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Mahn R, Glüer OA, Sadeghlar F, Möhring C, Zhou T, Anhalt T, Monin MB, Kania A, Glowka TR, Feldmann G, Brossart P, Kalff JC, Schmidt-Wolf IGH, Strassburg CP, Gonzalez-Carmona MA. First-Line Treatment for Advanced Hepatocellular Carcinoma: A Three-Armed Real-World Comparison. J Hepatocell Carcinoma 2024; 11:81-94. [PMID: 38239279 PMCID: PMC10794153 DOI: 10.2147/jhc.s432948] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/27/2023] [Indexed: 01/22/2024] Open
Abstract
Background and Aim There are several existing systemic 1st- line therapies for advanced hepatocellular carcinoma (HCC), including atezolizumab/bevacizumab (Atez/Bev), sorafenib and lenvatinib. This study aims to compare the effectiveness of these three 1st-line systemic treatments in a real-world setting for HCC, focusing on specific patient subgroups analysis. Methods A total of 177 patients with advanced HCC treated with Atez/Bev (n = 38), lenvatinib (n = 21) or sorafenib (n = 118) as 1st line systemic therapy were retrospectively analyzed and compared. Primary endpoints included objective response rate (ORR), progression-free survival (PFS) and 15-month overall survival (15-mo OS). Subgroups regarding liver function, etiology, previous therapy and toxicity were analyzed. Results Atez/Bev demonstrated significantly longer median 15-month OS with 15.03 months compared to sorafenib with 9.43 months (p = 0.04) and lenvatinib with 8.93 months (p = 0.05). Similarly, it had highest ORR of 31.6% and longest median PFS with 7.97 months, independent of etiology. However, significantly superiority was observed only compared to sorafenib (ORR: 4.2% (p < 0.001); PFS: 4.57 months (p = 0.03)), but not comparing to lenvatinib (ORR: 28.6% (p = 0.87); PFS: 3.77 months (p = 0.10)). Atez/Bev also resulted in the longest PFS in patients with Child-Pugh A and ALBI 1 score and interestingly in those previously treated with SIRT. Contrary, sorafenib was non inferior in patients with impaired liver function. Conclusion Atez/Bev achieved longest median PFS and 15-mo OS independent of etiology and particularly in patients with stable liver function or prior SIRT treatment. Regarding therapy response lenvatinib was non-inferior to Atez/Bev. Finally, sorafenib seemed to perform best for patients with deteriorated liver function.
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Affiliation(s)
- Robert Mahn
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Oscar André Glüer
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Christian Möhring
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Thomas Anhalt
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | | | - Alexander Kania
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Tim R Glowka
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Joerg C Kalff
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Ingo G H Schmidt-Wolf
- Department of Integrated Oncology CIO Bonn, University Hospital of Bonn, Bonn, Germany
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Sadeghlar F, Seelemann J, Vogt A, Möhring C, Zhou T, Mahn R, Kornek M, Lukacs-Kornek V, Casares N, Lasarte JJ, Sarobe P, van Beekum C, Matthaei H, Manekeller S, Kalff J, Schmidt-Wolf IGH, Strassburg CP, Gonzalez-Carmona MA. Regulatory T Cell Inhibition by P60 Combined with Adenoviral AFP Transduced Dendritic Cells for Immunotherapy of Hepatocellular Carcinoma. Immunol Invest 2023; 52:966-984. [PMID: 37846958 DOI: 10.1080/08820139.2023.2261980] [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] [Indexed: 10/18/2023]
Abstract
BACKGROUND & AIMS Vaccination with tumor-associated antigen-pulsed dendritic cells leads to specific T-cell response against hepatocellular carcinoma. However, clinical response has been shown to be limited. High regulatory T-cell count is associated with poor prognosis and seems to mediate immune tolerance in hepatocellular carcinoma. Forkhead box P3-peptide inhibitor P60 has been shown to specifically inhibit regulatory T-cell function in murine models. Aim of this study was to investigate whether P60 can improve the immune response induced by vaccination with adenovirus-transduced dendritic cells expressing alpha-fetoprotein in subcutaneous and orthotopic murine models for hepatocellular carcinoma. METHODS Mice developing subcutaneous or orthotopic HCC received daily treatment with P60 starting at different tumor stages. Additionally, mice were vaccinated twice with dendritic cells expressing alpha-fetoprotein. RESULTS In a preventive setting prior to tumor engraftment, vaccination with alpha-fetoprotein-expressing dendritic cells significantly decreased tumor growth in a subcutaneous model (p = .0256), but no further effects were achieved by addition of P60. However, P60 enhanced the antitumoral effect of a vaccination with alpha-fetoprotein-expressing dendritic cells in established subcutaneous and orthotopic hepatocellular carcinoma characterized by high Treg levels (p = .011). CONCLUSION In this study, we showed that vaccination with alpha-fetoprotein-expressing dendritic cells in combination with a specific inhibition of regulatory T-cells by using P60 leads to synergistic tumor inhibition and prolonged survival. This emphasizes the importance of regulatory T-cells inhibition for obtaining an effective antitumoral immune response in hepatocellular carcinoma.
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Affiliation(s)
| | - Julia Seelemann
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Annabelle Vogt
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Christian Möhring
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Robert Mahn
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Miroslaw Kornek
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Veronika Lukacs-Kornek
- Institute for Molecular Medicine and Experimental Immunology, University Hospital of the Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Noelia Casares
- Program of Immunology and Immunotherapy, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Juan José Lasarte
- Program of Immunology and Immunotherapy, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Pablo Sarobe
- Program of Immunology and Immunotherapy, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Cornelius van Beekum
- Program of Immunology and Immunotherapy, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
| | - Hanno Matthaei
- Department of Visceral Surgery, University Hospital of Bonn, Bonn, Germany
| | - Steffen Manekeller
- Department of Visceral Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jörg Kalff
- Department of Visceral Surgery, University Hospital of Bonn, Bonn, Germany
| | - Ingo G H Schmidt-Wolf
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
- Department of Integrated Oncology (CIO), University Hospital of Bonn, Bonn, Germany
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Monin MB, Baier LI, Gorny JG, Berger M, Zhou T, Mahn R, Sadeghlar F, Möhring C, Boesecke C, van Bremen K, Rockstroh JK, Strassburg CP, Eis-Hübinger AM, Schmid M, Gonzalez-Carmona MA. Deficient Immune Response following SARS-CoV-2 Vaccination in Patients with Hepatobiliary Carcinoma: A Forgotten, Vulnerable Group of Patients. Liver Cancer 2023; 12:339-355. [PMID: 37901199 PMCID: PMC10601882 DOI: 10.1159/000529608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/06/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Data on immune response rates following vaccination for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in patients with hepatobiliary carcinoma (HBC) are rare. However, impaired immunogenicity must be expected due to the combination of chronic liver diseases (CLDs) with malignancy and anticancer treatment. Methods In this prospective, longitudinal study, 101 patients were included, of whom 59 were patients with HBC under anticancer treatment. A cohort of patients with a past medical history of gastrointestinal cancer, of whom 28.6% had HBC without detectable active tumor disease having been off therapy for at least 12 months, served as control. Levels of SARS-CoV-2 anti-spike IgG, surrogate neutralization antibodies (sNABs), and cellular immune responses were compared. In uni- and multivariable subgroup analyses, risk factors for impaired immunogenicity were regarded. Data on rates and clinical courses of SARS-CoV-2 infections were documented. Results In patients with HBC under active treatment, levels of SARS-CoV-2 anti-spike IgG were significantly lower (2.55 log10 BAU/mL; 95% CI: 2.33-2.76; p < 0.01) than in patients in follow-up care (3.02 log10 BAU/mL; 95% CI: 2.80-3.25) 4 weeks after two vaccinations. Antibody levels decreased over time, and differences between the groups diminished. However, titers of SARS-CoV-2 sNAB were for a longer time significantly lower in patients with HBC under treatment (64.19%; 95% CI: 55.90-72.48; p < 0.01) than in patients in follow-up care (84.13%; 95% CI: 76.95-91.31). Underlying CLD and/or liver cirrhosis Child-Pugh A or B (less than 8 points) did not seem to further impair immunogenicity. Conversely, chemotherapy and additional immunosuppression were found to significantly reduce antibody levels. After a third booster vaccination for SARS-CoV-2, levels of total and neutralization antibodies were equalized between the groups. Moreover, cellular response rates were balanced. Clinically, infection rates with SARS-CoV-2 were low, and no severe courses were observed. Conclusion Patients with active HBC showed significantly impaired immune response rates to basic vaccinations for SARS-CoV-2, especially under chemotherapy, independent of underlying cirrhotic or non-cirrhotic CLD. Although booster vaccinations balanced differences, waning immunity was observed over time and should be monitored for further recommendations. Our data help clinicians decide on individual additional booster vaccinations and/or passive immunization or antiviral treatment in patients with HBC getting infected with SARS-CoV-2.
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Affiliation(s)
- Malte B. Monin
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Leona I. Baier
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jens G. Gorny
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- Institute of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Christian Möhring
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Christoph Boesecke
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Kathrin van Bremen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Jürgen K. Rockstroh
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | | | | | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
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Möhring C, Khan O, Zhou T, Sadeghlar F, Mahn R, Kaczmarek DJ, Dold L, Toma M, Marinova M, Glowka TR, Matthaei H, Manekeller S, Kalff JC, Strassburg CP, Weismüller TJ, Gonzalez-Carmona MA. Comparison between regular additional endobiliary radiofrequency ablation and photodynamic therapy in patients with advanced extrahepatic cholangiocarcinoma under systemic chemotherapy. Front Oncol 2023; 13:1227036. [PMID: 37711210 PMCID: PMC10497756 DOI: 10.3389/fonc.2023.1227036] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
Background and aims Extrahepatic cholangiocarcinoma (eCCA) remains a malignancy with a dismal prognosis. The first-line standard of care includes systemic chemotherapy (SC) and biliary drainage through stenting. Endobiliary ablative techniques, such as photodynamic therapy (ePDT) and radio-frequency ablation (eRFA), have demonstrated feasibility and favorable survival data. This study aimed to compare the oncologic outcome in patients treated with SC and concomitant eRFA or ePDT. Method All patients with eCCA were evaluated for study inclusion. Sixty-three patients receiving a combination of SC and at least one endobiliary treatment were retrospectively compared. Results Patients were stratified into three groups: SC + ePDT (n = 22), SC + eRFA (n = 28), and SC + ePDT + eRFA (n = 13). The median overall survival (OS) of the whole cohort was 14.2 months with no statistically significant difference between the three therapy groups but a trend to better survival for the group receiving ePDT as well as eRFA, during SC (ePDT + SC, 12.7 months; eRFA + SC, 13.8 months; ePDT + eRFA + SC, 20.2 months; p = 0.112). The multivariate Cox regression and subgroup analysis highlighted the beneficial effect of eRFA on OS. Overall, combined therapy was well tolerated. Only cholangitis occurred more often in the SC + eRFA group. Conclusion Additional endobiliary ablative therapies in combination with SC were feasible. Both modalities, eRFA and ePDT, showed a similar benefit in terms of survival. Interestingly, patients receiving both regimes showed the best OS indicating a possible synergism between both ablative therapeutic techniques.
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Affiliation(s)
- Christian Möhring
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Oliver Khan
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | | | - Robert Mahn
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | | | - Leona Dold
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Marieta Toma
- Department of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Tim R. Glowka
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Hanno Matthaei
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | | | - Jörg C. Kalff
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | | | - Tobias J. Weismüller
- Department of Medicine I, University Hospital of Bonn, Bonn, Germany
- Department of Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
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5
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Monin MB, Gorny JG, Berger M, Baier LI, Zhou T, Mahn R, Sadeghlar F, Möhring C, Boesecke C, van Bremen K, Rieke GJ, Schlabe S, Breitschwerdt S, Marinova M, Schmidt-Wolf IGH, Strassburg CP, Eis-Hübinger AM, Gonzalez-Carmona MA. Impaired immunogenicity after vaccination for SARS-CoV-2 in patients with gastrointestinal cancer: does tumor entity matter? J Gastrointest Oncol 2023; 14:1218-1234. [PMID: 37435197 PMCID: PMC10331752 DOI: 10.21037/jgo-22-1065] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/21/2023] [Indexed: 07/13/2023] Open
Abstract
Background SARS-CoV-2 immunogenicity in patients with gastrointestinal cancer (GI cancer) following second and third vaccination was analyzed. Methods A total of 125 patients under active anticancer therapy or in follow-up care were included in this prospective study. Seroprevalence of SARS-CoV-2 anti-spike and surrogate neutralization antibodies (NABs) was measured. Results Four weeks after second vaccination, adequate titers of SARS-CoV-2 anti-spike immunoglobulin G (IgG) [≥282.0 binding antibody units (BAU)/mL] were found in 62.2% of patients under treatment versus 96.3% of patients in follow-up care (P<0.01). Sufficient titers of SARS-CoV-2 surrogate NAB (≥85.0%) were found in 32.7% of patients under treatment versus 70.6% in follow-up care (P<0.01). Titers of SARS-CoV-2 anti-spike IgG were especially low in patients with colorectal cancer (CRC). For SARS-CoV-2 surrogate NAB, patients with hepatocellular carcinoma (HCC) and with pancreaticobiliary cancer showed the lowest titers (P<0.01). SARS-CoV-2 anti-spike IgG and SARS-CoV-2 surrogate NAB were associated with a correlation coefficient of 0.93. Reaching a titer of SARS-CoV-2 anti-spike IgG ≥482.0 BAU/mL, protective levels of SARS-CoV-2 surrogate NAB (≥85.0%) could be assumed. Following booster vaccination, all patients reached effective antibody titers. Conclusions Patients with active GI cancer showed impaired immunogenicity after second SARS-CoV-2 vaccination which was overcome by booster vaccination. Our findings were tumor-related and pronounced in patients with CRC and HCC. Waning immunity over time and antibody escape phenomena by variant of concern Omicron must be considered in these especially vulnerable patients.
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Affiliation(s)
- Malte Benedikt Monin
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Jens Gabriel Gorny
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- Institute for Medical Biometry, Informatics and Epidemiology, Bonn University Hospital, Bonn, Germany
| | - Leona I. Baier
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Christian Möhring
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Christoph Boesecke
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Kahtrin van Bremen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Gereon J. Rieke
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Stefan Schlabe
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Stefan Breitschwerdt
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Ingo G. H. Schmidt-Wolf
- Department of Integrated Oncology, Center for Integrated Oncology (CIO), University Hospital Bonn, Bonn, Germany
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Möhring C, Mańczak A, Timotheou A, Sadeghlar F, Zhou T, Mahn R, Monin MB, Toma M, Feldmann G, Brossart P, Köksal M, Sarria GR, Sommer N, Lingohr P, Jafari A, Kalff JC, Strassburg CP, Gonzalez-Carmona MA. Perioperative Therapy with Flot4 Significantly Increases Survival in Patients with Gastroesophageal and Gastric Cancer in A Large Real-World Cohort. Int J Cancer 2023. [PMID: 36919950 DOI: 10.1002/ijc.34511] [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: 12/22/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
In 2019, the FLOT4 protocol was established as the new standard for perioperative therapy in patients with locally advanced gastroesophageal and gastric cancer. Whether this protocol is beneficial in a real-world setting remains a question with limited answers to date. In this study, a large cohort of unselected patients treated with FLOT4 was analyzed and compared to protocols based on 5-FU/platinum derivative. This retrospective analysis included patients with locally advanced gastroesophageal and gastric cancer treated with perioperative FLOT or 5-FU/platinum derivative at University Hospital, Bonn between 2010 and 2022 in a curative setting (n=99). Overall survival, disease-free survival, therapy response and therapy complications were analyzed. Patients treated with FLOT showed a statistically significant longer median overall survival of 57.8 vs. 28.9 months (HR: 0.554, 95% CI: 0.317 - 0.969, p=0.036). Moreover, pathological tumor regression (pTR) was significantly higher in the FLOT group compared to the 5-FU/platinum group (p=0.001). Subgroup analysis showed a favorable survival benefit for the FLOT vs. 5-FU/platinum derivate in patients with AEG and non-signet cell carcinoma. Overall, FLOT was tolerated well but CTCAE ≥3 grade neutropenia and diarrhea occurred more often within the FLOT group. Similar to the prospective phase II/III trials, FLOT4 was the best protocol for patients with locally advanced gastroesophageal and gastric cancer as perioperative therapy in terms of overall survival and pathological response rate compared to 5-FU/platinum derivative protocols. Interestingly, patients with gastroesophageal cancer benefitted more from this therapy. In contrast, patients with signet ring cells appear not to benefit from addition of docetaxel.
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Affiliation(s)
- Christian Möhring
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Adrianna Mańczak
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Aliki Timotheou
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Malte B Monin
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Marieta Toma
- Department of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Nils Sommer
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Azin Jafari
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
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Möhring C, Frontado Graffe FJ, Bartels A, Sadeghlar F, Zhou T, Mahn R, Marinova M, Feldmann G, Brossart P, Glowka TR, Kalff JC, Strassburg CP, Gonzalez-Carmona MA. Second-line and third-line therapy with nanoliposomal irinotecan (nal-IRI) in pancreatic cancer: a single-center experience and review of literature. J Gastrointest Oncol 2023; 14:352-365. [PMID: 36915455 PMCID: PMC10007927 DOI: 10.21037/jgo-22-632] [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: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 02/17/2023] Open
Abstract
Background Prognosis of patients with pancreatic cancer is still extremely poor. First-line palliative therapies with FOLFIRINOX or gemcitabine/nab-paclitaxel have been established in the last decade. In the second-line, 5-FU/LV in combination with nanoliposomal irinotecan (nal-IRI) after gemcitabine has been shown to be effective. However, the use of nal-IRI as third-line therapy after FOLFIRINOX and gemcitabine-based chemotherapies is still controversial. In this study, we report about the use of 5-FU/LV + nal-IRI in a daily practice and analyze whether nal-IRI is an option as third-line therapy after FOLFIRINOX and gemcitabine/nab-paclitaxel. Methods This is a single center retrospective analysis of patients with irresectable pancreatic cancer who were treated with 5-FU/LV and nal-IRI from 2017 to 2021 as second- or third-line palliative treatment. Overall survival (OS), progression-free survival (PFS) and toxicity were analyzed, and multivariate analysis was used to identify independent prognostic factors. Results Twenty-nine patients receiving 5-FU/LV and nal-IRI were included in the analysis. The majority of patients (n=19) received 5-FU/nal-IRI as third-line therapy after pre-exposition to FOLFIRINOX and gemcitabine/nab-paclitaxel. Median OS and PFS were 9.33 months (95% CI: 3.37, 15.30) and 2.90 months (95% CI: 1.64, 4.16), respectively. Furthermore, patients receiving nal-IRI + 5-FU/LV as third-line treatment also showed some benefits, with no OS difference compared to second-line patients (9.33 vs. 10.27 months; HR: 1.85; 95% CI: 0.64, 5.41; P=0.253). Adverse effects were similar to reported trials. Conclusions In our study, the use of 5-FU/nal-IRI in unselected patients with advanced pancreatic cancer showed similar OS, PFS and tolerance as randomized prospective phase II/III trials. Interestingly, the use of 5-FU/nal-IRI seemed to be beneficial in third-line therapy, despite a pre-exposure to non-liposomal irinotecan.
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Affiliation(s)
- Christian Möhring
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | | | - Alexandra Bartels
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Tim R Glowka
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
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Monin MB, Baier L, Berger M, Gorny JG, Zhou T, Mahn R, Sadeghlar F, Möhring C, van Bremen K, Boesecke C, Rockstroh J, Strassburg C, Eis-Hübinger AM, Gonzalez-Carmona MA. SARS-CoV-2 vaccination in patients with GI and hepatobiliary carcinoma: a call for booster vaccination. Gut 2022; 72:1227-1229. [PMID: 35882561 DOI: 10.1136/gutjnl-2022-328169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 12/08/2022]
Affiliation(s)
- Malte Benedikt Monin
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany .,German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Leona Baier
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Jens Gabriel Gorny
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Christian Möhring
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Kathrin van Bremen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Christoph Boesecke
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
| | - Jürgen Rockstroh
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner-site Cologne-Bonn, Bonn, Germany
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9
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Zhou T, Mahn R, Möhring C, Sadeghlar F, Meyer C, Toma M, Kreppel B, Essler M, Glowka T, Matthaei H, Kalff JC, Strassburg CP, Gonzalez-Carmona MA. Case Report: Sustained complete remission on combination therapy with olaparib and pembrolizumab in BRCA2-mutated and PD-L1-positive metastatic cholangiocarcinoma after platinum derivate. Front Oncol 2022; 12:933943. [PMID: 35957899 PMCID: PMC9359099 DOI: 10.3389/fonc.2022.933943] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
Cholangiocarcinoma (CCA) still has a poor prognosis and remains a major therapeutic challenge. When curative resection is not possible, palliative systemic chemotherapy with gemcitabine and platinum derivate as first line followed by a 5-FU doublet combination as second line is the standard therapy. Recently, targeted therapy and immunotherapy have rapidly emerged as personalized therapeutic approaches requiring previous tumor sequencing and molecular profiling. BRCA mutations are well-characterized targets for poly (ADP-ribose) polymerase inhibitors (PARPi). However, BRCA gene mutations in CCA are rare and few data of PARPi in the treatment of CCA are available. Immunotherapy with programmed death receptor-1 (PD-1) has been shown to be effective in combination with chemotherapy or in PD-L1-positive CCA. However, data from immunotherapy combined with targeted therapy, including PARPi, are lacking. In this report, we present the case of a male patient with PD-L1-positive and BRCA2-mutated metastatic intrahepatic cholangiocarcinoma, who was treated with a combined therapy with PARP (PARPi), olaparib, and a PD-1 antibody, pembrolizumab, as second-line therapy after gemcitabine/platinum derivate failure. Combined therapy was able to induce a long-lasting complete remission for over 15 months. The combined therapy was feasible and well tolerated. Only mild anemia and immune-related thyroiditis were observed, which were easily manageable and did not result in discontinuation of olaparib and pembrolizumab.
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Affiliation(s)
- Taotao Zhou
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
- *Correspondence: Taotao Zhou, ; Maria A. Gonzalez-Carmona,
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Christian Möhring
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - Marieta Toma
- Department of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Barbara Kreppel
- Department of Nuclear Medicine, University Hospital of Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital of Bonn, Bonn, Germany
| | - Tim Glowka
- Department of Visceral Surgery, University Hospital of Bonn, Bonn, Germany
| | - Hanno Matthaei
- Department of Visceral Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jörg C. Kalff
- Department of Visceral Surgery, University Hospital of Bonn, Bonn, Germany
| | | | - Maria A. Gonzalez-Carmona
- Department of Internal Medicine I, University Hospital of Bonn, Bonn, Germany
- *Correspondence: Taotao Zhou, ; Maria A. Gonzalez-Carmona,
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10
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Möhring C, Timotheou A, Mańczak A, Sadeghlar F, Zhou T, Mahn R, Bartels A, Monin M, Toma M, Feldmann G, Brossart P, Köksal M, Sarria GR, Giordano FA, Lingohr P, Jafari A, Kalff JC, Strassburg CP, Gonzalez-Carmona MA. Efficacy and tolerability of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) in unselected patients with advanced gastric and gastroesophageal cancer: does age really matter? J Cancer Res Clin Oncol 2022; 149:1849-1862. [PMID: 35763109 DOI: 10.1007/s00432-022-04109-8] [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: 03/25/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) regimen has shown strong efficacy as perioperative therapy for patients with locally advanced gastric (GC) and gastroesophageal (AEG) carcinoma. In the palliative situation, FLOT is recommended only for young fit patients. Data of efficacy and tolerability of FLOT in elderly patients are scarce and controversial. Thus, this study aimed to provide real-life experience of elderly patients with GC and AEG treated with FLOT as first-line palliative chemotherapy. METHODS Patients with advanced or metastatic GC or AEG and treated with FLOT as first-line palliative therapy between 2010 and 2021 were analyzed. Patients were grouped into < 65 years old (n = 35) and ≥ 65 years old (n = 22) groups. Overall survival (OS), progression-free survival (PFS), feasibility and toxicity were analyzed. RESULTS The median OS was 10.4 months with no significant difference between both groups (HR 0.86; 95% CI 0.48, 1.57; p = 0.632). The ECOG performance status showed powerful influence on OS in the subgroup analysis with median OS of 12.3 months for ECOG = 0 compared to 5.0 months for ECOG ≥ 1 (p = 0.015) as well as in multivariate analysis (HR 2.62; 95% CI 1.36, 5.04; p = 0.004). CONCLUSION In the present study the ECOG performance status showed a stronger prognostic value than patient age in FLOT as first- line therapy in a real-life cohort with advanced and metastatic GC and AEG. The performance status should therefore be considered in the therapeutic decision making of elderly patients with GC and AEG.
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Affiliation(s)
- Christian Möhring
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Aliki Timotheou
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Adrianna Mańczak
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Alexandra Bartels
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Malte Monin
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Marieta Toma
- Department of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Azin Jafari
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Maria A Gonzalez-Carmona
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
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11
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Gonzalez-Carmona MA, Möhring C, Mahn R, Zhou T, Bartels A, Sadeghlar F, Bolch M, Vogt A, Kaczmarek DJ, Heling DJ, Dold L, Nattermann J, Branchi V, Matthaei H, Manekeller S, Kalff JC, Strassburg CP, Mohr RU, Weismüller TJ. Impact of regular additional endobiliary radiofrequency ablation on survival of patients with advanced extrahepatic cholangiocarcinoma under systemic chemotherapy. Sci Rep 2022; 12:1011. [PMID: 35046437 PMCID: PMC8770452 DOI: 10.1038/s41598-021-04297-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/04/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
Prognosis of patients with advanced extrahepatic cholangiocarcinoma (eCCA) is poor. The current standard first-line treatment is systemic chemotherapy (CT) with gemcitabine and a platinum derivate. Additionally, endobiliary radiofrequency ablation (eRFA) can be applied to treat biliary obstructions. This study aimed to evaluate the additional benefit of scheduled regular eRFA in a real-life patient cohort with advanced extrahepatic cholangiocarcinoma under standard systemic CT. All patients with irresectable eCCA treated at University Hospital Bonn between 2010 and 2020 were eligible for inclusion. Patients were stratified according to treatment: standard CT (n = 26) vs. combination of eRFA with standard CT (n = 40). Overall survival (OS), progression free survival (PFS), feasibility and toxicity were retrospectively analyzed using univariate and multivariate approaches. Combined eRFA and CT resulted in significantly longer median OS (17.3 vs. 8.6 months, p = 0.004) and PFS (12.9 vs. 5.7 months, p = 0.045) compared to the CT only group. While groups did not differ regarding age, sex, tumor stage and chemotherapy treatment regimen, mean MELD was even higher (10.1 vs. 6.7, p = 0.015) in the eRFA + CT group. The survival benefit of concomitant eRFA was more evident in the subgroup with locally advanced tumors. Severe hematological toxicities (CTCAE grades 3 – 5) did not differ significantly between the groups. However, therapy-related cholangitis occurred more often in the combined treatment group (p = 0.031). Combination of eRFA and systemic CT was feasible, well-tolerated and could significantly prolong survival compared to standard CT alone. Thus, eRFA should be considered during therapeutic decision making in advanced eCCA.
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Affiliation(s)
- Maria A Gonzalez-Carmona
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Christian Möhring
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexandra Bartels
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Maximilian Bolch
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Annabelle Vogt
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dominik J Kaczmarek
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dominik J Heling
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Leona Dold
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Vittorio Branchi
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Hanno Matthaei
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | | | - Jörg C Kalff
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Raphael U Mohr
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tobias J Weismüller
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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12
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Möhring C, Feder J, Mohr RU, Sadeghlar F, Bartels A, Mahn R, Zhou T, Marinova M, Feldmann G, Brossart P, von Websky M, Matthaei H, Manekeller S, Glowka T, Kalff JC, Weismüller TJ, Strassburg CP, Gonzalez-Carmona MA. First Line and Second Line Chemotherapy in Advanced Cholangiocarcinoma and Impact of Dose Reduction of Chemotherapy: A Retrospective Analysis. Front Oncol 2021; 11:717397. [PMID: 34858809 PMCID: PMC8631360 DOI: 10.3389/fonc.2021.717397] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/22/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Prognosis of patients with irresectable cholangiocarcinoma is still poor. The ABC-02 trial established the current first line (1L) standard systemic chemotherapy (CT) with gemcitabine/platinum derivate for advanced cholangiocarcinoma. However, the majority of patients needed therapy adaptions. Thus, the aim of this study was to evaluate 1L and second line (2L) therapy regimens and the impact of therapy adaptions in an unselected real-life cohort of patients with advanced cholangiocarcinoma. MATERIALS AND METHODS This is a single institution retrospective analysis of patients with irresectable cholangiocarcinoma who were treated with gemcitabine/platinum derivate from 2010 to 2018. Overall survival (OS), progression-free survival (PFS) and toxicity were analyzed for all patients, especially with regard to CT de-escalation. RESULTS Fifty-eight patients receiving gemcitabine/platinum derivate were included in the analysis. Median OS and PFS were 12.2 and 6.9 months. Interestingly, 41 patients (71%) needed therapy de-escalation. However, despite reduced CT exposition, there was no-significant difference in OS (10.8 months vs. 15.6 months, p = 0.127), and patients suffered from less adverse events during CT. 21 (36%) patients reached 2L CT, most often with FOLFIRI (57%). Survival beyond the end of 1L CT was 7.1 months with 2L CT vs. 2.9 months with BSC. CONCLUSION In our study, the combination of gemcitabine/platinum derivate showed similar OS and PFS as randomized prospective phase II/III trials. Therapy regimen adaptions were needed in the majority of patients. However, individualized modifications of the therapy regimen allowed better tolerance as well as continuation of therapy and did not significantly influence median OS. Furthermore, our study revealed a potential survival benefit with 2L CT for selected patients.
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Affiliation(s)
- Christian Möhring
- Department of Internal Medicine I, University Hospital, Bonn, Germany
| | - Jan Feder
- Department of Internal Medicine I, University Hospital, Bonn, Germany
| | - Raphael U. Mohr
- Department of Internal Medicine I, University Hospital, Bonn, Germany
| | | | - Alexandra Bartels
- Department of Internal Medicine I, University Hospital, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital, Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital, Bonn, Germany
| | - Milka Marinova
- Department of Radiology, University Hospital, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University Hospital, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine III, University Hospital, Bonn, Germany
| | - Martin von Websky
- Department of Internal Medicine III, University Hospital, Bonn, Germany
| | - Hanno Matthaei
- Department of Internal Medicine III, University Hospital, Bonn, Germany
| | | | - Tim Glowka
- Department of Internal Medicine III, University Hospital, Bonn, Germany
| | - Jörg C. Kalff
- Department of Internal Medicine III, University Hospital, Bonn, Germany
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13
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Mahn R, Sadeghlar F, Bartels A, Zhou T, Weismüller T, Kupczyk P, Meyer C, Gaertner FC, Toma M, Vilz T, Knipper P, Glowka T, Manekeller S, Kalff J, Strassburg CP, Gonzalez-Carmona MA. Multimodal and systemic therapy with cabozantinib for treatment of recurrent hepatocellular carcinoma after liver transplantation: A case report with long term follow-up outcomes. Medicine (Baltimore) 2021; 100:e27082. [PMID: 34559100 PMCID: PMC8462617 DOI: 10.1097/md.0000000000027082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains a major therapeutic challenge. In recent years, new molecular-targeted therapies, such as cabozantinib, have been approved for the treatment of advanced HCC. However, clinical experience with these new drugs in the treatment of HCC in the LT setting is very limited. PATIENT CONCERNS In 2003, a 36-year-old woman was referred to the hospital with right upper abdominal pain. DIAGNOSIS An initial ultrasound of the liver demonstrated a large unclear lesion of the left lobe of the liver. The magnet resonance imaging findings confirmed a multifocal inoperable HCC in a non-cirrhotic liver. Seven years after receiving a living donor LT, pulmonary and intra-hepatic recurrence of the HCC was radiologically diagnosed and histologically confirmed. INTERVENTIONS Following an interdisciplinary therapy concept consisting of surgical, interventional-radiological (with radiofrequency ablation [RFA]) as well as systemic treatment, the patient achieved a survival of more than 10 years after tumor recurrence. As systemic first line therapy with sorafenib was accompanied by grade 3 to 4 toxicities, such as mucositis, hand-foot skin reaction, diarrhea, liver dysfunction, and hyperthyroidism, it had to be discontinued. After switching to cabozantinib from June 2018 to April 2020, partial remission of all tumor manifestations was achieved. The treatment of the remaining liver metastasis could be completed by RFA. The therapy with cabozantinib was well tolerated, only mild arterial hypertension and grade 1 to 2 mucositis were observed. Liver transplant function was stable during the therapy, no drug interaction with immunosuppressive drugs was observed. OUTCOMES More than 10 years survival after recurrence of HCC after living-donor LT due to intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy with cabozantinib in the second line therapy. LESSONS In conclusion, this report highlights the tolerability and effectiveness of cabozantinib for the treatment of HCC recurrence after LT. We show that our patient with a late recurrence of HCC after LT benefitted from intensive multimodal therapy concepts, including surgery, RFA, and systemic therapy.
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Affiliation(s)
- Robert Mahn
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | | | - Alexandra Bartels
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | - Tobias Weismüller
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | | | - Carsten Meyer
- Department of Radiology, University Hospital Bonn, Germany
| | | | - Marieta Toma
- Department of Pathology, University Hospital Bonn, Germany
| | - Tim Vilz
- Department of Visceral Surgery, University Hospital Bonn, Germany
| | - Petra Knipper
- Department of Visceral Surgery, University Hospital Bonn, Germany
| | - Tim Glowka
- Department of Visceral Surgery, University Hospital Bonn, Germany
| | | | - Jörg Kalff
- Department of Visceral Surgery, University Hospital Bonn, Germany
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14
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Vogt A, Sadeghlar F, Ayub TH, Schneider C, Möhring C, Zhou T, Mahn R, Bartels A, Praktiknjo M, Kornek MT, Toma M, Schmidt-Wolf IGH, Branchi V, Matthaei H, Kalff JC, Strassburg CP, Gonzalez-Carmona MA. Alpha-Fetoprotein- and CD40Ligand-Expressing Dendritic Cells for Immunotherapy of Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13133375. [PMID: 34282787 PMCID: PMC8269346 DOI: 10.3390/cancers13133375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In first clinical trials, vaccinations against tumor-associated antigens (TAA), such as Alpha-Fetoprotein (AFP) using antigen presenting cells, such as dendritic cells (DC), failed to achieve effective immune responses towards hepatocellular carcinoma (HCC). CD40Ligand is a potent immune checkpoint, which can increase the antitumoral immune response of DC. In this study, a subcutaneous vaccination with DCs, which were transduced with AFP-coding adenoviruses and an intratumoral treatment with DCs, which were transduced with CD40L-coding adenoviruses, induced an antitumoral immune response and led to complete remissions and long-term survival in 62% of mice with established HCC. Combined strategy causes rapid and profound changes in the tumor environment with enhanced Th1-cytokine expression, strong tumor infiltration of cytotoxic T lymphocytes and DC, and higher tumor apoptosis, leading to effective tumor regression of HCC. Thus, intratumoral CD40L co-stimulation represents a promising tool for improving tumor-antigen DC-based immunotherapy of HCC. Abstract Dendritic cells (DC) as professional antigen presenting cells are able to prime T-cells against the tumor-associated antigen α-fetoprotein (AFP) for immunotherapy of hepatocellular carcinoma (HCC). However, a strong immunosuppressive tumor environment limits their efficacy in patients. The co-stimulation with CD40Ligand (CD40L) is critical in the maturation of DC and T-cell priming. In this study, the impact of intratumoral (i.t.) CD40L-expressing DC to improve vaccination with murine (m)AFP-transduced DC (Ad-mAFP-DC) was analyzed in subcutaneous (s.c.) and orthotopic murine HCC. Murine DC were adenovirally transduced with Ad-mAFP or Ad-CD40L. Hepa129-mAFP-cells were injected into the right flank or the liver of C3H-mice to induce subcutaneous (s.c.) and orthotopic HCC. For treatments, 106 Ad-mAFP-transduced DC were inoculated s.c. followed by 106 CD40L-expressing DC injected intratumorally (i.t.). S.c. inoculation with Ad-mAFP-transduced DC, as vaccine, induced a delay of tumor-growth of AFP-positive HCC compared to controls. When s.c.-inoculation of Ad-mAFP-DC was combined with i.t.-application of Ad-CD40L-DC synergistic antitumoral effects were observed and complete remissions and long-term survival in 62% of tumor-bearing animals were achieved. Analysis of the tumor environment at different time points revealed that s.c.-vaccination with Ad-mAFP-DC seems to stimulate tumor-specific effector cells, allowing an earlier recruitment of effector T-cells and a Th1 shift within the tumors. After i.t. co-stimulation with Ad-CD40L-DC, production of Th1-cytokines was strongly increased and accompanied by a robust tumor infiltration of mature DC, activated CD4+-, CD8+-T-cells as well as reduction of regulatory T-cells. Moreover, Ad-CD40L-DC induced tumor cell apoptosis. Intratumoral co-stimulation with CD40L-expressing DC significantly improves vaccination with Ad-mAFP-DC in pre-established HCC in vivo. Combined therapy caused an early and strong Th1-shift in the tumor environment as well as higher tumor apoptosis, leading to synergistic tumor regression of HCC. Thus, CD40L co-stimulation represents a promising tool for improving DC-based immunotherapy of HCC.
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Affiliation(s)
- Annabelle Vogt
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Tiyasha H. Ayub
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Carlo Schneider
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Christian Möhring
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Taotao Zhou
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Alexandra Bartels
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Miroslaw T. Kornek
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Marieta Toma
- Department of Pathology, University Hospital of Bonn, 53127 Bonn, Germany;
| | | | - Vittorio Branchi
- Department of Visceral Surgery, University Hospital of Bonn, 53127 Bonn, Germany; (V.B.); (H.M.); (J.C.K.)
| | - Hanno Matthaei
- Department of Visceral Surgery, University Hospital of Bonn, 53127 Bonn, Germany; (V.B.); (H.M.); (J.C.K.)
| | - Jörg C. Kalff
- Department of Visceral Surgery, University Hospital of Bonn, 53127 Bonn, Germany; (V.B.); (H.M.); (J.C.K.)
| | - Christian P. Strassburg
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
| | - Maria A. Gonzalez-Carmona
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany; (A.V.); (F.S.); (T.H.A.); (C.S.); (C.M.); (T.Z.); (R.M.); (A.B.); (M.P.); (M.T.K.); (C.P.S.)
- Correspondence: ; Tel.: +49-228-287-17017
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15
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Mahn R, Vogt A, Kupczyk P, Sadeghlar F, van Beekum K, Hüneburg R, Meyer C, Toma M, Ahmadzadehfar H, Essler M, Matthaei H, Lingohr P, Kalff JC, Strassburg CP, Gonzalez-Carmona MA. Programmed cell death protein 1 (PD-1)-inhibition in hepatocellular carcinoma (HCC): a single center experience. Scand J Gastroenterol 2020; 55:1057-1062. [PMID: 32692941 DOI: 10.1080/00365521.2020.1794539] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prognosis for advanced Hepatocellular carcinoma (HCC)is still very poor. Despite initial usefulness of immune checkpoint inhibitor (PD-1), phase 3 trials failed to show significant benefit of PD-1 inhibition with nivolumab or pembrolizumab in the first and second line therapy of HCC. Clinical evidence of PD-1 inhibition in patients with advanced and heavily pretreated HCC outside clinical trials is extremely limited. In this study, we analyzed the clinical experience with PD-1 inhibition in patients with heavily pretreated HCC. METHODS Between May 2016 and January 2019 14 patients with advanced and heavily pretreated HCC were treated with nivolumab or pembrolizumab at the University Hospital Bonn, Germany. Base line characteristics prior to immunotherapy, immunohistochemistry of different immunological markers, beneficial outcome and safety were recorded and retrospectively analyzed. RESULTS Immunotherapy with PD-1 inhibition was well tolerated and resulted in significant clinical benefit as last line therapy. Median overall survival (OS) was 6.6 months (95%CI:3.9-11.8), progression-free survival (PFS) was 5.3 months (95%CI:2.4-11.7) and overall response rate (ORR) was 30.8%. One patient reached a complete remission. CONCLUSIONS Despite numerous pretreatments, PD-1 inhibition was well tolerated and showed clinical benefit in patients with heavily pretreated HCC.
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Affiliation(s)
- Robert Mahn
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Annabelle Vogt
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Patrick Kupczyk
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Farsaneh Sadeghlar
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Katrin van Beekum
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Robert Hüneburg
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Marieta Toma
- Department of Pathology, University Hospital Bonn, Bonn, Germany
| | - Hojjat Ahmadzadehfar
- Department of Pathology, University Hospital Bonn, Bonn, Germany.,Nuclear Medicine Clinic, Dortmund, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Hanno Matthaei
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
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16
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Sib E, Voigt AM, Wilbring G, Schreiber C, Faerber HA, Skutlarek D, Parcina M, Mahn R, Wolf D, Brossart P, Geiser F, Engelhart S, Exner M, Bierbaum G, Schmithausen RM. Antibiotic resistant bacteria and resistance genes in biofilms in clinical wastewater networks. Int J Hyg Environ Health 2019; 222:655-662. [PMID: 30905579 DOI: 10.1016/j.ijheh.2019.03.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/25/2019] [Accepted: 03/13/2019] [Indexed: 01/09/2023]
Abstract
Increasing isolation rates of resistant bacteria in the last years require identification of potential infection reservoirs in healthcare facilities. Especially the clinical wastewater network represents a potential source of antibiotic resistant bacteria. In this work, the siphons of the sanitary installations from 18 hospital rooms of two German hospitals were examined for antibiotic resistant bacteria and antibiotic residues including siphons of showers and washbasins and toilets in sanitary units of psychosomatic, haemato-oncological, and rehabilitation wards. In addition, in seven rooms of the haemato-oncological ward, the effect of 24 h of stagnation on the antibiotic concentrations and MDR (multi-drug-resistant) bacteria in biofilms was evaluated. Whereas no antibiotic residues were found in the psychosomatic ward, potential selective concentrations of piperacillin, meropenem and ciprofloxacin were detected at a rehabilitation ward and ciprofloxacin and trimethoprim were present at a haemato-oncology ward. Antibiotic resistant bacteria were isolated from the siphons of all wards, however in the psychosomatic ward, only one MDR strain with resistance to piperacillin, third generation cephalosporins and quinolones (3MRGN) was detected. In contrast, the other two wards yielded 11 carbapenemase producing MDR isolates and 15 3MRGN strains. The isolates from the haemato-oncological ward belonged mostly to two specific rare sequence types (ST) (P. aeruginosa ST823 and Enterobacter cloacae complex ST167). In conclusion, clinical wastewater systems represent a reservoir for multi-drug-resistant bacteria. Consequently, preventive and intervention measures should not start at the wastewater treatment in the treatment plant, but already in the immediate surroundings of the patient, in order to minimize the infection potential.
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Affiliation(s)
- E Sib
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - A M Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - G Wilbring
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - C Schreiber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - H A Faerber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D Skutlarek
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M Parcina
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - R Mahn
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D Wolf
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany; University Clinic V, Department Hematology and Oncology, Medical University Innsbruck, Christoph-Probst-Platz Innrain 52, 6020, Innsbruck, Austria
| | - P Brossart
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Geiser
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - S Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - G Bierbaum
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - R M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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17
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Gonzalez-Carmona MA, Bolch M, Jansen C, Vogt A, Sampels M, Mohr RU, van Beekum K, Mahn R, Praktiknjo M, Nattermann J, Trebicka J, Branchi V, Matthaei H, Manekeller S, Kalff JC, Strassburg CP, Weismüller TJ. Combined photodynamic therapy with systemic chemotherapy for unresectable cholangiocarcinoma. Aliment Pharmacol Ther 2019; 49:437-447. [PMID: 30637783 DOI: 10.1111/apt.15050] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/20/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chemotherapy with gemcitabine and cisplatin is the current standard for patients with unresectable cholangiocarcinoma. Local photodynamic therapy has also demonstrated benefit in patients with extrahepatic cholangiocarcinoma. AIM To evaluate the benefit of photodynamic therapy in combination with systemic chemotherapy in advanced extrahepatic cholangiocarcinoma. METHODS Three hundred and fifty-three patients diagnosed with cholangiocarcinoma between 2004 and 2016 were treated at the University Hospital of Bonn, Germany. Of these, 96 suffering from unresectable extrahepatic cholangiocarcinoma were included. Patients were stratified according to treatment: combination photodynamic therapy and chemotherapy (36 patients), photodynamic therapy alone (34 patients), and chemotherapy alone (26 patients). RESULTS Combined photodynamic therapy with chemotherapy resulted in significantly longer overall survival than chemotherapy alone (P = 0.022). Median survival was 20 months in the combination group (95% CI: 16.38-23.62), 15 months in the photodynamic alone group (95% CI: 10.02-19.98) and 10 months in the chemotherapy alone group (95% CI: 8.45-11.55). In multivariate analysis, combination therapy and photodynamic therapy alone (HR: 0.41, 95% CI: 0.22-0.77, P = 0.006), metal stenting, and radiofrequency ablation were independent predictors of longer survival. CONCLUSIONS Combination photodynamic therapy and chemotherapy was well tolerated and resulted in significantly longer survival than chemotherapy alone. Application of photodynamic therapy significantly correlated with longer survival, demonstrating benefit in advanced cholangiocarcinoma. Thus, photodynamic therapy should be considered during therapeutic decision making in advanced cholangiocarcinoma.
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Affiliation(s)
| | - Maximilian Bolch
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Annabelle Vogt
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Matthias Sampels
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Raphael U Mohr
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Katrin van Beekum
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Robert Mahn
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
| | - Vittorio Branchi
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
| | - Hanno Matthaei
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
| | | | - Jörg C Kalff
- Department of Visceral Surgery, University Hospital Bonn, Bonn, Germany
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18
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Voigt AM, Faerber HA, Wilbring G, Skutlarek D, Felder C, Mahn R, Wolf D, Brossart P, Hornung T, Engelhart S, Exner M, Schmithausen RM. The occurrence of antimicrobial substances in toilet, sink and shower drainpipes of clinical units: A neglected source of antibiotic residues. Int J Hyg Environ Health 2019; 222:455-467. [PMID: 30622005 DOI: 10.1016/j.ijheh.2018.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/22/2018] [Accepted: 12/31/2018] [Indexed: 12/18/2022]
Abstract
Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference. To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02 μg·L-1 to a maximum of 79 mg·L-1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.
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Affiliation(s)
- A M Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - H A Faerber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | - G Wilbring
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - D Skutlarek
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - C Felder
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - R Mahn
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - D Wolf
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany; University Clinic V, Dpt. Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - P Brossart
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - T Hornung
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - S Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - R M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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19
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Mahn R, Heukamp LC, Rogenhofer S, von Ruecker A, Müller SC, Ellinger J. Circulating microRNAs (miRNA) in serum of patients with prostate cancer. Urology 2011; 77:1265.e9-16. [PMID: 21539977 DOI: 10.1016/j.urology.2011.01.020] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 12/01/2010] [Accepted: 01/11/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To analyze circulating microRNAs (miRNA) in serum as non-invasive biomarker in patients with localized prostate cancer (PCA), benign prostate hyperplasia (BPH) and healthy individuals (HI). METHODS Total RNA was isolated from serum samples and the circulating levels of different RNA species (miRNA, miR-16; small nuclear RNA, RNU1A-1; messenger RNA, HPRT1), as well as of 4 oncogenic miRNAs (miR-26a, miR-32, miR-195, miR-let7i), were determined using a quantitative real-time polymerase chain reaction. We also evaluated miRNA levels in a second cohort of 10 PCA patients in cancer/nonmalignant tissue, and pre- and post-prostatectomy serum samples. RESULTS The levels of miR-16 and RNU1A-1 were reliably measured, whereas HPRT1 levels were often below the detection limit of our assay. Circulating oncogenic miRNA levels were different, and especially the miR-26a level allowed sensitive (89%) discrimination of PCA and BPH patients at a moderate specificity (56%; area under the curve [AUC]: 0.703); the analysis of oncogenic miRNAs in combination increased the diagnostic accuracy (sensitivity: 78.4%; specificity: 66.7%; AUC: 0.758). Despite the low number of patients limiting the statistical power of the study, we observed correlations with clinical-pathologic parameters: miR-16, miR-195, and miR-26a were significantly correlated with surgical margin positivity; miR-195 and miR-let7i were significantly correlated with the Gleason score. Tissue miRNA levels were correlated with preprostatectomy miRNA levels in serum, and serum miRNA decreased after prostatectomy, thereby indicating tumor-associated release of miRNA. CONCLUSIONS Tumor-associated miRNAs in serum allow noninvasive discrimination of PCA and BPH.
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Affiliation(s)
- Robert Mahn
- Klinik und Poliklinik für Urologie, Universitätsklinikum Bonn, Germany
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20
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Barbera A, Guerra L, Castro M, Mahn R, Mahan D, Bartolotti E, Videla C, García R. [A computerized drug surveillance system: its application in health care, information and teaching]. Bol Oficina Sanit Panam 1980; 89:124-9. [PMID: 6449942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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21
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Bruchmüller W, Mahn R, Fikentscher R. [Problems of early diagnosis of carcinoma of the cancer of the larynx (author's transl)]. Laryngol Rhinol Otol (Stuttg) 1977; 56:986-91. [PMID: 146134] [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: 12/13/2022]
Abstract
Using the anamneses of 1231 patients with laryngeal carcinoma, who were treated in the ORL-clinic at the University om Halle, we investigated the relations among the duration of the anamneses, the place and the stage (TNM-system) of the tumor at the first registration. The causes of the neglection by the patient, the family doctor and the medical specialist are pointed at, and the possibilities for a modern laryngological diagnosis are given. An improvement of the early registration of patients with laryngeal carcinoma cannot be proved in the area of this clinic during the period from 1940 to 1974.
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