomy remained an independent prognostic variable, irrespective of PCI, on the multivariate analysis (p < 0.001). CONCLUSIONS Pelvic peritonectomy at the time of CRS/HIPEC is associated with higher morbidity and worse oncological outcomes. These findings should be taken into consideration in the management of patients with pelvic involvement.
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Affiliation(s)
- Eyal Mor
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Assaf
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shachar Laks
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Efrat Keren Gilat
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - David Hazzan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ofer Margalit
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Tamar Beller
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ofer Purim
- Department of Oncology, Assuta Ashdod Public Hospital, Ashdod, Israel, Affiliated With Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Daria Perelson
- Department of Anesthesiology, Sheba Medical Center, Affiliated With Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Douglas Zippel
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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Kian W, Krayim B, Alsana H, Giles B, Purim O, Alguayn W, Alguayn F, Peled N, Roisman LC. Overcoming CEP85L-ROS1, MKRN1-BRAF and MET amplification as rare, acquired resistance mutations to Osimertinib. Front Oncol 2023; 13:1124949. [PMID: 36923435 PMCID: PMC10009227 DOI: 10.3389/fonc.2023.1124949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023] Open
Abstract
Lung cancer is the most common cancer-related cause of death worldwide, most of which are non-small cell lung cancers (NSCLC). Epidermal growth factor receptor (EGFR) mutations are common drivers of NSCLC. Treatment plans for NSCLC, specifically adenocarcinomas, rely heavily on the presence or absence of specific actionable driver mutations. Liquid biopsy can guide the treatment protocol to detect the presence of various mechanisms of resistance to treatment. We report three NSCLC EGFR mutated cases, each treated with Osimertinib in a combination therapy regimen to combat resistance mechanisms. The first patient presented with EGFR L858R/L833V compound mutation with MET amplification alongside CEP85L-ROS1 fusion gene, the second with EGFR exon 19del and MKRN1-BRAF fusion, and the last EGFR L858R/V834L compound mutation with MET amplification. Each regimen utilized a tyrosine kinase inhibitor or monoclonal antibody in addition to osimertinib and allowed for a prompt and relatively durable treatment response.
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Affiliation(s)
- Waleed Kian
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Bilal Krayim
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Hadel Alsana
- Pulmonology Department, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
| | - Betsy Giles
- Medical School of International Health, Faculty of Health Sciences at Ben-Gurion University, Beer-Sheva, Israel
| | - Ofer Purim
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Wafeek Alguayn
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Farouq Alguayn
- Barzilai Medical Center, Department of Intensive Care, Ashkelon, Israel and Soroka Medical Center, Department of Neurosurgery, Ben-Gurion University, Beer-Sheva, Israel
| | - Nir Peled
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Laila C Roisman
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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Mor E, Shemla S, Assaf D, Laks S, Benvenisti H, Hazzan D, Shiber M, Shacham-Shmueli E, Margalit O, Halpern N, Boursi B, Beller T, Perelson D, Purim O, Zippel D, Ben-Yaacov A, Nissan A, Adileh M. ASO Visual Abstract: Natural History and Management of Small Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy. Ann Surg Oncol 2022; 29:8582. [PMID: 35974235 DOI: 10.1245/s10434-022-12422-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shanie Shemla
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mai Shiber
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Shacham-Shmueli
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Ofer Margalit
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Naama Halpern
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Ben Boursi
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Tamar Beller
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Daria Perelson
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Anesthesiology, Sheba Medical Center, Tel HaShomer, Israel
| | - Ofer Purim
- The Department of Oncology, Assuta Ashdod Public Hospital, Ashdod, Israel
- Affiliated with the Faculty of Health and Science, Ben-Gurion University, Beersheba, Israel
| | - Douglas Zippel
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel.
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Mor E, Shemla S, Assaf D, Laks S, Benvenisti H, Hazzan D, Shiber M, Shacham-Shmueli E, Margalit O, Halpern N, Boursi B, Beller T, Perelson D, Purim O, Zippel D, Ben-Yaacov A, Nissan A, Adileh M. Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy. Ann Surg Oncol 2022; 29:8566-8579. [PMID: 35941342 DOI: 10.1245/s10434-022-12370-x] [Citation(s) in RCA: 1] [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] [Received: 01/05/2022] [Accepted: 07/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Small-bowel obstruction (SBO) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a common complication associated with re-admission that may alter patients' outcomes. Our aim was to characterize and investigate the impact of bowel obstruction on patients' prognosis. METHODS This was a retrospective analysis of patients with SBO after CRS/HIPEC (n = 392). We analyzed patients' demographics, operative and perioperative details, SBO re-admission data, and long-term oncological outcomes. RESULTS Out of 366 patients, 73 (19.9%) were re-admitted with SBO. The cause was adhesive in 42 (57.5%) and malignant (MBO) in 31 (42.5%). The median time to obstruction was 7.7 months (range, 0.5-60.9). Surgical intervention was required in 21/73 (28.7%) patients. Obstruction eventually resolved (spontaneous or by surgical intervention) in 56/73 (76.7%) patients. Univariant analysis identified intraperitoneal chemotherapy agents: mitomycin C (MMC) (HR 3.2, p = 0.003), cisplatin (HR 0.3, p = 0.03), and doxorubicin (HR 0.25, p = 0.018) to be associated with obstruction-free survival (OFS). Postoperative complications such as surgical site infection (SSI), (HR 2.2, p = 0.001) and collection (HR 2.07, p = 0.015) were associated with worse OFS. Multivariate analysis maintained MMC (HR 2.9, p = 0.006), SSI (HR 1.19, p = 0.001), and intra-abdominal collection (HR 2.19, p = 0.009) as independently associated with OFS. While disease-free survival was similar between the groups, overall survival (OS) was better in the non-obstruction group compared with the obstruction group (p = 0.03). CONCLUSIONS SBO after CRS/HIPEC is common and complex in management. Although conservative management was successful in most patients, surgery was required more frequently in patients with MBO. Patients with SBO demonstrate decreased survival.
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Affiliation(s)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shanie Shemla
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mai Shiber
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ofer Margalit
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Naama Halpern
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ben Boursi
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Tamar Beller
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Daria Perelson
- The Department of Anesthesiology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ofer Purim
- The Department of Oncology, Assuta Ashdod Public Hospital, Affiliated with the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel, Ashdod, Israel
| | - Douglas Zippel
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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8
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Ben-Yaacov A, Laks S, Goldenshluger M, Nevo Y, Mor E, Schtrechman G, Margalit O, Boursi B, Shacham-Shmueli E, Halpern N, Purim O, Hazzan D, Segev L, Zippel D, Adileh M, Nissan A. Impact of "critical lesions" on outcomes following cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. Eur J Surg Oncol 2021; 47:2933-2938. [PMID: 34088586 DOI: 10.1016/j.ejso.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Peritoneal Cancer Index (PCI) and complete cytoreduction are the best outcome predictors following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Lesions in critical areas, regardless of PCI, complicate surgery and impact oncological outcomes. We prospectively defined "Critical lesions" (CL) as penetrating the hepatic hilum, diaphragm at hepatic outflow, major blood vessels, pancreas, or urinary tract. METHODS Retrospective analysis of a prospective database of 352 CRS + HIPEC patients from 2015 to 2019. Excluded patients with aborted/redo operation (n = 112), or incomplete data (n = 19). Patients categorized by CL status and compared: operative time, estimated blood loss (EBL), PCI, transfusions, hospital stay, post-operative complications and mortality, overall survival (OS) and disease-free survival (DFS). RESULTS Included 221 patients (78 CL; 143 no-CL). No difference in patients' characteristics: age, BMI, gender or co-morbidities noted. Operative time longer (5.3 h vs 4.3 h, p < 0.01), EBL higher (769 ml vs 405 ml, p < 0.01), transfusions higher (1.9 vs 0.7 Units, p < 0.001) and PCI higher (15.5 vs 9.5, p < 0.01) in CL. No difference in major complications. Postoperative complications, CL, OR-time and transfusions were predictive of OS in univariate analysis, while only complications remained on multivariate analysis. Median follow up of 21.4 months, 3-year DFS/OS was 22% vs 30% (p < 0.037) and 73% vs 87% (p < 0.014) in CL and non-CL, respectively. Despite CL complete resection, 17/38 patients (44.7%) that recurred had recurrence at previous CL site. CONCLUSIONS Critical lesions complicate surgery and may be associated with poor oncological outcomes with high local recurrence rate, despite no significant difference in complications. Utilizing adjuvant or intra-operative radiation may be beneficial.
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Affiliation(s)
- A Ben-Yaacov
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - S Laks
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - M Goldenshluger
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Y Nevo
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - E Mor
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - G Schtrechman
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - O Margalit
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - B Boursi
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Shacham-Shmueli
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - N Halpern
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - O Purim
- Gastrointestinal Malignancy Service at Assuta Samson Hospital, Ashdod, Israel
| | - D Hazzan
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - L Segev
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - D Zippel
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - M Adileh
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - A Nissan
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
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9
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Laks S, Schtrechman G, Adileh M, Ben-Yaacov A, Purim O, Ivanov V, Aderka D, Shacham-Shmueli E, Halpern N, Goren S, Perelson D, Nissan A. Repeat Cytoreductive Surgery and Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Recurrences is Safe and Efficacious. Ann Surg Oncol 2021; 28:5330-5338. [PMID: 33591479 DOI: 10.1245/s10434-021-09684-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for colorectal cancer peritoneal metastases (CRPM) is associated with improved survival in patients with historically dismal prognosis. Nonetheless, peritoneal recurrences remain common and represent a difficult challenge in these patients' management. Repeat CRS/HIPEC is associated with even greater morbidity and its survival benefit has not yet been clearly demonstrated. METHODS We retrospectively reviewed our prospectively maintained database and aimed to assess the safety and oncological efficacy of repeat CRS/HIPEC. RESULTS Two hundred thirty-two patients underwent an initial CRS/HIPEC, whereas 30 subsequently had repeat CRS/HIPEC for CRPM. Groups were similar in demographics, comorbidities, and peritoneal cancer index (PCI). No significant difference in morbidity, hospital stay, or reoperation rate was noted between initial and repeat procedures. Patients who underwent repeat CRS/HIPEC had a median overall survival of 68 months versus 51 months in patients who did not undergo repeat procedure for their peritoneal recurrence (p = 0.03). Disease-free survival (DFS) in patients after repeat and after initial procedure were similar with median of 9.6 versus 12 months, respectively (p = 0.083). Univariate analysis demonstrated that PCI, DFS, and repeat procedure displayed significant factors on outcomes in patients with peritoneal recurrences, whereas PCI > 16 and DFS remained independent predictors on multivariable analysis. CONCLUSIONS Our analysis, which represents the largest series to date of repeat CRS/HIPEC for CRPM, indicates that this approach as a part of multimodal therapy is both safe and efficacious in appropriately selected patients.
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Affiliation(s)
- Shachar Laks
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel. .,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.
| | - Gal Schtrechman
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Ofer Purim
- Department of Oncology, Assuta Samson Hospital, Ashdod, Israel
| | - Vyacheslav Ivanov
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Dan Aderka
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Einat Shacham-Shmueli
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Naama Halpern
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shani Goren
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Daria Perelson
- Department of Anesthesiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
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10
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Amitay-Laish I, Prag-Naveh H, Ollech A, Davidovici B, Leshem YA, Snast I, Popovtzer A, Purim O, Flex D, David M, Brenner B, Ben-Aharon I, Peled N, Hodak E, Stemmer SM. Prophylactic Topical Treatment for EGFR Inhibitor-Induced Papulopustular Rash: A Randomized Clinical Trial. Dermatology 2020; 237:988-994. [PMID: 33378750 DOI: 10.1159/000511869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The incidence of epidermal growth factor receptor inhibitor (EGFRI)-induced papulopustular rash is 60-85%. OBJECTIVE To investigate prophylactic topical treatment for EGFRI-induced rash. METHODS A single-center, randomized, double-blind, placebo-controlled trial. Adult cancer patients initiating treatment with EGFRIs were randomized to receive facial topical treatment with chloramphenicol 3% + prednisolone 0.5% (CHL-PRED) ointment, chloramphenicol 3% (CHL) ointment, or aqua cream (AQUA). The primary end points were the incidence of ≥grade 3 rash using the Common Terminology Criteria for Adverse Events (CTCAE), on days 14 and 30. A subanalysis was conducted for incidence of a protocol-specified significant rash, defined as ≥10 facial papulopustular lesions. RESULTS The per-protocol analysis on day 14 included 69 patients, who received CHL-PRED (21), CHL (23), or AQUA (25). The incidence of CTCAE ≥grade 3 rash was not statistically significant between arms; however, the incidence of the protocol-specified significant rash was: CHL-PRED 14%, CHL 39%, and AQUA 48% (p = 0.03, CHL-PRED vs. AQUA). At 30 days, the CTCAE ≥grade 3 incidence was similar, but the incidences of protocol-specified significant rash were 6%, 16%, and 43% (p = 0.03, CHL-PRED vs. AQUA). No significant differences were found between CHL and CHL-PRED and between CHL and AQUA. CONCLUSIONS Prophylactic topical CHL-PRED was efficacious when compared to AQUA, in the treatment of EGFRI-induced facial papulopustular rash.
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Affiliation(s)
- Iris Amitay-Laish
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Hadas Prag-Naveh
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel
| | - Ayelet Ollech
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Batya Davidovici
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Anne Leshem
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Snast
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Institute of Oncology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Flex
- Institute of Oncology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael David
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Peled
- Institute of Oncology, Davidoff Cancer Center, Petah Tikva, Israel.,The Legacy Heritage Oncology Center and Dr. Larry Norton Institute, Soroka Medical Center and Ben-Gurion University, Beer-Sheva, Israel
| | - Emmillia Hodak
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salomon M Stemmer
- Institute of Oncology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Sarid D, Berger R, Levertovsky M, Gadot M, Maurice-Dror C, Peer A, Perets R, Purim O, Sarfaty M, Rosenbaum E, Neiman V, Ligumsky H, Rouvinov K, Romanov E, Marmelstein W, Shani-Shrem N, Weiner G, Leibowitz-Amit R. Genomic analysis of urothelial cancer and associations with treatment choice and outcome. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Sarid D, Berger R, Levartovsky M, Gadot M, Maurice-Dror C, Collin M, Peer A, Perets R, Purim O, Sarfaty M, Rosenbaum E, Neiman V, Ligumsky H, Rouvinov K, Romanov I, Mermershtain W, Shani Shrem N, Vainer GW, Leibowitz-Amit R. Genomic analysis of urothelial cancer and associations with treatment choice and outcome. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16026] [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
e16026 Background: The use of next generation sequencing (NGS) is in a constant rise, without clear evidence to its utility in guiding treatment choices in urologic malignancies. While platinum-based chemotherapy (chemo) is still the mainstay of treatment, anti-PD1/L1 antibodies (IO) and FGFR3 inhibitors are emerging therapeutic options. Here our aim was to retrospectively assess the utility of next-generation sequencing (NGS) in selecting advanced treatment lines and define the response rates (RR) to chemo and IO in a real-life cohort. Methods: Metastatic urothelial carcinoma (UC) patients (pts) receiving first-line chemo were included. Paraffin-embedded pathological samples were subjected to FoundationOne genomic analysis (Roche) and to PD-L1 IHC staining using the FDA-approved Ventana's companion diagnostic test. Reports were anonymized and analysis was performed using Excel (Microsoft Office). Response was defined as either a clinically or radiologically-significant improvement. Results: 60 pts were included in this analysis with a median age of 69, of which 87.7% were men and 70% were current or past-smokers. RR to first line chemo or IO was 66% (95% CI 50-82) and 33% (95% CI 12-64), respectively. RR to second-line IO was 14% ((95% CI 4-40). Median TMB was 10 Mut/Mb (range 1-62) with no difference between smokers and non-smokers. 31% pts had tumor PD-L1 staining of > 5% and 3.7% were MSI-high. 107 genes were altered across all pts. The median number of genomic alterations (mutations (muts), amplifications (amps), deletions (dels) and re-arrangements) was 7 (range 2-17). The most frequent were TERT promotor and TP53 mutations, occurring in in 39 (69.6%) and 30 (53.6%) pts, respectively. FGFR3 alterations were found in 9 (15%) pts (7 mut and 2 fusions), 12 pts (20%) had alterations in ERBB2/Her2 (6 amps, 3 muts, 3 equivocal amps), BRCA1 mutations were found in 6 (10%) pts, and TSC1 alterations were found in 6 (10%) pts (4 muts and 2 dels). Altogether, about 40% of patients had potentially actionable alterations; of these, to date, the treatment of 8 patients (13%) was consequently altered. The RR to IO was non-significantly higher in pts with TMB > 10 (29% VS 20%, p = 0.1) across all pts in this cohort. Conclusions: RR to first-line chemo is higher than to first-line IO, and the association between TMB and response to IO is still debatable in UC. NGS can yield potentially 'actionable' alterations in about 40% of UC pts, and can change the treatment paradigm in the third of them.
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Affiliation(s)
- David Sarid
- Ichilov Hospital-Sourasky Medical Center, Tel-Aviv, Israel
| | | | | | - Moran Gadot
- Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | | | | | | | | | | | | | - Eli Rosenbaum
- Rabin Medical Center, Davidoff Center, Petah Tikva, Israel
| | - Victoria Neiman
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Keren Rouvinov
- Department of Oncology, Soroka University Medical Center, and Faculty of the Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Wilmosh Mermershtain
- Department of Oncology, Soroka University Medical Center, and Faculty of the Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
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13
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Kundel Y, Nasser NJ, Rath-Wolfson L, Purim O, Yanichkin N, Brenner R, Zehavi T, Nardi Y, Fenig E, Sulkes A, Brenner B. Molecular Predictors of Response to Neoadjuvant Chemoradiation for Rectal Cancer. Am J Clin Oncol 2019; 41:613-618. [PMID: 27740975 DOI: 10.1097/coc.0000000000000337] [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: 01/28/2023]
Abstract
OBJECTIVES To determine whether the expression of specific molecular markers in the rectal cancer biopsies prior to treatment, can correlate with complete tumor response to chemoradiotherapy (CRT) as determined by the pathology of the surgical specimen. METHODS We retrospectively examined pretreatment rectal biopsies of patients aged 18 years or older with locally advanced rectal cancer who had been treated with neoadjuvant CRT and surgical resection in our tertiary-care, university-affiliated medical center, between January 2001 and December 2011. Samples were analyzed for expression of B-cell lymphoma 2, P53, Ki67, epidermal growth factor receptor (EGFR), vascular endothelial growth factor receptor, and the tumor regression grade after CRT and radical surgery. RESULTS Forty-seven patients were included in the final analysis. Main outcome measures were the correlation between the expression of the molecular markers tested in the pretreatment biopsy, and complete tumor response. Complete pathologic response after CRT was attained in 27% of the patients. Percentage of cells expressing EGFR in the pretreated biopsies of patients having complete pathologic response after CRT and surgery was 33.08±7.87% compared to 19±15.36% (P=0.38), 6.66±2.83% (P<0.003), and 12.5±4.93% (P=0.033) in patients with partial response and tumor regression grades of 2, 3, and 4, respectively. The other molecular markers tested in the pretreatment biopsy did not corresponded with complete pathologic response. CONCLUSIONS EGFR expression pattern in the pretreatment biopsies of rectal tumors can assist in identifying patients who will benefit from neoadjuvant CRT.
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Affiliation(s)
- Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Nicola J Nasser
- Oncology Institute, Ziv Medical Center, Safed.,Faculty of Medicine in the Galilee, Bar-Ilan University
| | - Lea Rath-Wolfson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.,Department of Pathology, Rabin Medical Center, Hasharon Hospital, Petach Tikva
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Natalia Yanichkin
- Department of Pathology, Rabin Medical Center, Hasharon Hospital, Petach Tikva
| | - Ronen Brenner
- Institute of Oncology, Wolfson Medical Center, Holon
| | | | - Yuval Nardi
- Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eyal Fenig
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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14
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Dudnik E, Twito T, Faull I, Dvir A, Soussan-Gutman L, Purim O, Lanman RB. Circulating Cell-Free Tumor DNA in the Management of Double Primary Tumors. JCO Precis Oncol 2018; 2:1-6. [DOI: 10.1200/po.17.00238] [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: 11/20/2022] Open
Affiliation(s)
- Elizabeth Dudnik
- Elizabeth Dudnik and Ofer Purim, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva; Tal Twito, Addie Dvir, and Lior Soussan-Gutman, TEVA Pharmaceuticals Industries, Shoam, Israel; and Iris Faull and Richard B. Lanman, Guardant Health, Redwood City, CA
| | - Tal Twito
- Elizabeth Dudnik and Ofer Purim, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva; Tal Twito, Addie Dvir, and Lior Soussan-Gutman, TEVA Pharmaceuticals Industries, Shoam, Israel; and Iris Faull and Richard B. Lanman, Guardant Health, Redwood City, CA
| | - Iris Faull
- Elizabeth Dudnik and Ofer Purim, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva; Tal Twito, Addie Dvir, and Lior Soussan-Gutman, TEVA Pharmaceuticals Industries, Shoam, Israel; and Iris Faull and Richard B. Lanman, Guardant Health, Redwood City, CA
| | - Addie Dvir
- Elizabeth Dudnik and Ofer Purim, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva; Tal Twito, Addie Dvir, and Lior Soussan-Gutman, TEVA Pharmaceuticals Industries, Shoam, Israel; and Iris Faull and Richard B. Lanman, Guardant Health, Redwood City, CA
| | - Lior Soussan-Gutman
- Elizabeth Dudnik and Ofer Purim, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva; Tal Twito, Addie Dvir, and Lior Soussan-Gutman, TEVA Pharmaceuticals Industries, Shoam, Israel; and Iris Faull and Richard B. Lanman, Guardant Health, Redwood City, CA
| | - Ofer Purim
- Elizabeth Dudnik and Ofer Purim, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva; Tal Twito, Addie Dvir, and Lior Soussan-Gutman, TEVA Pharmaceuticals Industries, Shoam, Israel; and Iris Faull and Richard B. Lanman, Guardant Health, Redwood City, CA
| | - Richard B. Lanman
- Elizabeth Dudnik and Ofer Purim, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva; Tal Twito, Addie Dvir, and Lior Soussan-Gutman, TEVA Pharmaceuticals Industries, Shoam, Israel; and Iris Faull and Richard B. Lanman, Guardant Health, Redwood City, CA
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15
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Shmuely H, Brenner B, Groshar D, Hadari N, Purim O, Nidam M, Eligalashvili M, Yahav J, Bernstine H. The Association of Helicobacter pylori Seropositivity and Colorectal Cancer. Isr Med Assoc J 2018; 20:726. [PMID: 30430810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Haim Shmuely
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Hadari
- Dan District, Clalit Health Services, Or Yehuda, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merab Eligalashvili
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Yahav
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Shmuely H, Brenner B, Groshar D, Hadari N, Purim O, Nidam M, Eligalashvili M, Yahav J, Bernstine H. The Association of Helicobacter pylori Seropositivity with All-Cause Mortality among Colorectal Cancer Patients Undergoing PET/CT Scans. Isr Med Assoc J 2018; 20:504-508. [PMID: 30084577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Evidence has been emerging that Helicobacter pylori may also impact colorectal cancer (CRC). Positron emission tomography/computed tomography (PET/CT) imaging can predict overall survival in CRC patients. OBJECTIVES To determine a possible association between H. pylori seropositivity and all-cause mortality among CRC patients evaluated by PET/CT scans. METHODS This prospective cohort study was comprised of 110 consecutive CRC patients who had undergone a PET/CT evaluation in a tertiary academic medical center. Data included demographics, body mass index (BMI), tumor node metastasis stage at diagnosis, treatment, time from diagnosis to PET/CT, and PET/CT findings. All patients were tested for anti-H. pylori immunoglobulin G (IgG) antibodies and followed for 36 months from the day of the PET/CT scan. Mortality was documented. Univariate and multivariate Cox regression was used to estimate the hazard ratio (HR) of H. pylori serological status. RESULTS During the follow-up period, of the 110 CRC patients 41 (37.3%) died and 69 (62.7%) survived. Of the 41 patients, 26 (63.4%) were H. pylori seropositive and 15 (36.6%) were seronegative. Multivariate analysis showed that H. pylori seropositivity was associated with increased mortality (HR 3.46, 95% confidence interval 1.63-7.32), stage IV at diagnosis, metastatic disease found on PET/CT, longer time from diagnosis to PET/CT, lower BMI, and older age. CONCLUSIONS Our findings suggest that H. pylori infection may be a risk factor for all-cause mortality among CRC patients who are evaluated by PET/CT. Multicenter studies with larger patient groups are needed to confirm our findings.
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Affiliation(s)
- Haim Shmuely
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Hadari
- Dan District, Clalit Health Services, Or Yehuda, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merab Eligalashvili
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Yahav
- Department of Internal Medicine D and Helicobacter Research Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Stemmer SM, Prag-Naveh H, Ollech A, Popovitzer A, Purim O, Flex D, Leshem Y, Davidovici B, Ulitsky O, Brenner B, Ben-Aharon I, Peled N, David M, Amitay Laish I. Prophylactic treatment for acneiform rash caused by EGFR inhibitors: Prospective randomized double-blind trial comparing daily topical chloramphenicol 3% plus prednisolone 0.5% vs chloramphenicol 3% vs aqua cream. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10092] [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: 11/20/2022] Open
Affiliation(s)
- Salomon M. Stemmer
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Hadas Prag-Naveh
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Ayelet Ollech
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Aron Popovitzer
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Ofer Purim
- Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Dov Flex
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Yael Leshem
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Batya Davidovici
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Olga Ulitsky
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Baruch Brenner
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Hod Hasharon, Israel
| | - Irit Ben-Aharon
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Tel Aviv, Israel
| | - Nir Peled
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Michael David
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Iris Amitay Laish
- Department of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
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18
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Purim O, Beny A, Inbar M, Shulman K, Brenner B, Dudnik E, Bokstein F, Temper M, Limon D, Matceyevsky D, Sarid D, Segal A, Semenisty V, Brenner R, Peretz T, Idelevich E, Pelles-Avraham S, Meirovitz A, Figer A, Russell K, Voss A, Dvir A, Soussan-Gutman L, Hubert A. Biomarker-Driven Therapy in Metastatic Gastric and Esophageal Cancer: Real-Life Clinical Experience. Target Oncol 2018; 13:217-226. [PMID: 29353436 PMCID: PMC5886994 DOI: 10.1007/s11523-017-0548-8] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Precision treatment of cancer uses biomarker-driven therapy to individualize and optimize patient care. OBJECTIVE To evaluate real-life clinical experience with biomarker-driven therapy in metastatic gastric and esophageal cancer in Israel. PATIENTS AND METHODS This multicenter retrospective cohort study included patients with metastatic gastric or esophageal cancer who were treated in the participating institutions and underwent biomarker-driven therapy. Treatment was considered to have a benefit if the ratio between the longest progression-free survival (PFS) post biomarker-driven therapy and the last PFS before the biomarker-driven therapy was ≥1.3. The null hypothesis was that ≤15% of patients gain such benefit. RESULTS The analysis included 46 patients (61% men; median age, 58 years; 57% with poorly-differentiated tumors). At least one actionable (i.e., predictive of response to a specific therapy) biomarker was identified for each patient. Immunohistochemistry was performed on all samples and identified 1-8 (median: 3) biomarkers per patient (most commonly: low TS, high TOPO1, high TOP2A). Twenty-eight patients received therapy after the biomarker analysis (1-4 lines). In the 1st line after biomarker analysis, five patients (18%) achieved a partial response and five (18%) stable disease; the median (range) PFS was 129 (12-1155) days. Twenty-four patients were evaluable for PFS ratio analysis; in seven (29.2%), the ratio was ≥1.3. In a one-sided exact binomial test vs. the null hypothesis, p = 0.019; therefore, the null hypothesis was rejected. CONCLUSIONS Our findings demonstrated that implementing biomarker-driven analysis is feasible and could provide clinical benefit for a considerable proportion (~30%) of patients with metastatic gastric or esophageal cancer.
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Affiliation(s)
- Ofer Purim
- Oncology Institute, Assuta Ashdod Academic Hospital, Harefua St 7, 7747629, Ashdod, Israel.
- Sackler Medical School, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel.
| | - Alexander Beny
- Oncology Department, Rambam Health Care Campus, 6 Ha'Aliya St, 31096, Haifa, Israel
| | - Moshe Inbar
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Katerina Shulman
- Oncology Unit, Hillel Yaffe Medical Center, Ha-Shalom St, 38100, Hadera, Israel
| | - Baruch Brenner
- Sackler Medical School, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, 39 Jabotinski St, 49100, Petah Tikva, Israel
| | - Elizabeth Dudnik
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, 39 Jabotinski St, 49100, Petah Tikva, Israel
| | - Felix Bokstein
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Mark Temper
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
| | - Dror Limon
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Diana Matceyevsky
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - David Sarid
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Amiel Segal
- Shaare Zedek Medical Center, The Oncology Institute, 12 Bayit St, 91031, Jerusalem, Israel
| | - Valeriya Semenisty
- Oncology Department, Rambam Health Care Campus, 6 Ha'Aliya St, 31096, Haifa, Israel
| | - Ronen Brenner
- Sackler Medical School, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
- Oncology Department, Wolfson Medical Center, 62 HaLohamim St, 58100, Holon, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
| | - Efraim Idelevich
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
- Kaplan Medical Center, Institute of Oncology, Pasternak St, 76100, Rehovot, Israel
| | - Sharon Pelles-Avraham
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Amichay Meirovitz
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
| | - Arie Figer
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weitzman St, 64239, Tel Aviv, Israel
| | - Kenneth Russell
- Caris Life Sciences, St. Jakobsstrasse 199, 4052, Basel, Switzerland
| | - Andreas Voss
- Caris Life Sciences, St. Jakobsstrasse 199, 4052, Basel, Switzerland
| | - Addie Dvir
- Teva Pharmaceutical Industries Ltd, 1 Hatee'na St, 60850, Shoham, Israel
| | | | - Ayala Hubert
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
- Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel
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19
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Lewin R, Gal O, Sulkes A, Gordon N, Ben-Aharon I, Purim O, Perel G, Kundel Y, Moore A, Ulitsky O, Brenner B. First line treatment of metastatic colorectal cancer: Are clinical trial results reproducible in real-life practice? J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.836] [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
836 Background: Treatment of metastatic colorectal cancer (mCRC) has greatly advanced over the past decade, based on data from randomized controlled trials (RCTs). This raises the question whether results of RCTs, performed on selected patients (pts), do reflect outcomes in real-life practice. The aim of this study was to summarize our experience in the treatment of mCRC and compare it to data reported in RCTs. Methods: A retrospective single-institution study on consecutive mCRC pts treated with first-line bevacizumab-containing regimens in our institute between 2006 and 2014. Results: The study included 300 pts, of whom 54% were males. Median age was 67 years (range 28-90), 26% aged ≥ 75 years. ECOG performance status was ≤1 in 93%. The primary tumor site was right colon in 37%, left colon in 40%, rectal in 23% and 1% of pts had synchronous tumors. RAS status was available in 60%, of whom 55% had wild-type alleles. 46% of pts had a single metastatic site, including 27% with liver-limited disease, and 54% had multiple metastatic sites. Irinotecan-based chemotherapy was used in 66%, oxaliplatin-based chemotherapy in 29% and flouropyrimidine monotherapy in 5%. Curative metastasectomy during 1st line treatment was performed in 29%. Grade ≥3 hematological and non-hematological toxicities were reported in 24% and 38% of pts, respectively. Second and third line treatments were administered to 75% and 66% of pts, respectively; 73% of pts received both irinotecan and oxaliplatin through their treatment course and 76% of those with wild-type RAS were treated with anti-EGFR therapy. Overall response rate and disease control rate were 69% and 89%, respectively. Median progression-free survival (PFS) and overall survival (OS) were 17 and 28 months, respectively. In a sub-group analysis on "RCT-like population", excluding pts ≥ 75 years, ECOG PS ≥ 3 and/or mutated/unknown RAS status, median PFS and OS were 15 and 29 months, respectively. Conclusions: The results of this study suggest that, if adhered to international clinical guidelines, outcomes reported in RCTs are indeed reproducible in routine clinical practice in unselected real-life pts. Additional data, with more pts and longer follow-up, will be presented.
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Affiliation(s)
- Ron Lewin
- Davidoff Cancer Center, Petah Tikva, Israel
| | - Omer Gal
- Davidoff Cancer Center, Petah Tikva, Israel
| | | | - Noa Gordon
- Davidoff Cancer Center, Petah Tikva, Israel
| | | | - Ofer Purim
- Rabin Medical Center, Petah Tikva, Israel
| | - Gali Perel
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | - Olga Ulitsky
- Beilinson Hospital, Davidoff Center, Petah Tikva, Israel
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20
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Stemmer SM, Benjaminov O, Silverman MH, Sandler U, Purim O, Sender N, Meir C, Oren-Apoteker P, Ohana J, Devary Y. A phase I clinical trial of dTCApFs, a derivative of a novel human hormone peptide, for the treatment of advanced/metastatic solid tumors. Mol Clin Oncol 2017; 8:22-29. [PMID: 29423221 PMCID: PMC5772927 DOI: 10.3892/mco.2017.1505] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/19/2017] [Indexed: 11/06/2022] Open
Abstract
The aim of the present phase I first-in-human study was to investigate the safety/efficacy of dTCApFs (a novel hormone peptide that enters cells through the T1/ST2 receptor), in advanced/metastatic solid tumors. The primary objective of this open-label dose-escalation study was to determine the safety profile of dTCApFs. The study enrolled patients (aged ≥18 years) with pathologically confirmed locally advanced/metastatic solid malignancies, who experienced treatment failure or were unable to tolerate previous standard therapy. The study included 17 patients (64% male; median age, 65 years; 47% colorectal cancer, 29% pancreatic cancer). The patients received 1-3 cycles of escalating dTCApFs doses (6-96 mg/m2). The mean number ± standard deviation of treatment cycles/patient was 3.2±1.4; no dose-limiting toxicities were observed up to a dose of 96 mg/m2, and the maximum tolerated dose was not reached. Half-life, maximal plasma concentration, and dTCApFs exposure were found to be linearly correlated with dose. Five patients were treated for ≥3 months (12, 24, 48 mg/m2) and experienced stable disease throughout the treatment period, and 1 experienced pathological complete response. Analysis of serum biomarkers revealed decreased levels of angiogenic factors at dTCApFs concentrations of 12-48 mg/m2, increased levels of anticancer cytokines, and induction of the endoplasmic reticulum (ER) stress biomarker GRP78/BiP. Efficacy and biomarker data suggest that patients whose tumors were T1/ST2-positive exhibited a better response to dTCApFs. In conclusion, dTCApFs was found to be safe/well-tolerated, and potentially efficacious, with linear pharmacokinetics. Consistent with preclinical studies, the mechanism through which dTCApFs exerts anticancer effects appears to involve induction of ER stress, suppression of angiogenesis, and activation of the innate immune response. However, further studies are warranted.
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Affiliation(s)
- Salomon M Stemmer
- Davidoff Center, Rabin Medical Center, Institute of Oncology, Petah Tikva 49414, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ofer Benjaminov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Department of Radiology, Rabin Medical Center, Petah Tikva 49414, Israel
| | | | - Uziel Sandler
- Immune System Key (ISK) Ltd., Jerusalem 9746009, Israel.,Bioinformatics Department, Lev Academic Center (JCT), Jerusalem 91160, Israel
| | - Ofer Purim
- Davidoff Center, Rabin Medical Center, Institute of Oncology, Petah Tikva 49414, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Naomi Sender
- Davidoff Center, Rabin Medical Center, Institute of Oncology, Petah Tikva 49414, Israel
| | - Chen Meir
- Davidoff Center, Rabin Medical Center, Institute of Oncology, Petah Tikva 49414, Israel
| | | | - Joel Ohana
- Immune System Key (ISK) Ltd., Jerusalem 9746009, Israel
| | - Yoram Devary
- Immune System Key (ISK) Ltd., Jerusalem 9746009, Israel
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21
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Sarfaty M, Lankry E, Moore A, Kurman N, Purim O, Kundel Y, Ben-Aharon I, Perl G, Ulitsky O, Gordon N, Sulkes A, Menasherov N, Kashtan H, Brenner B. Esophageal Cancer in Israel has Unique Clinico-Pathological Features: A Retrospective Study. J Cancer 2017; 8:2417-2423. [PMID: 28900478 PMCID: PMC5595070 DOI: 10.7150/jca.19210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/16/2017] [Accepted: 04/26/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction: Data regarding esophageal cancer (EC) in Israel are limited. The aim of this study was hence to characterize this entity in the Israeli population and to compare it to the literature. Patients/Methods: This is a retrospective study of all consecutive EC patients treated at our institution between 1997-2013. Data were retrieved from patients' medical files. Results: Two hundred patients were included. The median age at diagnosis was 70.5 years; 63.5% were males; 63% were Ashkenazi Jews, 29% were Sephardic Jews, and 0.5% were Arabs. Squamous cell carcinoma (SCC) was predominant: 52% versus 45.5% with adenocarcinoma (ADC). SCC was common even in the distal esophagus (45%). The overall 5-year survival rate was 25.5%. A temporal trend (2006-2013 vs 1997-2005) shows a decline in the proportion of SCC (47% vs 63%, p=0.061) and a rise in ADC (50% vs 33%, p=0.041), with a parallel decrease in patients' age (median: 68.5 vs 73 years, p=0.014). In the later period, patients received more treatment for localized and metastatic disease, with a trend for improved median survival (20.1 vs 14.9 months, p=0.658). Ashkenazi Jews were diagnosed at an older age than Sephardic Jews (median: 73 vs. 65 years, p=0.001), had a higher rate of family history of GI cancer (34% vs. 17%, p=0.026) and a higher rate of cardiovascular co-morbidity (41% vs. 24%, p=0.041). Conclusion: EC in Israel represents an intermediate entity between the Western and the endemic subtypes, showing some unique features. These included delayed reversal of the SCC/ADC ratio, commonness of SCC in the distal esophagus, prevalence of other malignancies and predominance of Ashkenazi ethnicity. The reason for these findings is unclear and its further evaluation is warranted.
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Affiliation(s)
- Michal Sarfaty
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Esty Lankry
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Assaf Moore
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Noga Kurman
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Olga Ulitsky
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nikolai Menasherov
- Department of Surgery A, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery B, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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22
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Moore A, Ben-Aharon I, Purim O, Perl G, Ulitsky O, Amit L, Kundel Y, Lewin R, Wasserberg N, Kashtan H, Brenner B. Early postoperative PET-CT in patients with pathological stage III colon cancer may change their outcome: Results from a large single institution study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Brenner B, Purim O, Gordon N, Goshen Lago T, Idelevich E, Kashtan H, Menasherov N, Fenig E, Sulkes A, Kundel Y. Association of the addition of cetuximab to preoperative chemoradiotherapy (CRT) for locally advanced esophageal squamous cell carcinoma (SqCC) with rate of long term survival: Mature results of a prospective phase Ib/II trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4057] [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
4057 Background: Current treatment results in locally advanced esophageal cancer (LAEC) are far from being satisfying. This prospective phase IB/II study evaluated the safety and efficacy of the addition of cetuximab to standard preoperative CRT in this disease. Methods: Patients (pts) with potentially resectable LAEC (T2-4N0-1M0, T1-4N1M0 or T1-4N0-1M1A) received an induction cycle of cisplatin 100 mg/m2, day 1, and 5-FU 1000 mg/m2/day as a continuous infusion (CI), days 1–5, followed 4 weeks later by 50.4 Gy radiotherapy given concurrently with 2 cycles of cisplatin 75 mg/m2 and escalating doses of CI 5-FU, days 1–4 and 29-32. Pts received also 10 weekly infusions of cetuximab, 250 mg/m2, with a loading dose of 400 mg/m2, starting from the induction. The phase II part of the study started when the 5-FU dose during CRT was defined. Surgery was planned 6-8 weeks after CRT. Results: 64 pts were enrolled and 60 completed CRT. Median age was 65 years (range: 38-84 years) and 66% were males. The SqCC/adenocarcinoma ratio was 39%/61% (25/39). Pts had very advanced tumors: 95% T3-T4, 67% N1 and 19% M1A. The most common grade > 3 toxicities were leucopenia (45% of pts) and neutropenia (41%). There were two cases (3%) of fatal toxicities (neutropenic sepsis and sudden death). Among the 55 operated pts, R0 resection was achieved in 51 (93%). There were 8 cases (14.5%) of postoperative mortality, due to infection (3 pts), esophageal leak (2), bleeding (2) and pulmonary insufficiency (1). Pathological down-staging was noted in 72% of pts and pathological complete response (pCR) in 33%. 5y-local control, progression-free survival (PFS) and overall survival (OS) rates for all pts were 94%, 40%, 39%, respectively. Pts with SqCC had a significantly higher pCR rate (52% vs 15%, p = 0.007), 5y-PFS (67% vs. 21%, p = 0.008) and 5y-OS (64% vs. 20%, p = 0.019). Conclusions: This study suggests that the addition of cetuximab to standard preoperative CRT is safe. R0, pCR, local control and long term PFS and OS rates in pts with SqCC tumors are encouraging. Further evaluation of this approach in this population seems warranted.
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Affiliation(s)
| | - Ofer Purim
- Rabin Medical Center, Petah Tikva, Israel
| | - Noa Gordon
- Davidoff Cancer Center, Petah Tikva, Israel
| | | | | | | | | | - Eyal Fenig
- Rabin Medical Center, Petah Tikva, Israel
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Purim O, Beny A, Inbar MJ, Brenner B, Dudnik E, Bokstein F, Temper M, Limon D, Sarid D, Semenisty V, Brenner RM, Peretz T, Idelevich E, Pelles S, Meirovitz A, Russell K, Voss A, Dvir A, Soussan-Gutman L, Hubert A. Molecular profiling-selected treatment in metastatic gastric and oesophageal cancer: Real-life clinical experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
e15537 Background: We evaluated real-life clinical experience with molecular profiling (MP)-guided therapy in metastatic gastric and oesophageal cancer in Israel Methods: This multicenter retrospective cohort study included patients with metastatic gastric or oesophageal cancer who were treated in the participating institutions and underwent MP (Caris Molecular Intelligence). Treatment was considered as having benefit if the ratio between the longest progression-free survival (PFS) post MP and the last PFS pre MP was ≥1.3. The null hypothesis was that ≤15% of patients gain such benefit. Results: The analysis included 46 patients (61% males; median age, 58 years; 57% with poorly-differentiated tumours). At least one actionable (i.e., predictive of response to a specific therapy) biomarker was identified per patient. Immunohistochemistry was performed on all samples and identified 1-8 (median: 3) biomarkers per patient (most commonly: low TS, high TOPO1, high TOP2A). Twenty-eight patients received therapy post MP (1-4 lines). In the 1st-line post MP, 5 patients (18%) achieved partial response and 5 (18%) stable disease; the median (range) PFS was 4.3 (0.4-38.5) months. Twenty-four patients were evaluable for PFS ratio analysis; in 7 (29.2%), the ratio was ≥1.3. In one-sided exact binomial test vs. the null hypothesis, P = 0.019; therefore, the null hypothesis was rejected. Conclusions: Our findings demonstrated that implementing MP is feasible and that MP could provide clinical benefit for a considerable proportion (~30%) of patients with metastatic gastric or oesophageal cancer.
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Affiliation(s)
- Ofer Purim
- Rabin Medical Center, Petah Tikva, Israel
| | - Alexander Beny
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | | | | | | | - Mark Temper
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dror Limon
- Davidoff Cancer Center, Petah Tikva, Israel
| | - David Sarid
- Division of Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | | | | | - Addie Dvir
- Teva Pharmaceutical Industries, Ltd., Shoham, Israel
| | | | - Ayala Hubert
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Moore A, Ben-Aharon I, Purim O, Perl G, Ulitsky O, Amit L, Kundel Y, Lewin R, Wasserberg N, Kashtan H, Brenner B. Early postoperative PET-CT in patients with pathological stage III colon cancer may change their outcome: Results from a large single-institution study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15163] [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
e15163 Background: Staging of patients (pts) with pathological stage III colon cancer (CC) is currently suboptimal; many pts still recur despite an unremarkable preoperative staging. We previously reported that early postoperative PET-CT can alter the stage and management of up to 15% of pts with high risk stage III CC and later reported also encouraging preliminary results in a larger cohort of consecutive pts with stage III CC, in which staging and management were altered in 14.5%. The aim of the current study was to expand the previous one to a larger cohort and to evaluate the actual impact of early postoperative PET-CT on pts outcome. Methods: A Retrospective study of all consecutive pts with stage III CC who were treated at our institution and underwent early postoperative PET-CT between 2007-2016. Demographic and clinicopathological data were retrieved. Statistical analyses were done using standard methods. Results: 348 pts, 166 (47.7%) males, with a median age of 66 years (range, 29-92), were included. Pathological stage was IIIA, IIIB and IIIC in 21(6%), 254 (73%) and 73 (21%) pts, respectively. The median number of lymph nodes examined and of positive ones were 14 (range, 3-54) and 2 (range, 0-32), respectively. High FDG-uptake was noted in 95 (27.3%) pts, including 23 (6.6%) with clear postoperative changes and 18 (5.2%) with a false positive uptake, of whom 6 underwent invasive diagnostic procedures. PET-CT results modified the management of 52 pts (14.9%) who were found to have true positive findings: 44 (12.6%) with overt metastatic disease and 8 (2.3%) with a second primary tumor. At a median follow-up of 45.6 months, the estimated 5y disease-free survival for true stage III pts was 81.9% and the 6y overall survival of the entire cohort was 76.4%. Interestingly, of the 44 pts found to be metastatic, 12 (27.3%) underwent curative treatments and 8 (66.7%) of those remain free of disease, with a median follow-up of 64.7 months. Conclusions: In this large cohort, early postoperative PET-CT changed the staging and management of 14.9% of pts with resected stage III CC, with encouraging outcome results. We are conducting a prospective trial to further evaluate this strategy.
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Affiliation(s)
| | | | - Ofer Purim
- Rabin Medical Center, Petah Tikva, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel-Aviv University, Petach-Tikva, Israel
| | - Olga Ulitsky
- Beilinson Hospital, Davidoff Center, Petah Tikva, Israel
| | - Limor Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel-Aviv University, Petach-Tikva, Israel
| | | | - Ron Lewin
- Davidoff Cancer Center, Petah Tikva, Israel
| | - Nir Wasserberg
- Rabin Medical Center, Department of Surgery B, Petah Tikva, Israel
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Goldvaser H, Katz Shroitman N, Ben-Aharon I, Purim O, Kundel Y, Shepshelovich D, Shochat T, Sulkes A, Brenner B. Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity. World J Gastroenterol 2017; 23:1387-1396. [PMID: 28293085 PMCID: PMC5330823 DOI: 10.3748/wjg.v23.i8.1387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/26/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To characterize colorectal cancer (CRC) in octogenarians as compared with younger patients.
METHODS A single-center, retrospective cohort study which included patients diagnosed with CRC at the age of 80 years or older between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Fisher’s exact test was used for dichotomous variables and χ2 was used for variables with more than two categories. Overall survival was assessed by Kaplan-Meier survival analysis, with the log-rank test. Cancer specific survival (CSS) and disease-free survival were assessed by the Cox proportional hazards model, with the Fine and Gray correction for non-cancer death as a competing risk.
RESULTS The study included 350 patients, 175 patients in each group. Median follow-up was 40.2 mo (range 1.8-97.5). Several significant differences were noted. Octogenarians had a higher proportion of Ashkenazi ethnicity (64.8% vs 47.9%, P < 0.001), a higher rate of personal history of other malignancies (22.4% vs 13.7%, P = 0.035) and lower rates of family history of any cancer (36.6% vs 64.6%, P < 0.001) and family history of CRC (14.4% vs 27.3%, P = 0.006). CRC diagnosis by screening was less frequent in octogenarians (5.7% vs 20%, P < 0.001) and presentation with performance status (PS) of 0-1 was less common in octogenarians (71% vs 93.9%, P < 0.001). Octogenarians were more likely to have tumors located in the right colon (45.7% vs 34.3%, P = 0.029) and had a lower prevalence of well differentiated histology (10.4% vs 19.3%, P = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of PS. Their 5-year CSS was worse (63.4% vs 77.6%, P = 0.009), both for metastatic (21% vs 43%, P = 0.03) and for non-metastatic disease (76% vs 88%, P = 0.028).
CONCLUSION Octogenarians presented with several distinct characteristics and had worse outcome. Further research is warranted to better define this growing population.
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Goldvaser H, Katz Shroitman N, Ben-Aharon I, Purim O, Kundel Y, Shepshelovich D, Shohat T, Brenner B. Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.552] [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
552 Background: Colorectal cancer (CRC) in Octogenarians is an emerging clinical entity. It is currently unclear whether these patients have unique features and whether their treatment should differ from younger patients with CRC. The aim of this study was to better characterize this patients population. Methods: A single-center, retrospective cohort study which included patients diagnosed with CRC at the age of ≥ 80 years between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Results: The study included 350 patients, followed for a median of 40.2 months (range 1.8-97.5). Several significant differences were noted. Elderly patients had a higher proportion of Ashkenazi ethnicity (p < 0.001), lower rates of family history of any cancer (p < 0.001) and family history of CRC (p = 0.006), and a higher rate of personal history of other malignancies (p = 0.035). CRC diagnosis by screening was less frequent in octogenarians (p < 0.001) and their performance status at presentation was worse. Octogenarians were more likely to have tumors located in the right colon (p = 0.029) and had a lower prevalence of well differentiated histology (p = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of performance status. Their 5-year cancer specific survival was worse (63.4% vs.77.6%, p = 0.009), both for metastatic (p = 0.03) and for non-metastatic disease (p = 0.028). Conclusions: Elderly patients with CRC presented several differences in clinical and tumor characteristics compared to their younger counterparts. They were less likely to receive treatment and they had worse outcome. Further research is needed to better define this growing patient population and to establish their optimal treatment.
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Affiliation(s)
- Hadar Goldvaser
- Rabin Medical Center, Beilinson Hospital, Davidoff Center, Toronto, ON, Canada
| | - Noa Katz Shroitman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel, Tel Aviv, Israel
| | - Irit Ben-Aharon
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Ofer Purim
- Rabin Medical Center, Petach Tikva, Israel
| | | | | | - Tzippy Shohat
- Beilinson hospital, Statistical Consulting Unit, Petach Tikva, Israel
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Ben-Aharon I, Goshen-Lago T, Geva R, Beny A, Dror Y, Steiner M, Hubert A, Idelevich E, Purim O, Mishaeli M, Shulman K, Man S, Soussan-Gutman L, Liebermann N, Brenner B. Sidedness matters: Surrogate biomarkers prognosticate colorectal cancer upon anatomic location. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
523 Background: Recent evidence indicate that the anatomic location of primary tumors across the colon correlate with survival in the metastatic setting, whereas left-sided tumors may exhibit superior survival compared with right-sided. The Oncotype DX, a 12-gene colon cancer assay, is a clinically validated predictor of recurrence risk in stage II colorectal cancer (CRC) patients. Previous studies had indicated that CDX2-negative colorectal tumors are often associated with several adverse prognostic variables. Recently, it has been shown that without adjuvant chemotherapy, CDX2-negative stage II CRC tumors were associated with a lower rate of disease-free survival than CDX2-positive stage II CRC tumors. We aimed to evaluate whether these validated two prognostic biomarkers may correlate with primary tumor location, and whether tumor location may reflect differential prognosis in stage II CRC. Methods: We retrospectively analyzed a cohort of patients with T3 mismatch repair proficient (MMR-P) stage II CRC for whom 12-gene assay was performed (between 1/2011-2/2016). Pathological report was reviewed for exact primary tumor location and CDX2 immunostaining. Recurrence score (RS) and CDX2 expression were correlated with primary tumor location. Results: The analysis included 1087 patients with MMR-P stage II CRC (median age 69 years (range 29-93)). Tumor distribution across the colon was as follows: 46% (n = 500) were right-sided (cecum, ascending colon, transverse colon) and 54% (n = 587) were left-sided (splenic flexure, descending colon, sigmoid colon and rectum). Recurrence score was higher in right-sided tumors compared with left-sided tumors (p = 0.01). The RS gradually decreased across the colon (cecum - highest score, sigmoid-lowest score, p = 0.04). Right-sided tumors exhibited more CDX2-negative tumors compared with left-sided tumors (p = 0.07). Conclusions: Our study indicate that right-sided colorectal tumors may display worse prognosis compared with left-sided tumors in MMR-P stage II CRC. Primary tumor location may serve as a prognostic factor that should be accounted for recurrence risk assessment and consideration of adjuvant treatment.
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Affiliation(s)
- Irit Ben-Aharon
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Ravit Geva
- TEL AVIV SOURASKY MEDICAL CENTER, Tel-Aviv, Israel
| | - Alexander Beny
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | - Mariana Steiner
- Oncology, Lin and Carmel Medical Centers, Clalit Health Services, Haifa, Israel
| | - Ayala Hubert
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ofer Purim
- Rabin Medical Center, Petach Tikva, Israel
| | - Moshe Mishaeli
- Oncology Institute, Meir Medical Center, Kfar Saba, Israel
| | | | - Sofia Man
- Soroka Medical center, Beer Sheva, Israel
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Moore A, Ben-Aharon I, Purim O, Perl G, Ulitsky O, Amit L, Kundel Y, Lewin R, Wasserberg N, Asman Y, Kashtan H, Brenner B. The role of early postoperative PET-CT in patients with pathological stage III colon cancer: Results from a large single institution study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.562] [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
562 Background: Current staging of patients (pts) with pathological stage III colon cancer is suboptimal; many pts still recur despite unremarkable preoperative staging work-up. We previously reported that early postoperative PET-CT can alter the stage and management of pts with high risk stage III colon cancer in up to 19% of patients. The aim of the current study was to expand the previous one to a larger cohort and to determine the role of early postoperative PET-CT in the general population of stage III colon cancer pts, regardless of their individual risk. Methods: A retrospective chart review of all consecutive pts with stage III colon cancer who underwent early postoperative PET-CT between 2007 and 2016. Demographic and clinicopathological data were collected. Results: 247 pts, 124 (50%) males, with a median age of 66 years (range, 30-92), were included. Pathological stage was IIIA, IIIB and IIIC in 18 (7.3%), 161 (65.1%) and 72 (29.1%) pts, respectively. The median number of lymph nodes retrieved was 15 (range, 6-64) and that of positive lymph nodes was 2 (range, 0-21). High FDG-uptake was observed in 52 (21.0%) pts, including 6 (2.4%) who had clear postoperative changes, 10 (4.0%) who had a false positive abnormal uptake of whom 6 underwent invasive diagnostic procedures. The PET-CT results modified the management of 36 pts (14.5%) who were found to have true positive findings: 30 (12.1%) were proven to have overt metastatic disease and in 6 (2.4%) a second primary was discovered. With the median follow-up of 39.0 months (range 7.2-98.4 months), of the 30 pts found to be metastatic, 10 (33.3%) underwent curative treatments and are currently with no evidence of disease (NED). Updated data, on more patients and a longer follow-up, will be presented at the meeting. Conclusions: Early postoperative PET-CT changed the staging and treatment of 14.5% of resected stage III pts, and has the potential for early detection of curable metastatic disease. We currently evaluate this strategy and its actual impact in a prospective trial.
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Affiliation(s)
- Assaf Moore
- Department of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel, Kfar Saba, Israel
| | - Irit Ben-Aharon
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Ofer Purim
- Rabin Medical Center, Petach Tikva, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach-Tikva, Israel
| | - Olga Ulitsky
- Beilinson hospital, Davidoff center, Petah Tikva, Israel
| | - Limor Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | | | - Ron Lewin
- Davidoff Cancer Center, Rabin Medical Center, Petach-Tikva, Israel
| | - Nir Wasserberg
- Rabin Medical Center, Department of Surgery B, Petach Tikva, Israel
| | - Yael Asman
- Rabin Medical Center, Petah Tikva, Israel
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Dux J, Rayman S, Zendel A, Segev L, Hoffman A, Ben Yaacov A, Marom G, Aderka D, Shacham Shmueli E, Beny A, Ayala H, Grenader T, Brenner B, Purim O, Gutman M, Venturero M, Nissan A. 117. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal surface malignancies in the elderly. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Perl G, Nordheimer S, Lando S, Benedict C, Brenner B, Perry S, Shmoisman G, Purim O, Amit L, Stemmer SM, Ben-Aharon I. Young patients and gastrointestinal (GI) tract malignancies - are we addressing the unmet needs? BMC Cancer 2016; 16:630. [PMID: 27519697 PMCID: PMC4983017 DOI: 10.1186/s12885-016-2676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/07/2015] [Accepted: 08/04/2016] [Indexed: 01/11/2023] Open
Abstract
Background Recent epidemiological studies indicate the rate of gastrointestinal (GI) malignancies among younger patients is increasing, mainly due to colorectal cancer. There is a paucity of data regarding the magnitude of treatment-related symptoms, psychosocial issues and potential unmet needs in this population. We aimed to characterize the needs of this population to evaluate whether unmet needs could be targeted by potential intervention. Methods Female and male patients diagnosed with cancer of the gastrointestinal tract <40y retrospectively completed a questionnaire to evaluate symptoms, daily function and unmet needs at pre-treatment, during and post-treatment. Comparisons were made by gender, disease stage and treatment modality. Multiple linear regression models evaluated effects of demographics, symptoms and needs on multiple domains of health-related-quality-of-life (using Short-Form Health Survey-12 and CARES). Results Fifty patients were enrolled (52 % female) to a pilot study. Median age at diagnosis was 35.5y (range, 21-40y). The symptoms that significantly increased from baseline to during and post-treatment were: diarrhea (37 %), sleeping disorder (32 %) and sexual dysfunction (40 %). Patients also reported significant deterioration in occupational activities and coping with children compared with baseline. Female patients reported significant unmet need for nutritional counseling and psychosocial support compared to male patients (p < 0.05). Patients treated with multimodality-treatment presented higher rates of unmet needs (p = 0.03). Conclusions Young patients with GI cancers represent a group with unique characteristics and needs compared with published evidence on other young-onset malignancies. The distinctive symptoms and areas of treatment-related functional impairments indicate there are unmet needs, especially in the area of psychosocial support and nutritional counseling.
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Affiliation(s)
- G Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - S Nordheimer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - S Lando
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Benedict
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B Brenner
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - S Perry
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - G Shmoisman
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - O Purim
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - L Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - I Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Brenner B, Sarfaty M, Purim O, Kundel Y, Amit L, Abramovich A, Sadeh Gonik U, Idelevich E, Gordon N, Medalia G, Sulkes A. A Phase Ib/II Study Evaluating the Combination of Weekly Docetaxel and Cisplatin Together with Capecitabine and Bevacizumab in Patients with Advanced Esophago-Gastric Cancer. PLoS One 2016; 11:e0157548. [PMID: 27390847 PMCID: PMC4938513 DOI: 10.1371/journal.pone.0157548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/31/2016] [Indexed: 12/21/2022] Open
Abstract
Introduction Current treatment options for advanced esophagogastric cancer (AEGC) are still unsatisfactory. The aim of this prospective phase Ib/II study was to evaluate the safety and efficacy of a novel regimen, AVDCX, consisting of weekly docetaxel and cisplatin together with capecitabine and bevacizumab, in AEGC. Methods Patients with AEGC received treatment with different dose levels of AVDCX (cisplatin and docetaxel 25–35 mg/m2, days 1,8, capecitabine 1,600 mg/m2 days 1–14, bevacizumab 7.5 mg/kg, day 1, Q:21 days). The study's primary objectives were to establish the recommended phase II doses of docetaxel and cisplatin in AVDCX (phase Ib part) and to determine the tumor response rate (phase II part). Results The study was closed early, after the accrual of 22 patients, due to accumulating toxicity-related deaths. The median age was 59 years and 77% of patients had gastric or gastroesophageal adenocarcinomas. Grade ≥3 adverse events were documented in 18 patients (82%), usually neutropenia (36%), fatigue (54%) or diarrhea (23%). There were three fatal toxicities (14%): mesenteric thromboembolism, gastric perforation and pancytopenic sepsis. The recommended phase II doses of cisplatin and docetaxel were determined to be 25 mg/m2 and 30 mg/m2, respectively. Twenty-one patients were evaluable for response: 12 (54%) had partial response (PR), 4 (18%) had stable disease (SD) and none had complete response (CR). Hence, the objective response rate (CR+PR) was 54% and the disease control rate (CR+PR+SD) was 72%. For the 17 patients treated at the MTD, the objective response rate was 41% and the disease control rate was 88%. The median overall survival (OS) for these patients was 13.9 months (range, 1.5–52.2 months) and the median progression-free survival was 7.6 months (range, 1.3–26.6 months). The 2-year OS rate reached 23.7%. Conclusions AVDCX was associated with a high rate of regimen related fatal adverse events and is not appropriate for further development in AEGC patients. Trial Registration ClinicalTrials.gov NCT00845884,
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Affiliation(s)
- Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- * E-mail:
| | - Michal Sarfaty
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Limor Amit
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Abramovich
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Udi Sadeh Gonik
- Department of Radiology, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efraim Idelevich
- Institute of Oncology, Kaplan Medical Center, Rehovot, and Hebrew Univerity, Jerusalem, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Medalia
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Goldvaser H, Purim O, Kundel Y, Shepshelovich D, Shochat T, Shemesh-Bar L, Sulkes A, Brenner B. Colorectal cancer in young patients: is it a distinct clinical entity? Int J Clin Oncol 2016; 21:684-695. [PMID: 26820719 DOI: 10.1007/s10147-015-0935-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/26/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of colorectal cancer in young patients is increasing. It remains unclear if the disease has unique features in this age group. METHODS This was a single-center, retrospective cohort study which included patients diagnosed with colorectal cancer at age ≤40 years in 1997-2013 matched 1:2 by year of diagnosis with consecutive colorectal cancer patients diagnosed at age >50 years during the same period. Patients aged 41-50 years were not included in the study, to accentuate potential age-related differences. Clinicopathological characteristics, treatment, and outcome were compared between groups. RESULTS The cohort included 330 patients, followed for a median time of 65.9 months (range 4.7-211). Several significant differences were noted. The younger group had a different ethnic composition. They had higher rates of family history of colorectal cancer (p = 0.003), hereditary colorectal cancer syndromes (p < 0.0001), and inflammatory bowel disease (p = 0.007), and a lower rate of polyps (p < 0.0001). They were more likely to present with stage III or IV disease (p = 0.001), angiolymphatic invasion, signet cell ring adenocarcinoma, and rectal tumors (p = 0.02). Younger patients more frequently received treatment. Young patients had a worse estimated 5-year disease-free survival rate (57.6 vs. 70 %, p = 0.039), but this did not retain significance when analyzed by stage (p = 0.092). Estimated 5-year overall survival rates were 59.1 and 62.1 % in the younger and the control group, respectively (p = 0.565). CONCLUSIONS Colorectal cancer among young patients may constitute a distinct clinical entity. Further research is needed to validate our findings and define the optimal approach in this population.
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Affiliation(s)
- Hadar Goldvaser
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel
| | - Ofer Purim
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Yulia Kundel
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Daniel Shepshelovich
- Department of Medicine A, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, Israel
| | | | - Aaron Sulkes
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel
| | - Baruch Brenner
- Davidoff Cancer Center, Rabin Medical Center, Institute of Oncology, Beilinson Hospital, 39 Jabotinski St., Petach Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, P.O Box 39040, Tel Aviv, Israel.
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Brenner B, Geva R, Rothney M, Beny A, Dror Y, Steiner M, Hubert A, Idelevich E, Gluzman A, Purim O, Shacham-Shmueli E, Shulman K, Mishaeli M, Man S, Soussan-Gutman L, Tezcan H, Chao C, Shani A, Liebermann N. Impact of the 12-Gene Colon Cancer Assay on Clinical Decision Making for Adjuvant Therapy in Stage II Colon Cancer Patients. Value Health 2016; 19:82-87. [PMID: 26797240 DOI: 10.1016/j.jval.2015.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/30/2015] [Accepted: 08/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the impact of the 12-gene Colon Cancer Recurrence Score Assay-a clinically validated prognosticator in stage II colon cancer after surgical resection-on adjuvant treatment decisions in T3 mismatch repair proficient (MMR-P) stage II colon cancer in clinical practice. METHODS This retrospective analysis included all patients with T3 MMR-P stage II colon cancer (Clalit Health Services members) with Recurrence Score results (time frame January 2011 to May 2012). Treatment recommendations pretesting were compared with the treatments received. Changes were categorized as decreased (to observation alone/removing oxaliplatin from the therapy) or increased (from observation alone/adding oxaliplatin to the therapy) intensity. RESULTS The analysis included 269 patients; 58%, 32%, and 10% of the values were in the low (<30), intermediate (30-40), and high (≥41) score groups, respectively. In 102 patients (38%), treatment changed post-testing (decreased/increased intensity 76/26 patients). The overall impact was decreased chemotherapy use (45.0% to 27.9%; P < 0.001). Treatment changes occurred in all score groups, but more frequently in the high (change rate 63.0%; 95% confidence interval [CI] 42.3%-80.6%) than in the intermediate (30.6%; 95% CI 21.0%-41.5%) and low (37.6%; 95% CI 30.0%-45.7%) score groups. The direction of the change was consistent with the assay result, with increased intensity more common in higher score values and decreased intensity more common in lower score values. CONCLUSIONS Testing significantly affected adjuvant treatment in T3 MMR-P stage II colon cancer in clinical practice. The study is limited by its design, which compared treatment recommendations pretesting to actual treatments received post-testing, lack of a control group, and nonassessment of confounding factors that may have affected treatment decisions.
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Affiliation(s)
- Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, affiliated with Sackler School of Medicine, Tel Aviv, Israel.
| | - Ravit Geva
- Division of Oncology, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Alexander Beny
- Department of Oncology, Rambam Medical Center, Haifa, Israel
| | - Ygael Dror
- Oncology Department, Meir Medical Center, Kfar Saba, Israel
| | | | - Ayala Hubert
- Sharett Institute of Oncology, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | | | - Alexander Gluzman
- Department of Clinical Oncology and Radiology, Soroka University Medical Center, Beer Sheva, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, affiliated with Sackler School of Medicine, Tel Aviv, Israel
| | | | | | - Moshe Mishaeli
- Oncology Department, Meir Medical Center, Kfar Saba, Israel
| | - Sophia Man
- Department of Clinical Oncology and Radiology, Soroka University Medical Center, Beer Sheva, Israel
| | | | | | | | - Adi Shani
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
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Levi M, Shalgi R, Brenner B, Perl G, Purim O, Amit L, Stemmer SM, Ben-Aharon I. The impact of oxaliplatin on the gonads: from bedside to the bench. Mol Hum Reprod 2015; 21:885-93. [PMID: 26443807 DOI: 10.1093/molehr/gav055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/01/2015] [Indexed: 01/18/2023] Open
Abstract
STUDY HYPOTHESIS What is the impact of oxaliplatin on gonadal function? STUDY FINDING Our results in both the clinical and pre-clinical settings indicate that oxaliplatin exerts moderate transient gonadal toxicity. WHAT IS KNOWN ALREADY Recent studies have indicated a significant increase in survivorship of colorectal cancer patients of reproductive age, who may then face fertility concerns. The impact of oxaliplatin on gonadal function is yet to be discovered. STUDY DESIGN, SAMPLES/MATERIALS, METHODS Eleven female (<43 years) and eight male (<45 years) patients recently diagnosed with colorectal cancer, who were candidates for oxaliplatin-based protocol, were enrolled into the study. FSH, estradiol, anti-Müllerian hormone (AMH) and menstrual pattern were measured in female patients, whereas FSH, inhibin-B, testosterone, and steroid-hormone binding globulin were measured in male patients. Hormones were measured at baseline and 6 months post-treatment (last chemotherapy administration) in men and women. In the animal model, pubertal mice were injected with oxaliplatin and sacrificed 1 week, 1 month and 3 months later. Ovarian reserve was estimated by serum AMH measurements. Testicular function was evaluated by serum inhibin-B and sperm evaluation. Gonadal apoptosis (TUNEL), proliferation (Ki-67), repair (PCNA), ovarian reserve (AMH) and testicular reserve (DAZL) were measured by immunohistochemistry. MAIN RESULTS AND THE ROLE OF CHANCE In all women, AMH decreased post-treatment, but remained above the detection limit in 9/11 patients (P < 0.05). FSH was elevated, but did not exceed the premenopausal range in 9/11 patients. All patients remain menstruating or resumed menstruation post-treatment. In female mice oxaliplatin induced transient apoptosis at 1-month post-treatment. In men Inhibin-B was slightly reduced post-treatment. In male mice oxaliplatin did not affect spermatozoa concentration, but was associated with transient, moderate reductions of spermatocytes-spermatogonia numbers and spermatozoa motility. LIMITATIONS, REASONS FOR CAUTION Future prospective large-scale studies are warranted in order to affirm these outcomes. WIDER IMPLICATIONS OF THE FINDINGS Due to high survival rates of colorectal cancer patients of reproductive age that were diagnosed at early stages of the disease, the issue of treatment-induced gonadotoxicity gains significance. Since at the individual level there might be a risk of infertility, a detailed discussion and referral to fertility preservation prior to initiation of treatment is recommended. Nevertheless, oxaliplatin-based protocols appear to be less gonadotoxic than other chemotherapeutic protocols. LARGE SCALE DATA None. STUDY FUNDING AND COMPETING INTERESTS This study was supported by the Israeli Science Foundation (ISF) grant 13-1816 (I.B.-A.). There is no conflict of interest.
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Affiliation(s)
- Mattan Levi
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Shalgi
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salomon M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Goldvaser H, Purim O, Kundel Y, Ulitsky O, Shepshelovich D, Wasserberg N, Hananel N, Shemesh-Bar L, Shochat T, Sulkes A, Brenner B. 1010 Colorectal cancer in young patients: is it a distinct clinical entity? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Epelbaum R, Shacham-Shmueli E, Klein B, Agbarya A, Brenner B, Brenner R, Gez E, Golan T, Hubert A, Purim O, Temper M, Tepper E, Voss A, Russell K, Dvir A, Soussan-Gutman L, Stemmer SM, Geva R. Molecular Profiling-Selected Therapy for Treatment of Advanced Pancreaticobiliary Cancer: A Retrospective Multicenter Study. Biomed Res Int 2015; 2015:681653. [PMID: 26161408 PMCID: PMC4464000 DOI: 10.1155/2015/681653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/03/2015] [Indexed: 12/29/2022]
Abstract
This multicenter cohort study assessed the impact of molecular profiling (MP) on advanced pancreaticobiliary cancer (PBC). The study included 30 patients treated with MP-guided therapy after failing ≥ 1 therapy for advanced PBC. Treatment was considered as having benefit for the patient if the ratio between the longest progression-free survival (PFS) on MP-guided therapy and the PFS on the last therapy before MP was ≥ 1.3. The null hypothesis was that ≤ 15% of patients gain such benefit. Overall, ≥ 1 actionable (i.e., predictive of response to specific therapies) biomarker was identified/patient. Immunohistochemistry (the most commonly used method for guiding treatment decisions) identified 1-6 (median: 4) actionable biomarkers per patient. After MP, patients received 1-4 (median: 1) regimens/patient (most commonly, FOLFIRI/XELIRI). In a decision-impact analysis, of the 27 patients for whom treatment decisions before MP were available, 74.1% experienced a treatment decision change in the first line after MP. Twenty-four patients were evaluable for clinical outcome analysis; in 37.5%, the PFS ratio was ≥ 1.3. In one-sided exact binomial test versus the null hypothesis, P = 0.0015; therefore, the null hypothesis was rejected. In conclusion, our analysis demonstrated the feasibility, clinical decision impact, and potential clinical benefits of MP-guided therapy in advanced PBC.
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Affiliation(s)
- Ron Epelbaum
- Department of Oncology, Rambam Health Care Campus, 3109601 Haifa, Israel
- Facutly of Medicine, Technion-Israel Institute of Technology, 3525406 Haifa, Israel
| | - Einat Shacham-Shmueli
- Division of Oncology, Sheba Medical Center Tel Hashomer, 5262100 Ramat-Gan, Israel
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
| | - Baruch Klein
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
- Department of Oncology, Assuta Hospital, 6971028 Tel Aviv, Israel
- Department of Oncology, Meir Medical Center, 4428164 Kfar Saba, Israel
| | - Abed Agbarya
- Department of Oncology, Rambam Health Care Campus, 3109601 Haifa, Israel
| | - Baruch Brenner
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
- Davidoff Center, Rabin Medical Center, 4941492 Petah Tikva, Israel
| | - Ronen Brenner
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
- Department of Oncology, Wolfson Hospital, 5822012 Holon, Israel
| | - Eliahu Gez
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel
| | - Talia Golan
- Division of Oncology, Sheba Medical Center Tel Hashomer, 5262100 Ramat-Gan, Israel
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
| | - Ayala Hubert
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 9124001 Jerusalem, Israel
- The Hebrew University Hadassah Medical School, 9112102 Jerusalem, Israel
| | - Ofer Purim
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
- Davidoff Center, Rabin Medical Center, 4941492 Petah Tikva, Israel
| | - Mark Temper
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, 9124001 Jerusalem, Israel
- The Hebrew University Hadassah Medical School, 9112102 Jerusalem, Israel
| | - Ella Tepper
- Department of Oncology, Assuta Hospital, 6971028 Tel Aviv, Israel
| | | | | | - Addie Dvir
- Oncotest-Teva Pharmaceutical Industries, Ltd., 60850 Shoham, Israel
| | | | - Salomon M. Stemmer
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
- Davidoff Center, Rabin Medical Center, 4941492 Petah Tikva, Israel
| | - Ravit Geva
- Sackler Medical School, Tel Aviv University, 6997801 Tel Aviv, Israel
- Division of Oncology, Tel-Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel
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Sarfaty M, Purim O, Kundel Y, Ulitsky O, Menasherov N, Kashtan H, Sulkes A, Brenner B. Esophageal cancer in Israel: A unique clinicopathological entity? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15050] [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: 11/20/2022] Open
Affiliation(s)
- Michal Sarfaty
- Davidoff Cancer Center, Rabin Medical Center, Petah Tiqva, Israel
| | - Ofer Purim
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Olga Ulitsky
- Beilinson hospital, Davidoff center, Petah Tikva, Israel
| | | | | | - Aaron Sulkes
- Davidoff Cancer Center, Rabin Medical Center, Petach-Tikva, Israel
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Stemmer1 SM, Benjaminov4 O, Silverman3 MH, Sandler2 U, Purim O, Sender1 N, Segal1 T, Meir1 C, Oren2 P, Ohana2 J, Devary Y. A phase 1 trial of a human thymus-expressed apoptosis factor in patients with advanced solid tumors: Interim report. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14018] [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: 11/20/2022] Open
Affiliation(s)
| | - Ofer Benjaminov4
- Institute of Oncology, Davidoff Center, Institute of Radiology, Petah Tikva, Israel
| | | | | | - Ofer Purim
- Rabin Medical Center, Petach Tikva, Israel
| | | | | | - Chen Meir1
- Rabin Medical Center, Petach Tikva, Israel
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Goldvaser H, Purim O, Kundel Y, Ulitsky O, Shepshelovich D, Wasserberg N, Hananel N, Shemesh-Bar L, Shohat T, Sulkes A, Brenner B. Colorectal cancer in young patients: Is it a distinct clinical entity? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14594] [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: 11/20/2022] Open
Affiliation(s)
- Hadar Goldvaser
- Rabin Medical Center, Beilinson Hospital, Davidoff Center, Petach Tikva, Israel
| | - Ofer Purim
- Rabin Medical Center, Petach Tikva, Israel
| | | | - Olga Ulitsky
- Beilinson hospital, Davidoff center, Petah Tikva, Israel
| | | | - Nir Wasserberg
- Rabin Medical Center, Department of Surgery B, Petach Tikva, Israel
| | - Nisim Hananel
- Beilinson hospital, Department of Surgery A, Petach Tikva, Israel
| | | | - Tzipora Shohat
- Beilinson hospital, Statistical Consulting Unit, Petach Tikva, Israel
| | - Aaron Sulkes
- Davidoff Cancer Center, Rabin Medical Center, Petach-Tikva, Israel
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Rabinovics N, Hadar T, Mizrachi A, Bachar G, Purim O, Popovtzer A. Adjuvant treatment for head and neck cancer in solid organ transplant recipients. Oral Oncol 2015; 51:e23-5. [PMID: 25753559 DOI: 10.1016/j.oraloncology.2015.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 01/25/2023]
Affiliation(s)
- Naomi Rabinovics
- Department of Otorhinolaryngology Head and Neck Surgery, Tel Aviv University, Tel Aviv, Israel.
| | - Tuvia Hadar
- Department of Otorhinolaryngology Head and Neck Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology Head and Neck Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology Head and Neck Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Purim
- Department of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Department of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
584 Background: Recent studies have indicated a significant increase of young colorectal cancer patients, who may then face unique survivorship issues as fertility concerns. The impact of oxaliplatin on gonadal function remains unclear. We prospectively evaluated oxaliplatin-induced gonadotoxicity in a cohort of young patients. In a preclinical setting, the impact of oxaliplatin on the gonads was prospectively studied in mice. Methods: Newly diagnosed female (< 43 years) and male (<45 years) patients who were candidates for oxaliplatin-based protocol were enrolled into the study. Hormonal profile (including AMH and menstrual pattern) was measured in female patients and in male patients at baseline and within 6 months post-treatment. In the pre-clinical setting, pubertal mice (female and male cohorts) were injected with oxaliplatin or saline (control) and sacrificed at various time-points (1 week, 1 or 3 months) post-treatment. Ovarian reserve was estimated by serial serum AMH. Testicular function was evaluated by serial serum inhibin and sperm count. Gonads had been retrieved at each time point for immunohistochemical study of apoptosis (TUNEL, Ki67) and repair (PCNA), ovarian reserve (AMH) and testicular reserve (DAZL). Results: Eighteen patients (10 women; 8 men) were enrolled. Median age for women was 34y (range 27-43) and for men 39y (33-44). AMH decreased in all women post-treatment, but was measurable in 8/10 patients (p<0.05). FSH was elevated yet in the premenopausal range in these patients. Three patients remain menstruating during treatment. Additional five patients resumed menstruation within 6 months post-treatment. In female mice oxaliplatin induced moderate apoptosis at 1-month post treatment with a recovery of the histology compared with control mice at later time points. Inhibin was slightly decreased in men post-treatment. In male mice oxaliplatin exerted moderate apoptosis and transient decrease in spermatocyte staining in histological sections and a non-significant decrease in sperm count. Conclusions: Our results in both the clinical and pre-clinical settings indicate that oxaliplatin exerts moderate transient gonadal toxicity. Future prospective large-scale studies are warranted in order to affirm these outcomes.
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Affiliation(s)
- Irit Ben-Aharon
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Mattan Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ofer Purim
- Rabin Medical Center, Petah Tikva, Israel
| | - Limor Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | | | - Ruth Shalgi
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wasserberg N, Kundel Y, Purim O, Keidar A, Kashtan H, Sadot E, Fenig E, Brenner B. Sphincter preservation in distal CT2N0 rectal cancer after preoperative chemoradiotherapy. Radiat Oncol 2014; 9:233. [PMID: 25338839 PMCID: PMC4215010 DOI: 10.1186/s13014-014-0233-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/15/2014] [Accepted: 10/08/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Preoperative chemoradiotherapy is usually not indicated for cT2N0 rectal cancer. Abdominoperineal resection is the standard treatment for distal rectal tumors. The aim of the study was to evaluate the actual sphincter-preservation rate in patients with distal cT2N0 rectal cancer given neoadjuvant chemoradiotherapy. METHODS Data were retrospectively collected for all patients who were diagnosed with distal cT2N0 rectal cancer at a tertiary medical center in 2000-2008 and received chemoradiotherapy followed by surgery (5-7 weeks later). RESULTS Thirty-three patients (22 male) of median age 65 years (range, 32-88) were identified. Tumor distance from the anal verge ranged from 0 to 5 cm. R0 resection with sphincter preservation was accomplished in 22 patients (66%), with a 22% pathological complete response rate. Median follow-up time was 62 months (range 7-120). There were no local failures. Crude disease-free and overall survival were 82% and 86%, respectively. Factors associated with sphincter preservation were tumor location (OR=0.58, p=0.02, 95% CI=0.37-0.91) and pathological downstaging (OR=7.8, p=0.02, 95% CI=1.35-45.85). Chemoradiotherapy was well tolerated. CONCLUSION High rates of sphincter preservation can be achieved after preoperative chemoradiotherapy for distal cT2N0 rectal cancer, with tolerable toxicity, without compromising oncological outcome.
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Affiliation(s)
| | - Yulia Kundel
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.
| | - Ofer Purim
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.
| | - Andrei Keidar
- Department of Surgery B, Petach Tikva, 49100, Israel.
| | | | - Eran Sadot
- Department of Surgery B, Petach Tikva, 49100, Israel.
| | - Eyal Fenig
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.
| | - Baruch Brenner
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.
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Vilkin A, Halpern M, Morgenstern S, Brazovski E, Gingold-Belfer R, Boltin D, Purim O, Kundel Y, Welinsky S, Brenner B, Niv Y, Levi Z. How reliable is immunohistochemical staining for DNA mismatch repair proteins performed after neoadjuvant chemoradiation? Hum Pathol 2014; 45:2029-36. [DOI: 10.1016/j.humpath.2014.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/28/2014] [Accepted: 07/09/2014] [Indexed: 02/08/2023]
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Berger Y, Zbar AP, Lebedyev A, Levi Y, Nevler A, Aderka D, Golan T, Purim O, Brenner B, Natur M, Gutman M. [Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal and appendiceal origin]. Harefuah 2014; 153:315-368. [PMID: 25095601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND We report our initial experience combining cytoreductive surgery (CRS) plus intraperitoneal chemotherapy with hyperthermia (HIPEC) in a selected group of patients presenting with disseminated peritoneal carcinomatosis (PC) of colorectaL or appendiceaL origin at a single tertiary referral institution. METHODS The study included patients who underwent CRS with HIPEC at the Sheba Medical Center between April 2009 and December 2011. The HIPEC technique was administered with the open Coliseum technique reaching a steady state of mitomycin-C delivery at 410 C for perfusion duration of 90 minutes. RESULTS AnaLysis included 45 patients (18 males) incorporating 42 cases of primary colorectal cancer (CRC) or appendiceal cancer and 3 cases of pseudomyxoma peritonei. Thirty-seven patients (82%) underwent CC-0 resections with a median overall hospital stay of 8 days (range 5-43). There was one perioperative death at 90 days. The perioperative complication rate was 31.1%. The median follow-up was 12 months (range 2-36) during which 13 patients died. Among the CRC and appendiceal cancer group the median overall survival was 20.2 months and the median progression free survival was 16.4 months (Kaplan-Meier analysis). During follow-up, 23 patients experienced disease progression. CONCLUSION The selective use of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for patients with peritoneal carcinomatosis from colorectal or appendiceal origin is safe with acceptable morbidity and low mortality.
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Hubert A, Geva R, Segal A, Brenner B, Brenner RM, Pelles-Avraham S, Beny A, Sarid D, Keren-Rosenberg SP, Stemmer SM, Gabizon A, Purim O, Tahover E, Inbar MJ, Wolf I, Dvir A, Soussan-Gutman L, Ross JS, Stephens P, Miller VA. Next-generation sequencing (NGS) in metastatic colorectal cancer (CRC) patients (pts) in Israel. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e14548] [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: 11/20/2022] Open
Affiliation(s)
- Ayala Hubert
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ravit Geva
- Division of Oncology, Tel-Aviv Sourasky Medical center, Tel Aviv, Israel
| | - Amiel Segal
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | | - Alexander Beny
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - David Sarid
- Division of Oncology, Tel-Aviv Sourasky Medical center, Tel Aviv, Israel
| | | | | | - Alberto Gabizon
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ofer Purim
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Esther Tahover
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Moshe J. Inbar
- Division of Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Division of Oncology, Tel-Aviv Sourasky Medical center, Tel Aviv, Israel
| | - Addie Dvir
- Teva Pharmaceutical Industries, Ltd., Shoham, Israel
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Dickman R, Kundel Y, Levy-Drummer R, Purim O, Wasserberg N, Fenig E, Sulkes A, Brenner B. Restaging locally advanced rectal cancer by different imaging modalities after preoperative chemoradiation: a comparative study. Radiat Oncol 2013; 8:278. [PMID: 24286200 PMCID: PMC4222036 DOI: 10.1186/1748-717x-8-278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 11/17/2013] [Indexed: 12/19/2022] Open
Abstract
Background To compare the accuracy of different imaging modalities, alone and in combination in predicting findings at surgery after preoperative chemoradiation for locally advanced rectal cancer. Methods Following chemoradiation, tumors were reclassified on the basis of findings on pelvic computed tomography (CT) (94 patients), endorectal ultrasonography (EUS) (138 patients) alone or by both CT and EUS (80 patients). The ability of the imaging modalities, to predict the pathologic T status, N status, and TNM stage at surgery was evaluated and compared. Results Mean age of the patients was 64.5 years (range 28–88 years); 55% were male. CT and EUS combined had a positive predictive value of 20% for pathologic pT1 stage, 29% for pT1, 29% for pT2, and 58% for pT3. Predictive values for the operative TNM stage were 50% for stage I, 45% for stage II, and 31% for stage III. These values did not exceed those for each modality alone. Conclusion The performance of preoperative CT and EUS in predicting the T and TNM stage of rectal cancer at surgery is poor. Neither modality alone nor the two combined is sufficiently accurate to serve as the basis for decisions regarding treatment modification.
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Affiliation(s)
- Ram Dickman
- Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva 49100, Israel.
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Brenner RM, Kivity S, Kundel Y, Purim O, Peled N, Idelevich E, Lavrenkov K, Kovel S, Fenig E, Sulkes A, Brenner B. Ethnic variation in toxicity and outcome of adjuvant chemoradiation for gastric cancer in Israel. Anticancer Res 2013; 33:5151-5157. [PMID: 24222163] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Data on differences in toxicity and efficacy of chemotherapy and radiotherapy among different ethnic groups is limited. We evaluated differences in toxicity, tolerability and clinical outcome of Ashkenazi and non-Ashkenazi Jews receiving postoperative chemoradiation for locally advanced gastric cancer (LAGC). PATIENTS AND METHODS Between 6/2000-12/2007, 84 Ashkenazi patients and 60 non-Ashkenazi patients underwent chemoradiation following resection of LAGC (INT-116 trial). RESULTS Patients' and tumor characteristics were comparable. Ashkenazi patients experienced significantly higher rates of fatigue, anorexia, and grade 3-4 dysphagia, as well as a trend for a higher rate of diarrhea. The incidence of other toxicities, dose adjustments of chemotherapy and radiotherapy and patient prognosis did not differ. CONCLUSION This study shows higher rates of various toxicities among Ashkenazi patients receiving postoperative chemoradiation for LAGC compared to non-Ashkenazi patients. To our knowledge, this is the first study comparing treatment toxicity, tolerability and outcome between these two groups.
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Kundel Y, Nasser NJ, Purim O, Yerushalmi R, Fenig E, Pfeffer RM, Stemmer SM, Rizel S, Symon Z, Kaufman B, Sulkes A, Brenner B. Phase II study of concurrent capecitabine and external beam radiotherapy for pain control of bone metastases of breast cancer origin. PLoS One 2013; 8:e68327. [PMID: 23874586 PMCID: PMC3707893 DOI: 10.1371/journal.pone.0068327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/26/2013] [Indexed: 11/19/2022] Open
Abstract
Background Pain from bone metastases of breast cancer origin is treated with localized radiation. Modulating doses and schedules has shown little efficacy in improving results. Given the synergistic therapeutic effect reported for combined systemic chemotherapy with local radiation in anal, rectal, and head and neck malignancies, we sought to evaluate the tolerability and efficacy of combined capecitabine and radiation for palliation of pain due to bone metastases from breast cancer. Methodology/Principal Findings Twenty-nine women with painful bone metastases from breast cancer were treated with external beam radiation in 10 fractions of 3 Gy, 5 fractions a week for 2 consecutive weeks. Oral capecitabine 700 mg/m2 twice daily was administered throughout radiation therapy. Rates of complete response, defined as a score of 0 on a 10-point pain scale and no increase in analgesic consumption, were 14% at 1 week, 38% at 2 weeks, 52% at 4 weeks, 52% at 8 weeks, and 48% at 12 weeks. Corresponding rates of partial response, defined as a reduction of at least 2 points in pain score without an increase in analgesics consumption, were 31%, 38%, 28%, 34% and 38%. The overall response rate (complete and partial) at 12 weeks was 86%. Side effects were of mild intensity (grade I or II) and included nausea (38% of patients), weakness (24%), diarrhea (24%), mucositis (10%), and hand and foot syndrome (7%). Conclusions/Significance External beam radiation with concurrent capecitabine is safe and tolerable for the treatment of pain from bone metastases of breast cancer origin. The overall and complete response rates in our study are unusually high compared to those reported for radiation alone. Further evaluation of this approach, in a randomized study, is warranted. Trial Registration ClinicalTrials.gov NCT01784393NCT01784393
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Affiliation(s)
- Yulia Kundel
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicola J. Nasser
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Ofer Purim
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Yerushalmi
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Fenig
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael M. Pfeffer
- Institute of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salomon M. Stemmer
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shulamith Rizel
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Zvi Symon
- Institute of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bella Kaufman
- Institute of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron Sulkes
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institue of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
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Purim O, Kundel Y, Sadeh Gonik U, Idelevich E, Medalia G, Gordon N, Sulkes A, Brenner B. Weekly docetaxel and cisplatin with capecitabine and bevacizumab (AVDCX) in patients with advanced esophagogastric cancer: Results of a phase Ib/II study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15078] [Citation(s) in RCA: 2] [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
e15078 Background: Many efforts are being made to improve treatment options for advanced esophagogastric cancer (AEGC). The aim of this phase Ib/II study was to evaluate the safety and efficacy of a novel regimen, AVDCX, consisting of weekly docetaxel and cisplatin together with capecitabine and bevacizumab, in AEGC. Methods: Patients with AEGC received treatment with different dose levels of AVDCX (cisplatin and docetaxel 25-35 mg/m2, days 1,8, capecitabine 1,600 mg/m2days 1-14, bevacizumab 7.5 mg/kg, day 1, Q:21 days). To assure regimen's safety a short phase Ib part, with three dose levels, was planned. The study's primary objectives were to establish the recommended phase II doses of docetaxel and cisplatin in AVDCX and to determine the tumor response rate. Results: The study was closed early, after the accrual of 22 patients, due to accumulating toxicity-related deaths. The median age was 59 years and 77% of patients had gastric or gastroesophageal adenocarcinomas. Grade ≥3 adverse events were documented in 18 patients (82%) and these were usually neutropenia (36%), fatigue (54%) or diarrhea (23%). There were three fatal toxicities (14%): mesenteric thromboembolism, gastric perforation and pancytopenic sepsis. Eventually, the recommended phase II doses of cisplatin and docetaxel were determined to be 25 mg/m2 and 30 mg/m2, respectively. Twenty-one patients were evaluable for response: 12 (54%) had partial response (PR), 4 (18%) had stable disease (SD) and none had complete response (CR). The objective response rate (CR+PR) was 54% and the disease control rate (CR+PR+SD) was 72%. Eighteen patients (82%) derived a clinical benefit: improvement of pain, weight or performance status without a deterioration of any of these factors, from treatment. The median overall survival was 11.3 months (range, 1.5-39.2+ months) and median progression-free survival was 8.7 months (range, 1.3–26.6 months). The 2-year OS rate reached 22.7%. Conclusions: AVDCX was associated with bevacizumab-related fatal toxicities. It seems to reproduce the efficacy of bevacizumab regimen AVAGAST trial, without a clue for significant improvement over common docetaxel regimens in AEGC.
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Affiliation(s)
- Ofer Purim
- Rabin Medical Center, Petach Tikva, Israel
| | | | | | | | | | - Noa Gordon
- Rabin Medical Center, Petach Tikva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
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