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Spicer J, Marabelle A, Baurain JF, Jebsen NL, Jøssang DE, Awada A, Kristeleit R, Loirat D, Lazaridis G, Jungels C, Brunsvig P, Nicolaisen B, Saunders A, Patel H, Galon J, Hermitte F, Camilio KA, Mauseth B, Sundvold V, Sveinbjørnsson B, Rekdal Ø. Safety, Antitumor Activity, and T-cell Responses in a Dose-Ranging Phase I Trial of the Oncolytic Peptide LTX-315 in Patients with Solid Tumors. Clin Cancer Res 2021; 27:2755-2763. [PMID: 33542073 DOI: 10.1158/1078-0432.ccr-20-3435] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/07/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE LTX-315 is a first-in-class, 9-mer membranolytic peptide that has shown potent immunomodulatory properties in preclinical models. We conducted a phase I dose-escalating study of intratumoral LTX-315 administration in patients with advanced solid tumors. PATIENTS AND METHODS Thirty-nine patients were enrolled, receiving LTX-315 injections into accessible tumors. The primary objective was to assess the safety and tolerability of this approach, with antitumor and immunomodulatory activity as secondary objectives. Tumor biopsies were collected at baseline and posttreatment for analysis of immunologic parameters. RESULTS The most common treatment-related grade 1-2 adverse events were vascular disorders including transient hypotension (18 patients, 46%), flushing (11 patients, 28%), and injection site reactions in 38% of patients. The most common grade 3 LTX-315-related toxicities were hypersensitivity or anaphylaxis (4 patients, 10%). Analysis of immune endpoints in serial biopsies indicated that LTX-315 induces necrosis and CD8+ T-cell infiltration into the tumor microenvironment. Sequencing of the T-cell receptor repertoire in peripheral blood identified significant expansion of T-cell clones after treatment, of which 49% were present in available tumor biopsies after treatment, suggesting that they were tumor associated. Substantial volume reduction (≥30%) of injected tumors occurred in 29% of the patients, and 86% (12/14 biopsies) had an increase in intralesional CD8+ T cells posttreatment. No partial responses by immune-related response criteria were seen, but evidence of abscopal effect was demonstrated following treatment with LTX-315. CONCLUSIONS LTX-315 has an acceptable safety profile, is clinically active, induces changes in the tumor microenvironment and contributes to immune-mediated anticancer activity.
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Affiliation(s)
- James Spicer
- King's College London, Guy's Hospital, United Kingdom.
| | - Aurélien Marabelle
- DITEP, INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, France
| | | | - Nina Louise Jebsen
- Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway.,Haukeland University Hospital, Bergen, Norway
| | | | - Ahmad Awada
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | | | - Jérôme Galon
- INSERM Laboratory of Integrative Cancer Immunology, Paris, France
| | | | | | | | | | - Baldur Sveinbjørnsson
- Lytix Biopharma, Oslo, Norway.,Department of Medical Biology, Arctic University of Norway, Tromsø, Norway
| | - Øystein Rekdal
- Lytix Biopharma, Oslo, Norway.,Department of Medical Biology, Arctic University of Norway, Tromsø, Norway
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Ellingsen EB, Aamdal E, Inderberg EM, Rasch W, Brunsvig P, Aamdal S, Hovig E, Nyakas M, Guren TK, Gaudernack G. A phase I/IIa clinical trial investigating the therapeutic cancer vaccine UV1 in combination with ipilimumab in patients with malignant melanoma: Four-year survival update. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.5_suppl.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
62 Background: Combining checkpoint blockade with a cancer vaccine may induce broader immune responses, leading to better clinical outcomes. UV1 targets the enzyme telomerase (hTERT) which is expressed in almost all cancer types and is essential for the immortality of cancer cells and a hallmark of cancer. UV1 consists of three synthetic long peptides and vaccination induces Th1 responses in most patients irrespective of HLA type. This trial explores the synergistic effect of CTLA-4 blockade and hTERT vaccination, allowing unchecked expansion of hTERT-specific T cell clones. Increased number of tumor-specific T cells is associated with a favorable clinical outcome in patients with metastatic melanoma. We investigated the safety, immunological and clinical responses of UV1 vaccine and ipilimumab in this group of patients. Methods: In a phase I/IIa, single-center trial (NCT02275416) patients with metastatic melanoma received treatment with UV1 (300 µg) + GM-CSF (75 µg) as an adjuvant, combined with ipilimumab (3 mg/kg). Safety was assessed according to CTCAE v. 4.0, and tumor responses according to RECIST v.1.1. Immune responses against UV1 peptides were monitored in peripheral mononuclear blood cells by using 3H-thymidine proliferation and IFN-γ ELISPOT assays. Tumor mutational burden (TMB) estimations were based on whole-exome sequencing. Results: 12 patients were treated from Feb to Nov 2015. Treatment was generally well tolerated. Adverse events mainly included injection site reactions and diarrhea. Immune responses occurred very early and 10/11 evaluable patients showed an immune response. Three patients obtained a partial response, and one patient a complete response. 3-year overall survival (OS) was 67%. 4-year survival outcome will be presented along with baseline characteristics and TMB estimations. Conclusions: Combining UV1 and ipilimumab is safe and induces clinical responses in melanoma. The high proportion of immunological responders and early induction of detectable immune responses suggest synergism. OS compares favorably to historical controls. Clinical trial information: NCT02275416.
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Affiliation(s)
- Espen Basmo Ellingsen
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Elin Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | | | - Paal Brunsvig
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Steinar Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Eivind Hovig
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Marta Nyakas
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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Felip E, Brunsvig P, Helland Å, Viñolas N, Aix S, Carcereny E, Gomez MD, Perez JT, Arriola E, Campelo RG, Spicer J, Thompson J, Granados AO, Holt R, Smethurst D, Lorens J, Shoaib M, Siddiqui A, Schoelermann J, Lorens K, Schmidt E, Chisamore M, Krebs M. MA03.06 Efficacy Results of Selective AXL Inhibitor Bemcentinib with Pembrolizumab Following Chemotherapy in Patients with NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Trigo Perez J, Felip E, Brunsvig P, Helland A, Viñolas N, Ponce Aix S, Carcereny Costa E, Domine Gomez M, Arriola E, Garcia Campelo R, Spicer J, Thompson J, Ortega Granados A, Holt R, Lorens J, Shoaib M, Siddiqui A, Schmidt E, Chisamore M, Krebs M. Efficacy results of selective AXL inhibitor bemcentinib with pembrolizumab following chemo in patients with NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Krebs M, Brunsvig P, Helland Å, Viñolas N, Aix S, Carcereny E, Gomez MD, Perez JT, Arriola E, Campelo RG, Spicer J, Thompson J, Granados AO, Holt R, Smethurst D, Lorens J, Shoaib M, Siddiqui A, Schoelermann J, Lorens K, Schmidt E, Chisamore M, Felip E. P1.01-72 A Phase II Study of Selective AXL Inhibitor Bemcentinib and Pembrolizumab in Patients with NSCLC Refractory to Anti-PD(L)1. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Baaurain JF, Jungels C, Kristeleit RS, Jossang DE, Jebsen NL, Rekdal Ø, Sveinbjornsson B, Gjerstad VS, Brunsvig P, Galon J, Hermitte F, Patel H. Abstract CT010: A phase I study of the oncolytic peptide LTX-315 generates de novoT-cell responses and clinical benefit in patients with advanced sarcoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: LTX-315 is a first-in class oncolytic peptide that has the ability to kill cancer cells and induce specific anticancer immune response when injected locally into experimental tumors established in immunocompetent mice. The underlying mechanism of action include induction of immunogenic cell death with subsequent infiltration of T-cells into the tumor microenvironment. A multicenter Phase I study was conducted to evaluate the safety and tolerability of LTX-315 in patients with solid tumors who had exhausted standard treatment options.
Methods: The primary objective of the trial was to assess the safety and tolerability of multiple, intratumoral doses of LTX-315 as a monotherapy. The secondary objective was to evaluate clinical activity (assessed using immune-related response criteria (irRC)) and the ability of LTX-315 to evoke local and systemic immune responses. Paired pre and post treatment tumor samples were obtained throughout the study. Immunohistochemistry and gene expression analysis were performed on these paired tumor biopsies. T-cell receptor (TCR) repertoire in peripheral blood and tumor biopsies was assessed by TCRβ-gene sequencing.
Results: Twenty-seven patients were treated with LTX-315 monotherapy and had at least one post baseline efficacy assessment, of which 5 patients had the diagnosis of sarcoma. Best overall response seen in the sarcoma patients was SD in 4 out of 5 patients (80%). In one patient, a marked tumor regression was observed in two distant non-injected lesions (39% and 66% reduction). All patients experienced a treatment emergent adverse event (TEAE) and all patients experienced at least one episode of LTX-315 related adverse event, most commonly an acute reaction to injection of LTX-315 such as hypotension, rash, flushing or itching. The majority (94%) of these injection-related events were grade 1. There were 2 episodes (6%) of grade 3 AE, no serious adverse events were reported. Enhanced tumor infiltration of CD3+ and CD8+T cells, assessed by immunoscore®, was observed in 100% and 75% of the responding sarcoma patients, respectively. Gene expression profiling by Immunosign ®21 in one injected lesion showed a distinct “cold to hot’’ signature change.TCR sequencing of the patient`s T cells in peripheral blood revealed significant clonal expansion of T-cells, 39% of these T cell clones were also detected in post-treatment biopsied tumors.
Conclusions: Intratumoral LTX-315 is generally safe and tolerable. LTX-315 monotherapy enhances TIL population and induces polyclonal T-cell responses Based on the data from the Phase I study, the dosing regimen of LTX-315 will be assessed and optimized to position LTX-315 as a therapeutic agent in combination with other targeted immune therapies such as checkpoint inhibitors to address an unmet need in a select group of indications. Registration number; NCT01986426
Citation Format: Jean-Francois Baaurain, Christiane Jungels, Rebecca S. Kristeleit, Dag E. Jossang, Nina L. Jebsen, Øystein Rekdal, Baldur Sveinbjornsson, Vibeke S. Gjerstad, Paal Brunsvig, Jerome Galon, Fabienne Hermitte, Hamina Patel. A phase I study of the oncolytic peptide LTX-315 generatesde novoT-cell responses and clinical benefit in patients with advanced sarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT010.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jerome Galon
- 9INSERM, Laboratory of Integratvie Cancer Immunology, Paris, France
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Marabelle A, Baurain JF, Awada A, Kristeleit RS, Loirat D, Jossang DE, Jebsen NL, Sveinbjornsson B, Rekdal Ø, Gjerstad VS, Brunsvig P, Galon J, Hermitte F, Patel H, Spicer J. Abstract CT069: A Phase I study of the oncolytic peptide LTX-315 generates de novo T-cell responses and clinical benefit in patients with advanced melanoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct069] [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: 11/16/2022]
Abstract
Abstract
Background: LTX-315 is a first-in class oncolytic peptide that has the ability to kill cancer cells and induce specific anticancer immune response when injected locally into experimental tumors in mice. The underlying mechanism of action includes induction of immunogenic cell death with subsequent infiltration of T cells into the tumor. A multicenter Phase I study was conducted to evaluate the safety and tolerability of LTX-315 in patients with solid tumors who had no treatment options available.
Methods: Patients with unresectable metastatic cancer were recruited to the study.The primary objective was to assess the safety and tolerability of multiple, intratumoral doses of LTX-315 as a monotherapy. The secondary objective was to evaluate clinical efficacy (assessed by irRC) and the ability of LTX-315 to evoke local and systemic immune responses. Paired pre and post treatment tumor samples were collected throughout the study. Immunohistochemistry and gene expression analysis were performed on the paired tumor biopsies. T-cell receptor (TCR) repertoire in peripheral blood and biopsies was assessed by TCRβ-gene sequencing.
Results: Twenty-seven patients were treated with LTX-315 monotherapy and had at least one post baseline efficacy assessment, of which 8 patients had melanoma. Best overall response seen in the melanoma patients was SD which was evident in 5 out of these 8 patients (62.5%). Five patients had a marked tumor regression (25-82% reduction) in distant non-injected lesions post treatment. Treatment emergent adverse events occurred in all 8 patients, but no patients experienced a serious adverse event. Six patients experienced LTX-315-related adverse events, the commonest being tingling post injection, others included rash, fatigue, diarrhea, hypo- and hypertension and weakness. Ninety percentage of LTX- 315 related events were grade 1, and one patient experienced a grade 3 event of hypertension. All toxicities resolved without sequale except weakness which was ongoing at time of study completion. Increased number of CD8+ T cells was observed in all treated lesions with evaluable biopsies. Gene expression profiling by Immunosign® 21 was assessed in injected lesions from 2 patients. A “cold to hot’’ signature change was found in one patient whereas “warm to hot” signature was seen in the other patient. Sequencing of T cell receptor from peripheral blood samples from pre- and post LTX-315 treatment revealed significant clonal expansion of T cells after treatment in the patient with “cold to hot” signature, and 24% of these clones were also detected in the post-treatment biopsy tumor sample.
Conclusions: Intratumoral LTX-315 is safe and well tolerated. LTX-315 monotherapy enhances TIL population and induces polyclonal T-cell responses. Based on the data from the Phase I study, further development of LTX-315 will focus on therapeutic combination with other targeted immune therapies such as checkpoint inhibitors to address unmet need in a selected indications. Registration Number: NCT01986426
Citation Format: Aurelien Marabelle, Jean-Francois Baurain, Ahmad Awada, Rebbecca S. Kristeleit, Delphine Loirat, Dag E. Jossang, Nina L. Jebsen, Baldur Sveinbjornsson, Øystein Rekdal, Vibeke S. Gjerstad, Paal Brunsvig, Jerome Galon, Fabienne Hermitte, Hamina Patel, James Spicer. A Phase I study of the oncolytic peptide LTX-315 generates de novo T-cell responses and clinical benefit in patients with advanced melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT069.
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Affiliation(s)
| | | | - Ahmad Awada
- 3Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium
| | | | | | | | - Nina L. Jebsen
- 7Center for Cancer Biomarkers (CCBIO), University of Bergen, Bergen, Norway
| | | | | | | | | | - Jerome Galon
- 11INSERM, Laboratory of Integrative Cancer Immunology, Paris, France
| | | | | | - James Spicer
- 13Kings College London, Guys Hospital, London, United Kingdom
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8
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Felip E, Brunsvig P, Vinolas N, Ponce Aix S, Carcereny Costa E, Dómine Gomez M, Trigo Perez JM, Arriola E, Campelo RG, Spicer JF, Thompson JR, Ortega Granados AL, Holt RJ, Lorens K, Lorens JB, Shoaib M, Siddiqui A, Schmidt EV, Chisamore MJ, Krebs M. A phase II study of bemcentinib (BGB324), a first-in-class highly selective AXL inhibitor, with pembrolizumab in pts with advanced NSCLC: OS for stage I and preliminary stage II efficacy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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
9098 Background: AXL is an RTK implicated in epithelial-to-mesenchymal transition and as a resistance mechanism to multiple therapies including anti-PD1. Bemcentinib (BGB324) is a first-in-class, oral, highly selective and potent AXL inhibitor which has been demonstrated to enhance anti-PD1 therapy in the pre-clinical setting. Methods: This is a Phase II single-arm, two-Stage study with bemcentinib (200mg/d) and pembrolizumab (200 mg/q3wk) for previously treated, IO naïve pts (n = 48 in total) with Stage IV lung adenocarcinoma. The primary endpoint was ORR according to RECIST 1.1 with pre-defined minimum requirement for 18% RR in the first Stage (n = 24) to proceed to Stage 2. Secondary endpoints included DCR, PFS, OS and safety. Tumour biopsies were analysed for PD-L1 (22C3 pharmDx), AXL, and infiltrating immune cells. Results: Stage 1 completed enrolment in Apr ‘18. As of Feb ‘19, 38 pts (24 and 14 in Stage 1 and 2, respectively) have been dosed with the combination; median age 66 (range 39-79) yr, 59% male, all previously received one prior line of platinum-based chemotherapy or a licensed EGFR/ALK-directed therapy. The most common TRAEs (occurring in > 15% of pts) were transaminase increases (37%), diarrhoea (29%), and asthenia (17%). All cases of transaminase increase were reversible and resolved with concomitant administration of systemic corticosteroids and interruption of study treatments. At time of writing, Stage 1 had met the efficacy threshold to proceed to Stage 2 with continued enrolment. Among 29 pts evaluable for response 7 PRs were reported (24%). For AXL positive pts (10/21 with available biopsies), ORR was 40%. PD-L1 status was known for 5 responders: 4 pts (80%) were PD-L1 negative or weakly positive. In Stage 1, mPFS was 4.0 months (95% CI 1.9 – NR) and 5.9 months in AXL positive pts (n = 10; 3.0 - NR). mOS was not mature. Conclusions: Overall, bemcentinib in combination with pembrolizumab was well tolerated and promising clinical activity was seen, particularly in pts with AXL positive disease. Updated results will be reported at the meeting, incl 12-month OS for Stage 1 and preliminary efficacy of Stage 2. Clinical trial information: NCT03184571.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - James B. Lorens
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | | | | | | | | | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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Nyakas M, Aamdal E, Jacobsen KD, Guren TK, Aamdal S, Hagene KT, Brunsvig P, Yndestad A, Halvorsen B, Tasken KA, Aukrust P, Maelandsmo GM, Ueland T. Prognostic biomarkers for immunotherapy with ipilimumab in metastatic melanoma. Clin Exp Immunol 2019; 197:74-82. [PMID: 30821848 PMCID: PMC6591141 DOI: 10.1111/cei.13283] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/23/2022] Open
Abstract
New therapies, including the anti‐cytotoxic T lymphocyte antigen (CTLA)‐4 antibody, ipilimumab, is approved for metastatic melanoma. Prognostic biomarkers need to be identified, because the treatment has serious side effects. Serum samples were obtained before and during treatment from 56 patients with metastatic or unresectable malignant melanoma, receiving treatment with ipilimumab in a national Phase IV study (NCT0268196). Expression of a panel of 17 inflammatory‐related markers reflecting different pathways including extracellular matrix remodeling and fibrosis, vascular inflammation and monocyte/macrophage activation were measured at baseline and the second and/or third course of treatment with ipilimumab. Six candidate proteins [endostatin, osteoprotegerin (OPG), C‐reactive protein (CRP), pulmonary and activation‐regulated chemokine (PARC), growth differentiation factor 15 (GDF15) and galectin‐3 binding‐protein (Gal3BP)] were persistently higher in non‐survivors. In particular, high Gal3BP and endostatin levels were also independently associated with poor 2‐year survival after adjusting for lactate dehydrogenase, M‐stage and number of organs affected. A 1 standard deviation increase in endostatin gave 1·74 times [95% confidence interval (CI) = 1·10–2·78, P = 0·019] and for Gal3BP 1·52 times (95% CI = 1·01–2·29, P = 0·047) higher risk of death in the adjusted model. Endostatin and Gal3BP may represent prognostic biomarkers for patients on ipilimumab treatment in metastatic melanoma and should be further evaluated. Owing to the non‐placebo design, we could only relate our findings to prognosis during ipilimumab treatment.
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Affiliation(s)
- M Nyakas
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - E Aamdal
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K D Jacobsen
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - T K Guren
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - S Aamdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K T Hagene
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - P Brunsvig
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - B Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - K A Tasken
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.,K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - G M Maelandsmo
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - T Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
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Arce-Lara C, Arriola E, Brunsvig P, Carcereny E, Domine M, Dragnev K, Felip E, García Campelo R, Krebs M, Paz-Ares L, Ponce Aix S, Spicer J, Trigo J, Vinolas Segarra N, Holt R, Micklem D, Brown A, Chisamore M, Lorens J. P2.04-27 Ph II Study of Oral Selective AXL Inhibitor Bemcentinib (BGB324) in Combination with Pembrolizumab in Patients with Advanced NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nyakas M, Aamdal E, Guren T, Aamdal S, Jacobsen KD, Brunsvig P, Tasken KA, Mælandsmo G, Yndestad A, Halvorsen B, Aukrust P, Ueland T. Abstract 5713: Promising predictive biomarkers for immunotherapy in metastatic melanoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5713] [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: 11/16/2022]
Abstract
Abstract
Aim: to explore biomarkers in order to predict outcome in patients with metastatic melanoma who have had immunotherapy with ipilimumab in a real-world setting. Metastatic melanoma is a very aggressive, incurable cancer with historically few therapeutic options and poor survival. Immunotherapy represents a revolution for metastatic melanoma treatment but there is a lack of biomarkers to predict treatment response. Material and methods: In the Norwegian National Phase 4 Multicenter Study, IPI4, 150 patients were included to receive ipilimumab (anti-CTLA3). A subgroup of 73 patients (4 screening failure) was included at Oslo University Hospital -The Norwegian Radium Hospital. Serum was available from 56 patients of this subgroup and were examined before and during ipilimumab treatment concerning possible predictive biomarkers. Expression of a panel of 17 inflammatory markers reflecting different inflammatory pathways including extra cellular matrix remodeling and fibrosis, vascular inflammation, notch signaling, inflammation in general and monocyte/macrophage activation were measured at baseline and at the 2nd and/or 3rd treatment with ipilimumab. Results: During an average 33.7 months follow-up, 33 (59%) patients died. Six promising candidates (endostatin, osteoprotegerin, C-reactive protein, pulmonary and activation-regulated chemokine and galectin-3 binding-protein) were higher in non-survivors. In particular, high endostatin and galectin-3 binding protein levels were independently associated with poor long time survival also in adjusted analysis (age, gender, lactate dehydrogenase). A 1 standard deviation (SD) increase in Gal3BP gave a 1.8 x times higher risk of death (95% CI 1.10-2.95, p=0.019) while a 1 SD increase in endostatin was associated with a 2x higher risk of death (95% CI 1.12-3.64, p=0.020) in the final model. Conclusion: Endostatin and galectin-3 binding protein may represent biomarkers for prognosis during immunotherapy with ipilimumab and should be further evaluated.
Citation Format: Marta Nyakas, Elin Aamdal, Tormod Guren, Steinar Aamdal, Kari Dolven Jacobsen, Paal Brunsvig, Kristin Austlid Tasken, Gunhild Mælandsmo, Arne Yndestad, Bente Halvorsen, Paal Aukrust, Thor Ueland. Promising predictive biomarkers for immunotherapy in metastatic melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5713.
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Lorens J, Arce-Lara CE, Arriola E, Brunsvig P, Carcereny Costa E, Domine M, Dragnev KH, Felip E, Campelo RG, Krebs M, Ponce Aix S, Spicer JF, Trigo Perez JM, Vinolas N, Holt RJ, Brown A, Chisamore MJ. Phase II open-label, multi-centre study of bemcentinib (BGB324), a first-in-class selective AXL inhibitor, in combination with pembrolizumab in patients with advanced NSCLC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Paal Brunsvig
- Radiumhospitalet (The Norwegian Radium Hospital), Oslo, Norway
| | - Enric Carcereny Costa
- Medical Oncology Department. Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Manuel Domine
- Oncology Department and Translational Oncology Division, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | | | | | | | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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13
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Spicer JF, Marabelle A, Baurain JF, Awada A, Kristeleit RS, Jossang DE, Jebsen N, Loirat D, Armstrong AC, Curigliano G, Nicolaisen B, Rekdal O, Sveinbjornsson B, Gjerstad VS, Brunsvig P. A phase I/II study of the oncolytic peptide LTX-315 combined with checkpoint inhibition generates de novo T-cell responses and clinical benefit in patients with advanced solid tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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)
| | | | | | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Spicer JF, Baurain JF, Awada A, Kristeleit RS, Jossang DE, Marabelle A, Loirat D, Wold H, Nicolaisen B, Rekdal O, Olsen WM, Saunders A, Brunsvig P. LTX-315, an oncolytic peptide, to convert immunogenically ‘cold' tumors to ‘hot' in patients with advanced or metastatic tumours: Results from an ongoing phase I study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3085 Background: Intratumoral LTX-315 disintegrates cytoplasmic organelles with release of tumor antigens in preclinical models accompanied by increase in tumor-infiltrating lymphocytes (TILs). LTX-315 induced complete regression in several rodent models, with systemic immune responses. LTX-315 is strongly synergistic preclinically with immune checkpoint inhibitors (ICI). We are conducting a phase 1 trial to evaluate LTX-315 in combination therapy. Methods: Patients with advanced metastatic solid tumours received injections of LTX-315 into a single accessible tumour over 6 weeks. Additional injections could be administered thereafter every 2 weeks. Biopsies of injected lesions were taken at baseline, and on treatment. Results: 28 have been enrolled to date, median age is 58 (range 32-80) and median prior treatments 2 (range 1-14). LTX-315 monotherapy was administered at doses of 2-7mg to a median of 1.8 tumour lesions (range 1-6) for a median of 9 weeks (range 1-33). In 24 patients all LTX-315-related adverse events were CTC grade 1 or 2, most commonly local erythema, flushing, pruritis and hypotension, most resolving within minutes of injection. Related grade 3 (3 patients) or 4 (1) allergic/anaphylaxis adverse event occurred and resolved without sequelae. Best response in 44 injected lesions in 20 evaluable patients included 2 complete responses, > 50% reduction in 5 tumours, and 20 stable (injected ). Significant increases in TILs occurred in 67% (14 of 21) patients with biopsies of injected tumours available. Regression of distant non-injected tumour has been observed clinically on biopsy (abscopal effect). No irRC response in non-injected tumours has been observed in 16 evaluable patients. Stable disease (median duration 14 weeks) occurred in 50% of patients as best response (melanoma (4), sarcoma (3), breast (1)). Conclusions: This phase 1 study demonstrates that intratumoural LTX-315 has a manageable safety profile and induces increases in TILs in pre-treated patients. Partial and complete regression was seen in some injected tumours. Evaluation of LTX-315 in combination with ICIs in breast and melanoma is ongoing. Clinical trial information: NCT01986426.
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Affiliation(s)
| | | | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | | | - Andrew Saunders
- Linden Oncology Limited, Bruntsfield, Edinburgh, United Kingdom
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15
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Halvorsen TO, Sundstrøm S, Fløtten Ø, Brustugun OT, Brunsvig P, Aasebø U, Bremnes RM, Kaasa S, Grønberg BH. Comorbidity and outcomes of concurrent chemo- and radiotherapy in limited disease small cell lung cancer. Acta Oncol 2016; 55:1349-1354. [PMID: 27549509 DOI: 10.1080/0284186x.2016.1201216] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many patients with limited disease small cell lung cancer (LD SCLC) suffer from comorbidity. Not all patients with comorbidity are offered standard treatment, though there is little evidence for such a policy. The aim of this study was to investigate whether patients with comorbidity had inferior outcomes in a LD SCLC cohort. MATERIAL AND METHODS We analyzed patients from a randomized study comparing two three-week schedules of thoracic radiotherapy (TRT) plus standard chemotherapy in LD SCLC. Patients were to receive four courses of cisplatin/etoposide and TRT of 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders received prophylactic cranial irradiation (PCI). Comorbidity was assessed using the Charlson Comorbidity Index (CCI), which rates conditions with increased one-year mortality. RESULTS In total 157 patients were enrolled between May 2005 and January 2011. Median age was 63 years, 52% were men, 16% had performance status 2, and 72% stage III disease. Forty percent had no comorbidity; 34% had CCI-score 1; 15% CCI 2; and 11% CCI 3-5. There were no significant differences in completion rates of chemotherapy, TRT or PCI across CCI-scores; or any significant differences in the frequency of grade 3-5 toxicity (p = 0.49), treatment-related deaths (p = 0.36), response rates (p = 0.20), progression-free survival (p = 0.18) or overall survival (p = 0.09) between the CCI categories. CONCLUSION Patients with comorbidity completed and tolerated chemo-radiotherapy as well as other patients. There were no significant differences in response rates, progression-free survival or overall survival - suggesting that comorbidity alone is not a reason to withhold standard therapy in LD SCLC.
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Affiliation(s)
- Tarje Onsøien Halvorsen
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Sundstrøm
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øystein Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Odd T. Brustugun
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paal Brunsvig
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Ulf Aasebø
- Department of Pulmonology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Roy M. Bremnes
- Department of Clinical Medicine, Faculty of Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn H. Grønberg
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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16
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Kyte JA, Gaudernack G, Faane A, Lislerud K, Inderberg EM, Brunsvig P, Aamdal S, Kvalheim G, Wälchli S, Pule M. T-helper cell receptors from long-term survivors after telomerase cancer vaccination for use in adoptive cell therapy. Oncoimmunology 2016; 5:e1249090. [PMID: 28123886 DOI: 10.1080/2162402x.2016.1249090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 06/27/2016] [Revised: 09/28/2016] [Accepted: 10/12/2016] [Indexed: 12/17/2022] Open
Abstract
We herein report retargeting of T-helper (Th) cells against the universal cancer antigen telomerase for use in adoptive cell therapy. The redirected Th cells may counter tumor tolerance, transform the inflammatory milieu, and induce epitope spreading and cancer senescence. We have previously conducted a series of trials evaluating vaccination with telomerase peptides. From long-term survivors, we isolated >100 CD4+ Th-cell clones recognizing telomerase epitopes. The clones were characterized with regard to HLA restriction, functional avidity, fine specificity, proliferative capacity, cytokine profile, and recognition of naturally processed epitopes. DP4 is the most prevalent HLA molecule worldwide. Two DP4-restricted T-cell clones with different functional avidity, C13 and D71, were selected for molecular T-cell receptor (TCR) cloning. Both clones showed a high proliferative capacity, recognition of naturally processed telomerase epitopes, and a polyfunctional and Th1-weighted cytokine profile. TCR C13 and D71 were cloned into the retroviral vector MP71 together with the compact and GMP-applicable marker/suicide gene RQR8. Both TCRs were expressed well in recipient T cells after PBMC transduction. The transduced T cells co-expressed RQR8 and acquired the desired telomerase specificity, with a polyfunctional response including production of TNFa, IFNγ, and CD107a. Interestingly, the DP4-restricted TCRs were expressed and functional both in CD4+ and CD8+ T cells. The findings demonstrate that the cloned TCRs confer recipient T cells with the desired hTERT-specificity and functionality. We hypothesize that adoptive therapy with Th cells may offer a powerful novel approach for overcoming tumor tolerance and synergize with other forms of immunotherapy.
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Affiliation(s)
- Jon Amund Kyte
- Department for Cell Therapy, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway; Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - Gustav Gaudernack
- Department for Immunology, Cancer Research Institute, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Faane
- Department for Cell Therapy, Oslo University Hospital , Oslo, Norway
| | - Kari Lislerud
- Department for Cell Therapy, Oslo University Hospital , Oslo, Norway
| | | | - Paal Brunsvig
- Clinical Trial Unit, Department of Oncology, Oslo University Hospital , Oslo, Norway
| | - Steinar Aamdal
- Faculty of Medicine, University of Oslo, Oslo, Norway; Clinical Trial Unit, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Gunnar Kvalheim
- Department for Cell Therapy, Oslo University Hospital , Oslo, Norway
| | - Sébastien Wälchli
- Department for Cell Therapy, Oslo University Hospital, Oslo, Norway; Department for Immunology, Cancer Research Institute, Oslo University Hospital, Oslo, Norway
| | - Martin Pule
- Department of Haematology, UCL Cancer Institute, University College London , London, UK
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17
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Subbiah V, Bang YJ, Lassen UN, Wainberg ZA, Soria JC, Wen PY, Zenz T, Moreau P, Brunsvig P, De Braud FG, De Greve J, De Jonge MJ, Hofheinz RD, Italiano A, Stein A, Willenbacher W, Schellens JH, Zielinski C, Rangwala FA, Kreitman RJ. ROAR: a phase 2, open-label study in patients (pts) with BRAF V600E–mutated rare cancers to investigate the efficacy and safety of dabrafenib (D) and trametinib (T) combination therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps2604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
- Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yung-Jue Bang
- Seoul National University Hospital, Seoul, South Korea
| | | | - Zev A. Wainberg
- Department of Medicine, Division of Hematology Oncology, UCLA School of Medicine, Los Angeles, CA
| | | | | | | | - Philippe Moreau
- Centre Hospitalier Universitaire Hôtel-Dieu de Nantes, Nantes, France
| | | | | | | | | | | | | | - Alexander Stein
- University Cancer Center Hamburg, University of Hamburg, Hamburg, Germany
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Spicer J, Awada A, Brunsvig P, Saunders A, Olsen W, Nicolaisen B, Rekdal O, Laruelle M, Marjuadi F, Vakili J, Aftimos P, Barthelemy P, Deva S, Baurain J. 528 Intratumoural treatment with LTX-, an oncolytic peptide immunotherapy, in patients with advanced metastatic disease induces CD8 effector cells and regression in some injected tumours. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30329-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grønberg BH, Levin N, Sundstrøm S, Fløtten Ø, Brustugun OT, Brunsvig P, Bremnes RM, Kaasa S, Halvorsen TO. Reduction in tumor size after the first course of cisplatin/etoposide (PE) in limited disease small-cell lung cancer (LD SCLC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e18553] [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)
- Bjørn Henning Grønberg
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Nina Levin
- St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Sundstrøm
- The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Øystein Fløtten
- Department of Pulmonology, Haukeland University Hospital, Bergen, Norway
| | | | | | | | - Stein Kaasa
- Trondheim University Hospital, Trondheim, Norway
| | - Tarje Onsoien Halvorsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway
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Brunsvig P, Aamdal S, Kolstad A, Haaskjold OI, Miller RM, Rekdal O, Nicolaisen B, Olsen WM. A phase I study with LTX-315, an immunogenic cell death inducer, in patients with transdermally accessible tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
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21
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Grønberg BH, Halvorsen TO, Fløtten Ø, Brustugun OT, Brunsvig P, Aasebø U, Bremnes RM, Tollali T, Hornslien K, Aksnessæther BY, Liaaen ED, Sundstrøm S. Randomized phase II trial comparing two schedules of thoracic radiotherapy (TRT) in limited disease small-cell lung cancer (LD SCLC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7027] [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
7027 Background: Concurrent chemotherapy and TRT is standard therapy for SCLC if all lesions can be included in a radiotherapy field (LD). Several schedules of TRT are used. One study showed that two fractions a day improved local control and overall survival (OS), but this schedule has not been compared to a commonly used 3 wks schedule. Methods: Eligible pts had LD SCLC and PS 0-2. Pleural fluid was accepted if negative cytology. Pts received 4 cycles of PE (cisplatin 75 mg/m2 IV day 1 and etoposide 100 mg/m2 IV day 1-3 q 3 wks) and were randomly assigned to 3 wks of 3D conformal TRT [A] 42 Gy (2.8 Gy x 1/day) or [B] 45 Gy (1.5 Gy x 2/day). TRT started 3-4 wks after the first PE. All responders received prophylactic cranial irradiation (PCI) 2 Gy x 15 ≤ 6 wks after last PE. Pts reported health related quality of life (HRQoL) on EORTC QLQ C30 + LC13. Primary endpoint: 1-year local failure. Secondary: OS, toxicity and HRQoL (dysphagia and dyspnea; a difference ≥ 10 points was considered significant). 75 pts were required in each arm to show a 30% improvement of local disease control with α=.05 and β=.8. Results: 159 eligible pts were enrolled at 18 sites in Norway May 05 – Jan 11 (A: 85, B: 74). Median age 60 (40-85); 52% men, 84 % PS 0-1, 11% pleural fluid. Mean no. of PE-cycles was 3.8, 97% completed TRT, 82 % PCI (no difference between arms). Response rates were similar (A: 92%, B: 94%; p=.8), but more pts on Arm B had CR (A: 13%, B: 35%; p=.01). There was no difference in local failure as first site of progression at 1 year (A: 17%, B: 12%; p=.4) or 1-year PFS (A: 44%, B: 50% ; p=.4). There was similar grade 3-4 esofagitis (A: 33%, B: 37 %; p=.7) and pneumonitis (A: 6 %, B: 7 %; p=.9). 2 pts (1 on each arm) died from pneumonitis. Pts in Arm B reported more dysphagia (A: 64 points, B: 73 points), but not more dyspnea (A: 29 points, B: 28 points). 1-year OS was similar (A: 77%, B: 76%; p=.9). Currently, 2-year survival among those followed ≥ 2 years (n=130) favors Arm B (A: 40%, B: 55%; p=.09) and so far (all pts followed ≥ 1-year; 103 events) median OS favors Arm B (A: 18.7 mos, B: 26.6 mos; p=.34). Conclusions: Twice daily TRT resulted in more CRs, slightly more dysphagia, similar 1-year local control and 1-year PFS. There are indications of improved 2-year and median OS in this arm.
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Affiliation(s)
- Bjørn Henning Grønberg
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
| | - Tarje Onsoien Halvorsen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
| | - Øystein Fløtten
- Department of Pulmonology, Haukeland University Hospital, Bergen, Norway
| | - Odd Terje Brustugun
- Oslo University Hospital - The Norwegian Radiumhospital and University of Oslo, Oslo, Norway
| | - Paal Brunsvig
- Oslo University Hospital - The Norwegian Radiumhospital, Oslo, Norway
| | - Ulf Aasebø
- Department of Pulmonolgy, University Hospital of North Norway and Dept of Clinical Medicine, Faculty of Medicine, University of Tromsø, Tromsø, Norway
| | - Roy M. Bremnes
- Department of Clinical Medicine, Faculty of Medicine, University of Tromsø and Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Terje Tollali
- Department of Pulmonology, Nordland Hospital – Bodø, Bodø, Norway
| | - Kjersti Hornslien
- Oslo University Hospital - Ullevål Hospital and The Norwegian Radiumhospital, Oslo, Norway
| | | | - Erik Dyb Liaaen
- Department of Pulmonology, Ålesund Hospital, Ålesund, Norway
| | - Stein Sundstrøm
- The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
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Ikdahl T, Dueland S, Hendlisz A, Dajani O, Brunsvig P, Awada A, Rao J, Farrell J, Rasch W. Phase II study of CP-4126, a gemcitabine-lipid conjugate, in patients with advanced pancreatic cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leyvraz S, Pampallona S, Martinelli G, Ploner F, Perey L, Aversa S, Peters S, Brunsvig P, Montes A, Lange A, Yilmaz U, Rosti G. A threefold dose intensity treatment with ifosfamide, carboplatin, and etoposide for patients with small cell lung cancer: a randomized trial. J Natl Cancer Inst 2008; 100:533-41. [PMID: 18398095 DOI: 10.1093/jnci/djn088] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The dose intensity of chemotherapy can be increased to the highest possible level by early administration of multiple and sequential high-dose cycles supported by transfusion with peripheral blood progenitor cells (PBPCs). A randomized trial was performed to test the impact of such dose intensification on the long-term survival of patients with small cell lung cancer (SCLC). METHODS Patients who had limited or extensive SCLC with no more than two metastatic sites were randomly assigned to high-dose (High, n = 69) or standard-dose (Std, n = 71) chemotherapy with ifosfamide, carboplatin, and etoposide (ICE). High-ICE cycles were supported by transfusion with PBPCs that were collected after two cycles of treatment with epidoxorubicin at 150 mg/m(2), paclitaxel at 175 mg/m(2), and filgrastim. The primary outcome was 3-year survival. Comparisons between response rates and toxic effects within subgroups (limited or extensive disease, liver metastases or no liver metastases, Eastern Cooperative Oncology Group performance status of 0 or 1, normal or abnormal lactate dehydrogenase levels) were also performed. RESULTS Median relative dose intensity in the High-ICE arm was 293% (range = 174%-392%) of that in the Std-ICE arm. The 3-year survival rates were 18% (95% confidence interval [CI] = 10% to 29%) and 19% (95% CI = 11% to 30%) in the High-ICE and Std-ICE arms, respectively. No differences were observed between the High-ICE and Std-ICE arms in overall response (n = 54 [78%, 95% CI = 67% to 87%] and n = 48 [68%, 95% CI = 55% to 78%], respectively) or complete response (n = 27 [39%, 95% CI = 28% to 52%] and n = 24 [34%, 95% CI = 23% to 46%], respectively). Subgroup analyses showed no benefit for any outcome from High-ICE treatment. Hematologic toxicity was substantial in the Std-ICE arm (grade > or = 3 neutropenia, n = 49 [70%]; anemia, n = 17 [25%]; thrombopenia, n = 17 [25%]), and three patients (4%) died from toxicity. High-ICE treatment was predictably associated with severe myelosuppression, and five patients (8%) died from toxicity. CONCLUSIONS The long-term outcome of SCLC was not improved by raising the dose intensity of ICE chemotherapy by threefold.
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Affiliation(s)
- Serge Leyvraz
- Centre Pluridisciplinaire d'Oncologie, University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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24
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Gronberg BH, Bremnes R, Aasebø U, Brunsvig P, Fløtten Ø, Hjelde H, Wammer F, Stornes F, Tollåli T, Sundstrøm SH. Pemetrexed + carboplatin versus gemcitabine + carboplatin in the treatment of stage IIIB/IV non-small cell lung cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7517] [Citation(s) in RCA: 4] [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
7517 Background: A prospective, randomized, multicentre study was conducted to compare pemetrexed + carboplatin (PC) with a standard regimen, gemcitabine + carboplatin (GC). Methods: Chemonaive patients with verified non-small cell lung cancer, stage IIIB (ineligible for curative radiotherapy) or stage IV, WHO performance status (PS) 0–2, adequate hematology and creatinine-clearance > 45 ml/min were eligible. All patients were supplemented with folic acid 0.4 mg OD and vitamin B12 1 mg IM every 9 weeks, from >= 5 days before and through the treatment period. Patients were randomized to receive either pemetrexed 500 mg/m2 + carboplatin AUC=5 (Calvert) day 1 or gemcitabine 1,000 mg/m2 day 1 & 8 + carboplatin AUC=5 (Calvert) day 1. Maximum 4 courses every 3 weeks were given. Primary endpoints: QoL defined as global health status, nausea/vomiting, dyspnea and fatigue - measured by the EORTC QLQ-C30 and LC13 before every cycle and 3 & 11 weeks after the last cycle. Secondary endpoints: Overall survival (OS) and toxicity measured by the CTCAE v3.0. Stratification was done for age (−75 vs +75 years), stage (IIIB vs IV) and PS (0–1 vs 2). 190 evaluable patients in each arm were required to detect a 15% improvement on predefined QoL parameters with an a of 0.05 and β of 0.80. A 15% loss to follow up was expected. Results: 446 patients were included from Apr 05 - Jul 06. The two arms were well balanced with respect to age, sex, stage, PS and histological classification. 436 patients were eligible for the primary QoL-analyses. No statistical significant differences in mean score of the QoL-scales were observed between the arms. So far, 384 patients have been analysed for toxicity. Significantly more patients in the GC arm experienced grade 3–4 thrombocytopenia (48 vs 107, p<0.001), leucopenia (44 vs 89, p<0.001) and granulocytopenia (78 vs 98, p=0.02). No difference in the frequency of neutropenic fever was recorded. More patients in the GC arm received transfusion of platelets (5 vs 19, p=0.02). At present, 291 patients are deceased. We expect to present complete OS analyses for a minimum of 380 patients at the annual meeting. Conclusions: No differences were detected between the two arms with respect to the primary QoL outcome. Patients in the PC arm experienced less toxicity. No significant financial relationships to disclose.
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Affiliation(s)
- B. H. Gronberg
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - R. Bremnes
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - U. Aasebø
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - P. Brunsvig
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - Ø. Fløtten
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - H. Hjelde
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - F. Wammer
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - F. Stornes
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - T. Tollåli
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
| | - S. H. Sundstrøm
- St. Olavs Hospital, Trondheim, Norway; University Hospital of North Norway, Tromsø, Norway; The Norwegian Radiumhospital, Oslo, Norway; Haukeland University Hospital, Bergen, Norway; Ålesund Hospital, Ålesund, Norway; Ullevål University Hospital, Oslo, Norway; Bodø Hospital, Bodø, Norway
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Sundstrøm S, Bremnes RM, Brunsvig P, Aasebø U, Kaasa S. Palliative thoracic radiotherapy in locally advanced non-small cell lung cancer: can quality-of-life assessments help in selection of patients for short- or long-course radiotherapy? J Thorac Oncol 2006; 1:816-24. [PMID: 17409965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Patient-assessed health-related quality-of-life (HRQOL) scores, together with demographic and clinical factors in stage III non-small cell lung cancer (NSCLC) patients, are important prognostic factors for survival and may be helpful in determining thoracic radiotherapy (TRT) strategy. METHODS In a previously published randomized trial, 301 patients were treated with different palliative radiotherapy schedules, comparing short-term hypofractionated TRT (arm A: 17 Gy/2 fractions [n = 105]) with more protracted TRT (arm B: 42 Gy/15 fractions [n = 104]); arm C: 50 Gy/25 fractions [n = 92]). Baseline HRQOL, demographic, and clinical data were available for all patients. All possible prognostic factors from univariate analysis were entered into the Cox multivariate regression model to identify variables of independent prognostic relevance. RESULTS Overall survival was similar, whereas long-term survival was restricted to higher-dose radiotherapy with 3-year survival rates of 1, 8, and 6% (p = 0.40) and 5-year survival rates of 0, 4, and 3% (p = 0.12) in arms A, B, and C, respectively. In univariate analysis, Karnofsky performance status, use of analgesics, and weight loss were highly significant non-HRQOL factors (p < 0.001), and physical function, appetite loss, cough, and pain were the most powerful HRQOL factors (p < 0.001). In multivariate analysis, appetite loss appeared as the most powerful independent prognostic indicator. In the group of patients treated with protracted fractionation (n = 196), the 2-, 3-, and 5-year survival rates in patients with no appetite loss (n = 95) were 22% (21/95), 12% (11/95), and 8% (8/95) compared with 3% (3/101), 1% (1/101), and 1% (1/101) in patients with appetite loss present at baseline (n = 101). CONCLUSION In addition to performance status and weight loss, patient-reported appetite loss should be assessed in stage III NSCLC patients before administrating TRT; such assessment is a valuable tool for selecting patients to normofractionated or lower-dose hypofractionated palliative TRT.
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Affiliation(s)
- Stein Sundstrøm
- Department of Oncology, St. Olavs Hospital, University Hospital of Trondheim, Norway.
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Sundstrøm S, Bremnes RM, Brunsvig P, Aasebø U, Kaasa S. Palliative Thoracic Radiotherapy in Locally Advanced Non-small Cell Lung Cancer: Can Quality-Of-Life Assessments Help in Selection of Patients for Short- or Long-Course Radiotherapy? J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)30411-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Leyvraz S, Pampallona S, Martinelli G, Ploner F, Aversa S, Rosti G, Brunsvig P, Montes A, Yilmaz U, Perey L. Randomized phase III study of high-dose sequential chemotherapy (CT) supported by peripheral blood progenitor cells (PBPC) for the treatment of small cell lung cancer (SCLC): Results of the EBMT Random-ICE trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7064 Background: EBMT has defined in a phase II trial (JCO 1999, 3531) feasibility and activity of high-dose sequential CT for SCLC increasing 3 fold the dose-intensity and significantly the peak-dose and the total dose of CT. Methods: Randomized prospective study aiming to improve the 3-year survival from 12% in the standard (S) to 24% in the high-dose (H) arm, for a total accrual of 340 patients. Limited or extensive ≤ 2 metastatic sites, age ≤ 65 y.o., PS 0–1. Arm S/Arm H: ifosfamide 5 g/m2 d1/2.5 g/m2/d × 4; carboplatin 300 mg/m2 d1/AUC = 5/d × 4; etoposide 180 mg/m2/d. × 2/300 mg/m2/d × 4, every 28 days, for 6 cycles in Arm S. Three cycles were given in Arm H supported by PBPC collected after 2 courses of epirubicin 150 mg/m2/paclitaxel 175 mg/m2. Due to low accrual, a formal stopping rule was introduced with boundaries for early stopping in favour of a difference (O’Brien-Fleming) or of lack thereof (Pocock). The present analysis has been done with 110 deaths. Results: Since June 1997, 145 patients have been accrued (evaluable =140, S = 71, H = 69), median age 53, prognostic factors balanced. Mobilization toxicity ≥ 3: neutropenia 61%, thrombopenia 11%, anemia 7%, infection 6%, mucositis 9% and 2 toxic deaths. Toxicity ≥ 3 among 353 cycles of S and 152 of H respectively: neutropenia 26%/100%, thrombopenia 12%/100%, anemia 8%/69%, infection 1%/15%, fever 11%/72%, toxic death 1/8. Response rate of S and H: 67% (CR 32%)/77% (CR 37%) (p = 0.188). Median follow-up 4.9 years. Progression free survival 8.8 and 12 months (p = 0.737, unadjusted) and median overall survival 15 and 19.1 months (p = 0.659, unadjusted) for S and H respectively. At 3 years, 19% of the patients were alive in both arms. Conclusions: Random-ICE was designed with strong statistical power and shows no evidence that the treatment of SCLC can be improved by increasing the dose-intensity, the peak-dose or the total dose of ICE and that such intensification strategy should probably be abandoned. No significant financial relationships to disclose.
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Affiliation(s)
- S. Leyvraz
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S. Pampallona
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - G. Martinelli
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - F. Ploner
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S. Aversa
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - G. Rosti
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - P. Brunsvig
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - A. Montes
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - U. Yilmaz
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - L. Perey
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
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Brunsvig P, Gjertsen M, Kvalheim G, Sve I, Møller M, Eriksen J, Aamdal S. PD-067 Telomerase peptide vaccination of patients with advancednon-small cell lung cancer —A phase I–II trial. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sundstrøm S, Bremnes R, Brunsvig P, Kaasa S. PD-117 Palliative thoracic radiotherapy (TRT) in locally advancednon-small cell lung cancer: Which patients should not be treated with short course TRT? Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80450-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sundstrøm S, Bremnes R, Brunsvig P, Aasebø U, Olbjørn K, Fayers PM, Kaasa S. Immediate or delayed radiotherapy in advanced non-small cell lung cancer (NSCLC)? Data from a prospective randomised study. Radiother Oncol 2005; 75:141-8. [PMID: 16094739 DOI: 10.1016/j.radonc.2005.03.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE To compare the course of symptoms and health-related quality-of-life (HRQOL) after immediate thoracic radiotherapy (TRT) between symptomatic (S) and non-symptomatic (NS) patients with advanced NSCLC. PATIENTS AND METHODS 407 stage III/IV patients were initially treated with immediate TRT within a randomised phase III trial comparing different fractionation schedules. At inclusion, patients were prospectively stratified according to presence (S) or absence (NS) of tumour-related chest/airway symptoms to facilitate comparison between these groups. The EORTC QLQ-C30 and LC-13 were used for symptom and HRQOL assessments at baseline and at regular intervals up to 1 year (N=395). RESULTS NS patients had significantly more favourable baseline characteristics when compared to S patients with a median survival of 11.8 versus 6.0 months (P<0.0001), respectively. At baseline, S patients demonstrated HRQOL scores inferior to those of NS patients (P<0.01) for most scales. Until week 14, NS patients developed more symptoms while S patients experienced symptom relief in most scales. After week 14, no significant differences could be observed between the groups. CONCLUSION This study indicates that immediate TRT, given to patients with minimal/none chest symptoms, does not prevent development of disease-related symptoms and diminished HRQOL. A wait-and-see policy appears to be acceptable.
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Affiliation(s)
- Stein Sundstrøm
- Department of Oncology, St. Olavs Hospital of Trondheim, Norway.
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Sundstrøm S, Bremnes R, Aasebø U, Aamdal S, Hatlevoll R, Brunsvig P, Johannessen DC, Klepp O, Fayers PM, Kaasa S. Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. J Clin Oncol 2004; 22:801-10. [PMID: 14990635 DOI: 10.1200/jco.2004.06.123] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate whether the effect of hypofractionated thoracic radiotherapy (TRT) is comparable to more standard fractionated radiotherapy (RT) in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS A total of 421 patients with locally advanced stage III or stage IV NSCLC tumors were included. Inclusion criteria were inoperable, disease too advanced for curative radiotherapy, and chest symptoms or central tumor threatening the airways. Patients were randomly assigned to three arms: A, 17 Gy per two fractions (n = 146); B, 42 Gy per 15 fractions (n = 145); and C, 50 Gy per 25 fractions (n = 130). Four hundred seven patients were eligible for the study; 395 patients (97%) participated in the health-related quality-of-life (HRQOL) study. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and EORTC QLQ-lung cancer-specific module (LC13) were used to investigate airway symptom relief and changes in HRQOL. Assessments were performed before TRT and until week 54. Clinicians' assessments of symptom improvement were at 2, 6, and 14 weeks after completion of TRT. The patients were observed for a minimum of 3 years. Results Baseline prognostic data were equally distributed in the treatment groups. Patient compliance with respect to the HRQOL investigation was minimum 74%. HRQOL and symptom relief were equivalent in the treatment arms. No significant difference in survival among arms A, B, and C was found, with median survival 8.2, 7.0, and 6.8 months, respectively. CONCLUSION Our data indicate that protracted palliative TRT renders no improvement in symptom relief, HRQOL, or survival when compared with short-term hypofractionated treatment in advanced NSCLC.
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Affiliation(s)
- Stein Sundstrøm
- Department of Oncology, St Olavs Hospital, University Hospital of Trondheim, N-7006 Trondheim, Norway. Stein.Sundstrom@ stolav.no
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